Wednesday, December 29, 2010

MS Quality of Life, Depression, and Fatigue Improve After Mindfulness Training: A Randomized Trial

There's a new study looking at a mindfulness-based treatment in a medical setting. A group of researchers in Switzerland recently published a study in Neurology assessing a mindfulness-based intervention for people with multiple sclerosis (MS). MS is a neurological disease. According to the article, people with MS have high rates of depression, anxiety, fatigue, and what they call health-related quality of life. 

Dr. Paul Grossman and colleagues randomized 164 people with MS in a neurology clinic at the University Hospital Basel to one of two conditions: 1.) an 8-week mindfulness-based intervention; 2.) usual care, in which they continued to receive medical care but had no behavioral intervention.

According the researchers, the mindfulness-based intervention was based on Mindfulness-Based Stress Reduction (MBSR). I'm not clear how their intervention differs from MBSR. From the description, the intervention seemed at have the major elements of MBSR. Outcomes were assessment prior to the intervention, after the 8-week mindfulness-based intervention, and at 6-month follow-up. The usual care group was offered the mindfulness-based intervention after the 6-month follow-up.

In addition to assessing anxiety, depression, and health-related quality of life, the researchers also conducted a neurological assessment. People with MS in the mindfulness-based intervention exhibited significant reductions in depression, anxiety, and fatigue. The improvements remained significant at the 6-month follow-up; however, there was some loss in the gains or "slippage" for health-related quality of life and depressive symptoms between the end of the intervention and the follow-up. The authors suggest that booster sessions may be necessary in order to maintain treatment gains. People appeared to respond favorably to the mindfulness-based intervention; attrition rates were low and people reported high goal satisfaction.

Although cognitive behavioral interventions have been shown to improve depression, anxiety, and fatigue in people with MS, these interventions were delivered individually. As it is a group intervention, the mindfulness-based intervention may be more cost effective than the existing cognitive behavioral treatments.

As the authors note, however, because the mindfulness-based intervention wasn't compared against another intervention, it remains uncertain if factors non-specific to the treatment (e.g., placebo, social support) may be responsible for the improvements more than the treatment itself. Nonetheless, this study adds to the growing literature suggesting mindfulness-based, group-administered treatments may be helpful for people with difficult medical conditions.

To download a copy of the article, click on the citation below:

Grossman, P., Kappos, L., Gensicke, H., D'Souza, Mohr, D.C., et al. (2010). MS Quality of Life, Depression, and Fatigue Improve After Mindfulness Training: A Randomized Trial. Neurology, 75, 1141-1149.

Tuesday, December 21, 2010

Podcast: The Art & Science of Valuing in Psychotherapy

A crucial component in Acceptance and Commitment Therapy (ACT) is helping people connect with values, important life directions. Work in ACT is always connected to the larger picture.

For those interested in learning more about values from an ACT perspective, ACT in Practice author D.J. Moran, posted a podcast of a workshop focused specifically on values. The workshop was presented at a conference in the Netherlands a few years ago. The presenters are Joanne Dahl, Jennifer Plumb, Ian Stewart, and Tobias Lundgren, who all also authored a recent book on values called The Art and Science of Valuing in Psychotherapy.

Dr. Moran's blog is Functionally Speaking, and the workshop podcast is broken down into two parts:

For part one, click here.

For part two, click here.

Citation for the book on which the workshop was based:

Dahl, J.C., Plumb, J.C., Stewart, I., & Lundgren, T. (2009) The Art and Science of Valuing in Psychotherapy: Helping Clients Discover, Explore, and Commit to Valued Actions Using Acceptance and Commitment Therapy. Oakland, CA: New Harbinger.

Friday, December 17, 2010

Mindfulness-Based Stress Reduction For Solid Organ Transplant Recipients: A Randomized Controlled Trial

In the United States, approximately 28,000 solid organ transplants are performed annually.  Transplant recipients frequently continue to have health problems, which can contribute to mental health difficulties. Given the complexity of transplant medication regimens, a drug-free strategy may be preferred in managing subsequent anxiety, depression, and anxiety. 

