Mindfulness-based Cognitive Therapy In Patients Research Articles

A Web-Based Mindfulness-Based Cognitive Therapy for Couples Dealing With Chronic Cancer-Related Fatigue: Protocol for a Single-Arm Pilot Trial.

Chronic fatigue is a common symptom among patients who have been treated for cancer. Current psychosocial interventions typically target the patient alone, despite growing evidence suggesting that a couples' approach can increase and broaden the efficacy of an intervention. Therefore, based on an existing web-based mindfulness-based cognitive therapy for patients, the couple intervention COMPANION was developed. The primary objectives of this study are to determine the acceptability of COMPANION and its potential efficacy in reducing fatigue in patients with cancer. Our secondary objectives are to examine the feasibility of the trial procedures and the potential working mechanisms of the couple intervention. We will conduct a single-arm pilot trial for couples (ie, patients with cancer with chronic fatigue and their partners). All couples are allocated to the web-based couple intervention that consists of psychoeducation, mindfulness, and cognitive-behavioral exercises. The 9 sessions of the intervention are supervised remotely by a trained therapist. Patients and partners will complete questionnaires before starting the intervention (T0), 2 weeks after completing the intervention (T1), and 1 month after T1 (T2). They will also fill out weekly diaries during the intervention period. A subsample of patients (n≈5) and partners (n≈5) as well as all the therapists providing COMPANION will participate in the final focus groups. Benchmark values have been defined to determine the acceptability (ie, ≥60% of couples complete the intervention and/or ≥70% of the participants are satisfied with the intervention) and potential efficacy (ie, a significant improvement in fatigue and/or a clinically relevant improvement in fatigue in 45% of the patients between T0 and T1) of the intervention. The trial procedures are deemed feasible if an average of at least three couples are included per recruiting month and/or adherence to the assessments is at least 65% for T1 and the diaries and 60% for T2. To establish potential working mechanisms, changes in affect, sleep, catastrophizing, partner communication and interactions, self-efficacy, mindfulness, and closeness will be examined. Quantitative outcomes will be interpreted along with the results from the focus groups. Data collection is expected to be completed by March 2024. This pilot trial will test the first web-based mindfulness-based cognitive therapy for couples targeting chronic cancer-related fatigue. Findings will indicate whether proceeding with a randomized controlled trial is warranted. ClinicalTrials.gov NCT05636696; https://clinicaltrials.gov/study/NCT05636696. DERR1-10.2196/48329.

Adverse or therapeutic? A mixed-methods study investigating adverse effects of Mindfulness-Based Cognitive Therapy in bipolar disorder.

Mindfulness-Based Interventions (MBIs) are widely used in clinical and non-clinical populations, but little attention has been given to potential adverse effects (AEs). This study aimed to gain insight in the prevalence and course of AEs during Mindfulness-Based Cognitive Therapy (MBCT) for patients with bipolar disorder (BD). The current mixed-methods study was conducted as part of a RCT on (cost-) effectiveness of MBCT in 144 patients with BD (Trial registered on 25th of April 2018, ClinicalTrials.gov, NCT03507647). During MBCT, occurrence of AEs was monitored prospectively, systematically, and actively (n = 72). Patients who reported AEs were invited for semi-structured interviews after completing MBCT (n = 29). Interviews were analysed with directed content analysis, using an existing framework by Lindahl et al. AEs were reported by 29 patients, in seven of whom the experiences could not be attributed to MBCT during the interview. AEs were reported most frequently up to week 3 and declined afterwards. Baseline anxiety appeared to be a risk factor for developing AEs. Seven existing domains of AEs were observed: cognitive, perceptual, affective, somatic, conative, sense of self, and social. Influencing factors were subdivided into predisposing, precipitating, perpetuating, and mitigating factors. With hindsight, more than half of patients considered the reported AEs as therapeutic rather than harmful. Although the occurrence of AEs in MBCT for patients with BD is not rare, even in this population with severe mental illness they were not serious or had lasting bad effects. In fact, most of them were seen by the patients as being part of a therapeutic process, although some patients only experienced AEs as negative.

