1. Researchers develop psychotherapy treatment for refugees’ trauma

    November 13, 2017 by Ashley

    From the Bielefeld University press release:

    They are suffering from nightmares, flashbacks, depression, or anxiety disorders: refugees coming to Germany from conflict areas are frequently traumatized. ‘Realistic estimates state that up to 40 per cent of refugees have mental problems. Hence, for the period since 2015, we are talking about several hundred thousand people who are in real need of psychological support,’ says Professor Dr. Frank Neuner from Bielefeld University. The psychologist is one of the team responsible for developing ‘Narrative Exposure Therapy’ (NET). It has been applied over the last 15 years in conflict zones from East Africa to Sri Lanka. What is special about this therapy is that it shows success after only a few sessions. In a new ‘research_tv’ programme at Bielefeld University, Frank Neuner talks about NET and explains the consequences of leaving refugees without treatment.

    ‘I believe that a large part of the general population is willing to accept that we now need to invest substantially in dealing with these traumatized refugees and that the state must make money available for this,’ says Frank Neuner. ‘Due to the threats in their home countries, many refugees will be staying with us for a long time. By helping them now, we shall be warding off problems that will otherwise confront us unavoidably in 20 or 30 years time.’

    Neuner designed and tested NET together with Dr. Maggie Schauer and Professor Dr. Thomas Elbert from the University of Konstanz. By working with this method, hundreds of child soldiers, victims of political violence, and war refugees have been able to process their traumatic experiences.

    The key principle of NET is a highly valued practice in every culture: telling stories. ‘Whenever we have gone through an emotional experience, we try to tell stories. This is how we try to make what we have experienced comprehensible to others,’ says Neuner. ‘Refugees have experienced a whole series of traumatic events. We talk together with them about their entire life history and build up a kind of autobiography that enables them to embed the single traumatic experiences in a meaningful context and work out the significance they have in their own personal lives.’ Together with their therapist, traumatized persons work their way repeatedly and chronologically through the negative and positive events in their lives. ‘The idea is to historicize the traumatic events. This permits closure, so that they no longer threaten the present.’

    To deliver therapy to people in crisis zones, Neuner together with colleagues from the University of Konstanz and further supporters founded the aid organisation ‘Vivo’. It is training lay therapists in countries such as Sri Lanka, Ruanda, Uganda, and the Congo. Unlike Germany, the health systems of these countries do not provide access to professional therapists. ‘However, even Germany does not have enough therapists to treat all the refugees with traumatic disorders. Many people in Germany already have to wait months for a treatment slot with a therapist,’ says Neuner. ‘One step towards a solution could be to give NET training to refugees and migrants here in Germany and to employ them within a stepped care model supervised by psychotherapists. However, the German legal situation does not permit this at present.’

    NET is already being practiced by professional therapists in Germany. Bielefeld University’s psychotherapy clinic is applying the method in therapy studies not only refugees with but also with survivors of child abuse, rape victims, and former members of the German military. The scientific further education centres at Bielefeld University and the University of Konstanz are qualifying psychologists, medical doctors, and psychotherapists to work with NET.


  2. Study shows clear effect of art therapy on severe depression

    November 10, 2017 by Ashley

    From the University of Gothenburg press release:

    Create a picture of how you are feeling on this particular day, said the first exercise in the art therapy. After ten treatments the patients who suffered from severe or moderately severe depression had shown more improvement than the patients in the control group, shows research at Sahlgrenska academy.

    “The conclusion is that it was the art therapy that facilitated their improvement,” says Christina Blomdahl, PhD at the institute of health and care sciences, licensed occupational therapist and art therapist.

    As part of her dissertation she has allowed 43 patients with severe or moderately severe depression to undergo a manual-based art therapy that she has developed herself. The control group consisted of 36 people who all suffered from the same medical condition.

    In parallel with this, all participants were given different combinations of medication, cognitive behavioral therapy, psychodynamic therapy and physical therapy. The majority of the participants were so affected by their depression that they were unable to work.

    The individual art therapy took place in psychiatry or primary care and was conducted by a specially trained therapist. Each session began with a short briefing and a relaxation exercise. After that it was crayons, water colors and creation that was on the agenda, all based on a predetermined setup.

