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Sarah Strohmaier, Fergal Jones, Clara Strauss, Kate Cavanagh

Dose-response meta-regression of mindfulness-based interventions (MBIs): Method, challenges & preliminary findings. Sarah Strohmaier, Fergal Jones, Clara Strauss, Kate Cavanagh Canterbury Christ Church University, University of Sussex, United Kingdom Email: sarah.strohmaier@canterbury.ac.uk.

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Sarah Strohmaier, Fergal Jones, Clara Strauss, Kate Cavanagh

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  1. Dose-response meta-regression ofmindfulness-based interventions (MBIs):Method, challenges & preliminary findings Sarah Strohmaier, Fergal Jones, Clara Strauss, Kate Cavanagh Canterbury Christ Church University, University of Sussex, United Kingdom Email: sarah.strohmaier@canterbury.ac.uk

  2. Overview • Background of dose in MBIs • Method & process • Challenges • Preliminary results • Discussion of results • Questions and comments

  3. Background of dose in MBIs • Increase in research with different types, formats and doses of MBIs • Research with different participants • Potential benefits of examining dose in MBIs • Expectations based on mindfulness theory • Previous research: Mixed results for role of dose in MBIs

  4. Method and process • Systematic literature searches • Screening (PRISMA guidelines; Moher et al., 2009) • Inclusion criteria • Randomised Controlled Trial (RCT) • MBI based on mindfulness principles & practices (Crane et al., 2017) • Quantitative measure of depression • Compared to inactive or active controls • Adult participants • Outcomes: Mindfulness, depression, anxiety and stress

  5. From 24 countries Included studies: Different participants Different doses of MBIs 179 RCTs Different quality studies Different intervention types Compared to inactive & active controls

  6. Dose variables

  7. Challenges in calculating dose for MBIs • Amount and type of (formal and informal) mindfulness practice difficult to extract and calculate • Memory and social desirability bias for actual practice reporting • Not enough studies available for each dose and outcome to run separate analyses for different population groups • Follow-up: Rarely collected how much participants practiced from end of intervention until follow-up data collection timepoint

  8. Meta-analysis results Prior to including dose: Significant between-group differences favouring MBI group compared to controls at post-intervention and follow-up time-points for mindfulness, depression, anxiety and stress outcomes • (ES: d = 0.3 to 0.8)

  9. Preliminary dose-response results • Mindfulness outcome: Doses relating to amount of facilitator contact and intensity wereassociated with increased mindfulness compared to inactive controls at post-intervention

  10. Preliminary psychological results No significant dose-response relationships found for majority of doses and depression, anxiety and stress compared to control groups • Example meta-regression plots for depression outcome: Recommended use of MBI (in hours) over 1 week Total hours of facilitator face-to-face contact

  11. Depression & anxiety at 1-4 months follow-up • Recommended home practice predicted significant increase in depression & anxiety compared to inactive controls • However, not recorded whether participants actually completed recommended practices • Could be that shorter (e.g. 5-10 minute) practices were more feasible to complete at follow-up

  12. Discussion of results • Mindfulness appears helpful to learn face-to-face from facilitator and if sessions closer together • Kabat-Zinn (2003): Helpful to learn mindfulness from experienced practitioners • Group processes may be important (e.g. Segal et al., 2002; Yalom, 1983) • Intensity as significant predictor: Similar to dose-response research with psychotherapy (Cuijpers et al., 2013) • Depression, anxiety, stress • Potential floor effect due to participants mostly from non-clinical population • Recent research supporting benefits of lower dose and online MBIs (e.g. Klatt et al., 2009; Spijkerman et al., 2016)

  13. Limitations • Possibility of Type I and II errors • Statistical multiple comparisons • Low power for some analyses • Actual use of intervention dose: Information not collected by majority of papers • Generally novice practitioners: Not necessarily generalisable for more experienced, long-term practitioners Future: Experimental examinations to determine causation

  14. Thank you very much!Questions? Comments? ? For any further questions, please feel free to contact me: Email: sarah.strohmaier@canterbury.ac.uk Twitter: @sarahstrohmaier Website: www.canterbury.ac.uk/appliedpsychology

  15. References Crane, R. S., Brewer, J., Feldman, C., Kabat-Zinn, J., Santorelli, S., Williams, J. M. G. & Kuyken, W. (2017). What defined mindfulness-based programs? The warp and the weft. Psychological Medicine, 47 (6) 990-999. doi: 10.1017/S0033291716003317. Cuijpers, P., Huibers, M., Ebert, D. D., Koole, S. L., & Andersson, G. (2013). How much psychotherapy is needed to treat depression? A meta-regression analysis. Journal of Affective Disorders, 149, 1-13. doi: 10.1016/j.jad.2013.02.030. Kabat-Zinn, J. (2003). Mindfulness-Based Interventions in Context: Past, Present, and Future. Clinical Psychology: Science and Practice, 10, 144-156. doi: 10.1093/clipsy/bpg016. Klatt, M. D., Buckworth, J., & Malarky, W. B. (2009). Effects of Low-Dose Mindfulness-Based Stress Reduction (MBSR-ld) on Working Adults. Health Education & Behavior, 36 (3), 601-614. doi: 10.1177/1090198108317627. Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med, 6 (7), e1000097. doi:10.1371/journal.pmed1000097. Segal, Z. V., Williams, M. G., & Teasdale, J. D. (2002). Mindfulness-based Cognitive Therapy for Depression: A new approach to preventing relapse. New York: Guildford Press. Spijkerman, M. P. J., Pots, W. T. M., & Bohlmeijer, E. T. (2016). Effectiveness of online mindfulness-based interventions in improving mental health: A review and meta-analysis of randomised controlled trials. Clinical Psychology Review, 45, 102-114. doi: 10.1016/j.cpr.2016.03.009. Yalom, I. D. (1983). Inpatient group psychotherapy. New York: Basic Books.

  16. Image references Cooke, H. (2018). [Balancing rocks on water] Retrieved November 3, 2018 from: http://helencookenutrition.co.uk/wp-content/uploads/2018/04/pebbles.jpg [Clipart of magnifying glass over papers] (2016). Retrieved November 10, 2018 from: https://new- img.patrika.com/upload/mediafiles/2016/09/30/l_the-charge-sheet-naib- 552a3161a3140_l-1475225937_835x547.jpg [Clipart of meditating person silhouette] Retrieved January 4, 2019 from: https://us.123rf.com/450wm/oljgaa/oljgaa1509/oljgaa150900020/45775185- stock-vector-meditation-silhouette-vector.jpg?ver=6 [Image of sign reading Challenges Ahead] Retrieved December 18, 2018 from: https://image.slidesharecdn.com/serchazdonkeynote-171004192551/95/ser- chazdon-keynote-26-638.jpg?cb=1507145358 [Image of Limits letters and their shadow] (2016). Retrieved December 18, 2018 from: https://www.lattianderson.com/wp-content/uploads/2016/06/Limitation-of- Liability-3.jpg [Photograph of woman meditating by lake] (2000). Retrieved November 3, 2018 from: https://odysseyonlineimg.rbl.ms/simage/https%3A%2F%2Fassets.rbl.ms%2F108 69218%2F980x.jpg/2000%2C2000/6XlsiwyvBPF%2BYuTR/img.jpg

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