Risk Factors Associated with Relapse in Major Depressive Disorder in Primary Care Patients: A Systematic Review.

Major Depressive Disorder (MDD) is highly recurrent. Most patients with MDD are treated in the Primary Care (PC) setting. The purpose of this systematic review was to identify risk factors associated with relapse of MDD in PC. A systematic review of PsycINFO, PubMed, Web of Science and ScienceDirect, from 1978 to 2019, following PRISMA guidelines was conducted. Eight studies fulfilling the eligibility criteria and 12 risk factors associated with relapse of MDD were found. Patients who showed a higher frequency of relapse were: 1) those with higher scores in neuroticism, disability, current MDD episode severity, and childhood abuse; 2) lower scores on extraversion, self-esteem, emotional role, physical functioning; 3) history of MDD relapse; 4) comorbidity; and 5) poorer adherence to antidepressant medication (ADM). In terms of treatment, ADM combined with cognitive behavioural therapy and psychoeducation was reported to produce fewer relapses, as was mindfulness-based cognitive therapy for patients with a higher score in childhood abuse. Despite the very varied nature of the studies, different risk factors associated with relapse were identified. However, more research is needed on this important problem, with randomized controlled trials.

The effectiveness of mindfulness-based cognitive therapy for major depressive disorder: evidence from routine outcome monitoring data.

Meta-analyses show efficacy of mindfulness-based cognitive therapy (MBCT) in terms of relapse prevention and depressive symptom reduction in patients with major depressive disorder (MDD). However, most studies have been conducted in controlled research settings. We aimed to investigate the effectiveness of MBCT in patients with MDD presenting in real-world clinical practice. Moreover, we assessed whether guideline recommendations for MBCT allocation in regard to recurrence and remission status of MDD hold in clinical practice. This study assessed a naturalistic cohort of patients with (recurrent) MDD, either current or in remission (n = 765), who received MBCT in a university hospital out-patient clinic in The Netherlands. Outcome measures were self-reported depressive symptoms, worry, mindfulness skills and self-compassion. Predictors were MDD recurrence and remission status, and clinical and sociodemographic variables. Outcome and predictor analyses were conducted with linear regression. MBCT adherence was high (94%). Patients with a lower level of education had a higher chance of non-adherence. Attending more sessions positively influenced improvement in depressive symptoms. Depressive symptoms significantly reduced from pre- to post-MBCT (Δ mean = 7.7, 95%CI = 7.0-8.5, Cohen's d = 0.75). Improvement of depressive symptoms was independent from MDD recurrence and remission status. Unemployed patients showed less favourable outcomes. Worry, mindfulness skills and self-compassion all significantly improved. These improvements were related to changes in depressive symptoms. Previous efficacy results in controlled research settings are maintained in clinical practice. Results illustrate that MBCT is effective in routine clinical practice for patients suffering from MDD, irrespective of MDD recurrence and remission status.

Long-term effects of mindfulness-based cognitive therapy in patients with obsessive-compulsive disorder and residual symptoms after cognitive behavioral therapy: Twelve-month follow-up of a randomized controlled trial

We examined the long-term efficacy of mindfulness-based cognitive therapy (MBCT) compared to a psychoeducation group as an active control condition in patients with obsessive-compulsive disorder (OCD) with residual symptoms of OCD after cognitive behavioral therapy. A total of 125 patients were included in a bicentric, interviewer-blind, randomized, and actively controlled trial and were assigned to either an MBCT group (n = 61) or a psychoeducation group (n = 64). Patients’ demographic characteristics and the results from our previous assessments have already been reported (Külz et al., 2019). At the 12-month follow-up the completion rate was 80%. OCD symptoms were reduced from baseline to follow-up assessment with a large effect, but no difference was found between groups. Exploratory analyses showed that a composite score of time occupied by obsessive thoughts, distress associated with obsessive thoughts, and interference due to obsessive thoughts differed between groups in the per-protocol analysis, with a stronger reduction in the MBCT group. At the 12-month follow-up, the two groups showed a similar reduction of symptoms. However, preliminary evidence indicates that MBCT has a superior effect on some aspects of OCD. This should be replicated in future studies.

