Mindfulness therapy beats drugs in preventing depression relapse

Mindfulness therapy — in the form known as mindfulness-based cognitive therapy (MBCT)– demonstrates greater efficacy than antidepressant medications for the prevention of a depression relapse, according to new data.

MBCT combines the use of tried-and-true cognitive-behavioral therapy (CBT) techniques with greater focus on self-awareness and self-reflection.

In the current study, the researchers describe how they implemented mindfulness-based therapy: “This is accomplished through daily homework exercises featuring (1) guided (taped) awareness exercises directed at increasing moment-by-moment nonjudgmental awareness of bodily sensations, thoughts, and feelings; (2) accepting difficulties with a stance of self-compassion; and (3) developing an ‘action plan’ composed of strategies for responding to early warning signs of relapse/recurrence.”

Researchers led by Zindel Segal, Ph.D., of the Centre for Addiction and Mental Health in Canada, studied 160 adults who met major depressive disorder criteria and had at least two previous episodes of depression.

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After eight months of treatment, 84 — over half — achieved remission from depression. Patients in remission were then randomly assigned to one of three treatment groups: 28 continued taking their medication; 30 had their medication slowly replaced by placebo; and 26 tapered their medication and then received MBCT.

The mindfulness therapy group had the lowest relapse rate at the 18-month followup — 38 percent, compared with 46 percent who were on maintenance antidepressant medication, an 8 percent difference. The placebo group had the worst depression relapse rate of 60 percent.

The researchers further examined and categorized people in the study according to whether they were considered stable or unstable remitters. About half (51 percent) of patients were classified as unstable remitters — individuals who had symptom “flurries” or intermittently higher scores on depression rating scales despite having a low enough average score to qualify for remission. The other half (49 percent) were stable remitters with consistently low scores.

Among unstable remitters, those taking maintenance medication or undergoing cognitive behavioral therapy were about 73 percent less likely to relapse than those taking placebo. Among stable remitters, there were no differences between the three groups.

“Our data highlight the importance of maintaining at least one active long-term treatment in recurrently depressed patients whose remission is unstable,” the authors wrote.

“For those unwilling or unable to tolerate maintenance antidepressant treatment, mindfulness-based cognitive therapy offers equal protection from relapse during an 18-month period.”

It is unclear exactly how mindfulness-based therapy works, but it may change neural pathways to support patterns that lead to recovery instead of to deeper depression, they note.

“Relapse and recurrence after recovery from major depressive disorder are common and debilitating outcomes that carry enormous personal, familial and societal costs,” the authors wrote as background information in the article.

The current standard for preventing relapse is maintenance therapy with a single antidepressant. This regimen is generally effective if patients take their medications, but as many as 40 percent of them do not.

“Alternatives to long-term antidepressant monotherapy, especially those that address mood outcomes in a broader context of well-being, may appeal to patients wary of continued intervention,” the authors said.

The study appears in the December issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

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Meditation reduces the emotional impact of pain, making it easier to bear

People who meditate regularly find it easier to cope with pain because their brains anticipate it less, a study has found.

The findings could help develop new treatments from those who suffer from conditions that cause chronic pain.

Scientists from Manchester University compared non-meditators with a group who had meditated. Although they had varying levels of experience they had all tried mindfulness meditation, which seeks to anchor the person in the present.

Brain scans revealed that the most advanced meditators were the least likely to anticipate pain induced by a laser device, which made the experience more bearable.

Lead researcher Dr Christopher Brown, said: ‘Meditation is becoming increasingly popular as a way to treat chronic illness such as the pain caused by arthritis.

‘Recently, a mental health charity called for meditation to be routinely available on the NHS to treat depression, which occurs in up to 50 per cent of people with chronic pain.

‘However, scientists have only just started to look into how meditation might reduce the emotional impact of pain.’

The study, to be published in the journal Pain, found that participants who meditated showed unusual activity in the brain region known to be involved in controlling attention and thought processes when potential threats are perceived.

Dr Brown said: ‘The results of the study confirm how we suspected meditation might affect the brain.

