A Randomized Controlled Pilot Study on Mindfulness-Based Cognitive Therapy for Unipolar Depression in Patients With Chronic Pain

Abstract

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

Effect of mindfulness-based training on aggression and empathy of adolescents at the juvenile correction and rehabilitation center

“…Another important difference is that cognitive-behavior therapy teaches coping skills to use during stressful or anxiety producing moments, whereas mindfulness is not just a coping tool but a way of being to be practiced in all moments. Mindfulness involves adopting a new life perspective [20] which one carries through all situations, continuously, moment to moment. Like all research projects, this study had limitations, some of which were the small number of the participants, the short interval between the posttest and delayed posttest and gender (females were not included).…”

“…There is some evidence that awareness reduces physical and mental problems. These include chronic pain and relapse of depression [20], mood and stress disorder [21], and anxiety. Until present, however, several attempts investigating the effectiveness of this approach on anger and aggression have failed.…”

The Role of Psychiatric Education in Pain Management

“…Cognitive-behavioral therapy, designed to modify cognitive distortions and distressing thoughts associated with pain and to enhance coping skills to deal effectively with the pain experience, is considered a first-line psychosocial treatment for chronic pain [16]. Other psychotherapeutic approaches, such as mindfulness-based interventions, may also be used in chronic pain management, especially when integrated into a comprehensive pain management approach [17] or when depression is comorbid [18]. Surprisingly, little has been written about the role of psychoeducation in pain management, although some suggest that it could be useful and potentially cost saving [19].…”

Between mood and matter

“…Based on: de Jong, M., Belleflamme J., Dale, C., Gard, T., Gamel, C., Mischoulon, D., Peeters, F. (2017). Metabolic syndrome in Dutch patients with bipolar disorder; a cross sectional study.…”

“…Based on: de Jong, M., Peeters, F., Gard, T., Ashih, H., Doorley, J., Walker, R., Rhoades, L., Kulich, R., Kueppenbender, K., Alpert, J., Hoge, E., Britton, W., Lazar, S., Fava, M., Mischoulon, D. (2017). A randomized controlled pilot study on mindfulness-based cognitive therapy for unipolar depression in patients with chronic pain.…”