Effects of a modified mindfulness-based cognitive therapy for family caregivers of people with dementia: A pilot randomized controlled trial.

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BACKGROUND:

Caregivers of people with dementia experience high stress levels. Mindfulness-based cognitive therapy has been found to be effective in reducing stress and improving the psychological well-being of several populations.

OBJECTIVE:

To explore the feasibility and preliminary effects of a modified mindfulness-based cognitive therapy for family caregivers of people with dementia.

METHODS:

In a single-blinded, parallel-group, randomized controlled trial, 36 caregivers of people with dementia were randomized to either the intervention group, receiving the 7-session modified mindfulness-based cognitive therapy in 10 weeks; or the control group, receiving the usual family care and brief education on dementia care. The brief education sessions were similar in frequency and duration to the intervention group. Various psychological outcomes of caregivers were assessed and compared at baseline, immediately post-intervention, and at the 3-month follow-up. A focus group with eight participants from the intervention group was conducted to identify the strengths, limitations, and difficulties of the intervention.

RESULTS:

Intervention feasibility was established with a high completion rate of 83% (completing ≥5 out of the 7 sessions) and a low attrition rate of 11.1%. The duration of the average weekly home-based mindfulness practice of the caregivers was 180 minutes (S.D. = 283.8). The intervention group experienced a statistically significant decrease in stress levels (Z = -1.98, p = 0.05, Cohen’s d = 0.7) and depressive symptoms (Z = -2.25, p = 0.02, Cohen’s d = 0.8) at the post-test; and a decrease in stress (Z = -2.58, p = 0.01, Cohen’s d = 0.9), depressive symptoms (Z = -2.20, p = 0.03, Cohen’s d = 0.7), and burden (Z = – 2.74, p = 0.006, Cohen’s d = 1.0), and improved quality of life (physical) (Z = -1.68, p = 0.09, Cohen’s d = 0.6) at the 3-month follow-up compared to the controls. A focus group conducted immediately after the intervention revealed three major themes: Impacts on the family caregivers, Impacts on the people with dementia, and Difficulty in practicing mindfulness.

CONCLUSION:

The findings support the feasibility and preliminary effects of the modified mindfulness-based cognitive therapy on reducing the stress of caregivers and improving their psychological well-being. Some potential effects on people with dementia (e.g., improvements in behavioral problems) were reported by the caregivers. A future study with a larger and more diverse sample is proposed to evaluate the longer-term effects and generalizability of the modified mindfulness-based cognitive therapy and the impacts on people with dementia.

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Mindfulness-based interventions for mental wellbeing among people with multiple sclerosis: a systematic review and meta-analysis of randomised controlled trials

 

Abstract
Objective

Impairment of mental well-being (anxiety,
depression, stress) is common among people with
multiple sclerosis (PwMS). Treatment options are limited,
particularly for anxiety. The aim of this study was to
update our previous systematic review (2014) and
evaluate via meta-analysis the efficacy of mindfulnessbased interventions (MBIs) for improving mental wellbeing in PwMS.
Methods

Systematic searches for eligible randomised
controlled trials (RCTs) were carried out in seven major
databases (November 2017, July 2018), using medical
subject headings and key words. Studies were screened,
data extracted, quality appraised and analysed by two
independent reviewers, using predefined criteria. Study
quality was assessed using the Cochrane Collaboration
risk of bias tool. Mental well-being was the primary
outcome. Random effects model meta-analysis was
performed, with effect size reported as standardised
mean difference (SMD).
Results

Twelve RCTs including 744 PwMS were
eligible for inclusion in the systematic review, eight had
data extractable for meta-analysis; n=635. Ethnicity,
socioeconomic status, comorbidity and disability were
inconsistently reported. MBIs varied from manualised
to tailored versions, lasting 6–9 weeks, delivered
individually and via groups, both in person and online.
Overall SMD for mental well-being (eight studies)
was 0.40 (0.28–0.53), p<0.01, I2=28%; against
active comparators only (three studies) SMD was 0.17
(0.01–0.32), p<0.05, I2=0%. Only three adverse events
were reported.
Conclusions

MBIs are effective at improving mental
well-being in PwMS. More research is needed regarding
optimal delivery method, cost-effectiveness and
comparative-effectiveness

 

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Mindfulness-based therapy for psychogenic nonepileptic seizures.

 

Abstract

BACKGROUND:

Mindfulness-based therapies (MBTs) are effective in many neuropsychiatric disorders, and represent a potential therapeutic strategy for psychogenic nonepileptic seizures (PNES).

OBJECTIVE:

The objective of this study was to investigate the clinical effect of a manualized 12-session MBT for PNES in an uncontrolled trial. We hypothesized reductions in PNES frequency, intensity, and duration, and improvements in quality of life and psychiatric symptom severity at treatment completion.

METHODS:

Between August 2014 and February 2018, 49 patients with documented PNES (with video electroencephalography [EEG]) were recruited at Brigham and Women’s Hospital to participate in the MBT for PNES treatment study. Baseline demographic and clinical information and self-rating scales were obtained during the diagnostic evaluation (T0). Baseline PNES frequency, intensity, and duration were collected at the first follow-up postdiagnosis (T1). Frequency was obtained at each subsequent MBT session and analyzed over time with median regression analysis. Outcomes for other measures were collected at the last MBT session (T3), and compared to baseline measures using linear mixed models.