Outcomes of Online Mindfulness-Based Cognitive Therapy for Patients With Residual Depressive Symptoms

Patients with residual depressive symptoms face a gap in care because few resources, to date, are available to manage the lingering effects of their illness. To evaluate the effectiveness for treating residual depressive symptoms with Mindful Mood Balance (MMB), a web-based application that delivers mindfulness-based cognitive therapy, plus usual depression care compared with usual depression care only. This randomized clinical trial was conducted in primary care and behavioral health clinics at Kaiser Permanente Colorado, Denver. Adults identified with residual depressive symptoms were recruited between March 2, 2015, and November 30, 2018. Outcomes were assessed for a 15-month period, comprising a 3-month intervention interval and a 12-month follow-up period. Patients were randomized to receive usual depression care (UDC; n = 230) or MMB plus UDC (n = 230), which included 8 sessions delivered online for a 3-month interval plus minimal phone or email coaching support. Primary outcomes were reduction in residual depressive symptom severity, assessed using the Patient Health Questionaire-9 (PHQ-9); rates of depressive relapse (PHQ-9 scores ≥15); and rates of remission (PHQ-9 scores <5). Secondary outcomes included depression-free days, anxiety symptoms (General Anxiety Disorder-7 Item Scale), and functional status (12-Item Short Form Survey). Among 460 randomized participants (mean [SD] age, 48.30 [14.89] years; 346 women [75.6%]), data were analyzed for the intent-to-treat sample, which included 362 participants (78.7%) at 3 months and 330 (71.7%) at 15 months. Participants who received MMB plus UDC had significantly greater reductions in residual depressive symptoms than did those receiving UDC only (mean [SE] PHQ-9 score, 0.95 [0.39], P < .02). A significantly greater proportion of patients achieved remission in the MMB plus UDC group compared with the UDC only group (PHQ-9 score, <5: β [SE], 0.38 [0.14], P = .008), and rates of depressive relapse were significantly lower in the MMB plus UDC group compared with the UDC only group (hazard ratio, 0.61; 95% CI, 0.39-0.95; P < .03). Compared with the UDC only group, the MMB plus UDC group had decreased depression-free days (mean [SD], 281.14 [164.99] days vs 247.54 [158.32] days; difference, -33.60 [154.14] days; t = -2.33; P = .02), decreased anxiety (mean [SE] General Anxiety Disorder-7 Item Scale score, 1.21 [0.42], P = .004), and improved mental functioning (mean [SE] 12-Item Short Form Survey score, -5.10 [1.37], P < .001), but there was no statistically significant difference in physical functioning. Use of MMB plus UDC resulted in significant improvement in depression and functional outcomes compared with UDC only. The MMB web-based treatment may offer a scalable approach for the management of residual depressive symptoms. ClinicalTrials.gov identifier: NCT02190968.

Mindfulness-based cognitive therapy for patients with chronic, treatment-resistant depression: A pragmatic randomized controlled trial.

