Neural effects on patients with major depressive disorder: systematic review

Vignaud, P., et al. (2018). Neural effects of mindfulness-based interventions on patients with major depressive disorder: A systematic review. Neuroscience & Biobehavioral Reviews, vol. 88, pp. 98-105, https://doi.org/10.1016/j.neubiorev.2018.03.004.

Abstract. Growing evidence has suggested that mindfulness-based interventions (MBIs) could have beneficial effects on the acute phase of depression and on the prevention of depressive relapse or recurrence. Despite growing clinical interest, the effects of MBIs on brain functioning in patients with MDD remain unclear. The aim of this systematic review was to assess the changes in brain functioning associated with MBIs in patients with MDD.

A systematic search was conducted, and of the 56 articles found, 8 were eligible. MBIs have modulatory effects on several brain regions implicated in the pathophysiology of MDD, such as the prefrontal cortex, the basal ganglia, the anterior and posterior cingulate cortices, and the parietal cortex. These regions have been implicated in self-awareness, attention and emotion regulation.

Some of these findings were consistent with the effects of MBIs observed in healthy subjects and patients with other psychiatric disorders, especially enhanced activity in the frontal and subcortical regions related to the improved somatosensory awareness. Further studies are needed to elucidate the mechanisms of MBIs in MDD.

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Interventions for psychiatric disorders

Goldberg, S. B., et al. (2018). Mindfulness-based interventions for psychiatric disorders: A systematic review and meta-analysis. Clinical psychology review, vol. 59, pp. 52-60, https://doi.org/10.1016/j.cpr.2017.10.011. Full text.

Highlights —

•  We examined the relative efficacy of mindfulness-based interventions on clinical symptoms of psychiatric disorders.

•  142 randomized clinical trials were included (N = 12,005 participants). Control conditions were coded on a five-tier system.

•  At post-treatment, mindfulness interventions were equivalent to evidence-based treatments and superior to other comparisons.

•  At follow-up, mindfulness interventions were equivalent to minimal and evidence-based treatments and superior to others.

•  The most consistent evidence for mindfulness-based interventions was seen for depression, pain, smoking, and addictions.

Adolescents with cronic diseases

Abujaradeh, H., et al. (2018). Mindfulness-Based Interventions among Adolescents with Chronic Diseases in Clinical Settings: A Systematic Review. Journal of Pediatric Health Care, https://doi.org/10.1016/j.pedhc.2018.04.001. Online ahead of publication.

Abstract. We aimed to determine the benefits/efficacy of mindfulness-based interventions (MBIs) implemented among adolescents with chronic diseases in clinical settings.

Nineteen eligible studies were included in this review. Fifteen studies included adolescents with psychiatric or pain disorders, and four included adolescents with a chronic physical disorders. Psychological outcomes and pain were examined in most studies with effect sizes for MBIs ranging from small to large.

MBI studies conducted in clinical settings mainly engaged adolescents with psychiatric or pain disorders. The effectiveness of MBIs on improving psychological outcomes were inconsistent. Large randomized trials are needed to examine the effectiveness of MBIs and should expand to include adolescents with chronic physical diseases.

Mindfulness-based treatment of addiction: the next wave of research

Garland, E. L., & Howard, M. O. (2018). Mindfulness-based treatment of addiction: current state of the field and envisioning the next wave of research. Addiction science & clinical practice, vol. 13, no1, pp. 14, https://doi.org/10.1186/s13722-018-0115-3. Full text.

Abstract. Contemporary advances in addiction neuroscience have paralleled increasing interest in the ancient mental training practice of mindfulness meditation as a potential therapy for addiction. In the past decade, mindfulness-based interventions (MBIs) have been studied as a treatment for an array addictive behaviors, including drinking, smoking, opioid misuse, and use of illicit substances like cocaine and heroin.

This article reviews current research evaluating MBIs as a treatment for addiction, with a focus on findings pertaining to clinical outcomes and biobehavioral mechanisms. Studies indicate that MBIs reduce substance misuse and craving by modulating cognitive, affective, and psychophysiological processes integral to self-regulation and reward processing.

