Friday, February 27, 2015

Mindfulness Fights Stress and Depression



Breast cancer survivors benefit from practicing mindfulness-based stress reduction

Women recently diagnosed with breast cancer have higher survival rates than those diagnosed in previous decades, according to the American Cancer Society. However, survivors continue to face health challenges after their treatments end. Previous research reports as many as 50 percent of breast cancer survivors are depressed. Now, University of Missouri researchers in the Sinclair School of Nursing say a meditation technique can help breast cancer survivors improve their emotional and physical well-being.

Yaowarat Matchim, a former nursing doctoral student; Jane Armer, professor of nursing; and Bob Stewart, professor emeritus of education and adjunct faculty in nursing, found that breast cancer survivors' health improved after they learned Mindfulness-Based Stress Reduction (MBSR), a type of mindfulness training that incorporates meditation, yoga and physical awareness.

"MBSR is another tool to enhance the lives of breast cancer survivors," Armer said. "Patients often are given a variety of options to reduce stress, but they should choose what works for them according to their lifestyles and belief systems."

The MBSR program consists of group sessions throughout a period of eight to ten weeks. During the sessions, participants practice meditation skills, discuss how bodies respond to stress and learn coping techniques. The researchers found that survivors who learned MBSR lowered their blood pressure, heart rate and respiratory rate. In addition, participants' mood improved, and their level of mindfulness increased after taking the class. Armer says, for best results, participants should continue MBSR after the class ends to maintain the positive effects.

"Mindfulness-based meditation, ideally, should be practiced every day or at least on a routine schedule," Armer said. "MBSR teaches patients new ways of thinking that will give them short- and long-term benefits."

Armer says the non-pharmaceutical approach works best as a complement to other treatment options such as chemotherapy, radiation and surgery.

"Post diagnosis, breast cancer patients often feel like they have no control over their lives," Armer said. "Knowing that they can control something -- such as meditation -- and that it will improve their health, gives them hope that life will be normal again."

The study, "Effects of Mindfulness-Based Stress Reduction (MBSR) on Health Among Breast Cancer Survivors," was published in the Western Journal of Nursing Research.

'Mindfulness' exercises help curb stress and fatigue associated with arthritis

"Mindfulness" exercises, which focus on experiencing the present moment, no matter how difficult, can help curb the stress and fatigue associated with painful rheumatoid joint disease, indicates a small study published December 2011 online in the Annals of Rheumatic Diseases.

The authors base their findings on 73 patients between the ages of 20 and 70, all of whom had had painful joint disease, caused by rheumatoid arthritis, ankylosing spondylitis, or psoriatic arthritis for at least a year.

Half of them were randomly allocated to scheduled "mindfulness" exercises, which took place in 10 group sessions over a period of 15 weeks, plus a booster session around six months after the course had completed.

The sessions, which were facilitated by healthcare professionals trained in mindfulness techniques, addressed particular topics, such as recognising individual limitations, and strong emotions, such as anger, joy, and sorrow.

The exercises, which were part of the Vitality Training Programme of VTP, encouraged participants to become aware of, and deliberately concentrate on their feelings, thoughts and bodily experiences, including pain, without judging or trying to avoid them.

Participants were also given creative exercises, such as guided imagery, music and drawing, and shared their experiences with other members of the group.

The rest of the volunteers randomly allocated to the comparison group were given standard care plus a CD containing similar exercises for use at home, as and when they wanted.

Stress levels, coping abilities, and symptom control, including pain and fatigue, were assessed, using validated scores, immediately after all 10 sessions had finished, and again 12 months later.

In total, 67 participants completed all the assessments. These showed no differences in pain levels, disease activity or the ability to talk about feelings.

But there were significant differences in levels of stress and fatigue.

The number of participants with a high stress score of above 23 in the GHQ-20 questionnaire fell from 13 at the start of the study to two, just 12 months after the sessions had finished. Comparable figures in the comparison group were 10 and eight, respectively.

There was, however, a tangible fall in measured levels of fatigue in the intervention group: no such change was evident in the comparison group.

There have been previous attempts to use psychological and educational tactics to help people with arthritis cope better with the distressing aspects of the disease, but they have tended to be short term, say the authors.

The lasting improvements found with the VTP course "indicate that the participants may have incorporated some mindfulness strategies into their daily lives and that these strategies have strengthened their ability to respond to their stressful experience in a more flexible way," they say.

The authors emphasise that while the treatment of rheumatoid arthritis has improved greatly, it is less effective in those with more established disease, and that ultimately the disease can only be partly controlled, forcing many patients to make very demanding lifestyle changes.