RESULTS:

Twenty-six patients completed the 12-session MBT program and were included in the analysis. Median PNES frequency decreased by 0.12 events/week on average with each successive MBT session (p = 0.002). At session 12, 70% of participants endorsed a reduction in PNES frequency of at least 50%. Freedom from PNES was reported by 50% of participants by treatment conclusion. Seventy percent reported a 50% reduction in frequency from baseline and 50% reported remission at session 12. By treatment end, PNES intensity decreased (p = 0.012) and quality of life improved (p = 0.002). Event duration and psychiatric symptom severity were lower after treatment, but reductions were not statistically significant.

CONCLUSIONS:

Completion of a manualized 12-session MBT for PNES provides improvement in PNES frequency, intensity, and quality of life. The high dropout rate is consistent with adherence studies in PNES. Possible reasons for dropout are discussed. Randomized controlled trials and longer-term outcomes are needed to demonstrate the efficacy of MBT in PNES.

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Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis

Abstract

IMPORTANCE:

Mind-body therapies (MBTs) are emerging as potential tools for addressing the opioid crisis. Knowing whether mind-body therapies may benefit patients treated with opioids for acute, procedural, and chronic pain conditions may be useful for prescribers, payers, policy makers, and patients.

OBJECTIVE:

To evaluate the association of MBTs with pain and opioid dose reduction in a diverse adult population with clinical pain.

DATA SOURCES:

For this systematic review and meta-analysis, the MEDLINE, Embase, Emcare, CINAHL, PsycINFO, and Cochrane Library databases were searched for English-language randomized clinical trials and systematic reviews from date of inception to March 2018. Search logic included (pain OR analgesia OR opioids) AND mind-body therapies. The gray literature, ClinicalTrials.gov, and relevant bibliographies were also searched.

STUDY SELECTION:

Randomized clinical trials that evaluated the use of MBTs for symptom management in adults also prescribed opioids for clinical pain.

DATA EXTRACTION AND SYNTHESIS:

Independent reviewers screened citations, extracted data, and assessed risk of bias. Meta-analyses were conducted using standardized mean differences in pain and opioid dose to obtain aggregate estimates of effect size with 95% CIs.

MAIN OUTCOMES AND MEASURES:

The primary outcome was pain intensity. The secondary outcomes were opioid dose, opioid misuse, opioid craving, disability, or function.

RESULTS:

Of 4212 citations reviewed, 60 reports with 6404 participants were included in the meta-analysis. Overall, MBTs were associated with pain reduction (Cohen d = -0.51; 95% CI, -0.76 to -0.26) and reduced opioid dose (Cohen d = -0.26; 95% CI, -0.44 to -0.08). Studies tested meditation (n = 5), hypnosis (n = 25), relaxation (n = 14), guided imagery (n = 7), therapeutic suggestion (n = 6), and cognitive behavioral therapy (n = 7) interventions. Moderate to large effect size improvements in pain outcomes were found for meditation (Cohen d = -0.70), hypnosis (Cohen d = -0.54), suggestion (Cohen d = -0.68), and cognitive behavioral therapy (Cohen d = -0.43) but not for other MBTs. Although most meditation (n = 4 [80%]), cognitive-behavioral therapy (n = 4 [57%]), and hypnosis (n = 12 [63%]) studies found improved opioid-related outcomes, fewer studies of suggestion, guided imagery, and relaxation reported such improvements. Most MBT studies used active or placebo controls and were judged to be at low risk of bias.

CONCLUSIONS AND RELEVANCE:

The findings suggest that MBTs are associated with moderate improvements in pain and small reductions in opioid dose and may be associated with therapeutic benefits for opioid-related problems, such as opioid craving and misuse. Future studies should carefully quantify opioid dosing variables to determine the association of mind-body therapies with opioid-related outcomes.

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Effects of mindfulness meditation on mindfulness, mental well-being, and perceived stress

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Introduction

The purpose of this study was to investigate the effects of mindfulness meditation using the Headspace™ app on mindfulness, mental well-being, and perceived stress in pharmacy students.

Methods

Professional year one (P1), professional year two (P2,) and professional year 3 (P3) pharmacy students were recruited to participate. Students were instructed to meditate using the Headspace™ app for at least 10 min per day for four weeks. Students at baseline completed the health promoting lifestyle profile (HPLP). Data was collected from the pre/post surveys using the Five Facet Mindfulness Questionnaire (FFMQ), Warwick-Edinburgh Mental Well-Being Scale (WEMWBS), and Cohen Perceived Stress Scale (PSS).

Results

Ninety-two pharmacy students enrolled in the study. Seventy-percent of the participants completed the study. Only one participant was excluded in the post data analysis due to non-adherence with the protocol. The data revealed that for all scales the intervention was associated with enhanced mindfulness and mental well-being and decreased perceived stress. Further analysis indicated that controlling for various health promoting lifestyle behaviors preserves the positive impact of mindfulness meditation as demonstrated.

Conclusions

Mindfulness meditation uniformly and independently improved the participants overall mental health. The data supports a feasible option for minimizing stress and maintaining mental well-being in a demanding professional program. This study encourages students in pharmacy schools to adopt these practices in their curriculum.

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