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Mindfulness-based interventions for chronic pain: a systematic review of the evidence.
No full textOBJECTIVES:
Chronic pain is a common disabling illness that does not completely respond to current medical treatments. As a consequence, in recent years many alternative interventions have been suggested. Among them, mindfulness-based interventions (MBIs) are receiving growing attention. The aim of the present article is to review controlled studies investigating the efficacy of MBIs for the reduction of pain and the improvement of depressive symptoms in patients suffering from chronic pain.
METHODS:
A literature search was undertaken using MEDLINE,(®) ISI web of knowledge, the Cochrane database, and references of retrieved articles. The search included articles written in English published up to July 2009. The data were independently extracted by two reviewers from the original reports. Quality of included trials was also assessed.
RESULTS:
Ten (10) studies were considered eligible for the present review. Current studies showed that MBIs could have nonspecific effects for the reduction of pain symptoms and the improvement of depressive symptoms in patients with chronic pain, while there is only limited evidence suggesting specific effects of such interventions. Further findings evidenced some improvements in psychologic measures related to chronic pain such as copying with pain following MBIs as well.
DISCUSSION:
There is not yet sufficient evidence to determine the magnitude of the effects of MBIs for patients with chronic pain. Main limitations of reviewed studies include small sample size, absence of randomization, the use of a waiting list control group that does not allow distinguishing of specific from nonspecific effects of MBI as well as differences among interventions.
CONCLUSIONS:
However, because of these preliminary results, further research in larger properly powered and better designed studies is warranted
Authors' reply to "Recommendations for conducting mindfulness based cognitive therapy trials".
No full textTo the Editors:
We appreciated very much the commentary by Siddaway and Wood (2013) on our review and meta-analysis “Mindfulness based cognitive therapy for psychiatric disorders: A systematic review and meta-analysis” (Chiesa and Serretti, 2011) and we are grateful for having the possibility to further explore the issues they raised. As the authors of the commentary noted, the main findings of our meta-analysis were that mindfulness-based cognitive therapy (MBCT) as an adjunct to treatment as usual (TAU) could be significantly superior to TAU only and the combination of MBCT and gradual discontinuation of antidepressant therapy could be as efficacious as the continuation of maintenance antidepressant therapy for the prevention of depressive relapses in recovered depressed patients with three or more prior depressive episodes (Chiesa and Serretti, 2011). In addition, we also found that MBCT+TAU could be significantly superior to TAU only for the reduction of residual depressive symptoms in currently depressed patients (Chiesa and Serretti, 2011).
However, the authors of the commentary also noted that our critique of the methodology employed in MBCT trials to date did not go far enough and they cautioned against the assumption that “third wave” cognitive therapies, such as MBCT, are unequivocally superior to first or second wave therapies. The present response is aimed at further exploring our conclusions in relationship to the issues raised by the authors of the commentary.
First of all, we would like to underscore that in the discussion of our work we did not suggest that “third wave” cognitive therapies, such as MBCT, are unequivocally superior to first or second wave therapies. Rather, we underscored that, taking into account the inadequate sophistication of the control groups, further better designed studies should be aimed at distinguishing between the specific and the non-specific effects of MBCT. Results in this direction can usually be achieved through different study designs. A first possibility is to employ a control group that is specifically structured to include the majority of non-specific “ingredients” of the active treatment under investigation, including, among others, benefits' expectation, teacher's care, group support, contact time with the therapist and amount of home practice, while excluding the claimed active ingredient (or ingredients) of the treatment under investigation, such as mindfulness meditation practice (Chiesa, 2011). If MBCT is found to be superior to such control condition, it can reasonably be suggested that MBCT could provide patients with significantly higher benefits than those expected only in relationship to the non-specific elements of MBCT.
It is worth mentioning that, since the publication of our review and meta-analysis, some preliminary results in this direction have been published. As an example, the preliminary results of an ongoing trial from our group suggested that MBCT could be more efficacious than a psycho-educational group designed ad hoc to match as much as possible the non-specific elements of MBCT for the reduction of depressive symptoms in depressed patients with residual depressive symptoms (Chiesa et al., 2012).
A second possibility to rule out that the effects of a new treatment, such as MBCT, are only due to non-specific elements is to compare such treatment with an existing treatment that already proved efficacy for the specific condition under investigation (for better details see Chiesa (2011)). Although limited by the small sample size and the lack of an a priori power calculation, the results of a recent randomized controlled trial provided preliminary evidence to suggest that MBCT could be as efficacious as group cognitive behavioural therapy (CBT) to reduce depressive symptoms in currently depressed patients (Manicavasgar et al., 2011). In addition, in a further randomized controlled trial, Segal et al. (2010) found that MBCT+gradual discontinuation of antidepressant therapy could be as efficacious as the continuation of maintenance antidepressant therapy and that both treatments could be more efficacious than placebo for the prevention of depressive relapses in recovered patients with major depression.
