Alberto Chiesa

Mindfulness-based stress reduction for stress management in healthy people: a review and meta-analysis

BACKGROUND Mindfulness-based stress reduction (MBSR) is a clinically standardized meditation that has shown consistent efficacy for many mental and physical disorders. Less attention has been given to the possible benefits that it may have in healthy subjects. The aim of the present review and meta-analysis is to better investigate current evidence about the efficacy of MBSR in healthy subjects, with a particular focus on its benefits for stress reduction. MATERIALS AND METHODS A literature search was conducted using MEDLINE (PubMed), the ISI Web of Knowledge, the Cochrane database, and the references of retrieved articles. The search included articles written in English published prior to September 2008, and identified ten, mainly low-quality, studies. Cohens d effect size between meditators and controls on stress reduction and spirituality enhancement values were calculated. RESULTS MBSR showed a nonspecific effect on stress reduction in comparison to an inactive control, both in reducing stress and in enhancing spirituality values, and a possible specific effect compared to an intervention designed to be structurally equivalent to the meditation program. A direct comparison study between MBSR and standard relaxation training found that both treatments were equally able to reduce stress. Furthermore, MBSR was able to reduce ruminative thinking and trait anxiety, as well as to increase empathy and self-compassion. CONCLUSIONS MBSR is able to reduce stress levels in healthy people. However, important limitations of the included studies as well as the paucity of evidence about possible specific effects of MBSR in comparison to other nonspecific treatments underline the necessity of further research.

Mindfulness based cognitive therapy for psychiatric disorders: A systematic review and meta-analysis

Mindfulness- based Cognitive Therapy (MBCT) is a meditation program based on an integration of Cognitive behavioural therapy and Mindfulness-based stress reduction. The aim of the present work is to review and conduct a meta-analysis of the current findings about the efficacy of MBCT for psychiatric patients. A literature search was undertaken using five electronic databases and references of retrieved articles. Main findings included the following: 1) MBCT in adjunct to usual care was significantly better than usual care alone for reducing major depression (MD) relapses in patients with three or more prior depressive episodes (4 studies), 2) MBCT plus gradual discontinuation of maintenance ADs was associated to similar relapse rates at 1year as compared with continuation of maintenance antidepressants (1 study), 3) the augmentation of MBCT could be useful for reducing residual depressive symptoms in patients with MD (2 studies) and for reducing anxiety symptoms in patients with bipolar disorder in remission (1 study) and in patients with some anxiety disorders (2 studies). However, several methodological shortcomings including small sample sizes, non-randomized design of some studies and the absence of studies comparing MBCT to control groups designed to distinguish specific from non-specific effects of such practice underscore the necessity for further research.

Treatment-emergent Sexual Dysfunction Related to Antidepressants: A Meta-analysis

Background: Sexual dysfunction (SD) is an important underestimated adverse effect of antidepressant drugs. Patients, in fact, if not directly questioned, tend to scarcely report them. The aim of the present meta-analysis was to quantify SD caused by antidepressants on the basis of studies where sexual functioning was purposely investigated through direct inquiry and specific questionnaires. Methods: A literature search was conducted using MEDLINE, ISI Web of Knowledge, and references of selected articles. Selected studies performed on patients without previous SD were entered in the Cochrane Collaboration Review Manager (RevMan version 4.2). Our primary outcome measure was the rate of total treatment-emergent SD. Our secondary outcome measures were the rates of treatment-emergent desire, arousal, and orgasm dysfunction. Results: Our analyses indicated a significantly higher rate of total and specific treatment-emergent SD and specific phases of dysfunction compared with placebo for the following drugs in decreasing order of impact: sertraline, venlafaxine, citalopram, paroxetine, fluoxetine, imipramine, phenelzine, duloxetine, escitalopram, and fluvoxamine, with SD ranging from 25.8% to 80.3% of patients. No significant difference with placebo was found for the following antidepressants: agomelatine, amineptine, bupropion, moclobemide, mirtazapine, and nefazodone. Discussion: Treatment-emergent SD caused by antidepressants is a considerable issue with a large variation across compounds. Some assumptions, such as the inclusion of open-label studies or differences in scales used to assess SD, could reduce the significance of our findings. However, treatment-emergent SD is a frequent adverse effect that should be considered in clinical activity for the choice of the prescribed drug.

