Transcript The Impact of Mindfulness-based Stress Reduction (MBSR) on Depression, Anxiety and Stress in People with Parkinson’s Disease Kelly Birtwell [email protected] Linda Dubrow-Marshall [email protected].

The Impact of Mindfulness-based Stress
Reduction (MBSR) on Depression,
Anxiety and Stress in People with
Parkinson’s Disease
Kelly Birtwell
[email protected]
Linda Dubrow-Marshall
[email protected]
Aim
• To evaluate the impact of an 8-week
Mindfulness-Based Stress Reduction
course (MBSR) on people with
Parkinson’s disease (PD) experiencing
depression, anxiety and stress, or difficulty
coping with PD
• Completed as part of MSc Applied
Psychology (Therapies) degree, University
of Salford
• Other authors: Dr J Raw, T Duerden & A.
Dunn
Parkinson’s disease
• Affects 120,000 people in the UK
• Mainly older adults, age 50+
• People under 40 can be affected, 10,000
diagnosed ‘young onset’ per year
• Exact cause unknown
• No cure, symptoms controlled by medication.
Treatment is complex
• Motor symptoms: resting tremor, bradykinesia,
rigidity, postural instability
Parkinson’s non-motor symptoms
• 40-45% of patients experience depression, up to
40% experience anxiety
• Anxiety and depression can predate motor
symptoms by several years
• Apathy, mild cognitive impairment (MCI), sleep
problems, autonomic disturbance, pain
• NMS have major impact on quality of life
• Improved management of NMS is needed
• New treatments needed, and further research
into psychosocial interventions for anxiety and
depression in PD
Mindfulness
• “Paying attention in a particular way: on
purpose, in the present moment and nonjudgementally” (Jon Kabat-Zinn, 2004)
• Building blocks: intention, attention, attitude
(Shapiro et al, 2006)
• 7 attitudes: non-judging, patience, a beginner’s
mind, trust, non-striving, acceptance and letting
go (Kabat-Zinn, 2004)
• Formal or informal practice
• One-to-one or group mindfulness courses
• MBCT (NICE guidelines), MBSR
MBCT & MBSR
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MBSR: group based, 8 week programme
Includes stories, poetry, metaphors
Yoga / mindful movement
Physiological and psychological bases of stress
For physical and mental health problems
More suitable for general population
Described but not manualised (responsive)
• MBCT: integration of MBSR and CBT
• NICE guidelines recommend MBCT for people
currently well, with a history of 3 or more episodes of
depression
• Manualised (developed through RCT)
Mindfulness - applications
• MBSR for pain (Kabat-Zinn et al, 1985), GAD (KabatZinn et al, 1992), psoriasis (Kabat-Zinn et al, 1998)
• MBSR increases grey matter density (Holzel et al 2011)
• Fitzpatrick et al (2010): MBCT acceptable and of benefit
to people with PD
• Dreeben et al (2011): MBSR for people with PD, reduced
anxiety and depression, psychological adjustment
• Sephton et al (2011): MBSR for people with PD, slower
breathing and reduced evening cortisol levels
• Bucks et al (2011): coping processes and quality of life in
PD, recommended mindfulness
• Pickut et al (2013): increases in grey matter density of
people with Parkinson’s who attended a mindfulness
course
Method: Patient & public involvement
Patients with Parkinson’s were involved
throughout the life of the study:
• Discussion of the initial idea
• Choosing outcome measures
• Adaptations to the MBSR course
• Review and feedback of the study
documents
Design and outcome measures
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Mixed methods design
Data collected at baseline, wk8, and wk16
Age and Parkinson’s history recorded
Primary outcome measure: DASS-21
Secondary outcome measures:
– PDQ39 (well-being and stigma)
– MAAS
– Qualitative follow-up questionnaires
DASS-21 – Primary Outcome Measure
• Depression Anxiety & Stress Scales
(DASS-21) Lovibond & Lovibond 1995
• Short form of the DASS – 21 questions
• Reliable and valid in elderly population
• Used in previous mindfulness studies
• Higher scores indicate higher levels of
distress / worsening of symptoms
PDQ39 – Secondary Outcome Measure
• Parkinson’s Disease Questionnaire 39
(Jenkinson et al 1995)
• Disease specific rating scale for PD
• 39 questions over 8 dimensions:
– mobility, activities of daily living (ADLs), emotional
well-being, stigma, social support, cognition,
communication, bodily discomfort
• Higher scores indicate worsening of symptoms
• Widely used and fully validated
• Developed with patients to cover areas of life
that are important to them
MAAS – Secondary Outcome Measure
• Mindful Attention Awareness Scale (Brown
& Ryan, 2003)
• 15 item questionnaire
• Provides overall rating of mindful
awareness
• Higher scores indicate increased mindful
awareness
• Suitable for meditation naïve participants
• Validated scale
Qualitative follow-up questionnaires
• Designed specifically for this study
• Questions about taking part in the MBSR
course, and in the study
• What was helpful or unhelpful
• What would they change
• Has their experience of living with PD
changed since attending the course
• What would they tell others considering
attending an MBSR course
Participants & recruitment
• Participants referred from an Acute
Hospital Trust
• Inclusion criteria
– Diagnosis of idiopathic Parkinson’s disease
(Parkinson’s UK Brain Bank criteria)
– Identified as experiencing depression,
anxiety, stress, or difficulty coping with PD
• Exclusion criteria
– Lacking capacity to consent
– Just begun a major life change
MBSR course
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Developed by Jon Kabat-Zinn
8 week, group course
1 session per week, up to 3 hours duration
One full day ‘silent retreat’ towards the end
of the course
• Daily home practice, up to 45 minutes
• CDs and worksheets provided
• Delivered by experienced mindfulness
teachers
MBSR course adaptations
• Order of practices and curriculum – body
as source of distress
• Option of sitting for body scan
• Duration of practices shortened
• Full day ‘retreat’ not included
• Other studies made adaptations (e.g.
