M. Jackson Group Update – November 2015 – Mindfulness in Healthcare

This month’s article is from Ken Pope’s listserv. The article is as follows:
 
*PLOS ONE* includes an article: “Standardised Mindfulness-Based Interventions in Healthcare: An Overview of Systematic Reviews and Meta-Analyses of RCTs.”

The authors are Rinske A. Gotink, Paula Chu, Jan J. V. Busschbach, Herbert Benson, Gregory L. Fricchione, M. G. Myriam Hunink.

PLEASE NOTE: As usual, I’ll include both the author’s email address (for requesting electronic reprints) and a link to the complete article at the end below.

Here’s how the article opens:

[begin excerpt]

Chronic illness is the largest cause of morbidity and mortality worldwide, causing 63% of all deaths[1]. Often there is no cure for these illnesses and patients face a high burden due to symptoms or side-effects of treatment. Consequently, stress, depression and anxiety are very common among these patients. Equally important as finding cures are efforts to provide chronic care and teach patients coping mechanisms to improve their quality of life. One adjunct therapy in chronic care that has gained popularity in the last 40 years is a secular variant of mindfulness.

Traditionally, mindfulness has been described as “a state of presence of mind which concerns a clear awareness of one’s inner and outer experiences, including thoughts, sensations, emotions, actions or surroundings as they exist at any given moment” [2,3]. Unfortunately, such classical descriptions of mindfulness do not easily lend themselves to scientific investigation. Core components are usually described as follows: ‘full attention to internal and external experiences as they occur in the present moment’ and ‘an attitude characterized by non-judgment of, and openness to, this current experience’ [4-6]. Recently, Goyal et al. published a review of mindfulness interventions compared to active control and found significant improvements in depression and anxiety[7]. However, they included quite a heterogeneous group of meditation styles. Although the history of mindfulness as a way of life goes back 2500 years [2], a standardised version of mindfulness interventions for Western health care was only recently developed. In 1979, Jon Kabat-Zinn integrated mindfulness in his treatment of chronic pain patients and showed how changing the way patients relate to their pain can change their experience of pain [4]. His program, known as Mindfulness Based Stress Reduction (MBSR), spread quickly to other hospitals and other health problems. Teasdale, Williams and Segal converted MBSR to Mindfulness Based Cognitive Therapy (MBCT) for the treatment of depression. Since their initial promising results (50% relapse prevention in patients with 3 or more episodes of depression), studies repeatedly confirmed the benefit of MBCT in depression [8]. Subsequently, both MBSR and MBCT were well-defined and introduced in the care of various chronic conditions; MBSR, focusing more on the physical level of stress, found its way into supportive care for cancer, chronic pain, heart disease and fibromyalgia, whereas MBCT pays more attention to cognitive aspects and is used in the treatment of depression, anxiety, burn-out and eating disorders. Since mindfulness as a life style intervention is unlikely to have dangerous side-effects and can reduce stress, a risk factor for both mental and physical disorders, it is also being used in prevention (e.g. in education, parenting, the work place, pregnancy, and in prisons) [9], [10].

Despite the expanding application of MBSR and MBCT, the evidence for their use and the appropriate indications are debated. The aim of this study is to provide a systematic overview of the effectiveness of MBSR and MBCT in different patient populations in order to identify the patient categories in which these interventions are indicated.

[end excerpt]

Here’s how the Discussion section opens: “This review provides an overview of more trials than ever before and the intervention effect has thus been evaluated across a broad spectrum of target conditions, most of which are common chronic conditions. Study settings in many countries across the globe contributed to the analysis, further serving to increase the generalizability of the evidence. Beneficial effects were mostly seen in mental health outcomes: depression, anxiety, stress and quality of life improved significantly after training in MBSR or MBCT. These effects were seen both in patients with medical conditions and those with psychological disorders, compared with many types of control interventions (WL, TAU or AT). Further evidence for effectiveness was provided by the observed dose-response relationship: an increase in total minutes of practice and class attendance led to a larger reduction of stress and mood complaints in four reviews [18,20,37,54].”

Here’s how the article closes: “Although there is continued scepticism in the medical world towards MBSR and MBCT, the evidence indicates that MBSR and MBCT are associated with improvements in depressive symptoms, anxiety, stress, quality of life, and selected physical outcomes in the adjunct treatment of cancer, cardiovascular disease, chronic pain, chronic somatic diseases, depression, anxiety disorders, other mental disorders and in prevention in healthy adults and children.”

REPRINTS: <m.hunink@erasmusmc.nl>

The article is online at:
<http://bit.ly/KenPopeMindfulnessInterventionsMetaAnalysis>

Ken Pope

POPE: APA, DETAINEE INTERROGATIONS, & THE HOFFMAN REPORT –
[REVISED SEPTEMBER 15, 2015]:
<http://bit.ly/KenPopeAPAChallengeOfChange>

“A poem…begins as a lump in the throat, a sense of wrong, a homesickness, a loneliness.  It is never a thought to begin with. It is at its best when it is a tantalizing vagueness.”
–Robert Frost  in a letter to his friend, Louis Untermeyer (January 1, 1916)




Take care,

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