ANOTHER STUDY HIGHLIGHTS THE EFFICACY OF MINDFULNESS IN TREATING DEPRESSION

Meditation is as good as anti-depressants for tackling depression according to the results of an Oxford University study recently published online in the Lancet.

The researchers found that mindfulness-based cognitive therapy (MBCT) prevented as many people from sliding back into clinical depression as conventional antidepressant medication.

The study followed 492 severely depressed adults over a period of 2 years. Half of the participants received mindfulness training and the other half stayed on antidepressant drugs.

It was found that 44 per cent of the MBCT group slipped back into major depression compared with 47 per cent of the group taking antidepressant medication.

Whilst the study doesn’t show that MBCT works any better than maintenance antidepressant medication in reducing the rate of relapse in depression, the results suggest that mindfulness is an acceptable alternative for the millions of people with recurrent depression on repeat prescriptions.

Study: Kuyken, W et al. ‘Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): a randomised controlled trial.’ The Lancet. Published Online: 20 April 2015. DOI: http://dx.doi.org/10.1016/S0140-6736(14)62222-4

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IMPORTANT NOTICE: See the Terms of Use and Disclaimer. The information provided on this blog is not a substitute for professional medical advice, diagnosis or treatment. Never delay or disregard seeking professional medical advice from your medical practitioner or other qualified health provider because of something you have read on this blog. For immediate advice or support call Lifeline on 13 1 1 14 or Kids Helpline on 1800 55 1800. For information, advice and referral on mental illness contact the SANE Helpline on 1800 18 SANE (7263) go online via sane.org

DEPRESSION, THE WANDERING MIND AND MINDFULNESS

 

This much is true: you can get the monkey off your back. Please read on.

The most satisfying work I’ve done in my long career as a lawyer, educator, therapist, and minister of religion is my ongoing lectureship at the NSW Institute of Psychiatry. It’s like this. Whenever I go there to lecture---and I've been doing that for some 12 years now---I hear real-life stories from mental health workers of various kinds about the stark reality of mental illness (or mental illnesses and mental disorders, I should say). Besides that, I have my own very real and at times very ugly story of mental illness---years of clinical depression and active alcoholism. 

Yes, I'm lucky to be here today to write this post. I kid you not. Only my wife and a few others know just how close I was to throwing in the towel. I even tried to do that on one occasion. As I say, it was an ugly story---and I've only told you a small part of it.

Auditorium/lecture room at the NSW Institute of Psychiaty

North Parramatta, New South Wales, Australia

Fortunately, those things are for me now well in the past, but many people still suffer from those and other mental illnesses---not only the actual sufferers themselves but also those with whom they’re closely associated. The untimely death of the actor and comedian Robin Williams reminds us all, if we needed any further reminder, that mental illness of all kinds is no respecter of persons. The main reason I write this blog is the hope that something I say may from time to time be of some help to someone else. That may sound a bit patronizing but it’s the goddamn truth.

Now, there have been many studies, and now even some meta-analytic reviews of studies, on the efficacy of mindfulness in treating depression. For example, one  such meta-analysis, published in the Journal of Consulting and Clinical Psychology in April 2010, which was based on 39 studies totaling 1,140 participants receiving mindfulness-based therapy for a range of conditions including cancer, generalized anxiety disorder, depression, and other psychiatric or medical conditions, concluded that mindfulness-based therapy was a useful intervention for treating anxiety and mood problems (including depression) in clinical populations.

I will in this post discuss yet another study---and, I think, a most interesting one---but first let me tell you about the phenomenon known as the ‘wandering mind’ (also known as the ‘monkey mind’). You will know that of which I speak, irrespective of whether or not you suffer from depression or certain other mental illnesses. Please note that we all have within us the wandering or monkey mind. In and of itself it is not a sign of mental illness or mental disorder. Got that? Our task is to quieten down the machinations and noise generated by this 'monkey' inside of our minds. MIndfulness is particularly useful for calming and slowing down the monkey mind. Of that there is no doubt.

Now, one of the very real problems associated with depression---and not just depression---is that the wandering mind chatters and chatters and wanders off and ruminates, often obsessively, on thoughts and situations that are ‘sad’ or ‘depressing' resulting in a plethora of related health problems both in the mind and in the body. 

