Mindfulness recent research

Summary Mindfulness –Why focus on depression MBCT –update of the trials ‘How does it work?’ Qualitative studies Mindfulness and Neuroscience MBCT and other clinical groups

Mindfulness Translation of ancient Pali word “sati” - “awareness” – direct, open-hearted “knowing” Traditionally cultivated by meditation practices –Learning to pay attention Moment by moment Intentionally With curiosity and compassion

Research Publications

Overview of MBCT  Eight weekly classes plus all-day session. Each hours.  Pre-class interview  to explain, motivate and point out the commitment that will be necessary  Up to 12 in each class (Kabat-Zinn – 30 in each class)  Homework, up to one hour per day, 6 days a week - mostly audiotapes of mindfulness practice + generalisation practice  Pattern  First half - concentration/steadying the mind  Second half – wider awareness; relapse prevention

First outcome trial: results nFor patients with only 2 previous episodes (23% of sample) - No effect of MBCT on relapse nFor patients with 3 or more previous episodes (77% of sample) - Significant effects n TAU: 66% relapsed in 12 months n MBCT: 37% relapsed in 12 months

Teasdale, Segal, Williams et al., 2000, JCCP Survival Curve (for patients with 3 or more previous episodes - 60 weeks)

MBCT as alternative to Continued Antidepressants Kuyken et al., 2008 JCCP Two group RCT All patients on long term ADMs All in remission or partial remission N = 62 - Continued with ADMs N = 61 – MBCT and help in coming off ADMs (75% succeeded)

Kuyken et al (2008) MBCT vs m-ADMs

MBCT for prevention of depressive relapse: summary nFirst RCTs of preventative clinical intervention based on mindfulness nFor more serious patients (history of >3 episodes), MBCT halves chances of relapse nMBCT effective for “autonomous” relapse processes nHighly cost effective (because class-based approach): Clinician time per patient < 5 hours on average nAppears equivalent to continued medication nEspecially relevant when recovery is ‘unstable’

Application to Treatment resistant depression (TRD) Kenny & Williams (2007) All symptomatic, despite ADM (74%) and CBT (68%) N = 50 (49 completers) 43% in remission at end (<10 on BDI)

How does it work ? Mindfulness Why focus on depression MBCT update of the trials ‘How does it work?’ Theoretical models Clinical observation Qualitative studies Mindfulness and Neuroscience MBCT and other clinical groups

John Teasdale Implicational meaning Evoke sad feeling Cognitive loops Bodily feedback loops inner collapse

“ The patterns of mind that keep people trapped in emotional suffering are, fundamentally the same patterns of mind that stand between all of us, and the flowering of our potential for a more deeply satisfying way of being”

Changes in three domains What the mind is processing ( attentional training shifting mental gear from doing to being mode ) How the mind is processing ( openness to experience, acceptance, curiosity, compassion, i.e. panic attacks ) View or perspective ( of self and others - behavioural changes )

Changes in self compassion

Qualitative studies “ greater awareness of warning signals” “coming to terms with depression – sense of acceptance “ “ feeling empowered to change” Changes in relationships Group effect very important Sense of struggle – hitting barriers

Neuroscience Mindfulness –Why focus on depression MBCT –update of the trials ‘How does it work?’ Qualitative studies Mindfulness and Neuroscience MBCT and other clinical groups

Lazar et al 2005 Meditation experience is associated with cortical thickness Neuroreport, 16,

Mindfulness training increases ‘viscero-somatic’ processing and uncouples ‘narrative-based’ processing (Farb et al, 07 )

Einstein “ A Human being is a part of the whole, a part limited in time and space. He experiences himself, his thoughts and feelings as something separated from the rest a kind of optical delusion of consciousness. This delusion is a kind of prison for us, restricting us to our personal desires and to a few persons nearest to us. Our task must be to free ourselves from this prison by widening our circle of compassion to embrace all, and the whole of nature in its beauty.”