    “They followed the manual I had created in order to ensure that it was scientific, but although everyone was given the same theme to go on the patients responded very differently to the exercises. The materials were simple, allowing people to doodle and feel free to express themselves the way they wanted to, and then they would talk about the picture and its significance to the participant,” explains Christina Blomdahl.

    After ten hour-long treatment sessions the patients had improved on an average of almost five steps on a rating scale used for depression. A large leap that entails a considerable change to everyday life, and sometimes it may also mean that a patient is able to return to work.

    Anxiety, sleep, ability to take initiative and emotional involvement are some of the factors that are assessed. In the control group that had not undergone art therapy there was no definite change.

    “The focal point was that people felt like they were meeting themselves; that the picture served as a mirror where you could see and make new discoveries about yourself, a bit like coming to life, says Christina Blomdahl.

    “Even the people who did not experience any direct benefit from the treatment had shown improvement. Painting pictures based on themes and discussing the pictures with the therapist promotes self-reflection and brain stimulation that takes place outside of the conscious mind,” she continues.

    “It is my hope that art therapy will be used in healthcare again. Based on evidence requirements it has been more or less scrapped by psychiatry, but this is one of the largest studies that has been conducted in this area and it is a step that may lead to more people being trained in it and the method being used again,” Christina Blomdahl concludes.

    Further information: https://gupea.ub.gu.se/handle/2077/52419


  3. Study suggests cognitive behavioral therapy improves functioning for people with chronic pain

    July 29, 2017 by Ashley

    From the American Pain Society press release:

    Cognitive Behavioral Therapy (CBT) is the most frequently used psychological intervention for people with chronic pain, and new approaches for improving CBT outcomes may be found in the psychological flexibility model and Acceptance and Commitment therapy (ACT), according to research reported in The Journal of Pain.

    Acceptance and Commitment Therapy (ACT) is based on the psychological flexibility model, which includes a therapeutic process known as “self-as-context” (SAC). Contextual self refers to a sense of self that is not based on self-evaluations. It is similar to being an observer of one’s own psychological experiences. Researchers in the United Kingdom writing in The Journal of Pain examined whether ACT influences SAC and if changes in measures of SAC are associated with treatment outcomes.

    Psychological flexibility is the ability to be more aware, more focused on goals and more engaged. Another aspect of psychological flexibility pertinent to chronic pain, and supported by SAC, is called committed action, which involves goal-directed, flexible persistence,” said co-author Lance M. McCracken, Professor of Behavioral Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London. “For pain management, ACT is an approach based on the psychological flexibility model and focuses on building effective patterns of behavior change rather than symptom reduction.”

    Four hundred twelve adults referred to a pain management center at Guy’s and St. Thomas’ Hospital in London were subjects for the study. They completed measures of treatment processes, such as SAC and committed action, and outcomes (pain-related interference, work and social adjustment, depression) before treatment, upon treatment completion and after nine months.

    Wider outcomes research suggests that ACT is effective for enhancing daily functioning and for decreasing psychological distress. A study published in 2011 assessed the long-term efficacy of acceptance and commitment therapy in more than 100 people with chronic pain. The evidence showed at three-year follow-up that 65 percent of study subjects had reliably improved in at least one key clinical domain, and improvements in psychological flexibility were associated with improvements in outcomes measures.

    Results of the current Kings College study showed that scores from both the process and outcomes measures significantly improved after treatment and were maintained at nine-month follow-up. The ACT-oriented treatment was associated with improved SAC as well as improved functioning. Changes in SAC were associated with changes in pain-related interference, work and social adjustment and depression.

    Greater psychological flexibility is associated with less pain-related anxiety and avoidance, less depression, less physical and psycho-social disability and other measures of patient function,” said McCracken. “Based on studies of forms of CBT that did not include ACT, acceptance of pain, one component of psychological flexibility, may be a general mechanism by which CBT treatments achieve improvements in functioning, and more specific targeting of pain-related acceptance may lead to further improvement is CBT outcomes.”