Albert Einstein once said, 'I accept that thoughts influence the body.' That's so true. A depressed and ruminating wandering mind results in the immune system being lowered, which makes us more susceptible to illnesses of various kinds. Also, a depressed state of mind tends to breed further depression as well as stress resulting in a decrease in neurotransmitter levels. (Neurotransmitters are brain chemicals that communicate information throughout the brain and the body. Adverse symptoms appear throughout the body when these levels are 'out-of-balance.') 

The effect of depression on neurotransmitters also impacts on our mental health. This is because a state of depression in the mind tends to result in the depletion of feel-good chemicals such as serontonin and endorphins---a state of affairs which results in a further lowering of one's neurotransmitter levels. This only adds more fuel to the already smouldering fires of depression. (Note. When we are 'happy,' the brain releases other chemicals such as serotonin, dopamine and oyytocin.)

In short, when the wandering mind ruminates on negative thoughts and situations anxiety and stress levels are heightened. Further biochemical changes occur in the mind and the body through the release of certain chemicals including cortisol, which results in a lowering of the immune system. This predisposes us to illnesses of various kinds including heart disease, stroke, and possibly also certain cancers. Worse still, a cycle of negativity tends to set in, leading to a further lowering of neurotransmitter levels, and on it goes. The good news is that the vicious cycle can be broken.

As I've said, even if we aren’t suffering from major depression we all know the presence and effects of the wandering mind. At times this ‘monkey’ can be almost a cute little thing but for some people this ‘monkey’ is nothing short of a ferocious King Kong. Its presence and effects destroy their peace of mind and have even been known to drive some to the brink of despair and even suicide. 

But what can be done about this state of affairs? Well, I am not one who believes that there is ever one single ‘magic bullet’ cure for any mental illness or mental disorder, and certainly not major depression. A combination of therapies, including drug therapy, is usually required. I got a lot of help for my depression from insight-oriented psychotheraypy and antidepressants. As regards alcoholism the only thing that saved me was AA---and I wholeheartedly recommend it to anyone who has a problem with drinking and has a desire to stop drinking. (Note. A desire to stop drinking, which is essential to giving up alcholol, is the only requirement for AA membership. Belief in a traditional God is not required. You simply need to be willing to accept the fact that alcoholism is an illness where 'self' is powerless to change 'self.')

More than one study has examined the relationship between wandering mind, depression and mindfulness. Here's one that I found especially interesting. The researchers used the Sustained Attention to Response Task to assess the wandering mind, while the online thought probes were employed as the subjective marker for mind-wandering. The Beck Depression Inventory and Mindfulness Attention and Awareness Scale were used to assess depression and dispositional mindfulness respectively. The results revealed that the wandering mind, even without awareness, was not only positively associated with depression, but also negatively related to dispositional mindfulness. Depression was negatively related to dispositional mindfulness.

In other words, depression and the wandering mind tend to cohabit, and it would seem the greater the activity and intensity of the wandering mind, the worse is the depression. (Note: The researchers are not actually saying that wandering mind is the cause, or even one of the possible causes, of a person’s depression.) So-called dispositional mindfulness---that is, a mindset, regularly held, practised and sustained, of mindful awareness of what is, including an awareness of awareness itself---reduces the activity and intensity of the wandering mind. Finally, depression and dispositional mindfulness do not ordinarily cohabit.

The researchers conclude that the results of the study might provide evidence that a wandering mind is positively associated with depression and mindfulness.

Now, although I am ‘sold’ on the efficacy of mindfulness I never advise anyone to give up their present treatment(s), and rely entirely upon mindfulness, for the treatment of mental illness until after discussing the matter with their health care professionals. There is also an important notice at the foot of this post.

Study: Deng Y, Li S, and Yang Y. ‘The Relationship Between Wandering Mind, Depression and Mindfulness,’ Mindfulness, April 2014, Vol 5, Issue 2, pp 124-128. Date: 13 Oct 2012.

