Moderators of Improvement From Mindfulness-Based vs Traditional Cognitive Behavioral Therapy for the Treatment of Provoked Vestibulodynia

A Comparison of Mindfulness-Based Cognitive Therapy Vs Cognitive Behavioral Therapy for the Treatment of Provoked Vestibulodynia in a Hospital Clinic Setting

Secular Mindfulness-Based Interventions: Efficacy and Neurobiology.

Provoked vestibulodynia (PVD) is a chronic vulvo-vaginal pain condition affecting 8% of premenopausal women. Cognitive-behavioral therapy (CBT) is effective in managing pain and associated sexual and psychological symptoms, and a recent study found group mindfulness-based cognitive therapy (MBCT) to be equivalent. Our goal was to examine the long-term outcomes of these treatments and to explore mediators of change. Participants were 130 women diagnosed with PVD who had participated in a clinical trial comparing 8 weeks of group CBT to 8 weeks of group MBCT. Data were collected at pretreatment, posttreatment, and at 6- and 12-month follow-up periods. Outcomes focused on (a) pain with vaginal penetration, (b) pain elicited with a vulvalgesiometer, and (c) sex-related distress. Mediators of interest included pain acceptance (both pain willingness and activities engagement), self-compassion, self-criticism, mindfulness, decentering, and pain catastrophizing. All improvements in the 3 outcomes were retained at 12-month follow-up, with no group differences. Pain catastrophizing, decentering, and chronic pain acceptance (both scales) were mediators of improvement common to both MBCT and CBT. Changes in mindfulness, self-criticism, and self-compassion mediated improvements only in the MBCT group. Both MBCT and CBT are effective for improving symptoms in women with PVD when assessed 12 months later. The findings have implications for understanding common and potentially distinct pathways by which CBT and MBCT improve pain and sex-related distress in women with PVD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Chapter 8 - Anxiety disorders: Mindfulness-based cognitive behavioral therapy

BackgroundTo explore if health related quality of life(HRQoL) increased after traditional yoga(TY), mindfulness based cognitive therapy(MBCT), or cognitive behavioral therapy(CBT), in patients on sick leave because of burnout.MethodsRandomized controlled trial, blinded, in ninety-four primary health care patients, block randomized to TY, MBCT or CBT (active control) between September 2007 and November 2009. Patients were living in the Stockholm metropolitan area, Sweden, were aged 18–65 years and were on 50%–100% sick leave. A group treatment for 20 weeks, three hours per week, with homework four hours per week. HRQoL was measured by the SWED-QUAL questionnaire, comprising 67 items grouped into 13 subscales, each with a separate index, and scores from 0 (worse) to 100 (best). SWED-QUAL covers aspects of physical and emotional well-being, cognitive function, sleep, general health and social and sexual functioning. Statistics: Wilcoxon’s rank sum and Wilcoxon’s sign rank tests, Bonett-Price for medians and confidence intervals, and Cohen’s D.ResultsTwenty-six patients in the TY (21 women), and 27 patients in both the MBCT (24 women) and in the CBT (25 women), were analyzed. Ten subscales in TY and seven subscales in MBCT and CBT showed improvements, p < 0.05, in several of the main domains affected in burnout, e.g. emotional well-being, physical well-being, cognitive function and sleep. The median improvement ranged from 0 to 27 points in TY, from 4 to 25 points in CBT and from 0 to 25 points in MBCT. The effect size was mainly medium or large. Comparison of treatments showed no statistical differences, but better effect (small) of both TY and MBCT compared to CBT. When comparing the effect of TY and MBCT, both showed a better effect (small) in two subscales each.ConclusionsA 20 week group treatment with TY, CBT or MBCT had equal effects on HRQoL, and particularly on main domains affected in burnout. This indicates that TY, MBCT and CBT can be used as both treatment and prevention, to improve HRQoL in patients on sick leave because of burnout, reducing the risk of future morbidity.Trial registrationJuly 22, 2012, retrospectively registered. ClinicalTrails.govNCT01168661. Funding: Stockholm County Council, grant 2003–5.

