Tania Perich

Mindfulness-based cognitive therapy vs cognitive behaviour therapy as a treatment for non-melancholic depression.

AIM To examine the comparative effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) and Cognitive Behaviour Therapy (CBT) as treatments for non-melancholic depression. METHOD Participants who met criteria for a current episode of major depressive disorder were randomly assigned to either an 8-week MBCT (n=19) or CBT (n=26) group therapy condition. They were assessed at pre-treatment, 8-week post-group, and 6- and 12-month follow-ups. RESULTS There were significant improvements in pre- to post-group depression and anxiety scores in both treatment conditions and no significant differences between the two treatment conditions. However, significant differences were found when participants in the two treatment conditions were dichotomized into those with a history of four or more episodes of depression vs those with less than four. In the CBT condition, participants with four or more previous episodes of depression demonstrated greater improvements in depression than those with less than four previous episodes. No such differences were found in the MBCT treatment condition. No significant differences in depression or anxiety were found between the two treatment conditions at 6- and 12-month follow-ups. LIMITATIONS Small sample sizes in each treatment condition, especially at follow-up. CONCLUSIONS MBCT appears to be as effective as CBT in the treatment of current depression. However, CBT participants with four or more previous episodes of depression derived greater benefits at 8-week post-treatment than those with less than four episodes.

A randomized controlled trial of mindfulness-based cognitive therapy for bipolar disorder.

To compare the efficacy of mindfulness‐based cognitive therapy (MBCT) plus treatment as usual (TAU) to TAU alone for patients with bipolar disorder over a 12‐month follow‐up period.

The association between meditation practice and treatment outcome in Mindfulness-based Cognitive Therapy for bipolar disorder.

This study aimed to examine the impact of quantity of mindfulness meditation practice on the outcome of psychiatric symptoms following Mindfulness-based Cognitive Therapy (MBCT) for those diagnosed with bipolar disorder. Meditation homework was collected at the beginning of each session for the MBCT program to assess quantity of meditation practice. Clinician-administered measures of hypo/mania and depression along with self-report anxiety, depression and stress symptom questionnaires were administered pre-, post-treatment and at 12-month follow-up. A significant correlation was found between a greater number of days meditated throughout the 8-week trial and clinician-rated depression scores on the Montgomery-Åsberg Depression Rating Scale at 12-month follow-up. There were significant differences found between those who meditated for 3 days a week or more and those who meditated less often on trait anxiety post-treatment and clinician-rated depression at 12-month follow-up whilst trends were noted for self-reported depression. A greater number of days meditated during the 8-week MBCT program was related to lower depression scores at 12-month follow-up, and there was evidence to suggest that mindfulness meditation practice was associated with improvements in depression and anxiety symptoms if a certain minimum amount (3 times a week or more) was practiced weekly throughout the 8-week MBCT program.

Cognitive predictors of change in cognitive behaviour therapy and mindfulness-based cognitive therapy for depression.

BACKGROUND An appreciation of cognitive predictors of change in treatment outcome may help to better understand differential treatment outcomes. The aim of this study was to examine how rumination and mindfulness impact on treatment outcome in two group-based interventions for non-melancholic depression: Cognitive Behaviour Therapy (CBT) and Mindfulness-Based Cognitive Therapy (MBCT). METHOD Sixty-nine participants were randomly allocated to either 8-weekly sessions of group CBT or MBCT. Complete data were obtained from 45 participants (CBT = 26, MBCT = 19). Outcome was assessed at completion of group treatments. RESULTS Depression scores improved for participants in both group interventions, with no significant differences between the two treatment conditions. There were no significant differences between the interventions at post-treatment on mindfulness or rumination scores. Rumination scores significantly decreased from pre- to post-treatment for both conditions. In the MBCT condition, post-treatment rumination scores were significantly associated with post-treatment mindfulness scores. CONCLUSIONS Results suggest that decreases in rumination scores may be a common feature following both CBT and MBCT interventions. However, post-treatment rumination scores were associated with post-treatment mindfulness in the MBCT condition, suggesting a unique role for mindfulness in understanding treatment outcome for MBCT.

Online mindfulness-based intervention for late-stage bipolar disorder: pilot evidence for feasibility and effectiveness

OBJECTIVES People in the late stage of bipolar disorder (BD) experience elevated relapse rates and poorer quality of life (QoL) compared with those in the early stages. Existing psychological interventions also appear less effective in this group. To address this need, we developed a new online mindfulness-based intervention targeting quality of life (QoL) in late stage BD. Here, we report on an open pilot trial of ORBIT (online, recovery-focused, bipolar individual therapy). METHODS Inclusion criteria were: self-reported primary diagnosis of BD, six or more episodes of BD, under the care of a medical practitioner, access to the internet, proficient in English, 18-65 years of age. Primary outcome was change (baseline - post-treatment) on the Brief QoL.BD (Michalak and Murray, 2010). Secondary outcomes were depression, anxiety, and stress measured on the DASS scales (Lovibond and Lovibond, 1993). RESULTS Twenty-six people consented to participate (Age M=46.6 years, SD=12.9, and 75% female). Ten participants were lost to follow-up (38.5% attrition). Statistically significant improvement in QoL was found for the completers, t(15)=2.88, 95% CI:.89-5.98, p=.011, (Cohen׳s dz=.72, partial η(2)=.36), and the intent-to-treat sample t(25)=2.65, 95% CI:.47-3.76, (Cohen׳s dz=.52; partial η(2)=.22). A non-significant trend towards improvement was found on the DASS anxiety scale (p=.06) in both completer and intent-to-treat samples, but change on depression and stress did not approach significance. LIMITATIONS This was an open trial with no comparison group, so measured improvements may not be due to specific elements of the intervention. Structured diagnostic assessments were not conducted, and interpretation of effectiveness was limited by substantial attrition. CONCLUSION Online delivery of mindfulness-based psychological therapy for late stage BD appears feasible and effective, and ORBIT warrants full development. Modifications suggested by the pilot study include increasing the 3 weeks duration of the intervention, adding cautions about the impact of extended meditations, and addition of coaching support/monitoring to optimise engagement.