‘Meditation trains the brain to be more present-focused and therefore to spend less time anticipating future negative events. This may be why meditation is effective at reducing the recurrence of depression, which makes chronic pain considerably worse.’

Dr Brown said the findings should encourage further research into how the brain is changed by meditation practice.

He said: ‘Although we found that meditators anticipate pain less and find pain less unpleasant, it’s not clear precisely how meditation changes brain function over time to produce these effects.

‘However, the importance of developing new treatments for chronic pain is clear: 40 per cent of people who suffer from chronic pain report inadequate management of their pain problem.’

In the UK, more than 10 million adults consult their GP each year with arthritis and related conditions. The estimated annual direct cost of these conditions to health and social services is £5.7billion.

Study co-author Professor Anthony Jones said: ‘There may also be some types of patient with chronic pain who benefit more from meditation-based therapies than others.

‘If we can find out the mechanism of action of meditation for reducing pain, we may be able to screen patients in the future for deficiencies in that mechanism, allowing us to target the treatment to those people.’

[via the Daily Mail]
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Free your mind

I meet Andy Puddicombe, meditation guru to Premier League footballers, cabinet ministers and leading actors, in a sparsely decorated room in a London clinic. It’s the sort of place you go to discuss bunions, not the meaning of life. Yet Puddicombe is soon imparting wisdom gleaned from several years as a Buddhist monk, and guiding me through a meditation. The meditation lasts for only 10 minutes, and during it I find my mind meandering through my to-do lists, yet, when I open my eyes, I feel calm and focused – as if the insides of my head have been spring-cleaned.

Over the years, a body of research has built up extolling the many benefits of meditation. Most recently the Mental Health Foundation said the NHS should prescribe meditation routinely for depression (at the moment only 1 in 20 GPs do). Scientific studies have shown that meditation – specifically, mindfulness-based cognitive therapy (MBCT), an NHS-approved, secular version of Buddhist mind-training – is at least as effective as antidepressants. Regular meditation can enlarge the parts of the brain that control emotion and reach right into the mind and strengthen it.

Yet even though most of us are aware of the benefits, we’re often deterred by a myriad confusing options about where to learn meditation, as well as an inability actually to find the time to practise it. This is a situation Puddicombe is determined to change. “Outside of a religious or spiritual community there is not much available. Transcendental Meditation comes from a Hindu tradition and some are uncomfortable with that. Then there are Buddhist centres, which are great as you can get meditation for free or for a small donation, but a lot of people also find the religious context off-putting. Within the school of mindfulness there are places where people can do secular courses, yet these are presented in a therapeutic way – and not everybody is up for therapy.”

Yesterday Puddicombe held his first group meditation event for Headspace, a not-for-profit organisation he has set up. Its guiding principle is to provide simple meditation tools to as many people as possible. Puddicombe has also recorded 10 exclusive meditations for the Sunday Times website, each tailored to a specific problem, and now available to access for free. “In and of itself there is nothing religious about meditation. If I am able to present it as more of a life skill, then that will be more relevant to most people. My message is that meditation is not necessarily about sitting on the floor cross-legged and chanting for hours. I say to people, just take 10 minutes out of your day to do a simple breathing technique and you will see big results.” Puddicombe was a student when he left England, aged 22. “I had a number of difficult situations to deal with: my stepsister was killed in a car accident, my ex-girlfriend died having heart surgery, and I was involved in an accident where a couple of my friends were killed. It left me asking some big questions, the sort of questions that a pint of Tetley’s down the pub with my friends wasn’t going to answer.”

For the next few years he travelled between monasteries in Tibet and Thailand, often going into year-long retreats where he would rise at 2.30am and practise 15 to 18 hours a day of meditation. “I learnt how to have humility. A lot of people have a romantic view of going away and living in a monastery, but you crave those distractions, and all you are left with is yourself. It’s painful, it’s humbling, you see the madness and the difficulty that everyone is going through in life, but you come

to a greater acceptance. Rather than chasing after elusive happiness, I was able to sit back and see it’s actually already there.” When he was ordained, he was sent to teach at a Buddhist centre in Moscow. “I began to realise that the whole bald-headed, skirt-wearing thing didn’t work for everyone. You don’t necessarily take robes for life, and I decided it might be more effective to teach meditation as a lay person.”

