Transcript Project UPLIFT - Rollins School of Public Health | Rollins

Main Outcome Results
November 6, 2009
Nancy J. Thompson, Ph.D., M.P.H.
Using Practice and
Learning to Increase Favorable Thoughts
Project UPLIFT
 Delivery of MBCT by Web and Telephone Groups
 To people with epilepsy
 Randomly assigned to groups of 7
 Computers and Internet access provided if needed
 Groups used for support surrounding Epilepsy
 8 Sessions
 Facilitators
 Peers and Graduate Students
 Supervised by a licensed psychologist
 Funding: Centers for Disease Control and Prevention
The 8 Sessions
Session #
Topic
1
Monitoring Thoughts
2
Challenging and Changing Thoughts
3
Coping and Relaxing
4
Attention and Mindfulness
5
The Present as a Calm Place
6
Thoughts as Changeable and Impermanent
7
Pleasure and Reinforcement
8
Relapse Action Plans
Each Session
• Check-in
• Teaching
• Group Exercise
• Discussion
• Skill-building w/ discussion
• Review & Homework
Design
 Emphasis on Feasibility and Acceptability
 Cross-over Design to Explore Effectiveness
Stratum 1:
Pretest 2 gp 8 wk phone Interim
Follow-up
Stratum 2:
Pretest 2 gp 8 wk Web
Interim
Follow-up
Stratum 3: Pretest
Interim 2 gp 8 wk phone
Follow-up
Stratum 4: Pretest
Interim
Follow-up
Baseline
Week 8
2 gp 8 wk Web
Week 16
Results
Participation
 Screened (n=98)
 Excluded (n=34)
 Eligible (n=53)
 Assessments
 Completed Baseline (n=48)
 Completed Interim Survey (n=40)
 Completed Third Survey (n=35)
 Participated in at least one session
 Phone Intervention Group (n=12)
 Web Intervention Group (n=10)
 Phone Waitlist Group (n=10)
 Web Waitlist Group (n=10)
 40 (75.5%) participated and completed the assessment following their
participation
Data Analysis
 Baseline Differences
 Only mean Self Compassion was statistically significant
(t = 3.00, df = 38, p = 0.005)