    The authors concluded that that the study results are consistent with an increasing number of longitudinal and mediation studies showing that ACT for chronic pain improves patient functioning, specifically through enhanced psychological flexibility.


  4. Study examines line between education and personal experience in the classroom

    June 29, 2017 by Ashley

    From the Concordia University press release:

    In the classroom, what’s the line between education and personal experience?

    This is a question addressed by Concordia alumnus Jason Butler (PhD 14) in an article recently published by The Arts in Psychotherapy.

    In the course of a North American and UK study, he found that the conflicting demands of education and therapy within the classroom can cause emotional stress and confusion among students in drama therapy and other professions using dramatic enactment.

    His conclusion? The use of personal material must be better defined to protect both students and faculty.

    “When educating therapists, particularly using experiential methods, things can become blurry,” Butler notes.

    “Instructors often take for granted that doing role-plays or other enactments within the classroom are relatively benign acts. However, this research shows that material can resonate with students in complex ways that often inhibit their learning and development.”

    Butler’s study offers eight recommendations for improving the practice of drama therapy education.

    These include increased transparency between teachers and students; clearer policies on the use of affective material in the classroom; guidelines for evaluating and assessing emotional performance; and discussions within the professions about ethical and pedagogical practices.

    “These findings point us in in the direction of creating better systems and pedagogical approaches to enhance the student experience and educate more effective therapists.”

    The impact of self-regulation

    In the study, students reported that they were asked to incorporate personal material into their assignments with the caveat that they avoid anything overwhelming.

    The expectation of self-regulation without clear guidelines for evaluating what was appropriate created stress and uncertainty.

    Some students also found the transition from mock therapy to teaching jarring, as it left emotional impacts insufficiently addressed or resolved. Others experienced uncertainty over how or if their emotional engagement would be graded.

    For example, in a teaching demonstration an instructor might ask a student to assume the role of a trauma survivor without knowing they have direct experience as such. The student may feel obliged to engage with potentially harmful material in an inappropriate setting due to classroom pressure and the potential for evaluation.

    Butler is quick to point out that affect is not the problem, however.

    Affective engagement can be a powerful tool for facilitating learning,” he notes.

    “Research has shown that therapists who are more aware of their own emotional experience are better equipped to work with the emotional experiences of their clients. The challenge here is to channel that affect in a responsible and transparent manner.”

    Better systems and pedagogical approaches

    Butler conducted interviews and focus groups with students and faculty members at three drama therapy training programs in North America and the United Kingdom.

    The data was sorted into themes and coded inductively to form a larger picture or research model of the student experience of affective engagement in the classroom.

    That model showed that students wrestle with expectations regarding the appropriate level of engagement. This often leads to strong emotional responses in the classroom, which in turn lead to negative consequences. Some students leave or fail out of the program; it is recommended that all seek therapy.

    For Butler, the findings suggest that more transparent communication is required between teachers and students.

    “Without an understanding of the processes at play, we are not able to capitalize on the strengths that come from these approaches to learning.”


  5. Study examines effect of CBT on chronic pain patients

    June 26, 2017 by Ashley

    From the European League against Rheumatism press release:

    The results of a study presented today at the Annual European Congress of Rheumatology (EULAR) 2017 has shown that Acceptance and Commitment Therapy, a form of cognitive behavioural therapy (CBT) that focuses on psychological flexibility and behaviour change, provided a significant reduction in self-reported depression and anxiety among patients participating in a pain rehabilitation programme.

    This treatment also resulted in significant increases in self-efficacy, activity engagement and pain acceptance.

    To assess the potential benefits of an 8-week programme of group Acceptance and Commitment Therapy (ACT) in people with persistent pain, measures of pain acceptance and activity engagement were taken using the Chronic Pain Acceptance Questionnaire. Measures of psychological distress using the Hospital Anxiety and Depression Scale and self-efficacy were also taken at assessment, on the final day of the programme, and at the follow up six-month review.

    For those chronic pain patients with scores at all three time points, there were statistically significant improvements in all parameters between baseline and at six-months follow-up, including the change in mean score of depression, anxiety, self-efficacy, activity engagement and pain willingness (p<0.001).

