- Mindfulness-based cognitive therapy had a positive effect on depression in chronically ill people, according to per-protocol analysis
- MBCT had a positive effect on mental health, according to both intent-to-treat and per-protocol analyses
- MBCT did not affect pain intensity in either type of analysis
Mindfulness-based therapies teach meditation techniques that help participants change dysfunctional thinking patterns and become more accepting of physical and emotional pain. Mindfulness-based stress reduction (MBSR) was developed for people with chronic medical illnesses, but it does not specifically target depression.
An adaptation of MBSR called mindfulness-based cognitive therapy (MBCT), which is delivered in a group setting, has proved effective in preventing relapse of depression. In addition, there is growing evidence that it can treat active depression. In the Journal of Clinical Psychiatry, Mass General Hospital clinician researchers David Mischoulon, MD, PhD, director of the Depression Clinical and Research Program and Maurizio Fava, MD, director of the Division of Clinical Research of the Mass General Research Institute and executive vice chair in the Department of Psychiatry, and colleagues report the first evidence that MBCT is feasible and potentially effective for the depressed chronic pain population.
Through clinician referral and web-based advertisements, the research team recruited adult patients for a pilot trial of MBCT. Adult participants needed to have pain for at least three months; meet DSM-IV criteria for major depressive disorder, dysthymic disorder or depressive disorder not otherwise specified; and have a score ≥6 on the Quick Inventory of Depressive Symptomatology (QIDS-C16) . Data were collected between January 2012 and July 2013.
Forty patients were randomly assigned on a 2:1 basis either to have MBCT in addition to treatment as usual (n=26) or to continue with treatment as usual (control group, n=14). Nineteen of the participants who started MBCT completed the “minimum effective dose” of four classes. The mean attendance was 7/8 classes.
The primary outcome measures were change in scores on the QIDS-C16 and the Hamilton Depression Rating Scale-17 (HDRS-17), which were administered by telephone every two weeks. In the intent-to-treat population (all 40 participants randomized), there was no significant difference between groups on either measure.
The researchers also analyzed the per-protocol population (the 19 participants who completed MBCT and the 14 control subjects). They found a significant on the QIDS-C16, driven by significant improvement in the MBCT group and not in the control group. There was no significant difference between groups on the HDRS-17.
For secondary outcome measures in the intent-to-treat population, the Mental Health scale of the Short-Form Health Survey (SF-36) showed a significant time × group interaction, and improvement in Patient Global Impression of Change (PGIC) questionnaire was significantly greater for MBCT-treated participants than controls. In the per-protocol population, the results were similar plus improvement on the SF-36 Vitality scale was clearly significantly better in the MBCT group.
The researchers say the lack of effect of MBCT on pain intensity was somewhat unexpected considering studies of other psychological therapies. But they consider the findings to align with the goal of their MBCT program, which is not to remove or reduce pain but rather to help patients manage pain and its negative effects on their lives. A larger study is planned to obtain more definitive conclusions.
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