BackgroundChronic and treatment‐resistant depressions pose serious problems in mental health care. Mindfulness‐based cognitive therapy (MBCT) is an effective treatment for remitted and currently depressed patients. It is, however, unknown whether MBCT is effective for chronic, treatment‐resistant depressed patients.MethodA pragmatic, multicenter, randomized‐controlled trial was conducted comparing treatment‐as‐usual (TAU) with MBCT + TAU in 106 chronically depressed outpatients who previously received pharmacotherapy (≥4 weeks) and psychological treatment (≥10 sessions).ResultsBased on the intention‐to‐treat (ITT) analysis, participants in the MBCT + TAU condition did not have significantly fewer depressive symptoms than those in the TAU condition (–3.23 [–6.99 to 0.54], d = 0.35, P = 0.09) at posttreatment. However, compared to TAU, the MBCT + TAU group reported significantly higher remission rates (χ 2(2) = 4.25, φ = 0.22, P = 0.04), lower levels of rumination (–3.85 [–7.55 to –0.15], d = 0.39, P = 0.04), a higher quality of life (4.42 [0.03–8.81], d = 0.42, P = 0.048), more mindfulness skills (11.25 [6.09–16.40], d = 0.73, P < 0.001), and more self‐compassion (2.91 [1.17–4.65], d = 0.64, P = 0.001). The percentage of non‐completers in the MBCT + TAU condition was relatively high (n = 12, 24.5%). Per‐protocol analyses revealed that those who completed MBCT + TAU had significantly fewer depressive symptoms at posttreatment compared to participants receiving TAU (–4.24 [–8.38 to –0.11], d = 0.45, P = 0.04).ConclusionAlthough the ITT analysis did not reveal a significant reduction in depressive symptoms of MBCT + TAU over TAU, MBCT + TAU seems to have beneficial effects for chronic, treatment‐resistant depressed patients in terms of remission rates, rumination, quality of life, mindfulness skills, and self‐compassion. Additionally, patients who completed MBCT showed significant reductions in depressive symptoms. Reasons for non‐completion should be further investigated.

Mindfulness-based cognitive therapy in patients with depression: current perspectives.

Mindfulness-based cognitive therapy (MBCT) was developed to prevent relapse in individuals with depressive disorders. This widely used intervention has garnered considerable attention and a comprehensive review of current trends is warranted. As such, this review provides an overview of efficacy, mechanisms of action, and concludes with a discussion of dissemination. Results provided strong support for the efficacy of MBCT despite some methodological shortcomings in the reviewed literature. With respect to mechanisms of action, specific elements, such as mindfulness, repetitive negative thinking, self-compassion and affect, and cognitive reactivity have emerged as important mechanisms of change. Finally, despite a lack of widespread MBCT availability outside urban areas, research has shown that self-help variations are promising. Combined with findings that teacher competence may not be a significant predictor of treatment outcome, there are important implications for dissemination. Taken together, this review shows that while MBCT is an effective treatment for depression, continued research in the areas of efficacy, mechanisms of action, and dissemination are recommended.

The Co-creation and Feasibility of a Compassion Training as a Follow-up to Mindfulness-Based Cognitive Therapy in Patients with Recurrent Depression

The aim of this study was to assess the feasibility, acceptability and preliminary effectiveness of Mindfulness-Based Compassionate Living (MBCL) as a follow-up intervention to Mindfulness Based Cognitive Therapy in adults with recurrent depression. We conducted an uncontrolled study in 17 patients with recurrent depression, in two successive groups. The first group contained novices to compassion training (N = 14); in the second group, ten of these participated again, in addition to three new participants (N = 13). The overall group contained 15 females and 2 males, aged between 37 and 71. The MBCL program was qualitatively evaluated using post-intervention focus group interviews in both groups. In addition, self-report questionnaires assessing depressive symptoms, worry and both self-compassion and mindfulness skills were administered before and after MBCL. No patients dropped out of the intervention. Average attendance was 7.52 (SD 0.73) out of eight sessions. Helpful elements were theory on the emotion regulation systems, practicing self-compassion explicitly and embodiment of a compassionate attitude by the teachers. Unhelpful elements were the lack of a clear structure, lack of time to practice compassion for self and the occurrence of the so-called back draft effect. We adapted the program in accordance with the feedback of the participants. Preliminary results showed a reduction in depressive symptoms in the second group, but not in the first group, and an increase in self-compassion in both groups. Worry and overall mindfulness did not change. MBCL appears to be feasible and acceptable for patients suffering from recurrent depressive symptoms who previously participated in MBCT. Selection bias may have been a factor as only experienced and motivated participants were used; this, however, suited our intention to co-create MBCL in close collaboration with knowledgeable users. Examination of the effectiveness of MBCL in a sufficiently powered randomised controlled trial is needed.

Self-Reported Long-Term Benefits of Mindfulness-Based Cognitive Therapy in Patients with Bipolar Disorder.