A group of researchers led by Dr. Gross conducted a randomized controlled trial to test the effectiveness of a Mindfulness-Based Stress Reduction (MBSR) program. MBSR has been associated with improved health outcomes for patients with medical and psychological concerns across a number of studies.

Transplant recipients who were at least 6 months post-transplant were randomly assigned to one of three conditions: an 8-week MBSR program, an 8-week health education program, and “usual care” waitlist. The health education program was created to account for non-specific effects of MBSR, such as group support. Of the initial 150 patients, 122 completed one or more of the follow-ups, which were administered at 8 weeks, 6 months, and 1 year.

MBSR showed the strongest outcomes. Greater home practice was related to reduced anxiety, increased vitality, and increased mindfulness. Compared to the waitlist condition, patients who completed MBSR showed fewer depressive symptoms, improved sleep, and increased vitality. Compared to the health education program, MBSR participants showed less anxiety, improved sleep, and more vitality at the 1-year follow-up; stated another way, improvements in the MBSR condition were more enduring at the 1-year follow-up than improvements in the health education condition. Contrary to expectations, there were no improvements in physical health and pain symptom perception.

As the authors note, the gains from MBSR were obtained without additional psychotropic meds (e.g., antidepressants). A non-psychopharmacological approach such as MBSR may be a useful alternative to additional medications, as it is likely transplant recipients already have complex med regimes managing other health problems. Moreover, the researchers were able to show that improvements from this 8-week program were maintained a year after treatment ended. Results are very supportive of MBSR as a viable treatment for organ transplant recipients.

For the full citation:

Gross, C.R., Krietzer, M.J., Thomas, W., Reilly-Spong, M., Cramer-Bornemann, M., et al. (2010). Mindfulness-Based Stress Reduction For Solid Organ Transplant Recipients: A Randomized Controlled Trial. Alternative Therapies, 16(5), 30-38.

Many thanks to Jennifer Connolly for her assistance in creating this post!

Tuesday, December 14, 2010

Acceptance: An Historical and Conceptual Review

Acceptance goes hand-and-hand with mindfulness and has been a core part of the major mindfulness-based therapies. The journal Imagination, Cognition, and Personality have recently published a comprehensive review of acceptance by Drs. John C. Williams and Steven Jay Lynn.

The 50-page (!) article traces the philosophical and religious roots of acceptance, tracing its inclusion in psychological theory from Freud to the present mindfulness and acceptance-based treatments. It also includes various measures of acceptance and related constructs. Overall, the article is quite expansive and comprehensive. I expect it will be widely cited for years to come.

For the full citation:

Williams, J.C., & Lynn, S.J. (2010-2011). Acceptance: An Historical and Conceptual Review. Imagination, Cognition, and Personality, 30(1), 5-56.

Sunday, December 12, 2010

Science Daily: Mindfulness-Based Cognitive Therapy vs. AntiDepressant in Preventing Depressive Relapse

Science Daily has an article about a recent study of Mindfulness-Based Cognitive Therapy (MBCT). In a group of people who had experienced at least two depressive episodes, study participants were randomly assigned to one of three groups. People who were tapered off an antidepressant and completed an 8-week MBCT course showed a 38% relapse rate, compared to 46% who remained on an antidepressant, and 60% whose antidepressant was replaced by a placebo. Quoted from the article:

"Our data highlight the importance of maintaining at least one active long-term treatment in recurrently depressed patients whose remission is unstable," the authors write. "For those unwilling or unable to tolerate maintenance antidepressant treatment, mindfulness-based cognitive therapy offers equal protection from relapse during an 18-month period."

 I intend to track down the original article. In the meantime, you can read the Science Daily article here.

