NEW STUDY SHOWS THAT MINDFULNESS IS AS GOOD AS CBT FOR DEPRESSION AND ANXIETY

Listen. I know the reality of depression and anxiety. I no longer suffer from those conditions but I did for a considerable period of time---especially depression. I didn't use mindfulness to manage and eventually overcome those conditions, for I didn't know about it at the time. I used traditional psychotherapy combined with antidepressant drug treatment. I do not condemn those modalities, in fact I endorse them. I am, however, always interested in other forms of treatment, especially mindfulness. Hence this blog.

Now, according to a new study from Lund University in Sweden and Region Skåne, group mindfulness treatment is as effective as individual cognitive behavioural therapy (CBT) in patients suffering from depression and anxiety. As an aside, we all know that group therapy can often be more effective than individual treatment. There is an energy, and a synergy, that arises from the group. Mindfulness involves seeing things-as-they-really-are, non-judgmentally, and that can at times be quite a confronting experience for persons with mental health issues. However, a group setting can assist greatly in that regard.

The researchers, led by Professor Jan Sundquist [pictured left], ran the study at 16 primary health care centres in Skåne, a county in southern Sweden. In spring 2012 some 215 patients with depression, anxiety or reactions to severe stress were randomised to either structured group mindfulness treatment with approximately 10 patients per group, or regular treatment (mainly individual CBT). Patients also received a private training programme and were asked to record their exercises in a diary. The treatment lasted 8 weeks.

Before and after treatment, the patients in the mindfulness and regular treatment groups answered questionnaires that estimated the severity of their depression and anxiety. Self-reported symptoms of depression and anxiety decreased in both groups during the 8-week treatment period. There was no statistical difference between the two treatments.

‘The study’s results indicate that group mindfulness treatment, conducted by certified instructors in primary health care, is as effective a treatment method as individual CBT for treating depression and anxiety’, says Jan Sundquist. ‘This means that group mindfulness treatment should be considered as an alternative to individual psychotherapy, especially at primary health care centres that can’t offer everyone individual therapy’.

Resource: Sundquist J, Lilja A, Palmer K, Memon A, Wang X, and Johansson L. ‘Mindfulness group therapy in primary care patients with depression, anxiety and stress and adjustment disorders: randomized controlled trial.’ British Journal of Psychiatry, 2014. Published online ahead of print Nov 27, 2014, doi: 10.1192/bjp.bp.114.150243.

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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

MINDFULNESS MAY HELP WITH MENOPAUSAL DEPRESSION

Psychotherapy and mindfulness techniques could help many women who experience depression during menopause, according to a review of existing research.

 

Too few studies have looked at whether cognitive therapies are good alternatives for women who can’t or don’t want to use pharmaceutical treatments to offset the symptoms of menopausal depression, but the handful that have done so have mostly shown positive results.

Cognitive-behavioural therapy helps patients change the way they think and feel to lead more productive lives. Behavioural therapy focuses more on modifying actions to stem self-destructive behaviour. Mindfulness meditation helps patients to better tolerate and deal with stress.

 

In 2013 Dr Sheryl M Green [pictured left], co-author of The Cognitive Behavioral Workbook for Menopause, and her colleagues searched 5,126 studies and found only two on the use of cognitive, cognitive-behavioural or mindfulness therapies for women with major depression during menopause. Both studies showed that women improved after cognitive-behavioural therapy. In the first study, half of the 169 menopausal women who had 16 sessions of individual therapy were much less depressed afterwards and 25 per cent were no longer depressed at all. Women were also much less depressed after 16 sessions of a two-hour, twice-weekly group therapy in a second study with 44 participants.

 

In 2014 Green’s team broadened its search, including studies that looked at depression as one of several menopausal symptoms and came up with 12 more.

Women tended to feel less depressed after therapy involving education, coping skills and muscle relaxation for menopausal symptoms in several of those studies. However, an educational seminar alone didn’t improve their moods. They also felt less depressed after mindfulness-based stress reduction and relaxation techniques, plus diaphragmatic breathing, according to studies on hot flashes and mood.

However, women didn’t always feel less depressed after cognitive therapies. In some cases, Green’s team writes, this might be because women need programs geared toward their specific physical issues, such as hot flashes or vaginal dryness, and feelings about going through the transition.

Some of the studies in the review were small, the authors caution, and did not include enough follow-up, didn’t have a comparison group or included only women who were mildly depressed. These limitations and the fact that there wasn’t much research to begin with mean more is needed, the authors say. 'Even though the literature is still in its infancy with establishing cognitive-behavioural therapy as an effective treatment for menopausal symptoms, and menopausal depression more specifically, cognitive-behavioural therapy has received empirical support and high acceptability for over three decades with many mental health and physical difficulties,' Dr Green says. 'With its low-risk nature, it is something that I continue to practise with menopausal patients who cannot or choose not to take medication---with suceess.'

