Effects of Mindfulness-Based Cognitive Therapy on the experience of positive emotions in daily life: A randomized controlled trial

Transcription

1 Effects of Mindfulness-Based Cognitive Therapy on the experience of positive emotions in daily life: A randomized controlled trial Nicole Geschwind nicole.geschwind@kuleuven.be Centre for Psychology of Learning and Psychopathology; Research Group on Health Psychology

2 Overview Positive emotions, why bother? Experience Sampling Method Mindfulness-Based Cognitive Therapy MindMaastricht trial Results Conclusion

3 MHeNS School for Mental Health and Neuroscience Introduction: Positive Emotions Associated with longevity and health Positive and negative emotions = different subsystems (Cohn & Fredrickson, 2009; Geschwind, 2011)

4 intensity Emotions Negative emotions Positive Emotions time

5 Experience Sampling Method At random 10 times per day 6 days Emotions Situation / activity Right now, I feel not at all moderately very Cheerful Anxious

6 beep beep beep beep beep beep beep beep beep beep Daily life person-context interaction Experience sampling procedure Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 one ESM day Positive emotions Activity Pleasantness Dailylife context

7 Positive emotions Daily-Life Reward Experience Daily life

8 How to increase positive emotions? Positive emotions Reward a t t e n t i o n a l b r o a d e n i n g

9 Mindfulness-Based Cognitive Therapy 8 week training, participants In touch with and aware of the present moment Non-evaluative and non-judgmental Daily homework: attention exercises

10 MindMaastricht RCT Sample: 130 participants with residual symptoms of depression, not currently depressed 6 days Experience Sampling Mindfulness Training (MBCT) Control 6 days Experience Sampling

11 Positive emotions Happy Satisfied Strong Enthusiastic Curious Animated Inspired [Relaxed] alpha = 0.89

12 Pleasantness of current activity Factor analysis: I enjoy this activity I am skilled at doing this This activity requires effort I would prefer to do s.th. else [I feel I m being active] [This is a challenge] Activity Pleasantness

13 Results Total Entries Invalid Participants Entries per participant (4 %) 130; 1 excluded 49 (SD 7.6)

14 After mindfulness training More positive emotions Activities appraised as more pleasant

15 Positive emotions Also: Increased reward experience after before Daily life

16 PA change *** pre post CONTROL MBCT

17 Activity pleasantness change pre post CONTROL MBCT

18 Reward Experience change pre post CONTROL MBCT

19 Increases in positive emotions

20 Related to reduction in residual symptoms? *** pre post low medium high Reduction in residual symptoms

21 Related to reduction in residual symptoms? pre post low medium high Reduction in residual symptoms

22 Related to reduction in residual symptoms? pre post Reduction in residual symptoms

23 But Original idea behind MBCT: learn to disengage from automatic negative thinking patterns that arise during dysphoric mood and facilitate relapse (Teasdale, 2000) So: Rumination, worry, NA PA etc.? Independent of changes in rumination, worry, NA, and stress sensitivity

24 Conclusions Reward experience can be learned Living in the moment more receptive higher experience of positive emotions during pleasant activities More research necessary underlying mechanisms! into

25 Conclusions MBCT has another, less often studied face: it facilitates the experience of positive emotions. Changes in PA-related variables possibly contribute to the protective effects of MBCT against future relapse

26 MHeNS School for Mental Health and Neuroscience Thanks to: Jim van Os Frenk Peeters Marieke Wichers (VENI grant nr to Dr Wichers)

27 MHeNS School for Mental Health and Neuroscience Geschwind, N., Peeters, F., Drukker, M., van Os, J., & Wichers, M. (2011). Mindfulness training increases momentary positive emotions and reward experience in adults vulnerable to depression: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 79(5), nicole.geschwind@ppw.kuleuven.be

28 MHeNS School for Mental Health and Neuroscience References Geschwind et al. (2010). Meeting risk with resilience: high daily life reward experience preserves mental health. Acta Psychiatrica Scandinavica. Geschwind et al. (2009). The role of affective processing in vulnerability to and resilience against depression. In C. M. Pariante, R. M. Nesse, D. Nutt & L. Wolpert (Eds.), Understanding Depression: A translational approach (pp ). NY: New York: Oxford University Press Inc. Wichers et al. (2007). Evidence that moment-to-moment variation in positive emotions buffer genetic risk for depression: a momentary assessment twin study. Acta Psychiatrica Scandinavica, 115, Wichers et al. (2009). Reduced stress-sensitivity or increased reward experience: The psychological mechanism of response to antidepressant medication. Neuropsychopharmacology, 34, Wichers et al. (2007). Genetic risk of depression and stress-induced negative affect in daily life. British Journal of Psychiatry, 191, Wichers, Schrijvers, Geschwind et al. (2009). Mechanisms of gene-environment interactions in depression: Evidence that genes potentiate multiple sources of adversity. Psychological Medicine, 39, Wichers et al. (2008). The psychology of psychiatric genetics: Evidence that positive emotions in females moderate genetic sensitivity to social stress associated with the BDNF Val(66)Met polymorphism. Journal of Abnormal Psychology, 117, Wichers, et al. (2008). Susceptibility to depression expressed as alterations in cortisol day curve: a cross-twin, cross-trait study. Psychosomatic Medicine, 70, Wichers, Geschwind et al. (2009). Transition from stress sensitivity to a depressive state: longitudinal twin study. The British Journal of Psychiatry, 195(6), Wichers, et al. (2008). The catechol-o-methyl transferase Val(158)Met polymorphism and experience of reward in the flow of daily life. Neuropsychopharmacology, 33, Wichers, Geschwind et al. (2010). Scars in depression: is a conceptual shift necessary to solve the puzzle? Psychological Medicine, 40(3),

29 Introduction: Positive Affect (PA) MHeNS School for Mental Health and Neuroscience PA reduces stress-induced psychiatric and physiological symptoms PA also reduces the expression of genetic vulnerability for affective disorders Effects PA > NA on resilience & well-being (Cohn & Fredrickson, 2009) PA preserves, and possibly improves, mental health.

