For those who are interested in learning about the emerging use of meditation and Mindfulness-Based CBT (MBCBT), it can be challenging to keep up with the number of articles and research reports. Here is an excellent summary (courtesy of Robert Van Siclen, Ph.D., L.P, who posted about it on a Minnesota Psychological Association listserv), from the Research Digest blog published by the British Psychological Society: The Psychology of Mindfulness, Digested
The post includes, somewhat incredibly but probably accurately, “In 2012, 40 new papers on mindfulness were published every month, a number that has probably risen since.” No wonder it is hard to keep up! The post goes on to provide brief, but helpful, summaries about several topics, including “What is mindfulness?” and discussion of the current thinking about the benefits of mindfulness and meditation (many!) and potential problems (some people apparently with some psychological vulnerabilities, experience “side effects” such as hallucinations and religious delusions). This blog posting has many links to other helpful sources.
The following 2 studies came to my attention courtesy of Ken Pope, Ph.D., who has a very prolific posting service.
The British journal The Lancet published a the results of a study comparing a version of MBCBT to medication for long term or “maintenance” treatment of chronic depression, “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.” This study is more rigorous than many other meditation/MBCBT studies. The participants had or more episodes of major depression and were prescribed maintenance antidepressant medication by their PCP. The participants either received continuing medication management by their PCP or a version of MBCBT, called MBCBT-TS. MBCBT-TS is a manualized treatment provided in a group setting, and includes support for reducing or eliminating the antidepressant medication. The primary outcome was “time to relapse or recurrence of depression,” with participants followed up at five separate intervals during the 24-month study period. A total of 424 patients participated.
From the “Findings” section of the report: “The time to relapse or recurrence of depression did not differ between MBCT-TS and maintenance antidepressants over 24 months…., nor did the number of serious adverse events.” And, “Five adverse events were reported, including two deaths, in each of the MBCT-TS and maintenance antidepressants groups. No adverse events were attributable to the interventions or the trial.”
From the “Interpretation” section: “n We found no evidence that MBCT-TS is superior to maintenance antidepressant treatment for the prevention of depressive relapse in individuals at risk for depressive relapse or recurrence. Both treatments were associated with enduring positive outcomes in terms of relapse or recurrence, residual depressive symptoms, and quality of life.”
From the “Discussion” section: “Consistent with an emergent pattern of findings, MBCT might confer most benefit to patients at greatest risk of relapse…Perhaps MBCT confers resilience in this group at highest risk because patients learn skills that address some of the underlying mechanisms of relapse or recurrence, a question we will explore in a subsequent publication from this trial.”
So, a version of mindfulness-based therapy is found, in a thorough study, to be the equivalent of medication for patients with chronic depression, and for some the results were superior. These findings are enhanced by the relatively long follow up period and excellence adherence rates in both study groups.
The report ends by recommended a “stratified” treatment approach for patients with chronic depression: “… the implication is that for patients at low risk, treatments such as psycho-education or maintenance antidepressants, which require less patient commitment and cost, might be indicated, whereas for patients at highest risk, more intensive treatments such as MBCT could be indicated. This implication has substantial potential to improve prevention by maximizing the delivery of treatments through stratified approaches, which also have the potential to improve patient choice.”
The Journal of the American Medical Association – Internal Medicine published an online article of interest on July 6, 2015. “Cognitive Behavioral Therapy for Insomnia Comorbid With Psychiatric and Medical Conditions: A Meta-analysis” surveyed studies comparing CBT-I (CBT with a focus on treating insomnia) with other common insomnia treatments. The meta-analysis found that CBT-I is an effective treatment for insomnia co-occurring with other medical, including psychiatric, conditions. The authors concluded, “These findings provide empirical support for the recommendation of using CBT-I as the treatment of choice for comorbid insomnia disorders.” And, “Given that insomnia disorders are highly prevalent in primary care settings, health care professionals in these settings should regularly assess for sleep disturbances in the context of co-morbid conditions and efforts should be directed at adapting CBT-I to the time constraints in this setting.”
Or, PCPs could refer to behavioral specialists for CBT-I, if CBT-I providers have connected with PCPs.
Finally, from JAMA-Internal Medicine, published online in April, “Mindfulness Meditation and Improvement in Sleep Quality and Daytime Impairment Among Older Adults With Sleep Disturbances: A Randomized Clinical Trial“, with additional reporting in the New York Times on Feb. 23, 2015, “Meditation for a Good Night’s Sleep.” This study compared a 6 week program teaching mindfulness meditation with a standard sleep hygiene training program. At the end of the study, which lasted one year, the meditators were found to “greater improvements in sleep quality and fewer symptoms of insomnia, depression and fatigue than those who received standard care.” The lead author, quoted in the New York Times article, expressed concern about problems with using sleep medication for “older people” and recommended trying meditation as “a safe and sensible health practice promoting sleep quality.” The article also noted that about 50% of people over age 55 have some sort of sleep problem.
My take: for therapists who are interested in medication/mindfulness and for patients who are receptive to these resources, there is an emerging body of increasingly solid research in support of meditation as “a safe and sensible health practice” and as a therapeutic intervention for some specific health and mental health problems. These options may be particularly of interest to patients with chronic depression or sleep problems who either are not interested in medication or desire to reduce or discontinue medication.