Objective: Cancer is associated with some psychological problems that play an important role in the severity and continuity of cancer. Cancer may lead to maladaptive psychological reactions such as anxiety, depression, and fatigue. Depression and anxiety are highly prevalent in cancer patients. This study aimed to compare the efficacy of mindfulness-based cognitive therapy (MBCT) and cognitive behavioral therapy (CBT) for anxiety, depression, and fatigue in cancer patients.Method: The present study was a randomized clinical trial (RCT). Of the 100 patients diagnosed with cancer, 60 patients were eligible to participate in this study according to the inclusion / exclusion criteria. They were randomly assigned into 3 groups: MBCT, CBT, and wait-list group (WLG). Afterward, the experimental groups received 8 weekly treatment sessions. All the participants fulfilled the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Cancer-Related Fatigue Scale (CFS) before and after the intervention. Data were analyzed using SPSS-16 software by Analysis of Covariance (ANCOVA). Results: The results indicated a significant reduction in depression, anxiety, and fatigue scores in CBT and MBCT groups. There was a significant difference between both treatment groups with WLG in the anxiety and depression, but no significant difference was found between MBCT and CBT groups. Additionally, there was only a significant difference between the CBT group and WLG in terms of fatigue (P = 0.01).Conclusion: CBT and MBCT performed equally well in decreasing anxiety and depression in cancer patients, and they were significantly better than WLG. It seems that MBCT is a good alternative to CBT for decreasing emotional symptoms in cancer patients. As a result, CBT and MBCT could be considered a good addition to pharmacological treatment of cancer patients with comorbid psychological symptoms. However, CBT was preferable to MBCT in decreasing fatigue.The study was registered at the irct.ir database under registration number IRCT20180503039509N1.

Objective This study examined the effect of mindfulness-based cognitive behavioral therapy on the social psychology of women with human papillomavirus (HPV) infection. Methods Sixty women with HPV infection who visited a health center were randomly assigned to either an intervention (30 cases) or control group (30 cases), from December 2018 to March 2019. The control group received routine health education and psychological intervention. On the basis of the control group, the intervention group received 8 weeks of mindfulness-based cognitive therapy. The HPV Impact Profile (HIP) was used as an evaluation tool to compare the efficacy of the two groups. Results There were no significant baseline differences between the two groups. After intervention, HIP scores for worries and concerns, affective impact, sexual impact, and partner and communication were lower in the intervention group compared with the control group: worries and concerns (31.87±9.94 vs. 44.80±7.89), affective impact (30.93±9.79 vs. 54.93±12.89), sexual impact (27.60±10.73 vs. 58.87±8.35), partner and communication (28.90±8.57 vs. 46.83±12.2). There was a statistically significant difference (P<0.05) in each domain. Conclusion Mindfulness-based cognitive behavioral therapy can significantly improve negative emotions and sexual satisfaction among women with HPV infection. Key words: Quality of life; Anxiety; Cognitive behavioral therapy

The Recurrent Pain and Sexual Sequelae of Provoked Vestibulodynia: A Perpetuating Cycle

Mindfulness-based cognitive therapy (MBCT) is a relatively new therapeutic approach that is rooted in mindfulness-based stress reduction and cognitive behavioral therapy. Leading MBCT requires a radically different method than other forms of group facilitation. We are currently conducting a multi-site, randomized controlled trial (RCT) of a mindfulness intervention for individuals with a traumatic brain injury where the development of the facilitators' capacity to provide the intervention is as important to the study as the RCT component itself. Thus, the first year of the study was devoted to training ten clinicians to deliver the intervention. The training included a 2-day retreat to introduce mindfulness, teleconferences, support from an experienced instructor and other facilitators within the group, a 5-day professional MBCT training program, and the development of a personal meditation practice. It culminated with trialing the intervention with “healthy” participants (e.g., friends, family, colleagues). Sessions from six facilitators were recorded and assessed by an external reviewer experienced in the delivery of MBCT who provided qualitative feedback. Four facilitators demonstrated consistency and adherence to the skills assessed. Upon completion of the trial intervention, 93.5 % of healthy group participants indicated that the classes were engaging or stimulating and 96.9 % reported that they used the skills acquired. We feel we provided a training program that remained flexible to the needs of the facilitators.

