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Objective Chronic Pain (CP) is a disabling illness, often comorbid with depression. We performed a randomized controlled pilot study on mindfulness-based cognitive therapy (MBCT) targeting depression in a CP population. Methods Participants with CP lasting ≥ 3 months, DSM-IV Major Depressive Disorder (MDD), Dysthymic Disorder, or Depressive disorder NOS, and a Quick Inventory of Depression scale (QIDS-C16) score ≥ 6 were randomized to MBCT (n = 26) or waitlist (n = 14). We adapted the original MBCT intervention for depression relapse prevention by modifying the psychoeducation and Cognitive Behavioral Therapy (CBT) elements to an actively depressed chronic pain population. We analyzed an intent-to treat (ITT) and a per protocol sample; the per protocol sample included participants in the MBCT group who completed at least 4 out of 8 sessions. The change in the QIDS-C16 and Hamilton Rating Sale for Depression (HRSD17) were the primary outcome measures. Pain, quality of life and anxiety were secondary outcome measures. Data collection took place between January 2012 and July 2013. Results Nineteen (73%) participants completed the MBCT program. No significant adverse events were reported in either treatment group. ITT analysis (n=40) revealed no significant differences. Repeated measures ANOVAs for the per protocol sample (n=33) revealed a significant treatment × time interaction (F (1, 31) = 4.67, p = 0.039, η2p = 0.13) for the QIDS-C16, driven by a significant decrease in the MBCT group (t (18) = 5.15, p < 0.001, d = 1.6), but not in the control group (t (13) = 2.01, p = 0.066). The HRSD17 scores did not differ significantly between groups. The study ended before the projected sample size was obtained, which might have prevented effect detection in some outcome measures. Conclusions MBCT shows potential as a treatment for depression in individuals with CP, but larger controlled trials are needed. Trial registration www.clinicaltrials.gov. Identifier: NCT01473615

Pharmacotherapy for alcohol dependence is always delivered in a psychosocial context that may affect the outcome of the treatment. The rigorous study of different psychotherapeutic treatments for alcohol dependence has shown several distinct approaches to be effective. This article reviews the combination of alcohol dependence pharmacotherapies, including disulfiram, naltrexone, and acamprosate, with different psychosocial interventions. Many psychosocial interventions for alcohol dependence, including Alcoholics Anonymous, can be integrated successfully with pharmacotherapy. Psychosocial interventions, ranging from brief medical management to more intensive manualized psychotherapies, have all been shown to produce positive outcomes in certain studies, depending on the specific medication and the study context. Particularly successful combinations may include the use of behavioral marital therapy plus a disulfiram contract for patients taking that medication, and the combination of naltrexone or acamprosate with cognitive-behavioral therapy or psychosocial support. Ongoing research examining the optimal combinations of medications with different psychosocial treatments for alcohol dependence may further inform the field.

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Longitudinal integrated clerkship experiences are effective and sustainable; they offer particular strengths and opportunities for psychiatry education, and may influence student choice of specialty.