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What’s Old Is New: Scientific Examination of Meditation In Mood. Saundra Jain, MA, PsyD , LPC Adjunct Clinical Affiliate University of Texas at Austin School of Nursing Austin, Texas Executive Director Mental Aerobics Project (MAP) Austin, Texas. - PowerPoint PPT Presentation
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What’s Old Is New: Scientific Examination of Meditation In Mood
Saundra Jain, MA, PsyD, LPCAdjunct Clinical AffiliateUniversity of Texas at AustinSchool of NursingAustin, Texas
Executive DirectorMental Aerobics Project (MAP)Austin, Texas
STAR*D Results: Are Current Treatment Options Giving Us All That We Want?
1Trivedi MH et al. Am J Psychiatry. 2006;163(1):28-40; 2Trivedi MH et al. N Engl J Med. 2006;354(12):1243-1252; 3Rush AJ et al. N Engl J Med. 2006;354(12):1231-1242; 4Nierenberg AA et al. Am J Psychiatry. 2006;163(9):1519-1530; 5Fava M et al. Am J Psychiatry. 2006;163(7):1161-1172; 6McGrath PJ et al. Am J Psychiatry. 2006;163(9):1531-1541.
Mono Aug Switch Aug Switch Aug Switch0%
10%
20%
30%
40%
High LowWindow of Opportunity
Patie
nts
in R
emis
sion
Remission: (HAM-D17 ≤7)
Level 1 Level 2 Level 3 Level 4
27.5%29.9%
21.2% 20.3%
16.1%13.7%
6.9%
STAR*D Remission Rates1-6
Mono Aug Switch Aug Switch Aug Switch
STAR*D Reveals 2 Striking Shortcomings of Current Therapy
1. Low rates of remission
2. High rates of relapse
STAR*D, Sequenced Treatment Alternatives to Relieve Depression.
As Clinicians Dealing With Depression, We Must Ask Ourselves A Few Questions:
• Is there an urgent need for other treatment options (as alternatives or as add-ons)?• Is meditation potentially an option that
meets both of these needs?• And if so, how do we incorporate meditation
into our clinical practices?
Volumetric Changes in Meditators
Hölzel BK et al. Soc Cogn Affect Neurosci. 2008;3(1):51-61.
MRI brain images of 20 mindfulness
(Vipassana) meditators (mean practice 8.6 years;
2 h daily) and compared the
regional gray matter concentration to that
of non-meditators matched for sex,
age, education, and handedness.
Volumetric Changes Over 8 Weeks of Mindfulness-Based Therapy: Focus on Amygdala
Hölzel BK et al. Soc Cogn Affect Neurosci. 2010;5(1):11-17.
Stressed but otherwise healthy individuals (N=26) participated in an 8-week mindfulness-based stress reduction intervention.
Volumetric Changes In The Hippocampus With 8 Weeks of Mindfulness-Based Therapy
Hölzel BK et al. Psychiatry Res. 2011;191(1):36-43.
16 healthy, meditation-naive participants were obtained before and after they underwent the 8-week program. Changes in gray matter concentration were investigated using voxel-
based morphometry, and compared with a waiting list control group of 17 individuals.
50 healthy women (mean age=41.32, range=30-65), 25 novices and 25 experts, were exposed to each of the conditions (yoga, movement control, and passive-video control) during 3 separate visits.
Autonomic Nervous System And Inflammatory Responses, Stress, And Meditation
Kiecolt-Glaser JK et al. Psychosom Med. 201;72(2):113-121.
HRSD15m, Hamilton Rating Scale for Depression scores at 15-month follow-up; MBCT, Mindfulness-Based Cognitive Therapy (n=43); M-ADM, Maintenance Antidepressant Medication (n=37).
Answer: By Reducing Cognitive ReactivityHow Does MBCT Work?
Kuyken W et al. Behav Res Ther. 2010;48(11):1105-1112.
What Does Emotional Regulation Have To Do With Depression?
My life is ruined
I feel hopeless
My life is worthless
I can’t function
I’m desperate
MBCT in Generalized Anxiety Disorder
BAI, Beck Anxiety Inventory; BDI, Beck Depression Inventory; PSWQ, Penn State Worry Questionnaire; POMS, Profile of Mood States.
Evans S et al. J Anxiety Disord. 2008;22(4):716-722.
BAI PSWQ POMS tension-anxiety BDI0
10
20
30
40
50
60
70
19
60.82
16.913.8
8.91
48.82
9.7 8.82
Baseline Post-intervention
Mea
n Sc
ore
P<0.05
MBCT and Panic Disorder
HAM-A, Hamilton Anxiety Rating Scale; PDSS, Panic Disorder Specific Scale.Kim B et al. J Anxiety Disord. 2010;24(6):590-595.
HAM-A PDSS0
2
4
6
8
10
12
14
16
18 16.8
10.0
12.6
6.2
12.5
4.23.3 3.3
0 week
2nd week
4th week
8th week
Mea
n Sc
ores
P<0.01
MBCT In Treatment-Resistant Depression
Kenny MA, Williams JM. Behav Res Ther. 2007;45(3):617-625.
79 patients, 8 weeks of MBCT
Pre-post effect size = 1.04
106 recovered depressed patients with a history of at least 3 depressive
episodes continued either with their
treatment as usual (TAU) or received MBCT
in addition to TAU.
