What’s Old Is New: Scientific Examination of Meditation In Mood Saundra Jain, MA, PsyD, LPC Adjunct Clinical Affiliate University of Texas at Austin School of Nursing Austin, Texas Executive Director Mental Aerobics Project (MAP) Austin, Texas
Are We Winning The Battle Against Depression? Let’s Examine Depression
STAR*D Results: Are Current Treatment Options Giving Us All That We Want? STAR*D Remission Rates1-6 Level 1 Level 2 Level 3 Level 4 1Trivedi MH et al. Am J Psychiatry. 2006;163(1):28-40; 2Trivedi MH et al. N Engl J Med. 2006;354(12):1243-1252; 3Rush AJ et al. N Engl J Med. 2006;354(12):1231-1242; 4Nierenberg AA et al. Am J Psychiatry. 2006;163(9):1519-1530; 5Fava M et al. Am J Psychiatry. 2006;163(7):1161-1172; 6McGrath PJ et al. Am J Psychiatry. 2006;163(9):1531-1541. Remission: (HAM-D17≤7) 29.9% 27.5% Patients in Remission 21.2% 20.3% 16.1% 13.7% 6.9% Mono Aug Switch Aug Switch Aug Switch High Window of Opportunity Low
STAR*D, Sequenced Treatment Alternatives to Relieve Depression. STAR*D Reveals 2 Striking Shortcomings of Current Therapy • Low rates of remission • High rates of relapse
As Clinicians Dealing With Depression, We Must Ask Ourselves A Few Questions: • Is there an urgent need for other treatment options (as alternatives or as add-ons)? • Is meditation potentially an option that meets both of these needs? • And if so, how do we incorporate meditation into our clinical practices?
Neurobiology and MBCT Is MBCT Good For The Brain?
Hölzel BK et al. Soc Cogn Affect Neurosci. 2008;3(1):51-61. Volumetric Changes in Meditators MRI brain images of 20 mindfulness (Vipassana) meditators (mean practice 8.6 years; 2 h daily) and compared the regional gray matter concentration to that of non-meditators matched for sex, age, education, and handedness.
Hölzel BK et al. Soc Cogn Affect Neurosci. 2010;5(1):11-17. Volumetric Changes Over 8 Weeks of Mindfulness-Based Therapy: Focus on Amygdala Stressed but otherwise healthy individuals (N=26) participated in an 8-week mindfulness-based stress reduction intervention.
Hölzel BK et al. Psychiatry Res. 2011;191(1):36-43. Volumetric Changes In The Hippocampus With 8 Weeks of Mindfulness-Based Therapy 16 healthy, meditation-naive participants were obtained before and after they underwent the 8-week program. Changes in gray matter concentration were investigated using voxel-based morphometry, and compared with a waiting list control group of 17 individuals.
Kiecolt-Glaser JK et al. Psychosom Med. 201;72(2):113-121. Autonomic Nervous System And Inflammatory Responses, Stress, And Meditation 50 healthy women (mean age=41.32, range=30-65), 25 novices and 25 experts, were exposed to each of the conditions (yoga, movement control, and passive-video control) during 3 separate visits.
Meditation As An Intervention: How Does It Work?
Kuyken W et al. Behav Res Ther. 2010;48(11):1105-1112. Answer: By Reducing Cognitive Reactivity How Does MBCT Work? HRSD15m, Hamilton Rating Scale for Depression scores at 15-month follow-up; MBCT, Mindfulness-Based Cognitive Therapy (n=43); M-ADM, Maintenance Antidepressant Medication (n=37).
What Does Emotional Regulation Have To Do With Depression? My life is worthless My life is ruined I feel hopeless I’m desperate I can’t function
Evidence-Based MBCT Does MBCT Really Help Our Patients?
BAI, Beck Anxiety Inventory; BDI, Beck Depression Inventory; PSWQ, Penn State Worry Questionnaire; POMS, Profile of Mood States. Evans S et al. J Anxiety Disord. 2008;22(4):716-722. MBCT in Generalized Anxiety Disorder P<0.05
HAM-A, Hamilton Anxiety Rating Scale; PDSS, Panic Disorder Specific Scale. Kim B et al. J Anxiety Disord. 2010;24(6):590-595. MBCT and Panic Disorder P<0.01
Kenny MA, Williams JM. Behav Res Ther. 2007;45(3):617-625. MBCT In Treatment-Resistant Depression 79 patients, 8 weeks of MBCT Pre-post effect size = 1.04
Godfrin KA, van Herringan C. Behav Res Ther. 2010;48(8):738-746. MBCT: The Power of Relapse Prevention, The Belgian Experience 106 recovered depressed patients with a history of at least 3 depressive episodes continued either with their treatment as usual (TAU) or received MBCT in addition to TAU. MBCT improved time to first relapse by 35% • Mean time to first relapse post study: • 39.5 wks for TAU • 53.7 wks MBCT/TAU
M-ADM, medication (antidepressant continuation); Pla+Clin, placebo plus clinical management. Segal ZV et al. Arch Gen Psychiatry. 2010;67(12):1256-1264. MBCT: A Promising New Therapy
IBMT, integrative body-mind training; RT, relaxation training. Xue S et al. Neuroreport. 2011;22(12):570-574. Results of The Xue Study 15 experimental participants (8 women) practiced 30-min IBMT from Monday to Friday for 1 month, with a total of 11 h of training; whereas 17 controls (9 women) received the same amount of RT. The trainees concentrated on achieving a balanced state of body and mind guided by an IBMT coach and the compact disc, whereas the control group focused on muscle relaxation guided by a tutor and compact disc.