"There is therefore a need for complementary interventions that enhance individuals' health-promoting resources and help them adjust to their disease," they conclude.


Mindfulness techniques can help protect pregnant women against depression

Pregnant women with histories of major depression are at high risk of becoming depressed again in the months before and after their babies are born. A new study led by the University of Colorado Boulder found that practicing mindfulness techniques--such as meditation, breathing exercises and yoga--could help protect these women against a recurrence.

About 30 percent of women who have struggled with depression in the past relapse during pregnancy, according to past research. In the new study, published November 2014 in the journal Archives of Women's Mental Health, the research team found that pregnant women with histories of depression who participated in Mindfulness Based Cognitive Therapy had a relapse rate of just 18 percent.

"It's important for pregnant women who are at high risk of depression to have options for treatment and prevention," said Sona Dimidjian, an associate professor in CU-Boulder's Department of Psychology and Neuroscience and lead author of the study. "For some women, antidepressant medication is truly a lifesaver, but others want a non-pharmacological intervention. This program focuses on teaching women skills and practices that are designed to help them stay well and care for themselves and their babies during this important time of life."

Mindfulness Based Cognitive Therapy--which combines mindfulness practice with more traditional cognitive behavioral therapy--has been shown to be effective at preventing recurrent episodes of depression in the general population. But few studies of any kind have looked at the effect of mindfulness or cognitive behavioral therapies among pregnant women.

For the current study, funded by the National Institutes of Mental Health, and conducted in collaboration with Sherryl Goodman, a professor at Emory University in Atlanta, 49 women in Colorado and Georgia with at least one prior episode of major depression enrolled in an eight-session class during their pregnancies. During class and using homework assignments, the women worked to develop mindfulness skills.

"Mindfulness is about how to pay attention to your own moment-to-moment experience in a way that is suffused with an openness, curiosity, gentleness and kindness towards oneself," Dimidjian said.

The standard mindfulness practices used in class were tweaked to be more valuable to pregnant women. Lessons included prenatal yoga, walking meditation exercises that could be done later while soothing a baby, and shorter practices that could be easily integrated into the busy lives of new moms. The lessons also specifically addressed worry, which can be common during pregnancy, and put particular focus on kindness for oneself and one's baby.

The research team--which also included CU-Boulder doctoral student Jennifer Felder; Amanda Brown of Emory University in Atlanta; and Robert Gallop of West Chester University in Pennsylvania--surveyed the women for symptoms of depression during their pregnancy and through six months postpartum.

A high percentage of the women who began the courses--86 percent--completed the study, a sign that the women found the sessions valuable, Dimidjian said. The researchers also were struck by the number of pregnant women who expressed interest in participating in a mindfulness program, even though they didn't meet the criteria to participate in this study.

"I was surprised by the level of interest, even among women who didn't have a history of depression," Dimidjian said. "Pregnant women know that the experience of having a child is going to change their lives, and they want to be ready."

Dimidjian has worked to create an online program of Mindfulness Based Cognitive Therapy that could be used as a tool to address the demand by pregnant women and others to develop these skills.

To test the effectiveness of the online program, Dimidjian is now recruiting adult women with a prior history of depression to participate in a new study. The women do not need to be pregnant.

Mindfulness meditation found to be as effective as antidepressants to prevent depression relapse

A new study from the Centre for Addiction and Mental Health (CAMH) has found that mindfulness-based cognitive therapy--using meditation--provides equivalent protection against depressive relapse as traditional antidepressant medication.

The study published in the December 2010 issue of the Archives of General Psychiatry compared the effectiveness of pharmacotherapy with mindfulness-based cognitive therapy (MBCT) by studying people who were initially treated with an antidepressant and then, either stopped taking the medication in order to receive MBCT, or continued taking medication for 18 months.

"With the growing recognition that major depression is a recurrent disorder, patients need treatment options for preventing depression from returning to their lives." said Dr. Zindel Segal, Head of the Cognitive Behaviour Therapy Clinic in the Clinical Research Department at CAMH.

"Data from the community suggest that many depressed patients discontinue antidepressant medication far too soon, either because of side effect burden, or an unwillingness to take medicine for years. Mindfulness-based cognitive therapy is a non pharmacological approach that teaches skills in emotion regulation so that patients can monitor possible relapse triggers as well as adopt lifestyle changes conducive to sustaining mood balance.