This study focused on patients with bipolar disorder (BD), several years after their participation in mindfulness-based cognitive therapy (MBCT). It aimed at documenting sustained mindfulness practice, perceived long-term benefit from the program, and changes regarded as direct consequences of the intervention. This cross-sectional survey took place at least 2 years after MBCT for 70.4% of participants. It was conducted in two specialized outpatient units for BDs that are part of the Geneva University Hospitals (Switzerland) and the Sainte-Anne Hospital in Paris (France). Eligibility criteria were a diagnosis of BD according to DSM-IV and participation in at least four MBCT sessions. Response rate was 66.4%. The final sample included 71 outpatients (71.8% bipolar I, 28.2% bipolar II). A questionnaire retrospectively assessed patient-perceived change, benefit from MBCT, and current mindfulness practice. Proportions of respondents who practiced mindfulness at least once a week were 54.9% for formal practice (body scan, sitting meditation, mindful walking, or movements) and 57.7% for informal practice (mindful daily activities). Perceived benefit for the prevention of relapse was moderate, but patients acknowledged long-lasting effects and persistent changes in their way of life. Formal mindfulness practice at least once a week tended to be associated with increased long-lasting effects (p = 0.052), whereas regular informal practice and mindful breathing were significantly associated with persistent changes in daily life (p = 0.038) and better prevention of depressive relapse (p = 0.035), respectively. The most frequently reported positive change was increased awareness of being able to improve one's health. Despite methodological limitations, this survey allowed documenting mindfulness practice and perceived sustained benefit from MBCT in patients with BD. Participants particularly valued increased awareness that they can influence their own health. Both informal and formal practices, when sustained in the long term, might promote long-lasting changes.

Secular Mindfulness-Based Interventions: Efficacy and Neurobiology.

Secular Mindfulness-Based Interventions: Efficacy and Neurobiology.

Mindfulness-Based Cognitive Therapy for Patients With Depression Decreases the Need for Outpatient Visits.

To determine if the use of mindfulness-based cognitive therapy (MBCT) in patients with a history of 2 or more episodes of major depressive disorder and other mood disorders will decrease the need for medication management and other interventions and will also decrease the need for outpatient services and the overall cost of treatment. The study patients completed MBCT group sessions between January 1, 2010, and December 31, 2013. Patients who had 2 or more episodes of major depressive disorder (recurrent MDD) were categorized into a group. The remaining patients with other mood disorders were placed in a comparison group. The mean differences in drug treatments and hospital utilizations between the recurrent MDD and nonrecurrent MDD group were compared. Wald P values and 95% CIs were obtained for both adjusted and unadjusted estimated mean differences. Covariates were adjusted for age at start of MBCT, gender, and race/ethnicity. The final sample consisted of 142 patients (93 recurrent MDD and 49 others). There was no significant difference in the effect of MBCT on medication changes between recurrent MDD patients and nonrecurrent MDD patients. Recurrent MDD patients who participated in MBCT experienced reduction in all calls and visits (P = .0068) and less psychiatric visits (P = .0026) in the year after MBCT when compared with the visits before the intervention. This study evaluated the effectiveness of MBCT in reducing the need for additional psychiatric services. The study evaluated patients who received MBCT over 3 years and demonstrated that MBCT decreased the need for care regardless of medication changes. The results raise the question of whether MBCT allows patients to respond to situations more skillfully or if MBCT itself decreases depressive symptoms. The limitations of this study include a small sample size, patient selection, and its design as a retrospective study. However, this study may have implications as a treatment strategy that may be generalizable to other clinics and patient populations.