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THE NSW INSTITUTE OF PSYCHIATRY

IMPORTANT NOTICE: See the Terms of Use and Disclaimer. The information provided on this blog is not a substitute for professional medical advice, diagnosis or treatment. Never delay or disregard seeking professional medical advice from your medical practitioner or other qualified health provider because of something you have read on this blog.
For immediate advice or support call Lifeline on 13 1 1 14 or Kids Helpline on 1800 55 1800. For information, advice and referral on mental illness contact the SANE Helpline on 1800 18 SANE (7263) go online via sane.org

MINDFULNESS MEDITATION INCREASES WELLBEING IN ADOLESCENT BOYS

Mindfulness, the process of learning to become more aware of our ongoing experiences, increases wellbeing in adolescent boys, a new study reports.

Researchers from the University of Cambridge analysed 155 boys from two independent UK schools, Tonbridge and Hampton, before and after a 4-week crash course in mindfulness.

After the trial period, the 14 and 15 year-old boys were found to have increased wellbeing, defined as the combination of feeling good (including positive emotions such as happiness, contentment, interest and affection) and functioning well.

Professor Felicia Huppert (pictured below) of the Well-being Institute at the University of Cambridge said:

"More and more we are realising the importance of supporting the overall mental health of children. Our study demonstrates that this type of training improves wellbeing in adolescents and that the more they practise, the greater the benefits. Importantly, many of the students genuinely enjoyed the exercises and said they intended to continue them – a good sign that many children would be receptive to this type of intervention.

"Another significant aspect of this study is that adolescents who suffered from higher levels of anxiety were the ones who benefitted most from the training."

For the experiment, students in 6 classes were trained in mindful awareness – mindfulness.

Mindfulness is a "way of paying attention. It means consciously bringing awareness to our experience, in the present moment, without making judgments about it" [as described in the Mental Health Foundation report Be Mindful issued in 2010].

That report makes the case for making meditation-based therapy available to everyone who experiences recurrent depression.

The report highlights the proven effectiveness of treatments such as mindfulness-based cognitive therapy (MBCT) and shows how developing services could reduce the cost - human and economic - of depression to society.

Students in the 5 control classes attended their normal religious studies lessons.

The classes covered the concepts of awareness and acceptance, and taught the schoolboys such things as how to practice bodily awareness by noticing where they were in contact with their chairs or the floor, paying attention to their breathing, and noticing all the sensations involved in walking.The training consisted of four 40 minute classes, one per week, which presented the principles and practice of mindfulness.

The students were also asked to practice outside the classroom and were encouraged to listen to a CD or mp3 file for 8 minutes a day. These exercises are intended to improve concentration and reduce stress.

All participants completed a short series of online questionnaires before and after the mindfulness project. The questionnaires measured the effect of the training on changes in mindful awareness, resilience (the ability to modify responses to changing situations) and psychological wellbeing.

The researchers found that although it was a short program, the students who participated in the mindfulness training had increased levels of wellbeing which were proportional to the amount of time the students spent practising their new skills.

Professor Huppert continued: "We believe that the effects of mindfulness training can enhance wellbeing in a number of ways. If you practice being in the present, you can increase positive feelings by savouring pleasurable on-going experiences. Additionally, calming the mind and observing experiences with curiosity and acceptance not only reduces stress but helps with attention control and emotion regulation – skills which are valuable both inside and outside the classroom."

NOTE. This blog sets out a simple form of mindfulness sitting meditation.

Source: University of Cambridge. Article Date: 19/9/10.


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IMPORTANT NOTICE: See the Terms of Use and Disclaimer. The information provided on this blogspot is not a substitute for professional medical advice, diagnosis or treatment. Never delay or disregard seeking professional medical advice from your medical practitioner or other qualified health provider because of something you have read on this blogspot. For immediate advice or support call Lifeline on 13 1 1 14 or Kids Helpline on 1800 55 1800. For information, advice and referral on mental illness contact the SANE Helpline on 1800 18 SANE (7263) go online via sane.org

STUDY FINDS MINDFULNESS AS EFFECTIVE AS ANTIDEPRESSANTS IN PREVENTING DEPRESSION RELAPSE

A new study from the Centre for Addiction and Mental Health (CAMH), which is Canada's largest mental health and addiction teaching hospital, as well as one of the world's leading research centres in the area of addiction and mental health, has found that mindfulness-based cognitive therapy - using meditation - provides equivalent protection against depressive relapse as traditional antidepressant medication. 

