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• 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)

• 43% in remission at end (<10 on BDI)

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Pre Post

BDI

How does it work ?

Mindfulness

Why focus on depression

MBCT

update of the trials

‘How does it work?’ Theoretical models

Clinical observation Qualitative studiesMindfulness and Neuroscience

MBCT and other clinical groups

John Teasdale Implicational meaning

Evoke sad feeling Cognitive loops

Bodily feedback loopsinner 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.”