    “To further validate the role of ACT in the treatment of chronic pain, specifically in a rheumatology context, a randomised controlled clinical trial that includes measures of physical and social functioning within a Rheumatology service would be desirable,” said lead author Dr. Noirin Nealon Lennox from Ulster University in Northern Ireland.

    ACT is a form of CBT that includes a specific therapeutic process referred to as “psychological flexibility”. ACT focuses on behaviour change consistent with patients’ core values rather than targeting symptom reduction alone. Evidence for this approach to the treatment of chronic pain has been mounting since the mid 2000’s. A previous systematic review had concluded that ACT is efficacious for enhancing physical function and decreasing distress among adults with chronic pain attending a pain rehabilitation programme.

    In this study, patients were referred into the ACT programme by three consultant rheumatologists over a five-year period. Over one hundred patients’ outcome measures were available for a retrospective analysis.


  6. Sleep duration impacts treatment response for depressed patients with insomnia

    June 21, 2017 by Ashley

    From the American Academy of Sleep Medicine press release:

    Preliminary results from a new study show that depressed patients with insomnia who sleep seven or more hours per night are more likely to benefit from cognitive behavioral therapy for insomnia (CBTI) and achieve depression remission.

    Results show that when insomnia and depression co-occur, longer pre-treatment objective sleep duration is predictive of remission of both disorders when patients are given a combination of CBTI for insomnia and antidepressant medication for depression.

    “A seven-hour, objective sleep duration of patients prior to entering treatment increased their chances of achieving both depression and insomnia remission by their treatment endpoints,” said lead author and co-principal investigator Jack D. Edinger, PhD, professor in the Section of Sleep Medicine at National Jewish Health in Denver, Colorado.

    The study involved 104 adults, including 75 women, who enrolled in the Treatment of Insomnia and Depression Study and completed one baseline night of polysomnography. Participants received 16 weeks of anti-depressant medication and were randomly assigned either to CBTI or sham insomnia therapy. The Hamilton Rating Scale for Depression (HAMD-17) and Insomnia Severity Index were administered at baseline and then bi-weekly during treatment to determine depression and insomnia remission.

    The study was part of a larger research project for which Edinger was co-investigator along with co-investigators Daniel Buysse, MD, from the University of Pittsburgh; Andy Krystal, MD, from Duke University and the University of California, San Francisco; and lead principal investigator Rachel Manber, PhD, professor of psychiatry and behavioral sciences at the Stanford University Medical Center.

    “Our findings highlight the importance of adequate objective sleep in the recovery from depression and insomnia,” said Manber. “The data suggest that short sleep duration may be a risk for refractory depression.”

    The research abstract was published recently in an online supplement of the journal Sleep and will be presented Monday, June 5, in Boston at SLEEP 2017, the 31st Annual Meeting of the Associated Professional Sleep Societies LLC (APSS), which is a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society.


  7. APA study suggests patients more likely to refuse drug therapy than psychotherapy for mental health

    March 23, 2017 by Ashley

    From the American Psychological Association press release:

    People seeking help for mental disorders are more likely to refuse or not complete the recommended treatment if it involves only psychotropic drugs, according to a review of research published by the American Psychological Association.

    Researchers conducted a meta-analysis of 186 studies of patients seeking help for mental health issues that examined whether they accepted the treatment that was recommended and if they did, whether they completed it. Fifty-seven of the studies, comprising 6,693 patients, had a component that reported refusal of treatment recommendations, and 182 of the studies, comprising 17,891 patients, had a component reporting premature termination of treatment.

    After diagnosis, patients in the studies were recommended to drug-only therapy (pharmacotherapy), talk therapy (psychotherapy) or a combination of the two.

    “We found that rates of treatment refusal were about two times greater for pharmacotherapy alone compared with psychotherapy alone, particularly for the treatment of social anxiety disorder, depressive disorders and panic disorder,” said lead researcher Joshua Swift, PhD, of Idaho State University. “Rates of premature termination of therapy were also higher for pharmacotherapy alone, compared with psychotherapy alone, particularly for anorexia/bulimia and depressive disorders.”

