Christina A. Metcalf

Randomized Controlled Trial of Mindfulness Meditation for Generalized Anxiety Disorder: Effects on Anxiety and Stress Reactivity

OBJECTIVE Mindfulness meditation has met increasing interest as a therapeutic strategy for anxiety disorders, but prior studies have been limited by methodological concerns, including a lack of an active comparison group. This is the first randomized, controlled trial comparing the manualized Mindfulness-Based Stress Reduction (MBSR) program with an active control for generalized anxiety disorder (GAD), a disorder characterized by chronic worry and physiologic hyperarousal symptoms. METHOD Ninety-three individuals with DSM-IV-diagnosed GAD were randomly assigned to an 8-week group intervention with MBSR or to an attention control, Stress Management Education (SME), between 2009 and 2011. Anxiety symptoms were measured with the Hamilton Anxiety Rating Scale (HAMA; primary outcome measure), the Clinical Global Impressions-Severity of Illness and -Improvement scales (CGI-S and CGI-I), and the Beck Anxiety Inventory (BAI). Stress reactivity was assessed by comparing anxiety and distress during pretreatment and posttreatment administration of the Trier Social Stress Test (TSST). RESULTS A modified intent-to-treat analysis including participants who completed at least 1 session of MBSR (n = 48) or SME (n = 41) showed that both interventions led to significant (P < .0001) reductions in HAMA scores at endpoint, but did not significantly differ. MBSR, however, was associated with a significantly greater reduction in anxiety as measured by the CGI-S, the CGI-I, and the BAI (all P values < .05). MBSR was also associated with greater reductions than SME in anxiety and distress ratings in response to the TSST stress challenge (P < .05) and a greater increase in positive self-statements (P = .004). CONCLUSIONS These results suggest that MBSR may have a beneficial effect on anxiety symptoms in GAD and may also improve stress reactivity and coping as measured in a laboratory stress challenge. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01033851.

Loving-Kindness Meditation practice associated with longer telomeres in women.

Relatively short telomere length may serve as a marker of accelerated aging, and shorter telomeres have been linked to chronic stress. Specific lifestyle behaviors that can mitigate the effects of stress might be associated with longer telomere lengths. Previous research suggests a link between behaviors that focus on the well-being of others, such as volunteering and caregiving, and overall health and longevity. We examined relative telomere length in a group of individuals experienced in Loving-Kindness Meditation (LKM), a practice derived from the Buddhist tradition which utilizes a focus on unselfish kindness and warmth towards all people, and control participants who had done no meditation. Blood was collected by venipuncture, and Genomic DNA was extracted from peripheral blood leukocytes. Quantitative real time PCR was used to measure relative telomere length (RTL) (Cawthon, 2002) in fifteen LKM practitioners and 22 control participants. There were no significant differences in age, gender, race, education, or exposure to trauma, but the control group had a higher mean body mass index (BMI) and lower rates of past depression. The LKM practitioners had longer RTL than controls at the trend level (p=.083); among women, the LKM practitioners had significantly longer RTL than controls, (p=.007), which remained significant even after controlling for BMI and past depression. Although limited by small sample size, these results offer the intriguing possibility that LKM practice, especially in women, might alter RTL, a biomarker associated with longevity.

Web-Based Intervention in Mindfulness Meditation for Reducing Residual Depressive Symptoms and Relapse Prophylaxis: A Qualitative Study