In sum, the results of some recent randomized controlled trials aimed at exploring the efficacy of MBCT for the prevention of major depression relapses and for the reduction of acute and residual depressive symptoms provided preliminary support for the notion that MBCT could be associated with specific effects in addition to the non-specific effects that are shared by all psychological and pharmacological treatments. However, the results of these studies do not (or do not yet) provide support to the notion that MBCT is superior to other first or second wave cognitive treatments and do not unequivocally provide information about the distinctive features of MBCT. To the best of our knowledge, no trial has yet been published that specifically provided support to the notion that MBCT is superior to established treatments for the treatment of psychological disorders such as major depression.
In addition, as the authors of the commentary aptly noted, we agree that, as the investigation of MBCT moves forwards, it will be increasingly important to compare MBCT with different active control conditions that are aimed at testing each specific ingredient of the MBCT program, including, among others, the underlying interactive cognitive system (ICS) theoretical model, the particular contribution of changing the content of cognitions versus changing the function and process of cognitions and the contribution of low arousal affective states.
In line with these issues, an important question raised by the authors of the commentary to our review and meta-analysis is whether the ICS information-processing theory that underpins MBCT and purports to specifically explain recurrent episodes of depression (Teasdale et al., 1995) can be adapted to treat a range of acute problems. We also agree with the authors that, because several recent trials investigated the efficacy of MBCT as a treatment for a range of acute problems and sometimes tweaked the MBCT protocol, they could be re-interpreted as dismantling studies that provide important evidence regarding shared and unique therapeutic factors.
Similarly, we agree with the authors of the commentary that further challenging issues, including the reasons behind the notion that MBCT could help prevent relapses in patients with three or more previous depressive episodes but not in those with only two previous depressive episodes and the need for investigating the neural mechanisms of MBCT, require further investigation so as to better understand the mechanisms underlying MBCT as well as its strengths and limitations as a means to treat a different set of clinical conditions.
In conclusion, we underscore that available studies provide preliminary support to the efficacy of MBCT for the prevention of depression relapses and the reduction of depressive symptoms in patients suffering from major depression. However, future trials investigating the original and the many adapted versions of MBCT should employ stronger methodological paradigms aimed at (1) distinguishing between the specific and the non-specific effects of MBCT, (2) investigating the distinctive features of MBCT in comparison with several related interventions such as Mindfulness based Stress Reduction, CBT or relaxation training, (3) understanding to which extent the ICS model that underpins MBCT can be adapted to treat a range of different acute problems, (4) investigating the psychological and neurobiological mechanisms of action of MBCT and (5) providing evidence as to which adaptations are needed so as to best tailor future MBCT programs and studies to the unique needs, learning styles and temperamental profiles of individuals suffering from different clinical conditions in different phases of their disorder
Mindfulness-based stress reduction for stress management in healthy people: a review and meta-analysis
No full text
Mindfulness based cognitive therapy for psychiatric disorders: a systematic review and meta-analysis.
No full textMindfulness- 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
Are mindfulness-based interventions effective for substance use disorders? A systematic review of the evidence.
No full textMindfulness-based interventions (MBIs) are increasingly suggested as therapeutic approaches for effecting substance use and misuse (SUM). The aim of this article is to review current evidence on the therapeutic efficacy of MBIs for SUM. A literature search was undertaken using four electronic databases and references of retrieved articles. The search included articles written in English published up to December 2011. Quality of included trials was assessed. In total, 24 studies were included, three of which were based on secondary analyses of previously investigated samples. Current evidence suggests that MBIs can reduce the consumption of several substances including alcohol, cocaine, amphetamines, marijuana, cigarettes, and opiates to a significantly greater extent than waitlist controls, non-specific educational support groups, and some specific control groups. Some preliminary evidence also suggests that MBIs are associated with a reduction in craving as well as increased mindfulness. The limited generalizability of the reviewed findings is noted (i.e., small sample size, lack of methodological details, and the lack of consistently replicated findings). More rigorous and larger randomized controlled studies are warranted
A meta-analysis of sexual dysfunction in psychiatric patients taking antipsychotics.