Xue S et al. Neuroreport. 2011;22(12):570-574. What Does The Xue Study Show Us? IBMT ACC Network Connectivity Network Efficiency Complete novices, even with 11 hours of training over a month, are able to ‘change’ brain connectivity in a structure of immense importance to mood regulation – the Anterior Cingulate Cortex (ACC).
Beyond Reduction of Negative Attributes, Does Meditation Change Positive Mood Attributes?
Jung YH et al. Neurosci Lett. 2010;479(2):138-142. Let’s Take A Look… Control (n=57); Meditation group (n= 67)
Jung YH et al. Neurosci Lett. 2010;479(2):138-142. Findings From The Jung Study • The meditation group obtained higher scores on positive affect (P=0.019) and lower scores on stress (P<0.001) compared to the control group • Plasma DA levels were higher in the meditation (P=0.031) than in the control group • Participants that had practiced meditation 48 months or more, showed a positive correlation between positive affect and plasma DA levels (r=0.501, P=0.013)
Let’s Turn Our Attention To The Clinical Aspects of Mindfulness Meditation Practical Tips For Incorporating Mindfulness Meditation Into Your Clinical Practice
Walking Down the Street You’re walking down the street. On the other side of the street you see somebody you know. You smile and wave. The person does not wave back and keeps walking.
Raisin Exercise SENSATIONS THOUGHTS FEELINGS
Meditation and CBT = MBCT Mindfulness Based Cognitive Therapy Cognitive Behavioral Therapy Mindfulness Meditation
Mindfulness: What Is It? “Paying Attention In A Particular Way: On Purpose, In The Present Moment, And Nonjudgementally.” --- Dr. Jon Kabat-Zinn University of Massachusetts Medical Center Kabat-Zinn J. Coming to Our Senses: Healing Ourselves and the World Through Mindfulness. New York, NY: Hyperion; 2005.
old patterns intrude memory bias wish for things to be different poor problem solving Mindlessness and Vulnerability to Depression depression non-awareness rumination
old patterns intrude safe “platform” Wish for things to be different Calm Connected Creative Mindfulness and Prevention of Relapse Into Depression freedom to choose not to “go there” low mood mindful awareness
Practicing Mindfulness (Attention) Mind on chosen target (Nonjudgmental) Observe wandering, begin again Attention wanders (Present Moment) “If your attention wanders a hundred times, simply bring it back a hundred times.”
MBCT Outline THOUGHTS FEELINGS • Mindfulness facilitator • 2 hours a week for 8 weeks • 1 all day session between weeks 5 and 7 • Daily homework using CDs • Talk about experiences with home practices, obstacles, and how to deal with them SENSATIONS
On Purpose • Present Moment • Without Judgment MBCT Class Themes Class 1: Automatic Pilot Class 2: Dealing with Barriers Class 3: Mindfulness of the Breath Class 4: Staying Present Class 5: Allowing and Letting Be Class 6: Thoughts are Not Facts Class 7: How Can I Best Take Care of Myself Class 8: Using What’s Been Learned to Deal with Future Moods
MBCT Classes The practices help to: • Become familiar with the workings of your mind • Notice the times when you are at risk of getting caught in old habits that re-activate downward mood spirals • Explore ways of letting go of old habits and, if you choose, entering a different way of being • Get in touch with a different way of knowing yourself and the world • Notice small beauties and pleasures in the world instead of living in your head • Be kind to yourself instead of wishing things were different • Find a way so you don’t have to battle with yourself • Accept yourself as you are, rather than judging yourself
3-Minute Breathing Space:Mini Meditation First Step in Responding to Challenging Situation & Feelings
3-Minute Breathing Space:Mini Meditation Becoming Aware A G Gathering E Expanding
MBCT Resources “The Green Book” Clinician Guide “The White Book “ Patient Guide
MBCT Resources Mindfulness iPhone App
MBSR Resources Founded by Dr. Jon Kabat-Zinn in 1979. Eight-week program focusing on how to use innate resources and abilities to respond more effectively to stress, pain, and illness. http://www.umassmed.edu/Content.aspx?id=41254&LinkIdentifier=id; Accessed 04/22/13.
Mindful: Another Great Website Resource http://www.mindful.org; Accessed 04/22/13.