Mindfulness-based approaches: are they all the same?

Mindfulness-based approaches are increasingly employed as interventions for treating a variety of psychological, psychiatric and physical problems. Such approaches include ancient Buddhist mindfulness meditations such as Vipassana and Zen meditations, modern group-based standardized meditations, such as mindfulness-based stress reduction and mindfulness-based cognitive therapy, and further psychological interventions, such as dialectical behavioral therapy and acceptance and commitment therapy. We review commonalities and differences of these interventions regarding philosophical background, main techniques, aims, outcomes, neurobiology and psychological mechanisms. In sum, the currently applied mindfulness-based interventions show large differences in the way mindfulness is conceptualized and practiced. The decision to consider such practices as unitary or as distinct phenomena will probably influence the direction of future research.

Mindfulness-Based Interventions for Chronic Pain: A Systematic Review of the Evidence

OBJECTIVES Chronic pain is a common disabling illness that does not completely respond to current medical treatments. As a consequence, in recent years many alternative interventions have been suggested. Among them, mindfulness-based interventions (MBIs) are receiving growing attention. The aim of the present article is to review controlled studies investigating the efficacy of MBIs for the reduction of pain and the improvement of depressive symptoms in patients suffering from chronic pain. METHODS A literature search was undertaken using MEDLINE,(®) ISI web of knowledge, the Cochrane database, and references of retrieved articles. The search included articles written in English published up to July 2009. The data were independently extracted by two reviewers from the original reports. Quality of included trials was also assessed. RESULTS Ten (10) studies were considered eligible for the present review. Current studies showed that MBIs could have nonspecific effects for the reduction of pain symptoms and the improvement of depressive symptoms in patients with chronic pain, while there is only limited evidence suggesting specific effects of such interventions. Further findings evidenced some improvements in psychologic measures related to chronic pain such as copying with pain following MBIs as well. DISCUSSION There is not yet sufficient evidence to determine the magnitude of the effects of MBIs for patients with chronic pain. Main limitations of reviewed studies include small sample size, absence of randomization, the use of a waiting list control group that does not allow distinguishing of specific from nonspecific effects of MBI as well as differences among interventions. CONCLUSIONS However, because of these preliminary results, further research in larger properly powered and better designed studies is warranted.

Are Mindfulness-Based Interventions Effective for Substance Use Disorders? A Systematic Review of the Evidence

Mindfulness-based interventions (MBIs) are increasingly suggested as therapeutic approaches for effecting substance use and misuse (SUM). The aim of this article is to review current evidence on the therapeutic efficacy of MBIs for SUM. A literature search was undertaken using four electronic databases and references of retrieved articles. The search included articles written in English published up to December 2011. Quality of included trials was assessed. In total, 24 studies were included, three of which were based on secondary analyses of previously investigated samples. Current evidence suggests that MBIs can reduce the consumption of several substances including alcohol, cocaine, amphetamines, marijuana, cigarettes, and opiates to a significantly greater extent than waitlist controls, non-specific educational support groups, and some specific control groups. Some preliminary evidence also suggests that MBIs are associated with a reduction in craving as well as increased mindfulness. The limited generalizability of the reviewed findings is noted (i.e., small sample size, lack of methodological details, and the lack of consistently replicated findings). More rigorous and larger randomized controlled studies are warranted.

A meta-analysis of sexual dysfunction in psychiatric patients taking antipsychotics.

