Mindfulness recent research
Summary
• Mindfulness – Why focus on depression
• MBCT– update of the trials
• ‘How does it work?’
• Qualitative studies
Mindfulness and Neuroscience
• MBCT and other clinical groups
Mindfulness
• Translation of ancient Pali word “sati” - “awareness”– direct, open-hearted “knowing”
• Traditionally cultivated by meditation practices– Learning to pay attention
• Moment by moment• Intentionally• With curiosity and compassion
Research Publications
Overview of MBCT Eight weekly classes plus all-day session. Each 2 - 2.5
hours. Pre-class interview
to explain, motivate and point out the commitment that will be necessary
Up to 12 in each class (Kabat-Zinn – 30 in each class) Homework, up to one hour per day, 6 days a week -
mostly audiotapes of mindfulness practice + generalisation practice
Pattern First half - concentration/steadying the mind Second half – wider awareness; relapse prevention
First outcome trial: results
For patients with only 2 previous episodes (23% of sample) - No effect of MBCT on relapse
For patients with 3 or more previous episodes (77% of sample) - Significant effects TAU: 66% relapsed in 12 months MBCT: 37% relapsed in 12 months
Teasdale, Segal, Williams et al., 2000, JCCP
Survival Curve (for patients with 3 or more previous episodes - 60 weeks)
MBCT as alternative to Continued Antidepressants
Kuyken et al., 2008 JCCP• Two group RCT
• All patients on long term ADMs
• All in remission or partial remission
• N = 62 - Continued with ADMs
• N = 61 – MBCT and help in coming off ADMs (75% succeeded)
Kuyken et al (2008) MBCT vs m-ADMs
MBCT for prevention of depressive relapse: summary
First RCTs of preventative clinical intervention based on mindfulness
For more serious patients (history of >3 episodes), MBCT halves chances of relapse
MBCT effective for “autonomous” relapse processes
Highly cost effective (because class-based approach): Clinician time per patient < 5 hours on average
Appears equivalent to continued medication Especially relevant when recovery is ‘unstable’
Application to Treatment resistant depression (TRD)
• Kenny & Williams (2007)• All symptomatic, despite
ADM (74%) and CBT (68%)
• N = 50 (49 completers)
• 43% in remission at end (<10 on BDI)
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Pre Post
BDI
How does it work ?
Mindfulness
Why focus on depression
MBCT
update of the trials
‘How does it work?’ Theoretical models
Clinical observation Qualitative studiesMindfulness and Neuroscience
MBCT and other clinical groups
John Teasdale Implicational meaning
Evoke sad feeling Cognitive loops
Bodily feedback loopsinner collapse
• “ The patterns of mind that keep people trapped in emotional suffering are, fundamentally the same patterns of mind that stand between all of us , and the flowering of our potential for a more deeply satisfying way of being”
Changes in three domains
• What the mind is processing
( attentional training shifting mental gear from doing to
being mode )
• How the mind is processing
(openness to experience , acceptance, curiosity , compassion, i.e. panic attacks )
• View or perspective
( of self and others - behavioural changes)
Changes in self compassion
Qualitative studies
• “ greater awareness of warning signals”
• “coming to terms with depression – sense of acceptance “
• “ feeling empowered to change”
• Changes in relationships
• Group effect very important
• Sense of struggle – hitting barriers
Neuroscience • Mindfulness
– Why focus on depression• MBCT
– update of the trials
• ‘How does it work?’
• Qualitative studies
Mindfulness and Neuroscience
• MBCT and other clinical groups
Lazar et al 2005 Meditation experience is associated with cortical thickness Neuroreport, 16,
1893- 1897
Mindfulness training increases ‘viscero-somatic’ processing
and uncouples ‘narrative-based’ processing (Farb et al, 07)
Einstein
• “ A Human being is a part of the whole, a part limited in time and space. He experiences himself, his thoughts and feelings as something separated from the rest a kind of optical delusion of consciousness. This delusion is a kind of prison for us, restricting us to our personal desires and to a few persons nearest to us. Our task must be to free ourselves from this prison by widening our circle of compassion to embrace all, and the whole of nature in its beauty.”
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