This integrative review provides the basis for manifold recommendations regarding the next wave of research needed to firmly establish the efficacy of MBIs and elucidate the mechanistic pathways by which these therapies ameliorate addiction. Issues pertaining to MBI treatment optimization and sequencing, dissemination and implementation, dose–response relationships, and research rigor and reproducibility are discussed.

Questions that warrant research attention

Davidson, R. J., & Dahl, C. J. (2018). Outstanding challenges in scientific research on mindfulness and meditation. Perspectives on Psychological Science, vol 13, no. 1, pp. 62-5, DOI: 10.1177/1745691617718358. Full text.

From the Introduction. The article by Van Dam and colleagues (see previous post in this blog) presents a very useful corrective to the hype and claims associated with the burgeoning interest in mindfulness and meditation. The authors review a number of key issues and concerns with research in this domain including the problematic meaning of the term “mindfulness,” the differing measures of mindfulness and challenges to their construct validity, challenges for clinical intervention methodology including the variations in the types and content of various mindfulness-based interventions (MBIs) that have been examined, the growing evidence of potential adverse effects in a small subset of individuals who partake of MBIs, and the challenge of conducting neuro-scientific research in this area. For each of these topics, the authors also provide a prescriptive vision for the types of research that are needed to address the concerns and challenges that are described.

While we wholeheartedly agree with the central issues highlighted in this article and believe that this article, along with several other critical articles that have appeared recently, will provide an important recalibration of the claims and conclusions that are warranted from the contemporary scientific literature on this topic, we believe that the prescriptive agenda offered in their article can be usefully expanded.

In this commentary, we address a few of the specific concerns raised by the authors and show that they are not specific to mindfulness or meditation research and that attention to the broader context of these challenges can be helpful in addressing them. Second, we widen the prescriptive agenda offered in their article and underscore several key questions that the authors did not raise that warrant serious research attention for this
field to have impact. In this commentary we make five key points that build from the issues raised by Van Dam and colleagues.

Promising psychological treatments for fibromyalgia

Pérez-Aranda, A., et al. (2017). Description and narrative review of well-established and promising psychological treatments for fibromyalgia. Mindfulness & Compassion, http://www.sciencedirect.com/science/article/pii/S2445407917300319

Abstract. Fibromyalgia (FMS) is a prevalent, disabling syndrome characterized by chronic widespread musculoskeletal pain and symptoms such as sleep disturbance, fatigue, stiffness, distress, cognitive impairments and a high comorbidity with anxiety and depressive disorders. Although no curative treatment has yet been found, various therapeutic approaches have been developed in the fields of pharmacology and psychology.

The present paper aims to offer a narrative review and a description for clinicians and researchers of psychological therapies that have been applied in a format group in FMS with strong or promising empirical support: i.e., Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Mindfulness-Based Stress Reduction (MBSR), Psychoeducational program for FMS (FibroQoL), Amygdala Retraining Therapy (ART), and Attachment-Based Compassion Therapy (ABCT).

This review will offer a brief practical summary of each therapy protocol (session-by-session), their rationale and available evidence of their effectiveness.

Effect of online mindfulness intervention on well-being

Bailey, N. W., et al. (2018). Effect on Well-Being from an Online Mindfulness Intervention: “Mindful in May”. Mindfulness, 1-11. First online March 18, 2018. DOI: https://doi.org/10.1007/s12671-018-0910-7.

Abstract (excerpt). Mindfulness has been shown to improve mental health and well-being both in clinical populations and in healthy controls. However, while most mindfulness interventions have been assessed in a research context, demonstrating efficacy, the majority of mindfulness interventions in the public sphere are not assessed, and there has been little research examining the effectiveness of these interventions in the public context.

As such, this study explored whether a public online mindfulness intervention providing 10-min daily guided meditations was associated with improvements in well-being, and whether these improvements were related to the number of days participants practiced mindfulness meditation. Two hundred and nineteen participants took part in the study. Participants were aged 22–75, and the majority of participants were female. The majority of participants undertook mindfulness practice on 25+ days.

Participants completed both baseline and post-intervention assessments of perceived stress, positive and negative affect, mindfulness, flourishing, and self-compassion. Results indicated that all measures improved from baseline to post-intervention and that number of days practiced predicted increased mindfulness, and increased mindfulness predicted improvements in positive affect. These results suggest that online mindfulness interventions may be effective at improving mental health in the general population.