1. Main Outcome Results November 6, 2009 Nancy J. Thompson, Ph.D., M.P.H.

2. Using Practice and Learning to Increase Favorable Thoughts

3. Project UPLIFT Delivery of MBCT by Web and Telephone Groups To people with epilepsy Randomly assigned to groups of 7 Computers and Internet access provided if needed Groups used for support surrounding Epilepsy 8 Sessions Facilitators Peers and Graduate Students Supervised by a licensed psychologist Funding: Centers for Disease Control and Prevention

4. Session #Topic 1Monitoring Thoughts 2Challenging and Changing Thoughts 3Coping and Relaxing 4Attention and Mindfulness 5The Present as a Calm Place 6Thoughts as Changeable and Impermanent 7Pleasure and Reinforcement 8Relapse Action Plans The 8 Sessions

5. Each Session Check-in Teaching Group Exercise Discussion Skill-building w/ discussion Review & Homework

6. Design Stratum 1: Pretest 2 gp 8 wk phone Interim Follow-up Stratum 2: Pretest 2 gp 8 wk Web Interim Follow-up Stratum 3: Pretest Interim 2 gp 8 wk phone Follow-up Stratum 4: Pretest Interim 2 gp 8 wk Web Follow-up Baseline Week 8 Week 16 Emphasis on Feasibility and Acceptability Cross-over Design to Explore Effectiveness

7. Results

8. Participation Screened (n=98) Excluded (n=34) Eligible (n=53) Assessments Completed Baseline (n=48) Completed Interim Survey (n=40) Completed Third Survey (n=35) Participated in at least one session Phone Intervention Group (n=12) Web Intervention Group (n=10) Phone Waitlist Group (n=10) Web Waitlist Group (n=10) 40 (75.5%) participated and completed the assessment following their participation

9. Data Analysis Baseline Differences Only mean Self Compassion was statistically significant (t = 3.00, df = 38, p = 0.005) Intervention group (mean = 19.7) Waitlist group (mean = 16.0) Repeated Measures ANCOVA Assess the change in scores over time in the intervention and the waitlist groups Controlled all analyses for Self Compassion

10. Depression Measures MeasureTime Intervention (M w/ outliers ) Treatment- as-Usual Waitlist (M w/ outliers ) Outliers IncludedOutliers Deleted F interaction (df 1,37) p-value F interaction (df 1,36) p-value BDI Pretest Interim 15.2 5.5 12.4 10.6 11.990.001**12.970.001** mBDIPretest Interim 31.1 19.5 27.9 25.9 10.080.003**10.670.002**

11. Depression: mBDI Treatment vs. Waitlist F overall = 40.93, p=.0001 F interaction = 10.14, p=.003* Phone vs. Web vs. Waitlist F overall = 40.11, p=.0001 F interaction = 4.99, p=.012*

12. Depression: BDI Treatment vs. Waitlist F overall = 42.22, p=.0001 F interaction = 11.99, p=.001*

13. Depression: BDI By Intervention Type Phone vs. Web vs. Waitlist F overall = 41.65, p=.0001 F interaction = 5.93, p=.006*

14. Effect by Presence of MDD MeasureTime InterventionWaitlist F interaction dfp-value no MDDMDD no MDDMDD BDI Pretest Interim 9.2 1.8 18.8 7.8 8.7 9.0 23.8 16.2 5.473 1 1.209 2 3,35 1,35 0.025* 0.279 mBDI Pretest Interim 23.4 14.3 35.9 23.0 24.0 40.7 32.6 4.820 1 0.651 2 3,35 1,35 0.035* 0.421 * <.05 1 Time by Condition 2 Time by Condition by MDD

15. Maintenance of Effects MeasureTimeIntervention Treatment -as-Usual Waitlist Fdfp-value BDI Pretest Interim Posttest 14.5 4.6 5.7 13.4 10.8 8.3 0.121 7.541 1.124 1,30 0.730 0.010* 0.297 mBDIPretest Interim Posttest 30.0 18.2 29.5 26.0 21.0 0.018 6.026 0.406 1,30 0.895 0.020* 0.529 * <.05

16. Knowledge/Skills & Self-Efficacy MeasureTimeInterventionTAU WaitlistF interaction df 1,37 P-value Knowledge/ Skills Pretest Interim 122.5 136.3 123.5 126.0 4.750.036* Depression Coping Self-Efficacy Pretest Interim 67.7 75.5 72.4 72.9 3.590.066

17. Knowledge & Skills Treatment vs. TAU Waitlist F overall = 8.97, p=.005 F interaction = 4.75, p=.036* Phone vs. Web vs. Waitlist F overall = 9.67, p=.004 F interaction = 3.67, p=.036*

18. Depression Coping Self-Efficacy Treatment vs. Waitlist F overall = 6.89, p=.013 F interaction = 3.59, p=.066

19. Quality of Life MeasureTimeIntervention Tx As Usual Waitlist F interaction df 1,37 P-value Satisfaction with Life Pretest Interim 18.2 21.0 18.3 18.0 3.0290.090 1 Mental Health QOL Pretest Interim 59.3 80.9 65.4 83.6 0.1230.727 Physical Health QOL Pretest Interim 68.9 78.9 76.2 80.8 0.4960.486 1.05<p<.10

20. Satisfaction with Life Treatment vs. Waitlist F overall = 4.52, p=.040 F interaction = 3.03, p=.090

21. Mental Health QOL Treatment vs. Waitlist F overall = 16.07, p=.0001 F interaction = 0.12, p=.727 Phone vs. Web vs. Waitlist F overall = 15.10, p=.0001 F interaction = 0.50, p=.609

22. Physical Health QOL Treatment vs. Waitlist F overall = 3.99, p=.053 F interaction = 0.50, p=.486 Phone vs. Web vs. Waitlist F overall = 3.83, p=.058 F interaction = 0.31, p=.737

23. Summary Effective in: Reducing depressive symptoms and teaching knowledge and skills associated with reducing depression Intervention group showed significant improvement compared to the waitlist Equally effective for those with and without MDD Reduction in depressive symptoms maintained Approaching significance for Satisfaction with Life and Depression Coping Self-Efficacy Delivery Both phone and web were significantly more effective in reducing depression than waitlist condition

24. Summary QOL Findings consistent with the premises of mindfulness that suffering is not something to turn away from or something in need of fixing, that it is worthy of attention, that through attention we can see the ways in which we attach thoughts to the suffering that exacerbate it, and that letting go of these thoughts reduces suffering (Segal et al.)

25. Going Forward ~$1 million Challenge Grant UPLIFT for Prevention Participants in 4 states Georgia Michigan Texas Washington