The aim of this meta-analysis was to quantify sexual dysfunction (SD) in patients treated with antipsychotics on the basis of selected papers that specifically investigated this type of adverse events by means of adequate instruments. A literature research was conducted using three electronic databases. Studies providing measures of SD in patients taking antipsychotics and providing separate data on single drugs were considered for inclusion. Our primary outcome measure was the rate of total SD, and our secondary outcome measures were the rates of desire, arousal, and orgasm dysfunction. We found that significant differences exist across different antipsychotics in terms of total SD, such that, partially consistent with the traditional dichotomy between prolactin-raising and prolactin-sparing antipsychotics, quetiapine, ziprasidone, perphenazine, and aripiprazole were associated with relatively low SD rates (16–27%), whereas olanzapine, risperidone, haloperidol, clozapine, and thioridazine were associated with higher SD rates (40–60%). Apart from a few exceptions, secondary analyses substantially confirmed the primary outcome measure. However, sensitivity analyses showed a significant impact of several variables on SD rates. In addition, taking into account several limitations, including the difficulty to disentangle SD related to drugs from SD related to illness itself, further studies are needed to determine more thorough evidence concerning antipsychotic-induced SD.

Vipassana Meditation: Systematic Review of Current Evidence

OBJECTIVES Vipassana meditation (VM) is one of the most ancient and diffused types of meditative practices belonging to the pole of mindfulness. Despite the growing interest toward the neurobiological and clinical correlates of many meditative practices, no review has specifically focused on current evidence on neuro-imaging and clinical evidence about VM. METHODS A literature search was undertaken using MEDLINE,((R)) ISI web of knowledge, the Cochrane database, and references of retrieved articles. Controlled and cross-sectional studies with controls published in English up to March 2009 were included. RESULTS Seven (7) mainly poor-quality studies were identified. Three (3) neuro-imaging studies suggested that VM practice could be associated with the activation of the prefrontal and the anterior cingulate cortex during meditative periods, and with increased thickness in cortical areas related to attention as well as increased subcortical gray matter in right insula and hippocampus in long-term meditators. Three (3) clinical studies in incarcerated populations suggested that VM could reduce alcohol and substance abuse but not post-traumatic stress disorder symptoms in prisoners. One (1) clinical study in healthy subjects suggested that VM could enhance more mature defenses and copying styles. DISCUSSION Current studies provided preliminary results about neurobiological and clinical changes related to VM practice. Nonetheless, few and mainly low-quality data are available especially for clinical studies and current results have to be considered with caution. Further research is needed to answer critical questions about replications, self-selection, placebo, and long-term effects of VM.

Zen meditation: an integration of current evidence.

OBJECTIVE Despite the growing interest in the neurobiological and clinical correlates of many meditative practices, in particular mindfulness meditations, no review has specifically focused on current evidence on electroencephalographic, neuroimaging, biological, and clinical evidence about an important traditional practice, Zen meditation. METHODS A literature search was conducted using MEDLINE, the ISI Web of Knowledge, the Cochrane collaboration database, and references of selected articles. Randomized controlled and cross-sectional studies with controls published in English prior to May 2008 were included. RESULTS Electroencephalographic studies on Zen meditation found increased alpha and theta activity, generally related to relaxation, in many brain regions, including the frontal cortex. Theta activity in particular seemed to be related to the degree of experience, being greater in expert practitioners and advanced masters. Moreover, Zen meditation practice could protect from cognitive decline usually associated with age and enhance antioxidant activity. From a clinical point of view, Zen meditation was found to reduce stress and blood pressure, and be efficacious for a variety of conditions, as suggested by positive findings in therapists and musicians. CONCLUSION To date, actual evidence about Zen meditation is scarce and highlights the necessity of further investigations. Comparison with further active treatments, explanation of possible mechanisms of action, and the limitations of current evidence are discussed.

Psychological mechanisms of mindfulness-based interventions: what do we know?

Little is known about the psychological mechanisms underlying the clinical benefits of mindfulness-based interventions (MBIs). In the present review, we suggest that mindfulness-based interventions may enhance positive emotional regulation strategies, as well as self-compassion levels, and decrease rumination and experiential avoidance. These changes are, in turn, associated with several clinical benefits including the reduction of stress and depression levels, as well as the enhancement of positive emotions. Limitations and potential applications of these findings are discussed.