    The research was published in the APA journal Psychotherapy.

    Across all the studies, the average treatment refusal rate was 8.2 percent. Patients who were offered pharmacotherapy alone were 1.76 times more likely to refuse treatment than patients who were offered psychotherapy alone. Once in treatment, the average premature termination rate was 21.9 percent, with patients on drug-only regimens 1.2 times more likely to drop out early. There was no significant difference for refusal or dropout rates between pharmacotherapy alone and combination treatments, or between psychotherapy alone and combination treatments.

    While Swift said the findings overall were expected, the researchers were most surprised by how large the differences were for some disorders. For example, patients diagnosed with depressive disorders were 2.16 times more likely to refuse pharmacotherapy alone and patients with panic disorders were almost three times more likely to refuse pharmacotherapy alone.

    The findings are especially interesting because, as a result of easier access, recent trends show that a greater percentage of mental health patients in the U.S. are engaging in pharmacotherapy than psychotherapy, according to co-author Roger Greenberg, PhD, SUNY Upstate Medical University.

    Some experts have argued that psychotherapy should be the first treatment option for many mental health disorders. Those arguments have been largely based on good treatment outcomes for talk therapy with fewer side effects and lower relapse rates, said Greenberg. “Our findings support that argument, showing that clients are more likely to be willing to start and continue psychotherapy than pharmacotherapy.”

    Swift and Greenberg theorized that patients may be more willing to engage in psychotherapy because many individuals who experience mental health problems recognize that the source of their problems may not be entirely biological.

    “Patients often desire an opportunity to talk with and work through their problems with a caring individual who might be able to help them better face their emotional experiences,” said Greenberg. “Psychotropic medications may help a lot of people, and I think some do see them as a relatively easy and potentially quick fix, but I think others view their problems as more complex and worry that medications will only provide a temporary or surface level solution for the difficulties they are facing in their lives.”

    While the meta-analysis provides information on refusal and dropout rates, the studies did not report the patients’ reasons for their actions, Swift noted. Going forward, research designed to identify these reasons could lead to additional strategies to improve initiation and completion rates for both therapies, he said. It is also important to note that participants in the research studies initially indicated they were willing to be assigned to any therapy, and therefore may not be representative of all consumers of treatment.


  8. Talking therapy changes brain wiring, study reveals for first time

    January 23, 2017 by Ashley

    From the King’s College London media release:

    psychotherapy discussionA new study from King’s College London and South London and Maudsley NHS Foundation Trust has shown for the first time that cognitive behaviour therapy (CBT) strengthens specific connections in the brains of people with psychosis, and that these stronger connections are associated with long-term reduction in symptoms and recovery eight years later.

    CBT — a specific type of talking therapy — involves people changing the way they think about and respond to their thoughts and experiences. For individuals experiencing psychotic symptoms, common in schizophrenia and a number of other psychiatric disorders, the therapy involves learning to think differently about unusual experiences, such as distressing beliefs that others are out to get them. CBT also involves developing strategies to reduce distress and improve wellbeing.

    The findings, published in the journal Translational Psychiatry, follow the same researchers’ previous work which showed that people with psychosis who received CBT displayed strengthened connections between key regions of the brain involved in processing social threat accurately.

    The new results show for the first time that these changes continue to have an impact years later on people’s long-term recovery.

    In the original study, participants underwent fMRI imaging to assess the brain’s response to images of faces expressing different emotions, before and after six months of CBT. Participants were already taking medication when they took part in the study, and so were compared to a group receiving medication only. The group receiving medication only did not show any increases in connectivity, suggesting that the effects on brain connections could be attributed to the CBT.

    For the new study, the health of 15 of the 22 participants who received CBT was tracked for eight years through their medical records. They were also sent a questionnaire at the end of this period to assess their level of recovery and wellbeing.

    The results show that increases in connectivity between several brain regions — most importantly the amygdala (the brain’s threat centre) and the frontal lobes (which are involved in thinking and reasoning) — are associated with long-term recovery from psychosis. This is the first time that changes in the brain associated with CBT have been shown to be associated with long-term recovery in people with psychosis.