For the full citation:

Segal, Z.V., Bieling, P., Young, T., MacQueen, G. Cooke, R. et al. (2010). Antidepressant Monotherapy vs Sequential Pharmacotherapy and Mindfulness-Based Cognitive Therapy, or Placebo, for Relapse Prophylaxis in Recurrent Depression. Archives of General Psychiatry, 67(12), 1256-1264.

Tuesday, December 7, 2010

A Podcast Interview with Steven Hayes, PhD, on

Following fast on the heels of his interview with Dr. Zettle, Dr. Trent Codd has posted a podcast interview with Steven Hayes, PhD, on Dr. Hayes is the core originator of Acceptance and Commitment Therapy (ACT). An enormously influential professor and psychologist,  Dr. Hayes has authored 32 books and over 400 scientific articles, as well as the popular self-help book Get Out of Your Mind and Into Your Life.

Dr. Hayes discusses the importance of defining the philosophical underpinnings of psychological theories, and how Functional Contextualism guides ACT.

You can listen to the interview at here.

Monday, December 6, 2010

Interview with Rob Zettle, PhD, on Acceptance and Commitment Therapy for Depression has an interview with Rob Zettle, PhD, who, as the first graduate student of Steven Hayes, PhD, was involved in the development of what would eventually become Acceptance and Commitment Therapy (ACT). Dr. Zettle is also the author of the book, ACT for Depression.

Dr. Trent Codd interviews Dr. Zettle about his early work in developing ACT and his work on using ACT to treat depression. (The American Psychological Association Division 12 officially recognized ACT as a research-supported treatment for depression.) The interview may a little technical for people unfamiliar ACT but provides a fascinating window into its early development.

The interview can be found on here.

If you're interested in Dr. Zettle's book, the citation is below:

Zettle, R. D. (2007). ACT for Depression: A Clinician's Guide to Using Acceptance and Commitment Therapy in Treating Depression. Oakland, CA: New Harbinger.

Thursday, December 2, 2010

Telephone-Delivered Acceptance and Commitment Therapy for Adult Smoking Cessation: A Feasibility Study

In an efforts to make psychotherapy more accessible to people, researchers have been experimenting with ways of offering treatment to people who cannot come in to see a therapist regularly, perhaps for financial reasons or geographic (e.g., rural areas).

Dr. Bricker and colleagues at the University of Washington and Fred Hutchinson Cancer Research Center did a pilot study on using a smoking cessation Acceptance and Commitment Therapy (ACT) intervention delivered over the telephone.

Of the 74 people screened, 14 participated in the study. Although small, the sample was pretty diverse: 57% were African American and 64% were low-income. Participants had to be a daily smoker for the past 30 days, and 64% reported smoking half a pack a day.

A licensed psychologist delivered up to 5 telephone sessions: the first was about 30 minutes, and the remaining averaged 15 minutes per call. The components of intervention involved learning skills to: 1.) increase willingness to experience smoking-related urges; 2.) alter the function of these urges; 3.) change how they respond to the urges (e.g., notice without acting on them).

The study had 20-day and 12-month follow-ups. At 12-months, 29% of the participants were no longer smoking. Although this may not seem like a great outcome, it's pretty impressive when compared to other smoking intervention outcomes. According the authors, success rates are 4% for those quitting on their own, 12% for other telephone interventions, and 30-35% for face-to-face ACT interventions. What this means is that the success rate for this intervention was more than twice that of other telephone interventions and comparable to face-to-face interventions.

Because this was a small sample with no comparison control group, further research is necessary. Nonetheless, this study offers some really promising evidence that a brief ACT-based telephone intervention for smoking cessation may be pretty effective. That it's brief and delivered by phone means that it may offer more bang for the buck compared to face-to-face interventions. Additionally, participants rated the intervention really positively.

For the full citation:

Bricker, J.B., Mann, S.L., Marek, P.M., Liu, J., & Peterson, A.V. (2010). Telephone-Delivered Acceptance and Commitment Therapy for Adult Smoking Cessation: A Feasibility Study. Nicotine & Tobacco Research, 12(4), 454-458.