The superiority of antidepressant medication to cognitive behavior therapy in melancholic depressed patients: a 12-week single-blind randomized study

To pursue the previously long‐standing but formally untested clinical view that melancholia is preferentially responsive to antidepressant medication in comparison with psychotherapy [specifically Cognitive Behavior Therapy (CBT)]. Second, to determine whether a broader action antidepressant medication sequencing regimen is superior to a Selective Serotonin Reuptake Inhibitor (SSRI) alone.

Towards recovery-oriented psychosocial interventions for bipolar disorder : quality of life outcomes, stage-sensitive treatments, and mindfulness mechanisms

Current adjunctive psychosocial interventions for bipolar disorder (BD) aim to impact illness course via information sharing/skill development. This focus on clinical outcomes contrasts with the emergent recovery paradigm, which prioritises adaptation to serious mental illness and movement towards personally meaningful goals. The aim of this review is to encourage innovation in the psychological management of BD by considering three recovery-oriented trends in the literature. First, the importance of quality of life as a target of recovery-oriented clinical work is considered. Second, the recent staging approach to BD is described, and we outline implications for psychosocial interventions tailored to stage. Finally, we review evidence suggesting that mindfulness-based psychosocial interventions have potential across early, middle and late stages of BD. It is concluded that the humanistic emphasis of the recovery paradigm provides a timely stimulus for development of a next generation of psychosocial treatments for people with BD.

Mindfulness, response styles and dysfunctional attitudes in bipolar disorder

BACKGROUND This study aimed to examine differences between mindfulness, dysfunctional attitudes and response styles in subjects with bipolar disorder, major depressive disorder and controls. METHOD A total of 192 participants were included in this study: 90 with bipolar disorder, 36 with remitted major depressive disorder and 66 subjects without a current or past history of a mood disorder. RESULTS After controlling for current mood state and co-morbid anxiety disorders, the groups did not differ on mindfulness or response styles scores, however, those with bipolar disorder scored significantly higher on the Dependency and Achievement subscales of the Dysfunctional Attitudes Scale than the other two groups. LIMITATIONS Sample sizes were relatively small for the control and remitted major depressive disorder groups making it difficult to draw definitive conclusions. CONCLUSIONS Participants with bipolar disorder appear to significantly differ from remitted depressives and controls on certain cognitive styles such as Dependency and Achievement on the Dysfunctional Attitudes Scale. Further research may help to understand how these cognitive domains impact on the course and outcome of bipolar disorder.

New-Generation Antidepressants, Suicide and Depressed Adolescents: How Should Clinicians Respond to Changing Evidence?

The purpose of the present paper was to identify, from the voluminous literature on efficacy and safety in new-generation antidepressants (NGAs) with depressed children and adolescents, practical clinical strategies for acute phase treatment. To this end a pragmatic survey of studies and reviews was undertaken. Meta-analyses of randomized controlled trials of NGAs in depressed children and adolescents have noted a comparative lack of efficacy, and a weak but statistically significant increased risk of self-harm and suicidal thoughts. But NGA prescription rates and youth suicide rates are generally inversely related, and ensuing ‘black box’ warnings about NGAs, by deterring NGA prescribing, have possibly contributed to rising youth suicide rates. In moderate–severe depression, benefits for fluoxetine and possibly other NGAs demonstrably outweigh risks. NGAs are not present in adolescents who die by suicide. Concern about NGA risks must be balanced against risks of non-treatment. While mild depression entails regular review, psychoeducation, self-care strategies and psychological interventions, NGAs should be administered concurrently with psychological treatments if depression is moderate– to severe, or if mild depression persists. Patients should be warned about off-label status of NGAs in depression, serious side-effects such as ‘activation’, suicidality, emotional blunting and manic switches, the need for adherence and avoiding abrupt discontinuation. They should be monitored early and regularly. Better evidence is required regarding psychological treatments, clinical course, and clinical practice trends. In moderate–severe depression the risk of suicide if NGAs are not used may outweigh any risk of self-harm associated with them.

Cognitive styles and clinical correlates of childhood abuse in bipolar disorder

In a relatively small number of previous studies, childhood abuse has been found to be associated with more severe symptom course, earlier onset, greater comorbidity, and greater suicidality in those diagnosed with bipolar disorder. There have been no prior reports looking for any association between childhood abuse and cognitive style. This study aimed to examine the relationship between cognitive factors, such as response styles to depressed mood and dysfunctional attitudes, clinical features, and childhood physical and sexual abuse in this population.