Transcript Mindfulness recent research

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
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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)
25
20
15
BDI
10
• 43% in remission at end
(<10 on BDI)
5
0
Pre
Post
How does it work ?
Mindfulness
Why focus on depression
MBCT
update of the trials
‘How does it work?’
Theoretical models
Clinical observation
Qualitative studies
Mindfulness and Neuroscience
MBCT and other clinical groups
John Teasdale
Implicational meaning
Evoke sad feeling
Cognitive loops
Bodily feedback loops
inner 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.”