The study, which was supported by the National Institute of Mental Health, and which was published in the December 2010 issue of Archives of General Psychiatry, compared the effectiveness of pharmacotherapy with mindfulness-based cognitive therapy (MBCT) by studying people who were initially treated with an antidepressant and then, either stopped taking the medication in order to receive MBCT, or continued taking medication for 18 months.

"With the growing recognition that major depression is a recurrent disorder, patients need treatment options for preventing depression from returning to their lives." said Dr Zindel Segal, Head of the Cognitive Behaviour Therapy Clinic in the Clinical Research Department at CAMH.

"Data from the community suggest that many depressed patients discontinue antidepressant medication far too soon, either because of side effect burden, or an unwillingness to take medicine for years.  Mindfulness-based cognitive therapy is a non pharmacological approach that teaches skills in emotion regulation so that patients can monitor possible relapse triggers as well as adopt lifestyle changes conducive to sustaining mood balance.”

The researchers conducted a randomized trial of 166 patients ages 18 to 65 at 2 outpatient clinics in Canada who met criteria for major depressive disorder, and focused on the 84 who achieved remission. These patients were assigned to one of 3 groups: antidepressant maintenance therapy, mindfulness-based cognitive therapy, or placebo.

Study participants who were diagnosed with major depressive disorder were all treated with an antidepressant until their symptoms remitted. They were then randomly assigned to:

* come off their medication and receive MBCT,
* come off their medication and receive a placebo, or
* stay on their medication.

The novelty of this design enabled a comparison to be made as regards the effectiveness of sequencing pharmacological and psychological treatments versus maintaining the same treatment - antidepressants - over time.

Participants in MBCT attended 8 weekly group sessions and practiced mindfulness as part of daily homework assignments. Clinical assessments were conducted at regular intervals, and over an 18 month period, relapse rates for patients in the MBCT group did not differ from patients receiving antidepressants (both in the 30% range), whereas patients receiving placebo relapsed at a significantly higher rate (70%). 

"The real world implications of these findings bear directly on the front line treatment of depression. For that sizeable group of patients who are unwilling or unable to tolerate maintenance antidepressant treatment, MBCT offers equal protection from relapse," said Dr Zindel Segal. "Sequential intervention - offering pharmacological and psychological interventions - may keep more patients in treatment and thereby reduce the high risk of recurrence that is characteristic of this disorder."

I know from my work at the NSW Institute of Psychiatry that many patients stop taking their antidepressants too soon either because of the side effects or because they don't like the idea of being on the drugs for years.

MBCT is being increasingly used as a psychotherapeutic approach for stress reduction, pain management, behaviour change, and for self-management of symptoms of depression. MBCT does not use drugs, but teaches patients how to be aware of and to a certain extent regulate emotions so they can spot triggers of relapse early, plus make changes in lifestyle that help them gain a sense of balance in mood and hold the gains for longer.

Now, what follows is most important. The researchers stressed that their findings highlighted how important it was for recurrently depressed patients whose remission is unstable to stay on at least one active long-term treatment. Further, if you want to stop taking an antidepressant, speak with your medical practitioner first and be guided by his or her advice. Do not stop taking any antidepressant abruptly without consulting with your medical practitioner who may recommend weaning your body off the medication gradually. People who stop an antidepressant too quickly may trigger antidepressant discontinuation syndrome which may result in rebound depression and other potentially serious problems.

Here is an abstract of the journal article, entitled “Antidepressant Monotherapy vs Sequential Pharmacotherapy and Mindfulness-Based Cognitive Therapy, or Placebo, for Relapse Prophylaxis in Recurrent Depression”, by Zindel V Segal, Peter Bieling, Trevor Young, Glenda MacQueen, Robert Cooke, Lawrence Martin, Richard Bloch and Robert D Levitan, and published in Archives of General Psychiatry 2010 Dec; 67(12):1256-1264.


This post sets out a simple form of mindfulness sitting meditation.

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IMPORTANT NOTICE: See the Terms of Use and Disclaimer. The information provided on this blogspot is not a substitute for professional medical advice, diagnosis or treatment. Never delay or disregard seeking professional medical advice from your medical practitioner or other qualified health provider because of something you have read on this blogspot. For immediate advice or support call Lifeline on 13 1 1 14 or Kids Helpline on 1800 55 1800. For information, advice and referral on mental illness contact the SANE Helpline on 1800 18 SANE (7263) go online via sane.org