 

 

Resource: Green SM, Key BL, and McCabe RE. ‘Cognitive-behavioral, behavioral, and mindfulness-based therapies for menopausal depression: A review.’ Maturitas. DOI: http://dx.doi.org/10.1016/j.maturitas.2014.10.004

 

 

 

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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

 

 

 

MINDFULNESS, PSYCHOANALYSIS, COGNITIVE BEHAVIOUR THERAPY AND BORDERLINE PERSONALITY DISORDER

In November 2010 some 230 psychodynamic psychotherapists (formerly known, and sometimes still referred to, as psychoanalysts or psychoanalytic psychotherapists) met in Sydney, Australia to hear from Dr Jonathan Shedler (pictured opposite), Associate Professor at the University of Colorado Medical School, who has gathered the first impressive evidence in 80 years that talking therapies of the psychoanalytic kind may work.

''The public has been told only new symptom-focused treatments like cognitive behaviour therapy have scientific support,'' he said. ''The actual evidence shows that psychodynamic therapy is highly effective.''

Dr Shedler published in the American Psychologist in 2010 a review of 160 studies of psychodynamic therapy (click on this link to find the paper), which is a less intensive form of classical Freudian psychoanalysis. The review not only countered the universal criticism of a lack of scientific evidence for psychoanalysis but also demonstrated it had substantial and lasting treatment benefits.

''Therapy is a way of coming to know the part of ourselves we don't fully know,'' Shedler said, who is scathing in his criticism of cognitive behaviour therapy (CBT). In the words of Shedler, ''The notion you can get rid of distressing feelings through working with reason and rationality alone is neurologically unsupportable.''

Now, I am not suitably qualified to pass judgment on either psycho-dynamic therapy (psychoanalysis) or CBT except to say that it appears to be the general consensus of opinion that when CBT works, it works fairly quickly and cost-effectively, whereas other forms of psychotherapy (including but not limited to classical psychoanalysis, insight-oriented psychotherapy and other forms of “talk therapies”) tend to take much longer.

However, what Shedler says above regarding the use of reason and rationality alone to treat what are inherently irrational states of mind seems intuitively, and self-evidently, plausible to me.

Now, there is considerable evidence, referred to in previous blogs, that Mindfulness can be a useful mechanism, whether in the form of an adjunct therapy or otherwise, for treating depression, anxiety and certain mood disorders. Mindfulness does not rely upon reason or rationality per se. Having said that, Mindfulness is not irrational or contrary to reason but simply transrational or supramundane ... that is, it grows out of, but also transcends, ordinary reason or rationality.

Mindfulness involves the use of the following three ordinary, everyday “skills” (but with a heightened state of self-awareness):

• observing … that is, giving bare and curious attention to what is what is happening in one’s body, mind and consciousness … with choiceless awareness;
• describing … that is, [in some Mindfulness "traditions" and practices] using techniques such as “noting” (eg “thinking … thinking”) and “labelling” (eg “sad”, “angry”) - without judgment, condemnation or criticism of any kind - what is happening in one’s body, mind and consciousness ... OR simply acknowledging - without anticipating or reflecting upon it - whatever be the sensation of the moment in the immediacy of its arising or vanishing;
• participating … that is, practising, whilst paying full and undivided attention to, certain activities (including but not limited to ordinary, everyday activities such as eating, reading and watching TV) in a manner that enables one to step back and otherwise disengage from what is what is happening in one’s body, mind and consciousness, thus enabling oneself to de-stress, detach and disengage from mental clutter and to have a clear mind.

For some time now I have been interested in the work and writings of Marsha M Linehan (pictured below), who is an American psychologist and author of such books as Cognitive-Behavioral Treatment of Borderline Personality Disorder (New York: Guildford Press, 1993). Linehan is a Professor of Psychology, Adjunct Professor of Psychiatry and Behavioral Sciences at the University of Washington and Director of the Behavioral Research and Therapy Clinics.

Lineham has developed a system of psychotherapy known as Dialectical Behavior Therapy (DBT), which is a type of psychotherapy that combines behavioural science with concepts of acceptance and Mindfulness derived from both Eastern and Western contemplative practices.

As regards the practice of Mindfulness, Linehan sees it as being a core skill in her type of CBT for Borderline Personality Disorder (BPD), which is a mental disorder that affects some 2 to 5 per cent of the population at some stage in their lives.

For more on BPD watch this quite helpful YouTube video:

People affected by BPD frequently experience distressing emotional states (often involving confused and contradictory feelings and emotions as well as deep feelings of insecurity), difficulty in relating to other people, self-harming behaviour and problems with impulse control. Mindfulness can be of assistance here by reason of the fact that Mindfulness leads to enhanced and more objective self-awareness.

By means of the regular practice of Mindfulness, aided and assisted by one or other of the various forms of psychotherapy and possibly medication (in the form of mood stabilizers) as well, people with BPD can gradually become more aware of what is happening in their body, mind and consciousness … in the present … on a moment to moment basis ... and more centred and grounded in the "here and now".

In time, the mind slows down, and one learns not to automatically engage in self-introspection of an obsessional kind, self-criticism and self-condemnation, and not to act impulsively and unthinkingly based on what are often ill-founded mental judgments as to whether one likes or doesn’t like what one is experiencing or encountering in daily life.

Equally importantly, one learns that, when painful or otherwise unpleasant feelings or memories arise, one need not become caught up by them but can let them drift or float away. In other words, there is a shift in focus and one's persepective of thinking from being in the past and future to being fully engaged in the present. Further, one learns to be an objective observer and witness of oneself in the "time at hand" … with emotional equanimity and tranquillity.

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


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