Background Mindful Mood Balance (MMB) is a Web-based intervention designed to treat residual depressive symptoms and prevent relapse. MMB was designed to deliver the core concepts of mindfulness-based cognitive therapy (MBCT), a group treatment, which, despite its strong evidence base, faces a number of dissemination challenges. Objective The present study is a qualitative investigation of participants’ experiences with MMB. Methods Qualitative content analysis was conducted via 38 exit interviews with MMB participants. Study inclusion required a current PHQ-9 (Patient Health Questionnaire) score ≤12 and lifetime history ≥1 major depressive episode. Feedback was obtained on specific website components, program content, and administration as well as skills learned. Results Codes were assigned to interview responses and organized into four main themes: MBCT Web content, MBCT Web-based group process, home practice, and evidence of concept comprehension. Within these four areas, participants highlighted the advantages and obstacles of translating and delivering MBCT in a Web-based format. Adding increased support was suggested for troubleshooting session content as well as managing time challenges for completing home mindfulness practice. Participants endorsed developing affect regulation skills and identified several advantages to Web-based delivery including flexibility, reduced cost, and time commitment. Conclusions These findings support the viability of providing MBCT online and are consistent with prior qualitative accounts derived from in-person MBCT groups. While there is certainly room for innovation in the domains of program support and engagement, the high levels of participant satisfaction indicated that MMB can significantly increase access to evidence-based psychological treatments for sub-threshold symptoms of unipolar affective disorder.

Plasma Oxytocin Immunoreactive Products and Response to Trust in Patients with Social Anxiety Disorder

Generalized Social Anxiety Disorder (GSAD) is characterized by excessive fear and avoidance of several types of social and performance situations. The pathophysiology is not well understood, but research in animals and humans has provided evidence that oxytocin helps regulate normal social affiliative behavior. Previous work in healthy male subjects demonstrated a rise in plasma oxytocin after receiving a high trust signal. To examine the oxytocin system in GSAD, we measured plasma oxytocin in GSAD patients and controls, before and after the social “Trust Game,” a neuroeconomic test examining trust behavior and reaction to trust using real monetary incentives.

Dwell or Decenter? Rumination and Decentering Predict Working Memory Updating After Interpersonal Criticism

Rumination and mindful decentering are cognitive responses to emotional experiences. Rumination involves dwelling on negative thoughts, whereas decentering involves observing negative thoughts as temporary mental events. However, the question of how rumination or decentering shape the effects of emotional experiences on cognitive or behavioral functioning remains ambiguous. The present study investigated the relationships between trait rumination, trait decentering, and working memory following exposure to interpersonal criticism. Results showed that rumination and decentering were negatively correlated, and predicted opposing patterns of working memory updating. Individuals high in rumination were slower to update working memory after criticism, but individuals high in decentering were faster to respond to the same trials. Increases in decentering predicted better task performance even at high levels of rumination. These findings suggest that a ruminative response style may impede the ability to clear irrelevant information from working memory under negative emotional conditions, but mindful decentering protects this ability.

A pragmatic randomized clinical trial of behavioral activation for depressed pregnant women.

Objective: Depression among pregnant women is a prevalent public health problem associated with poor maternal and offspring development. Behavioral activation (BA) is a scalable intervention aligned with pregnant women’s preference for nonpharmacological depression care. This is the first test of the effectiveness of BA for depression among pregnant women, which aimed to evaluate the effectiveness of BA as compared with treatment as usual (TAU). Method: Pregnant women (mean age = 28.75 years; SD = 5.67) with depression symptoms were randomly assigned to BA (n = 86) or TAU (n = 77). Exclusion criteria included known bipolar or psychotic disorder or immediate self-harm risk. Follow-up assessment occurred 5 and 10 weeks postrandomization and 3 months postpartum using self-report measures of primary and secondary outcomes and putative targets. Results: Compared with TAU, BA was associated with significantly lower depressive symptoms (d = 0.34, p = .04) and higher remission (56.3% vs. 30.3%, p = .003). BA also demonstrated significant advantage on anxiety and perceived stress. Participants attended most BA sessions and reported high satisfaction. Participants in BA reported significantly higher levels of activation (d = 0.69, p < .0002) and environmental reward (d = 0.54, p < .003) than those who received TAU, and early change in both of these putative targets significantly mediated subsequent depression outcomes. Conclusions: BA is effective for pregnant women, offering significant depression, anxiety, and stress benefits, with mediation analyses supporting the importance of putative targets of activation and environmental reward.