Vulvodynia is an underdiagnosed pain syndrome with persistent duration, usually without an identifiable organic cause. It negatively affects the quality of life, mental health and romantic relationships and sexual function of women. This review aimed to systematically appraise the available data on the effectiveness of Cognitive Behavioral Therapy on perceived pain and sexual functioning of women with vulvodynia from randomized clinical trials irrespective of their time of publication. The review was performed following the PRISMA guidelines. The literature search was conducted based on specific eligibility criteria in the PubMed, PsycInfo, and Scopus databases using appropriate keywords. The methodological quality of the included studies was assessed with the Jadad Scale. The search resulted in 10 randomized clinical trials that compared the effectiveness of Cognitive Behavioral Therapy compared to other psychotherapeutic approaches and clinical, pharmaceutical, and surgical interventions on 835 women with vulvodynia. The results, which were synthesized narratively based on intervention type and outcomes assessed, revealed the superiority of Cognitive Behavioral Therapy compared to topical treatments with significant improvements in sexual function and pain management, particularly evident at follow-up assessments. Comparisons with other psychotherapeutic approaches (mindfulness-based cognitive therapy, supportive psychotherapy) resulted in similar results. Compared to physiotherapeutic and surgical protocols, Cognitive Behavioral Therapy resulted in more favorable findings, although the improvement regarding sexual function was significant mostly at the 6-month follow-up measurements. Cognitive Behavioral Therapy appeared to help by restructuring dysfunctional beliefs, reducing pain catastrophizing, and developing alternative pain coping strategies. Despite the encouraging evidence, variations with respect to the cognitive-behavioral interventions, comparison groups, and assessment tools used to assess the variables under investigation, direct comparison of the findings was challenging. The results highlighted Cognitive Behavioral Therapy as a promising, non-pharmacological approach to the management of vulvodynia. Education of psychotherapists and clinicians, particularly gynecologists, would contribute to early diagnosis and effective treatment of vulvodynia.

Mindfulness-based interventions for women victims of interpersonal violence: A systematic review

Objective: The present study aimed to compare the effectiveness of cognitive bias modification therapy (CBM) and mindfulness-based cognitive behavioral therapy (MCBT) on cognitive avoidance and ineffective attitudes in university students with social anxiety. Methods and Materials: This research employed a semi-experimental design with pre-test, post-test, and control group. The statistical population included all university students with social anxiety disorder at Shiraz University of Teachers during the academic years 2022-2023. A sample of 60 individuals was selected using convenience sampling method, randomly assigned to three groups (20 participants per group). The interventions consisted of cognitive bias modification therapy (7 sessions of 90 minutes each) and mindfulness-based cognitive behavioral therapy (8 sessions of 90 minutes each). Data collection tools included the Connor Social Anxiety Scale (2000), the Cognitive Avoidance Questionnaire by Sexton and Dugas (2004), and the Dysfunctional Attitudes Scale by Weissman and Beck (1978). Data analysis was conducted using descriptive and inferential statistics (analysis of covariance). Findings: Results indicated significant differences among the three groups in cognitive avoidance, and mindfulness-based cognitive behavioral therapy showed comparable effectiveness to cognitive bias modification therapy. However, there were significant differences in the mean scores of ineffective attitudes and its components between the experimental and control groups, with mindfulness-based cognitive behavioral therapy demonstrating greater effectiveness compared to cognitive bias modification therapy. Conclusion: The results indicated significant differences among the three groups. This finding also shows that Cognitive Behavioral Therapy and Mindfulness did not have significantly different effectiveness in terms of cognitive avoidance and its components (except for thought substitution).

A Case Study of Individually Delivered Mindfulness-Based Cognitive Behavioral Therapy for Severe Health Anxiety

Major depressive disorder (MDD) is a chronic condition with high relapse rates affecting patients and health systems. Cognitive behavioral therapy (CBT) and mindfulness-based cognitive therapy (MBCT) are strategies for relapse prevention, but their comparative long-term cost-effectiveness remains unclear. We developed a cohort-based Markov model with three health states, depressive episode, remission, and death, to compare MBCT and CBT in adults with MDD. The model used a lifetime horizon, six-month cycles, with healthcare payer and societal perspectives. Costs included direct medical and productivity losses discounted at 1.5%. Health-state utilities were drawn from published sources. Incremental cost-effectiveness ratios (ICERs) and net monetary benefit (NMB) were estimated at willingness-to-pay (WTP) thresholds of $50,000 and $100,000 per quality-adjusted life-year (QALY). Deterministic and probabilistic sensitivity analyses, plus scenario analyses with alternative horizons and discount rates, assessed uncertainty. In the base case, MBCT was associated with 14.71 QALYs at a cost of $543,861, while CBT yielded 15.07 QALYs at $549,487. CBT provided an incremental 0.37 QALYs at $5625 higher cost, producing an ICER of $15,266 per QALY gained, well below both thresholds. NMB favored CBT ($204,242 vs. $191,443 at $50,000; $957,971 vs. $926,746 at $100,000). Sensitivity analyses highlighted remission- and depression-related costs as main drivers. Probabilistic analyses showed CBT optimal in 56% of simulations at $50,000 and 61% at $100,000, with MBCT preferred at lower thresholds. CBT may be more cost-effective relative to MBCT for relapse prevention in MDD, though differences are modest. MBCT remains a competitive alternative where CBT access is limited.

Mindfulness-based cognitive therapy vs cognitive behaviour therapy as a treatment for non-melancholic depression