Mindfulness facets as differential mediators of short and long-term effects of Mindfulness-Based Cognitive Therapy in diabetes outpatients: Findings from the DiaMind randomized trial

BackgroundThere is increasing evidence that mindfulness-based interventions reduce psychological distress in various medical populations. However, it has hardly been studied if these effects are mediated by an increase in mindfulness. The aim of this study was to examine mediating effects of various mindfulness facets on effects of a Mindfulness Based Cognitive Therapy (MBCT) on perceived stress and mood. MethodsOutpatients with diabetes types 1 and 2 and low levels of emotional wellbeing were randomized into a group receiving MBCT (n=70) or a waiting-list control group (n=69). Primary outcomes were mood and perceived stress. Before, after and at follow-up (6months post intervention) relevant questionnaires were completed. ResultsMediation analysis using bootstrap resampling indicated that increases in total mindfulness and the facets observing and nonreactivity mediated the effects of the intervention on depressed and angry mood, anxiety (only observing), and perceived stress (only nonreactivity) from pre- to post-intervention. In contrast, from post-intervention to follow-up, besides total mindfulness the facets of acting with awareness and nonjudging mediated the effects on depressed, anxious, and angry mood, while only nonjudging mediated the effects on perceived stress. DiscussionThe findings indicate that increases in levels of mindfulness mediate the effects of the Mindfulness-Based Cognitive Therapy in patients with diabetes. It is notable that different facets may be important for immediate change versus long-term outcome. These findings might be relevant for post-intervention care.

Patients with a preference for medication do equally well in mindfulness-based cognitive therapy for recurrent depression as those preferring mindfulness

BackgroundPrevious studies have suggested that patients’ treatment preferences may influence treatment outcome. The current study investigated whether preference for either mindfulness-based cognitive therapy (MBCT) or maintenance antidepressant medication (mADM) to prevent relapse in recurrent depression was associated with patients’ characteristics, treatment adherence, or treatment outcome of MBCT. MethodsThe data originated from two parallel randomised controlled trials, the first comparing the combination of MBCT and mADM to MBCT in patients preferring MBCT (n=249), the second comparing the combination to mADM alone in patients preferring mADM (n=68). Patients’ characteristics were compared across the trials (n=317). Subsequently, adherence and clinical outcomes were compared for patients who all received the combination (n=154). ResultsPatients with a preference for mADM reported more previous depressive episodes and higher levels of mindfulness at baseline. Preference did not affect adherence to either MBCT or mADM. With regard to treatment outcome of MBCT added to mADM, preference was not associated with relapse/recurrence (χ2=0.07; p=.80), severity of (residual) depressive symptoms during the 15-month follow-up period (β=−0.08, p=.49), or quality of life. LimitationsThe group preferring mADM was relatively small. The influence of preferences on outcome may have been limited in the current study because both preference groups received both interventions. ConclusionsThe fact that patients with a preference for medication did equally well as those with a preference for mindfulness supports the applicability of MBCT for recurrent depression. Future studies of MBCT should include measures of preferences to increase knowledge in this area.

Participants' perspectives on mindfulness-based cognitive therapy for inflammatory bowel disease: a qualitative study nested within a pilot randomised controlled trial.

BackgroundMindfulness-based interventions have shown to improve depression and anxiety symptoms as well as quality of life in patients with inflammatory bowel disease (IBD). However, little is known about the experiences of this group of patients participating in mindfulness interventions. This paper sets out to explore the perspectives of patients with IBD recruited to a pilot randomised controlled trial (RCT) of mindfulness-based cognitive therapy (MBCT) about the intervention.MethodsIn a qualitative study nested within a parallel two-arm pilot RCT of mindfulness-based cognitive therapy for patients with IBD, two focus group interviews (using the same schedule) and a free text postal survey were conducted. Data from both were analysed using thematic analysis. Data and investigator triangulation was performed to enhance confidence in the ensuing findings.Forty-four patients with IBD were recruited to the pilot RCT from gastroenterology outpatient clinics from two Scottish NHS boards. Eighteen of these patients (ten from mindfulness intervention and eight from control group) also completed a postal survey and participated in two focus groups after completing post intervention assessments.ResultsThe major themes that emerged from the data were the following: perceived benefits of MBCT for IBD, barriers to attending MBCT and expectations about MBCT. Participants identified MBCT as a therapeutic, educational and an inclusive process as key benefits of the intervention. Key barriers included time and travel constraints.ConclusionsThis qualitative study has demonstrated the acceptability of MBCT in a group of patients with IBD. Participants saw MBCT as a therapeutic and educational initiative that transformed their relationship with the illness. The inclusive process and shared experience of MBCT alleviated the sense of social isolation commonly associated with IBD. However, time commitment and travel were recognised as a barrier to MBCT which could potentially influence the degree of therapeutic gain from MBCT for some participants.Electronic supplementary materialThe online version of this article (doi:10.1186/s40814-015-0041-z) contains supplementary material, which is available to authorized users.