Body Piercings and Posttraumatic Stress Disorder Symptoms in Young Adults

Body piercing, which is prevalent in young adults, has been suggested to be associated with features usually related to posttraumatic stress disorder (PTSD) such as high-risk behaviours and psychopathological symptoms and might be motivated by a wish to deal with prior traumatic experiences. However, to date, no research has investigated the relationship between this practice and PTSD symptoms. The present research aims to investigate the possible relationship between body piercing and PTSD symptoms in French-speaking young adults. According to our results, having two or more body piercings was associated with a twofold increased risk for scoring above the cut-off score for PTSD on the PTSD checklist. Our findings suggest that two or more body piercings might serve as an identifiable marker for PTSD symptoms and may have important implications for clinical screening.

Anxiety and its correlates among young adults with a history of parental cancer

ABSTRACT Purpose: We assessed whether experiencing parental cancer during childhood was associated with anxiety levels during young adulthood—and whether parental survival status moderated anxiety or related psychosocial outcomes. Methods: Young adults who experienced parental cancer during their childhood (n = 68) and those who did not (n = 298) completed measures of current anxiety and family functioning. The parental cancer group completed measures of social support and life changes during the parental cancer and posttraumatic growth. Results: Young adults who experienced parental cancer endorsed higher state and trait anxiety than matched controls. Higher anxiety correlated with less current family cohesion and lower past social support satisfaction. Parental cancer outcome moderated the relationship between current anxiety and dimensions of posttraumatic growth and predicted the number of cancer-related life changes. Conclusion: Experiencing parental cancer during childhood predicted higher reported anxiety during young adulthood. Anxiety levels were partially moderated by parental survival status.

C4-5: Behavioral Activation Therapy for Perinatal Depression: Preliminary Results from a Multi-site Randomized Trial

Background/Aims Perinatal depression is both prevalent and associated with adverse correlates and consequences for women and offspring. Women and their health care providers often face complex choices regarding treatment of depression during pregnancy. Although studies suggest that pregnant women express a preference for psychotherapy over antidepressants, the latter is most frequently provided. These treatment patterns highlight the need for evidence-based psychotherapies with broad dissemination potential. We report preliminary results from a multi-site randomized trial comparing the effectiveness of brief Behavioral Activation (BA) therapy to usual care for women with elevated depressive symptoms during pregnancy. Methods Women receiving prenatal care at Kaiser Permanente Colorado and Georgia, Group Health Cooperative, and HealthPartners (N = 163) were screened for depressive symptoms prior to or at their OB visit. Those with scores ≥ 10 on the PHQ-9 were recruited, consented, and randomized to receive 10 sessions of BA (N = 85) or usual care (N = 78). Obstetric nurses and behavioral health providers were trained to deliver BA by telephone, in the obstetrics clinics, or in patients’ homes. Participants’ mean age was 28, 37% (64/163) were pregnant with their first child, 47% (76/163) were non-White, and 15% (25/163) were Hispanic ethnicity. A majority (63%, or 102/163) reported receiving prior treatment for depression. There were no differences in demographic or clinical characteristics between the BA and usual care groups. The primary outcome measure was change in depression symptoms on the PHQ-9, obtained via a centralized web-based survey 10 weeks following randomization. Results Mean baseline PHQ-9 scores for the BA and usual care groups were 14.9 (95% CI 14.1, 15.7) and 14.4 (95% CI 13.7, 15.2), respectively. Women randomly assigned to BA reported significantly greater improvement than women in usual care; mean PHQ-9 scores for the BA and control groups were 8.5 (95% CI 7.2, 9.8) and 10.3 (95% CI 9.1, 11.5), respectively (P = .04), and 46.5% (33/71) of the BA group had a 50% or greater reduction in PHQ-9 scores, vs. 30.4% (21/69) of the control group (P = .05). Conclusions Behavioral activation may be an effective and feasible treatment for depressed pregnant women, with broad dissemination potential.