No full textThe aim of this meta-analysis was to quantify sexual dysfunction (SD) in patients treated with antipsychotics on the basis of selected papers that specifically investigated this type of adverse events by means of adequate instruments. A literature research was conducted using three electronic databases. Studies providing measures of SD in patients taking antipsychotics and providing separate data on single drugs were considered for inclusion. Our primary outcome measure was the rate of total SD, and our secondary outcome measures were the rates of desire, arousal, and orgasm dysfunction. We found that significant differences exist across different antipsychotics in terms of total SD, such that, partially consistent with the traditional dichotomy between prolactin-raising and prolactin-sparing antipsychotics, quetiapine, ziprasidone, perphenazine, and aripiprazole were associated with relatively low SD rates (16-27%), whereas olanzapine, risperidone, haloperidol, clozapine, and thioridazine were associated with higher SD rates (40-60%). Apart from a few exceptions, secondary analyses substantially confirmed the primary outcome measure. However, sensitivity analyses showed a significant impact of several variables on SD rates. In addition, taking into account several limitations, including the difficulty to disentangle SD related to drugs from SD related to illness itself, further studies are needed to determine more thorough evidence concerning antipsychotic-induced SD
L'UTILITA' DELLE MEDITAZIONI BASATE SULLA CONSAPEVOLEZZA PER I DISTURBI PSICHIATRICI: UNA REVIEW SISTEMATICA
No full textIntroduzione: Negli ultimi decenni la comunità scientifica ha mostrato un crescente interesse verso il ruolo che la spiritualità può avere sulla salute fisica e mentale. Più alti livelli di religiosità sono stati associati a un maggiore benessere psicologico, una maggiore soddisfazione di vita e felicità e una minore severità e incidenza di disturbi depressivi. Tra le innumerevoli pratiche spirituali, la meditazione, e in particolare un sottogruppo di meditazioni conosciute col nome di Mindfulness meditations (MM: tr. it. le meditazioni basate sulla consapevolezza), hanno ricevuto recentemente grande attenzione dalla comunità scientifica per le possibilità di applicazione a una grande varietà di disturbi sia fisici che mentali. Il concetto di Mindfulness si riferisce ad una maniera particolare di prestare attenzione al momento presente ed è caratterizzato da una consapevolezza non giudicante delle esperienze interne ed esterne così come da un’attitudine aperta e recettiva. Le MM comprendono sia antiche meditazioni appartenenti alla tradizione Buddista come la meditazione Vipassana e la meditazione Zen sia nuove pratiche meditative derivate dallo sforzo di organizzare il concetto originale di Mindfulness in corsi standardizzati e clinicamente orientati quali la Riduzione dello stress basata sulla Mindfulness (RSBM) e la terapia cognitiva basata sulla Mindfulness (TCBM) Alla luce del crescente interesse verso l’utilizzo di queste pratiche nel campo della salute, lo scopo del presente lavoro è quello di riassumere in maniera critica le evidenze scientifiche disponibili sul ruolo delle MM nei disturbi mentali. Metodo: Una ricerca di articoli scientifici sulle MM per il trattamento dei disturbi psichiatrici è stata condotta attraverso MEDLINE, ISI Web of Knowledge, il database della Cochrane Collaboration e le reference degli articoli trovati. La ricerca ha incluso articoli originali pubblicati in lingua inglese fino a dicembre 2008. I termini principali utilizzati per la ricerca sono stati: Mindfulness meditation, Vipassana, Zen, stress reduction, cognitive therapy, major depression, bipolar disorder, anxiety disorders, insomnia, alcohol abuse and substances abuse. Risultati: I ritrovamenti principali mostrano che la TCBM in aggiunta al trattamento standard (TS) e, sebbene meno studiata, la RSBM potrebbero essere più efficaci della sola TS per i pazienti che soffrono di depressione maggiore ricorrente dopo la terza ricaduta depressiva, per i pazienti affetti da depressione resistente, distimia e disturbo bipolare in fase di remissione. La RSBM e secondariamente la TCBM hanno mostrato qualche efficacia per i disturbi d’ansia, in particolare il disturbo d’attacchi di panico, il disturbo d’ansia generalizzata e la fobia sociale. La RSBM, tuttavia, si è rivelata meno efficace rispetto alla terapia cognitiva di gruppo standard per il trattamento della fobia sociale e un ritiro di Vipassana della durata di 10 giorni non ha mostrato alcuna efficacia nel ridurre i sintomi di disturbo post traumatico da stress in una popolazione carceraria. Inoltre la TCBM e la RSBM hanno dimostrato anche qualche efficacia per i soggetti affetti da insonnia, disturbi alimentari e disturbo da deficit di attenzione e iperattività nell’età adulta. Conclusioni: Le MM potrebbero essere utili per diversi disturbi psichiatrici soprattutto per quanto riguarda i disturbi d’ansia e d’umore. Tuttavia un numero relativamente grande di studi è affetto da deficit metodologici come l’assenza di randomizzazione, l’assenza di un gruppo di controllo a una piccola numerosità campionaria che suggeriscono di considerare tali risultati con cautela. In conclusione, sebbene l’evidenza attuale sia incoraggiante, ulteriore ricerca attraverso studi dal design metodologico migliore è necessaria per rispondere a domande critiche quali l’esclusione di un effetto legato all’auto selezione e ad un possibile effetto placebo di tali pratiche
The challenge of uncovering the genetics of anxiety: an editorial comment to Arias B, Aguilera M, Moya J et al. 'The role of genetic variability in the SLC6A4, BDNF and GABRA6 genes in anxiety-related traits' (2).
No full textThe role of genetic variability in the SLC6A4, BDNF and GABRA6 genes in anxiety-related traits
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