    Lead author of the study Dr Liam Mason from King’s College London, who is a clinical psychologist at the Maudsley Hospital where the research took place, said: “This research challenges the notion that the existence of physical brain differences in mental health disorders somehow makes psychological factors or treatments less important. Unfortunately, previous research has shown that this ‘brain bias’ can make clinicians more likely to recommend medication but not psychological therapies. This is especially important in psychosis, where only one in ten people who could benefit from psychological therapies are offered them.”

    The researchers now hope to confirm the results in a larger sample, and to identify the changes in the brain that differentiate people who experience improvements with CBT from those who do not. Ultimately, the results could lead to better, and more tailored, treatments for psychosis, by allowing researchers to understand what determines whether psychological therapies are effective.

     


  9. Active-duty military find PTSD relief through individual cognitive therapy

    November 29, 2016 by Ashley

    From the Duke University Medical Center media release:

    military_soldierAlthough both group and individual therapy can ease post-traumatic stress disorder (PTSD) symptoms in active-duty military service members, individual therapy relieved PTSD symptoms better and quicker, according to a study led by a Duke University School of Medicine researcher.

    The randomized clinical trial is the largest to date to examine an evidence-based treatment for active-duty military service members, with 268 participants from the U.S. Army’s Fort Hood in Killeen, Texas. Findings will be published Nov. 23 in JAMA Psychiatry.

    The study analyzed the effectiveness of six weeks of Cognitive Processing Therapy (CPT), and found that nearly half the participants in one-on-one therapy improved so much they no longer carried a PTSD diagnosis. Almost 40 percent of the participants in group sessions also dropped their PTSD diagnoses after six weeks.

    For some of the participants, you can see a change just by looking at them — as though they have been unburdened,” said Patricia Resick, Ph.D., the study’s lead author, who developed CPT in the 1980s for victims of rape and other interpersonal trauma and is now a professor of psychiatry and behavioral sciences at the Duke University School of Medicine.

    “Some people think you have to go to therapy for years to address PTSD, but in this large-scale clinical trial with CPT, we saw a large percentage of patients show significant improvements and even recover from PTSD in a matter of weeks,” Resick said.

    CPT examines how an individual thinks about a traumatic event and how that affects their emotions, Resick said.

    “We look at what people have been saying to themselves about the trauma, which in people with PTSD can be distorted,” Resick said. “Many of them think there’s something they could have done differently to prevent the trauma. We teach them how to examine their thoughts and feel their natural emotions instead of feelings, such as guilt or blame that may result from distorted thinking. We go back and look at the evidence. Once they think in a more balanced, factual way, their emotions and symptoms of PTSD subside.”

    To measure effectiveness in active-duty military members, the trial was established through STRONG STAR Consortium, a multi-institutional initiative to develop and evaluate effective prevention, detection and treatment of combat-related PTSD. The consortium is funded by the U.S. Department of Defense.

    “Cognitive-behavioral therapies such as CPT and Prolonged Exposure therapy are the leading treatments for PTSD, with the most scientific support for their effectiveness,” said Alan Peterson, Ph.D., director of the STRONG STAR Consortium and professor of psychiatry at the University of Texas Health Science Center San Antonio.

    However, both were developed primarily for civilians, and until the STRONG STAR Consortium was developed, they had never been evaluated in clinical trials with an active-duty military population,” said Peterson, who is also a retired lieutenant colonel of the U.S. Air Force. “This study shows that CPT is effective, but it still needs to be adapted and tailored in ways that increase its effectiveness with combat-related PTSD so that more patients can fully recover.”

    About half of the participants were assigned to group therapy, attending 90-minute sessions twice a week for six weeks. The other half met one-on-one with a therapist for 60-minute sessions twice a week for six weeks.

    Independent evaluators used standard PTSD diagnostic tools to measure the severity of PTSD and associated conditions such as depression and suicidal thoughts. The participants were evaluated before and during treatment, with a follow-up six months after the treatment was over.

    For all participants, PTSD-related symptoms such as nightmares, intrusive thoughts or being easily startled improved. Overall, about 50 percent of participants experienced such improvement that they no longer met the criteria for a PTSD diagnosis, although many still had some symptoms, particularly trouble sleeping, Resick said.