Puddicombe, now 37, was taken under the wing of a vice-president of BP to whom he had taught meditation in Moscow, who gave him the means to set up Headspace in the UK. Since then he has built up an impressive roster of private and NHS clients, and there is now an eight-month waiting list to see him. He believes that meditation really helps with profound issues, and people come to him at the clinic with a huge variety of problems. “I see people with anxiety, depression, issues of anger, insomnia and addictive behaviour. The bottom line is that most of these things are driven by really strong habitual patterns of thought. Yes, of course they stem from difficult times in people’s lives, but what keeps them going is not being able to step out of that pattern.”

Meditation, says Puddicombe, allows you to become aware of those negative patterns and therefore step out of them. It can also ease milder complaints, increasing a general sense of wellbeing and reducing stress. As I leave his clinic with a smile on my face, I can well believe it.

[via Times Online]
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Meditation key to treat depression

Times of India: People with severe and recurrent depression could benefit from a new form of therapy that combines ancient forms of meditation with modern cognitive behaviour therapy, early-stage research by Oxford University psychologists suggests. Read more here.

The results of a small-scale randomised trial of the approach, called mindfulness-based cognitive therapy (MBCT), in currently depressed patients are published in the journal Behaviour Research and Therapy.

In an experiment, 28 people currently suffering from depression, having also had previous episodes of depression and thoughts of suicide, were randomly assigned into two groups.

One group received MBCT in addition to treatment as usual, while the other just received treatment as usual. The result indicated that the number of patients with major depression reduced in the group which received treatment with MBCT while it remained the same in the other group.

The therapy included special classes of meditation learning and advice on how best participants can look after themselves when their feelings threaten to overwhelm them.

Professor Mark Williams, who along with his colleagues in the Department of Psychiatry at the University of Oxford, developed the treatment said, “We are on the brink of discovering really important things about how people can learn to stay well after depression.”

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Buddhist meditation helps people quit drinking

A combination of cognitive behavioral therapy and Buddhist meditation can help people with drinking problems turn their backs on alcohol. Dr. Paramabandhu Groves, a consultant psychiatrist at the Alcohol Advisory Service in London, who has successfully run workshops with people with depression, has now turned his attention to using the techniques to help people with addictions. Dr. Groves has been ordained into the Triratna Buddhist Order based at the London Buddhist Center in Bethnal Green, east London.

Dr. Groves unveiled results at the annual conference of a pilot study in which 15 people with alcohol problems undertook mindfulness-based cognitive therapy (MBCT). Most found it helped them in their battle against alcohol and reported that it gave them the tools to challenge the negative thoughts that drove them to drink.

The technique comprises “mindfulness” which, through meditation, develops an awareness of emotions and physical feelings and then guides people to make creative choices about how to respond to them.

“It emphasizes critical awareness, rather than concentration,” said Dr Groves. “In meditation the mind keeps wandering off, so you note where the mind has gone and then you come back to the body sensation. When you do this, you begin to notice where the habitual patterns are and this gives you the ability to stay with negative thoughts. Once you stay with these negative thoughts, you can diffuse them and take the power out of them.” By doing this, said Dr. Groves, the vicious cycle of alcoholism can be broken. Negative thoughts, particularly linked to an external trigger, such a row with a partner, can trigger a relapse and lead to substance use. Mindfulness can break this link, Dr. Groves told delegates. Clients are taught how to recognize and resist negative thoughts by observing themselves non-judgmentally and learning to accept their emotions.

Each member was given a CD and asked to practice at home. One reported that it gave him a spiritual practice he found lacking in other recovery methods; others said it had given them a more immediate and conscious awareness of how they felt at a given moment.

The success of the program has not been a surprise to Dr. Groves: “I’ve have been doing the MBCT for depression since 2004 and that had been very popular,” he said.

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