Study participants who were diagnosed with major depressive disorder were all treated with an antidepressant until their symptoms remitted. They were then randomly assigned to come off their medication and receive MBCT; come off their medication and receive a placebo; or stay on their medication. The novelty of this design permits comparing the effectiveness of sequencing pharmacological and psychological treatments versus maintaining the same treatment - antidepressants - over time

Participants in MBCT attended 8 weekly group sessions and practiced mindfulness as part of daily homework assignments. Clinical assessments were conducted at regular intervals, and over an 18 month period, relapse rates for patients in the MBCT group did not differ from patients receiving antidepressants (both in the 30% range), whereas patients receiving placebo relapsed at a significantly higher rate (70%).

"The real world implications of these findings bear directly on the front line treatment of depression. For that sizeable group of patients who are unwilling or unable to tolerate maintenance antidepressant treatment, MBCT offers equal protection from relapse,".said Dr. Zindel Segal. "Sequential intervention-- offering pharmacological and psychological interventions-- may keep more patients in treatment and thereby reduce the high risk of recurrence that is characteristic of this disorder.

Mindfulness-based therapy could offer an alternative to antidepressants for preventing depression relapse

The results come from the first ever large study to compare MBCT -- structured training for the mind and body which aims to change the way people think and feel about their experiences -- with maintenance antidepressant medication for reducing the risk of relapse in depression.

The study aimed to establish whether MBCT is superior to maintenance antidepressant treatment in terms of preventing relapse of depression. Although the findings show that MBCT isn't any more effective than maintenance antidepressant treatment in preventing relapse of depression, the results, combined with those of previous trials, suggest that MCBT may offer similar protection against depressive relapse or recurrence for people who have experienced multiple episodes of depression, with no significant difference in cost.

"Depression is a recurrent disorder. Without ongoing treatment, as many as four out of five people with depression relapse at some point," explains Willem Kuyken, lead author and Professor of Clinical Psychology at the University of Oxford in the UK.

"Currently, maintenance antidepressant medication is the key treatment for preventing relapse, reducing the likelihood of relapse or recurrence by up to two-thirds when taken correctly," adds study co-author Professor Richard Byng, from the Plymouth University Peninsula Schools of Medicine and Dentistry, UK. "However, there are many people who, for a number of different reasons, are unable to keep on a course of medication for depression. Moreover, many people do not wish to remain on medication for indefinite periods, or cannot tolerate its side effects."

MBCT was developed to help people who have experienced repeated bouts of depression by teaching them the skills to recognise and to respond constructively to the thoughts and feelings associated with relapse, thereby preventing a downward spiral into depression.

In this trial, which was conducted from the University of Exeter, UK, 424 adults with recurrent major depression and taking maintenance antidepressant medication were recruited from 95 primary care general practices across the South West of England. Participants were randomly assigned to come off their antidepressant medication slowly and receive MBCT (212 participants) or to stay on their medication (212 participants).

Participants in the MBCT group attended eight 2 ¼ hour group sessions and were given daily home practice. After the group they had the option of attending 4 follow up sessions over a 12 month period. The MBCT course consists of guided mindfulness practices, group discussion and other cognitive behavioural exercises. Those in the maintenance antidepressant group continued their medication for two years.

All trial participants were assessed at regular intervals over 2 years for a major depressive episode using a psychiatric diagnostic interview tool -- the Structured Clinical Interview for DSM-IV.

Over 2 years, relapse rates in both groups were similar (44% in the MBCT group vs 47% in the maintenance antidepressant medication group). Although five adverse events were reported, including two deaths, across both groups, they were not judged to be attributable to the interventions or the trial.

According to study co-author Professor Sarah Byford, from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King's College London, UK, "As a group intervention, mindfulness-based cognitive therapy was relatively low cost compared to therapies provided on an individual basis and, in terms of the cost of all health and social care services used by participants during the study, we found no significant difference between the two treatments." 

According to Professor Kuyken, "Whilst this study doesn't show that mindfulness-based cognitive therapy works any better than maintenance antidepressant medication in reducing the rate of relapse in depression, we believe these results suggest a new choice for the millions of people with recurrent depression on repeat prescriptions. "*

Study participant Mr Nigel Reed from Sidmouth, Devon, UK, comments that, "Mindfulness gives me a set of skills which I use to keep well in the long term. Rather than relying on the continuing use of antidepressants mindfulness puts me in charge, allowing me to take control of my own future, to spot when I am at risk and to make the changes I need to stay well."

Writing in a linked Comment, Professor Roger Mulder from the University of Otago in New Zealand says, "Because it is a group treatment that reduces costs and the number of trained staff needed, it might be feasible to offer [mindfulness-based cognitive therapy] as a choice to patients in general practice…We therefore have a promising new treatment that is reasonably cost effective and applicable to the large group of patients with recurrent depression."

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