Mindfulness- based Cognitive Therapy (MBCT) is a meditation program based on an integration of Cognitive behavioural therapy and Mindfulness-based stress reduction. The aim of the present work is to review and conduct a meta-analysis of the current findings about the efficacy of MBCT for psychiatric patients. A literature search was undertaken using five electronic databases and references of retrieved articles. Main findings included the following: 1) MBCT in adjunct to usual care was significantly better than usual care alone for reducing major depression (MD) relapses in patients with three or more prior depressive episodes (4 studies), 2) MBCT plus gradual discontinuation of maintenance ADs was associated to similar relapse rates at 1year as compared with continuation of maintenance antidepressants (1 study), 3) the augmentation of MBCT could be useful for reducing residual depressive symptoms in patients with MD (2 studies) and for reducing anxiety symptoms in patients with bipolar disorder in remission (1 study) and in patients with some anxiety disorders (2 studies). However, several methodological shortcomings including small sample sizes, non-randomized design of some studies and the absence of studies comparing MBCT to control groups designed to distinguish specific from non-specific effects of such practice underscore the necessity for further research.
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"Given that MBCT was specifically designed to prevent depression in those at risk, it has been argued that it may be of value in the perinatal period where, as outlined, the risk of developing depression or experiencing a depressive relapse may be elevated . There is also good empirical evidence that MBIs can reduce current symptoms of depression , anxiety and stress , suggesting they may be valuable where such difficulties do emerge. Recent evidence suggests that MBIs work in part by reducing levels of rumination and, given that factors such as 'brooding rumination' have been found to predict the maintenance of depression in the perinatal period , mindfulness may be a particularly apt intervention at this time. "
[Show abstract][Hide abstract]ABSTRACT: Perinatal mental health difficulties are associated with adverse consequences for parents and infants. However, the potential risks associated with the use of psychotropic medication for pregnant and breastfeeding women and the preferences expressed by women for non-pharmacological interventions mean it is important to ensure that effective psychological interventions are available. It has been argued that mindfulness-based interventions may offer a novel approach to treating perinatal mental health difficulties, but relatively little is known about their effectiveness with perinatal populations. This paper therefore presents a systematic review and meta-analysis of the effectiveness of mindfulness-based interventions for reducing depression, anxiety and stress and improving mindfulness skills in the perinatal period. A systematic review identified seventeen studies of mindfulness-based interventions in the perinatal period, including both controlled trials (n = 9) and pre-post uncontrolled studies (n = 8). Eight of these studies also included qualitative data. Hedge’s g was used to assess uncontrolled and controlled effect sizes in separate meta-analyses, and a narrative synthesis of qualitative data was produced. Pre- to post-analyses showed significant reductions in depression, anxiety and stress and significant increases in mindfulness skills post intervention, each with small to medium effect sizes. Completion of the mindfulness-based interventions was reasonable with around three quarters of participants meeting study-defined criteria for engagement or completion where this was recorded. Qualitative data suggested that participants viewed mindfulness interventions positively. However, between-group analyses failed to find any significant post-intervention benefits for depression, anxiety or stress of mindfulness-based interventions in comparison to control conditions: effect sizes were negligible and it was conspicuous that intervention group participants did not appear to improve significantly more than controls in their mindfulness skills. The interventions offered often deviated from traditional mindfulness-based cognitive therapy or mindfulness-based stress reduction programmes, and there was also a tendency for studies to focus on healthy rather than clinical populations, and on antenatal rather than postnatal populations. It is argued that these and other limitations with the included studies and their interventions may have been partly responsible for the lack of significant between-group effects. The implications of the findings and recommendations for future research are discussed.
"It therefore remains a hypothesis that mindfulness training should precede the safe introduction of compassion training in vulnerable patients, predominantly based on clinical arguments. There is considerable evidence for the efficacy of mindfulness-based group interventions with groups of various psychiatric disorders studied in homogenous and mixed groups (Chiesa and Serretti 2011; Hofmann et al. 2010; Khoury et al. 2013; Klainin-Yobas et al. 2012; O'Reilly et al. 2014; Piet and Hougaard 2011; Vollestad et al. 2012; WandenBerghe et al. 2011; Zgierska et al. 2009). Recently, several specific loving kindness and selfcompassion training programs have been developed and studied in non-clinical samples, with promising results (Fredrickson et al. 2008; Jazaieri et al. 2013; Neff and Germer 2013; Pace et al. 2009 Pace et al. , 2010 Wallmark et al. 2013). "
"MDD often recurs, so indicated preventive interventions targeting people with confirmed vulnerability based on history of repeated major depressive episodes (MDEs) have potential to appreciably reduce population prevalence, associated disease burden and influence of a range of health-care and societal costs (Patten, 2007). Mindfulness-based cognitive therapy (MBCT) (Segal et al., 2002 ) is a group-based programme that, as an intervention indicated for people with three or more previous MDEs, has convincingly demonstrated efficacy in reducing relapse/recurrence rates of MDD in controlled trials (Chiesa and Serretti, 2011; Piet and Hougaard, 2011). While the Royal Australian and New Zealand College of Psychiatrists Clinical Practice Guidelines and the United Kingdom's National Institute of Health and Clinical Excellence (NICE) Guidelines include MBCT for prevention of relapse/recurrence of multiple recurring MDD (Malhi et al., 2015; NICE, 2009), the adoption of MBCT as a complex intervention in health care will be influenced not only by effectiveness findings but also by health economic and other considerations (Demarzo et al., 2015 ). "
[Show abstract][Hide abstract]ABSTRACT: Objective:
While mindfulness-based cognitive therapy is effective in reducing depressive relapse/recurrence, relatively little is known about its health economic properties. We describe the health economic properties of mindfulness-based cognitive therapy in relation to its impact on depressive relapse/recurrence over 2 years of follow-up.
Non-depressed adults with a history of three or more major depressive episodes were randomised to mindfulness-based cognitive therapy + depressive relapse active monitoring (n = 101) or control (depressive relapse active monitoring alone) (n = 102) and followed up for 2 years. Structured self-report instruments for service use and absenteeism provided cost data items for health economic analyses. Treatment utility, expressed as disability-adjusted life years, was calculated by adjusting the number of days an individual was depressed by the relevant International Classification of Diseases 12-month severity of depression disability weight from the Global Burden of Disease 2010. Intention-to-treat analysis assessed the incremental cost-utility ratios of the interventions across mental health care, all of health-care and whole-of-society perspectives. Per protocol and site of usual care subgroup analyses were also conducted. Probabilistic uncertainty analysis was completed using cost-utility acceptability curves.
Mindfulness-based cognitive therapy participants had significantly less major depressive episode days compared to controls, as supported by the differential distributions of major depressive episode days (modelled as Poisson, p < 0.001). Average major depressive episode days were consistently less in the mindfulness-based cognitive therapy group compared to controls, e.g., 31 and 55 days, respectively. From a whole-of-society perspective, analyses of patients receiving usual care from all sectors of the health-care system demonstrated dominance (reduced costs, demonstrable health gains). From a mental health-care perspective, the incremental gain per disability-adjusted life year for mindfulness-based cognitive therapy was AUD83,744 net benefit, with an overall annual cost saving of AUD143,511 for people in specialist care.
Mindfulness-based cognitive therapy demonstrated very good health economic properties lending weight to the consideration of mindfulness-based cognitive therapy provision as a good buy within health-care delivery.
No preview · Article · Apr 2016 · Australian and New Zealand Journal of Psychiatry