Intervention group (mean = 19.7)
Waitlist group (mean = 16.0)
 Repeated Measures ANCOVA
 Assess the change in scores over time in the intervention
and the waitlist groups
 Controlled all analyses for Self Compassion
Depression Measures
TreatmentMeasure
Time
Intervention
as-Usual
(Mw/ outliers)
Waitlist
(Mw/ outliers)
BDI
mBDI
Pretest
15.2
12.4
Interim
5.5
10.6
Pretest
31.1
27.9
Interim
19.5
25.9
Outliers Included
Finteraction
p-value
(df 1,37)
Outliers Deleted
Finteraction
p-value
(df 1,36)
11.99
0.001**
12.97
0.001**
10.08
0.003**
10.67
0.002**
Depression: mBDI
 Treatment vs. Waitlist
 Foverall = 40.93, p=.0001
 Finteraction = 10.14, p=.003*
 Phone vs. Web vs.
Waitlist
 Foverall = 40.11, p=.0001
 Finteraction = 4.99, p=.012*
Depression: BDI
40.0
 Treatment vs. Waitlist
 Foverall = 42.22, p=.0001
 Finteraction = 11.99, p=.001*
35.0
30.0
25.0
Intervention
20.0
Waitlist
15.0
10.0
5.0
0.0
Pretest
Interim
Depression: BDI
By Intervention Type
BDI
40
35
• Phone vs. Web vs.
Waitlist
 Foverall = 41.65, p=.0001
 Finteraction = 5.93, p=.006*
30
25
Phone Tx
20
Web Tx
15
Waitlist
10
5
0
Pretest
Interim
Effect by Presence of MDD
Intervention
Measure
Time
no
no
MDD MDD
BDI
mBDI
Waitlist
MDD
MDD
Finteraction
df
p-value
Pretest
9.2
18.8
8.7
23.8
5.4731
3,35
0.025*
Interim
1.8
7.8
9.0
16.2
1.2092
1,35
0.279
Pretest
23.4
35.9
24.0
40.7
4.8201
3,35
0.035*
Interim
14.3
23.0
24.0
32.6
0.6512
1,35
0.421
* < .05
1Time by Condition
2Time by Condition by MDD
Maintenance of Effects
Measure
Time
Intervention Treatment
-as-Usual
F
df
p-value
Waitlist
BDI
mBDI
* < .05
Pretest
14.5
13.4
0.121
1,30
0.730
Interim
4.6
10.8
7.541
1,30
0.010*
Posttest
5.7
8.3
1.124
1,30
0.297
Pretest
30.0
29.5
0.018
1,30
0.895
Interim
18.2
26.0
6.026
1,30
0.020*
Posttest
18.2
21.0
0.406
1,30
0.529
Knowledge/Skills & Self-Efficacy
Measure
Time
Intervention
TAU Waitlist
Finteraction
P-value
df 1,37
Knowledge/
Skills
Pretest
Interim
122.5
136.3
123.5
126.0
4.75
0.036*
Depression
Coping
Self-Efficacy
Pretest
Interim
67.7
75.5
72.4
72.9
3.59
0.066
Knowledge & Skills
 Treatment vs. TAU
Waitlist
153.0
 Foverall = 8.97, p=.005
133.0
 Finteraction = 4.75, p=.036*
113.0
Intervention
93.0
 Phone vs. Web vs.
Waitlist
Waitlist
73.0
53.0
 Foverall = 9.67, p=.004
33.0
 Finteraction = 3.67, p=.036*
13.0
Pretest
Interim
Depression Coping Self-Efficacy
100.0
 Treatment vs. Waitlist
 Foverall = 6.89, p=.013
 Finteraction = 3.59, p=.066
90.0
80.0
70.0
60.0
Intervention
50.0
Waitlist
40.0
30.0
20.0
10.0
0.0
Pretest
Interim
Quality of Life
Measure
Time
Intervention
Tx As Usual
Waitlist
Finteraction
P-value
df 1,37
Satisfaction
with Life
Pretest
Interim
18.2
21.0
18.3
18.0
3.029
0.0901
Mental
Health QOL
Pretest
Interim
59.3
80.9
65.4
83.6
0.123
0.727
Physical
Health QOL
Pretest
Interim
68.9
78.9
76.2
80.8
0.496
0.486
1.05<p<.10
Satisfaction with Life
35.0
 Treatment vs. Waitlist
 Foverall = 4.52, p=.040
 Finteraction = 3.03, p=.090
30.0
25.0
Intervention
20.0
Waitlist
15.0
10.0
5.0
Pretest
Interim
Mental Health QOL
 Treatment vs. Waitlist
 Foverall = 16.07, p=.0001
 Finteraction = 0.12, p=.727
 Phone vs. Web vs.
Waitlist
 Foverall = 15.10, p=.0001
 Finteraction = 0.50, p=.609
120.0
100.0
80.0
Intervention
60.0
Waitlist
40.0
20.0
0.0
Pretest
Interim
Physical Health QOL
 Treatment vs. Waitlist
 Foverall = 3.99, p=.053
 Finteraction = 0.50 , p=.486
91.0
81.0
71.0
 Phone vs. Web vs.
Waitlist
 Foverall = 3.83, p=.058
 Finteraction = 0.31, p=.737
61.0
Intervention
51.0
Waitlist
41.0
31.0
21.0
11.0
1.0
Pretest
Interim
Summary
 Effective in:
 Reducing depressive symptoms and teaching knowledge
and skills associated with reducing depression



Intervention group showed significant improvement
compared to the waitlist
Equally effective for those with and without MDD
Reduction in depressive symptoms maintained
 Approaching significance for Satisfaction with Life and
Depression Coping Self-Efficacy
 Delivery
 Both phone and web were significantly more effective in
reducing depression than waitlist condition
Summary
 QOL Findings consistent with the premises of
mindfulness
 that suffering is not something to turn away from or
something in need of fixing,
 that it is worthy of attention,
 that through attention we can see the ways in which we
attach thoughts to the suffering that exacerbate it, and
 that letting go of these thoughts reduces suffering (Segal
et al.)
Going Forward
 ~$1 million Challenge Grant
 UPLIFT for Prevention
 Participants in 4 states
 Georgia
 Michigan
 Texas
 Washington