Sephton et al, 2011).
Findings
Recruitment and reasons for withdrawal
• 13 participants were recruited
• 9 attended wk1, 6 completed full course
• Withdrawal before the MBSR course began:
– Scheduling conflict
=2
– Unexpected health issues = 2
• Withdrawal after the first MBSR session:
– Scheduling conflict
=1
– Unexpected health issues = 1
– Did not wish to continue = 1
Demographics and PD history
• 6 Participants: male = 5, female = 1
• Mean age = 67.96 (5.64 SD, range: 60.8 - 72.9)
• PD history:
Mean (SD)
Range
Age at disease onset
59.13 (7.39)
51.2 - 70.5
Age at diagnosis
60.33 (5.92)
55 - 70
Disease duration
8.82 (5.47)
2.16 - 18.35
Hoehn & Yahr staging
2.33 (0.68)
1.5 - 3.0
(symptom progression)
DASS-21
• Mean scores for depression, anxiety and stress decreased
• Statistically significant improvements
18
16
Mean score
14
12
Depression
10
Anxiety
8
Stress
6
4
2
0
Baseline
Week 8
Week 16
DASS-21 – severity categories
Depression
Anxiety
Stress
0-9
0-7
0-14
Mild
10-13
8-9
15-18
Moderate
14-20
10-14
19-25
Severe
21-27
15-19
26-33
28+
20+
37+
Normal
Extremely Severe
• Score range: 0 - 42
PDQ39
• At wk8 and wk16 levels of change varied
across the dimensions
60
1 Mobility
Mean scores (0-100)
50
2 Activities of daily living
3 Emotional well being
40
4 Stigma
30
5 Social support
6 Cognitive impairment
20
7 Communication
8 Bodily discomfort
10
PDQ39 Summary Index
0
Baseline
Week 8
Week 16
PDQ39
• Results were not statistically significant
• Continuous improvements seen in 3 dimensions:
mobility, stigma, social support
• ADLs and well-being showed increase in problems at
wk8 then return to baseline levels at wk16
• Problems with bodily discomfort increased at wk8 then
decreased at wk16, but not to baseline levels
• Cognitive impairment and communication worsened at
wk8 then stayed the same or worsened again at wk16
• The mean summary index score worsened at wk8 then
returned to baseline at wk16
MAAS
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Little change in self-reported mindfulness
Mean scores: 3.83 – 3.77 – 3.90
Slight decrease at wk8
Slight increase at wk16 compared to
baseline
• Results not statistically significant
• Score range: 1-6, higher score = increased
mindful awareness
Qualitative follow-up questionnaires
• Overall participants found the course worthwhile and felt
some benefit
• ‘Has your experience of living with Parkinson’s changed
at all since attending the MBSR course?’
5
4
3
2
1
0
Significant positive
change
Some positive
change
No change
Some negative
change
Significant negative
change
Qualitative follow-up questionnaires
• Some confusion reported:
– Some mindfulness concepts
– Aims of the practices
– Terminology used
• Needed fuller explanations earlier in
course
• Mindfulness of breath practiced most often
What would you tell other people with Parkinson’s
considering attending an MBSR course?
• “I would tell them not to be put off too soon, as its
relevance takes some time to become obvious.”
• “Go with an open mind, enjoy the course.”
• “To go ahead and try it.”
• “Yes get involved because it's made me think about
things and realise I'm not on my own.”
• “Do it.”
• “Prepare to be stimulated in an unusual way.”
Conclusion
• Mindfulness-based interventions could
benefit people with Parkinson’s
• The intervention is acceptable to patients
• Interpretation of the results is limited –
small sample size and lack of control
group
Future research
• Larger sample sizes required
• Carers could also participate in the
mindfulness course
• Further adaptations could be considered
to meet the needs of people with PD
• People with Parkinson’s should be
involved in all stages of future studies,
including study design
Questions
• [email protected]
• [email protected]