MBCT for Patients with Respiratory Conditions Who Experience Anxiety and Depression: A Qualitative Study

Patients with asthma and chronic obstructive pulmonary disease (COPD) often experience anxiety and depression in relation to their respiratory condition. Anxiety and depression in this population are associated with decreased activity. The aim of this phenomenological study was to carry out in-depth qualitative interviews with a purposive sample of patients with asthma and COPD taking part in an 8-week mindfulness-based cognitive therapy (MBCT) course to explore their experiences of MBCT. In particular, we were interested in how the mindfulness approach helped them, or not, and their awareness of any meaningful changes in relation to their breathlessness, activity levels, anxiety or low mood. Twenty-two patients were recruited from primary and secondary care to receive an 8-week course in MBCT. Two groups of MBCT were taught by qualified MBCT teachers in a community setting. Of the 22 patients who attended the MBCT course, 12 patients were purposively sampled to take part in an in-depth qualitative interview 2 months after completing the MBCT course. Interviews were digitally recorded and transcribed verbatim. Analysis was thematic. The themes that emerged included greater acceptance and reduced sense of disease-related stigma; noticing subtle bodily sensations to detect early warning signs of breathlessness; linking pulmonary rehabilitation advice with mindfulness; developing a new relationship to breathing, activity and associated thoughts; having a greater sense of control; being creative around limitations and removing psychological barriers to being more active. Findings offer, for the first time, qualitative evidence on how MBCT benefits patients with asthma and COPD who experience anxiety and depression. These data provide a useful adjunct to existing quantitative evidence in this area.

A Controlled Evaluation of Mindfulness-Based Cognitive Therapy for Patients with Coronary Heart Disease and Depression

This study evaluated the effectiveness of an eight-session mindfulness-based cognitive therapy (MBCT) group intervention programme for treating depression in coronary heart disease (CHD) patients. Thirty-two depressed CHD patients were assigned to an MBCT treatment group, and a demographically and clinically similar group of 30 cases were assigned to a waiting list control group. Participants were evaluated at baseline, 8 weeks, and 6-month follow-up with the Hospital Anxiety and Depression Scale (HADS), Brief Symptom Inventory (BSI), Profile of Mood States (POMS), Psychosocial Adjustment to Illness Scale (PAIS) and the Mindful Attention Awareness Scale (MAAS). After each session, MBCT participants completed the post-session Questionnaire on helpful aspects of therapy and after the programme, completed the Client Satisfaction Questionnaire. At follow-up, 71 % of the MBCT group was clinically recovered from depression compared with 50 % of the control group. The MBCT group showed significantly greater improvement than the control group on all measures with effect sizes at follow-up of d = 0.43–1.0. Increases in mindfulness on the MAAS correlated significantly with improvements on the HADS, BSI, POMS and PAIS. Key helpful aspects of therapy identified by MBCT participants included learning meditation, obtaining group support and developing optimism. There was a high level of satisfaction with the MBCT programme. These results indicate that a randomized controlled trial of MBCT for depressed CHD patients is now warranted.