MBCT: The Power of Relapse Prevention, The Belgian Experience
Godfrin KA, van Herringan C. Behav Res Ther. 2010;48(8):738-746.
Mean time to first relapse post study:• 39.5 wks for TAU• 53.7 wks MBCT/TAU
MBCT improved time to first
relapse by 35%
MBCT: A Promising New Therapy
M-ADM, medication (antidepressant continuation); Pla+Clin, placebo plus clinical management.Segal ZV et al. Arch Gen Psychiatry. 2010;67(12):1256-1264.
Results of The Xue Study
IBMT, integrative body-mind training; RT, relaxation training.Xue S et al. Neuroreport. 2011;22(12):570-574.
15 experimental participants (8 women) practiced 30-min IBMT from Monday to Friday for 1 month, with a total of 11 h of training; whereas 17 controls (9 women)
received the same amount of RT.
The trainees concentrated on achieving a balanced state of body and mind guided by an IBMT coach and the compact disc, whereas the control group
focused on muscle relaxation guided by a tutor and compact disc.
What Does The Xue Study Show Us?
Xue S et al. Neuroreport. 2011;22(12):570-574.
Complete novices, even with 11 hours of training over a month, are able to ‘change’ brain connectivity in a structure of immense
importance to mood regulation – the Anterior Cingulate Cortex (ACC).
IBMT
ACCN
etw
ork
Eff
icie
nc
y
Net
wo
rk C
on
nec
tivi
ty
Let’s Take A Look…
Jung YH et al. Neurosci Lett. 2010;479(2):138-142.
Control (n=57); Meditation group (n= 67)
Findings From The Jung Study
• The meditation group obtained higher scores on positive affect (P=0.019) and lower scores on stress (P<0.001) compared to the control group• Plasma DA levels were higher in the meditation
(P=0.031) than in the control group• Participants that had practiced meditation 48
months or more, showed a positive correlation between positive affect and plasma DA levels (r=0.501, P=0.013)
Jung YH et al. Neurosci Lett. 2010;479(2):138-142.
Let’s Turn Our Attention To The Clinical Aspects of Mindfulness Meditation
Practical Tips For Incorporating Mindfulness Meditation Into Your Clinical Practice
Walking Down the Street
On the other side of the street you see somebody you know.
You smile and wave.
The person does not wave back and keeps walking.
You’re walking down the street.
Meditation and CBT = MBCT
Cognitive Behavioral Therapy
Mindfulness Meditation
MindfulnessBased
Cognitive Therapy
“Paying Attention In A Particular Way: On Purpose, In The Present Moment, And Nonjudgementally.”
--- Dr. Jon Kabat-Zinn University of Massachusetts Medical Center
Mindfulness: What Is It?
Kabat-Zinn J. Coming to Our Senses: Healing Ourselves and the World Through Mindfulness. New York, NY: Hyperion; 2005.
Mindlessness and Vulnerability to Depression
NON-AWARENESS
OLD PATTERNS INTRUDE
WISH FOR THINGS TO BE
DIFFERENT
RUMINATION DEPRESSION
MEMORY BIAS
POOR PROBLEM SOLVING
Mindfulness and Prevention of Relapse Into Depression
LOW MOOD
OLD PATTERNS INTRUDE
WISH FOR THINGS TO BE
DIFFERENT
MINDFUL AWARENESS
FREEDOM TO CHOOSE NOT
TO “GO THERE”
SAFE “PLATFORM”
CALMCONNECTED
CREATIVE
Practicing Mindfulness
“If your attention wanders a hundred times, simply bring it back a hundred
times.”
(Present Moment)
(Attention)
(Nonjudgmental)
Mind on chosen target
Attention wanders
Observe wandering
, begin again
MBCT Outline
• Mindfulness facilitator
• 2 hours a week for 8 weeks
• 1 all day session between weeks 5 and 7
• Daily homework using CDs
• Talk about experiences with home practices, obstacles, and how to deal with them
THOUGHTS
FEELINGS
SENSATIONS
MBCT Class Themes
Class 1: Automatic Pilot
Class 2: Dealing with Barriers
Class 3: Mindfulness of the Breath
Class 4: Staying Present
Class 5: Allowing and Letting Be
Class 6: Thoughts are Not Facts
Class 7: How Can I Best Take Care of Myself
Class 8: Using What’s Been Learned to Deal with Future Moods
• On Purpose• Present
Moment• Without
Judgment
MBCT Classes
The practices help to:• Become familiar with the workings of your mind• Notice the times when you are at risk of getting caught in old
habits that re-activate downward mood spirals• Explore ways of letting go of old habits and, if you choose,
entering a different way of being• Get in touch with a different way of knowing yourself and the
world• Notice small beauties and pleasures in the world instead of
living in your head• Be kind to yourself instead of wishing things were different • Find a way so you don’t have to battle with yourself • Accept yourself as you are, rather than judging yourself
3-Minute Breathing Space:Mini Meditation
First Step in Responding to Challenging Situation & Feelings
MBSR Resources
http://www.umassmed.edu/Content.aspx?id=41254&LinkIdentifier=id; Accessed 04/22/13.
Founded by Dr. Jon Kabat-Zinn in 1979. Eight-week program focusing on how to
use innate resources and
abilities to respond more effectively to
stress, pain, and illness.