    Those who attended individual therapy saw more significant improvements in the severity of their PTSD symptoms and the improvements were seen more quickly, Resick said.

    The study also showed that whether subjects received group or individual therapy, they had equal reductions in depression and suicidal thinking. These results continued through a six-month follow-up.

    The findings are based on the total 268 participants who enrolled and intended to complete the full six-week program. Overall results include about 9 percent of participants who did not begin treatment due to military deployment or other reasons, and participants who received fewer than 12 sessions (full details included in manuscript).

    The findings, although encouraging, show that many participants still had lingering symptoms after six weeks of treatment, and about half retained their PTSD diagnosis. Further research will allow researchers to refine the therapy, considering any specific adjustments for active-duty service members such as varying the number of weeks patients would participate. Researchers with the STRONG STAR Consortium will also expand on the research by evaluating the roles of substance abuse and traumatic brain injury on patients’ outcomes.


  10. Use of mindfulness-based stress reduction for chronic low back pain

    October 20, 2016 by Ashley

    From the The JAMA Network Journals media release:

    senior business teacher meditatingAmong adults with chronic low back pain, both mindfulness-based stress reduction [MBSR] and cognitive behavioral therapy [CBT] resulted in greater improvement in back pain and functional limitations when compared with usual care, according to a study appearing in the March 22/29 issue of JAMA.

    Low back pain is a leading cause of disability in the United States. There is need for treatments with demonstrated effectiveness that are low risk and have potential for widespread availability. Mindfulness-based stress reduction (MBSR) focuses on increasing awareness and acceptance of moment-to-moment experiences including physical discomfort and difficult emotions. Only 1 large randomized clinical trial has evaluated MBSR for chronic low back pain, and that trial was limited to older adults.

    Daniel C. Cherkin, Ph.D., of Group Health Research Institute, Seattle, and colleagues randomly assigned 342 adults age 20 to 70 years with chronic low back pain to receive MBSR (n = 116), cognitive behavioral therapy (CBT; n = 113), or usual care (n = 113). CBT (training to change pain-related thoughts and behaviors) and MBSR (training in mindfulness meditation and yoga) were delivered in 8 weekly 2-hour groups. Usual care included whatever other treatment, if any, the participants received. The average age of the participants was 49 years; the average duration of back pain was 7.3 years.

    The researchers found that at 26 weeks, the percentage of participants with clinically meaningful improvement on a measure of functional limitations was higher for those who received MBSR (61 percent) and CBT (58 percent) than for usual care (44 percent). The percentage of participants with clinically meaningful improvement in pain bothersomeness at 26 weeks was 44 percent in the MBSR group and 45 percent in the CBT group, vs 27 percent in the usual care group. Findings for MBSR persisted with little change at 52 weeks for both primary outcomes.

    “The effects were moderate in size, which has been typical of evidence-based treatments recommended for chronic low back pain. These benefits are remarkable given that only 51 percent of those randomized to receive MBSR and 57 percent of those randomized to receive CBT attended at least 6 of the 8 sessions,” the authors write.

    “These findings suggest that MBSR may be an effective treatment option for patients with chronic low back pain.”

    Editorial: Is It Time to Make Mind-Body Approaches Available for Chronic Low Back Pain?

    “Although understanding the specificity of treatment effects, mechanisms of action, and role of mediators are important issues for researchers, they are merely academic for many clinicians and their patients. For patients with chronic painful conditions, options are needed to help them live with less pain and disability now,” write Madhav Goyal, M.D., M.P.H., and Jennifer A. Haythornthwaite, Ph.D., of Johns Hopkins University School of Medicine, Baltimore.

    The challenge is how to ensure that these mind-body interventions are available, given the existing evidence demonstrating they may work for some patients with chronic low back pain. Most physicians encounter numerous obstacles finding appropriate referrals for mind-body therapies that their patients can access and afford. High-quality studies such as the clinical trial by Cherkin et al create a compelling argument for ensuring that an evidence-based health care system should provide access to affordable mind-body therapies.”