Mindfulness-Based Cognitive Therapy for Patients with Medically Unexplained Symptoms: A Randomized Controlled Trial

Background: Patients with medically unexplained symptoms make heavy demands on the health care system. An offer for psychological treatment is often declined. There is a need for acceptable and effective treatments. We assessed the acceptability and effectiveness of mindfulness-based cognitive therapy (MBCT) for patients with persistent medically unexplained symptoms. Method: A randomized controlled trial comparing MBCT (n = 64) to enhanced usual care (EUC; n = 61). Participants were the 10% most frequently attending patients in primary care. The primary outcome measure was general health status at the end of treatment. Secondary outcome measures were mental and physical functioning. Assessments took place at the end of treatment and at the 9-month follow-up. Results: Health status and physical functioning did not significantly differ between groups. However, participants in the MBCT group reported a significantly greater improvement in mental functioning at the end of treatment (adjusted mean difference, 3.9; 95% CI, 0.24-7.6), in particular with regard to vitality and social functioning. In addition, at 9 months of follow-up, the mindfulness skills ‘observing' and ‘describing' were significantly higher in the MBCT group. Within the MBCT group, almost half of the outcome measures had significantly improved at the end of treatment, whereas in the EUC group none had. Conclusions: MBCT was feasible for frequently attending patients with persistent medically unexplained symptoms in primary care. Although MBCT did not lead to a significant difference in general health status between the two groups, it did result in a significant improvement in mental functioning.

The effects of mindfulness-based cognitive therapy in patients with bipolar disorder: A controlled functional MRI investigation

BackgroundPreliminary research findings have shown that mindfulness-based cognitive therapy improves anxiety and depressive symptoms in bipolar disorder. In this study, we further investigated the effects of MBCT in bipolar disorder, in a controlled fMRI study. MethodTwenty three patients with bipolar disorder underwent neuropsychological testing and functional MRI. Sixteen of these patients were tested before and after an eight-week MBCT intervention, and seven were wait listed for training and tested at the same intervals. The results were compared with 10 healthy controls. ResultsPrior to MBCT, bipolar patients reported significantly higher levels of anxiety and symptoms of stress, scored significantly lower on a test of working memory, and showed significant BOLD signal decrease in the medial PFC during a mindfulness task, compared to healthy controls. Following MBCT, there were significant improvements in the bipolar treatment group, in measures of mindfulness, anxiety and emotion regulation, and in tests of working memory, spatial memory and verbal fluency compared to the bipolar wait list group. BOLD signal increases were noted in the medial PFC and posterior parietal lobe, in a repeat mindfulness task. A region of interest analysis revealed strong correlation between signal changes in medial PFC and increases in mindfulness. LimitationsThe small control group is a limitation in the study. ConclusionThese data suggest that MBCT improves mindfulness and emotion regulation and reduces anxiety in bipolar disorder, corresponding to increased activations in the medial PFC, a region associated with cognitive flexibility and previously proposed as a key area of pathophysiology in the disorder.

Mindfulness-based cognitive therapy for patients with medically unexplained symptoms: A cost-effectiveness study

ObjectiveOur aim was to assess cost-effectiveness of mindfulness-based cognitive therapy (MBCT) compared with enhanced usual care (EUC) in treating patients with persistent medically unexplained symptoms(MUS). MethodsA full economic evaluation with a one year time horizon was performed from a societal perspective. Costs were assessed by prospective cost diaries. Health-related Quality of Life was measured using SF-6D. Outcomes were costs per Quality-Adjusted Life Year (QALY). Bootstrap simulations were performed to obtain mean costs, QALY scores and incremental cost-effectiveness ratios (ICERs). ResultsMBCT participants (n=55) had lower hospital costs and higher mental health care costs than patients who received EUC (n=41). Mean bootstrapped costs for MBCT were €6269, and €5617 for EUC (95% uncertainty interval for difference: −€1576; €2955). QALYs were 0.674 for MBCT and 0.663 for EUC. MBCT was on average more effective and more costly than EUC, resulting in an ICER of €56,637 per QALY gained. At a willingness to pay of €80,000 per QALY, the probability that MBCT is cost-effective is 57%. ConclusionTotal costs were not statistically significantly different between MBCT and EUC. However, MBCT seemed to cause a shift in the use of health care resources as mental health care costs were higher and hospital care costs lower in the MBCT condition. Due to the higher drop-out in the EUC condition the cost-effectiveness of MBCT might have been underestimated. The shift in health care use might lead to more effective care for patients with persistent MUS. The longer-term impact of MBCT for patients with persistent MUS needs to be further studied.