30 Increase in Positive Affect MHeNS School for Mental Health and Neuroscience 0,4 Activity-related reward experience 0,35 0,3 0,25 0,2 0,15 0,1 pre post 0,05 0 Responders Nonresponders Responders Nonresponders Mindfulness Control

31 Increase in Negative Affect MHeNS School for Mental Health and Neuroscience 0,4 Activity-related stress sensitivity 0,35 0,3 0,25 0,2 0,15 0,1 pre post 0,05 0 Responders Nonresponders Responders Nonresponders Mindfulness Control

32 NA MHeNS School for Mental Health and Neuroscience NA change pre/post: Mindfulness vs. Controls 2,20 2,00 1,80 1,60 1,40 Mindful Control 1,20 1,00 pre post

33 MHeNS School for Mental Health and Neuroscience Maastricht

34 intensity Measuring emotions in daily life? NA and PA fluctuate time NA PA

35 MHeNS School for Mental Health and Neuroscience Method 49 depressed patients (randomized to Imipramine or placebo) Week 1 HAM early improvement PA early change NA early change Week 6: HAM score Remission Recovery

36 MHeNS School for Mental Health and Neuroscience Reward Experience & Resilience High reward experience should contribute to the preservation of mental health Especially when at risk for low mood Childhood trauma Recent Stressful Life Events Genetic Risk

37 MHeNS School for Mental Health and Neuroscience Differential relapse prevention effect Finding: MBCT reduces relapse only in 3+ patients, not in 2- (Teasdale et al., 2000; Ma & Teasdale, 2004) Assumptions: 1) MBCT works mainly via cognitive processes (Rumination, meta-cognition ) 2) Automatic negative thinking patterns stronger and more related to relapse in 3+ Consequence: Most studies exclude 2-

38 MHeNS School for Mental Health and Neuroscience Differential relapse prevention effect (Teasdale et al., 2000; Ma & Teasdale, 2004)

39 MHeNS School for Mental Health and Neuroscience Assumptions 1) MBCT works mainly via cognitive processes (rumination, meta-cognition ) 2) Automatic negative thinking patterns stronger and more related to relapse in 3+

40 MHeNS School for Mental Health and Neuroscience Consequence 2- Most later studies excluded 2- patients: Bondolfi, et al., 2010; Godfrin & van Heeringen, 2010; Kuyken, et al., 2008; Kuyken, et al., 2010; Segal, et al., 2010 Even when not directly examining risk for relapse: Barnhofer, et al., 2009; Hargus et al., 2010; Kingston et al., 2007

41 MHeNS School for Mental Health and Neuroscience Exclusion justified? Arguments against exclusion: Subpopulation overlap argument Diversity argument Continuity argument Confounder argument

42 MHeNS School for Mental Health and Neuroscience Subpopulation overlap argument

43 MHeNS School for Mental Health and Neuroscience Diversity Argument (1) Diverse effects: Changes in emotion regulation: Positive emotions increase (Geschwind et al, submitted; Fredrickson et al., 2008) Upward spiral (Garland et al, 2010) Related to reduction of dep. symptoms Various other reported effects works on more basal level

44 effectiveness MHeNS School for Mental Health and Neuroscience Diversity Argument (2) Beneficial for diverse populations not suffering from major depression working people, cancer, pregnancy, anxiety, No dep 2-3+

45 MHeNS School for Mental Health and Neuroscience Continuity Argument (1) Relapse = dichotomous Evidence for continuity of symptoms Problems with dichotomous classifications Useful to examine continuous measures

46 MHeNS School for Mental Health and Neuroscience Continuity Argument (2) Residual depressive symptoms Continuous Predict risk for relapse (Judd et al., 1999; Nierenberg, et al., 2010) MBCT associated with reduction residual symptoms (Kenny & Williams, 2007; Kingston, et al., 2007; Mathew et al., 2010) No comparison yet between 2- and 3+

47 MHeNS School for Mental Health and Neuroscience Confounder argument MBCT vs TAU trial in 3+ patients only (Segal et al., 2010) MBCT only effective among unstable remitters = with intermittent residual symptoms No effect in stable remitters = residual symptoms <7 Patients with residual symptoms were actually excluded in original studies! MBCT in 2- with residual symptoms???

48 MHeNS School for Mental Health and Neuroscience Hypotheses MBCT residual symptoms Independent of 2- or 3+ subgroup = no interaction treatment*subgroup Explore whether MBCT works via diff. mechanisms in the 2- and 3+ subgroups (rumination, worry, mindfulness positive and negative emotions)

49 No evidence for interaction MHeNS School for Mental Health and Neuroscience Treatment*Subgroup Measure β p HDRS IDS Rumination Worry KIMS observe KIMS describe KIMS act aware KIMS accept PA NA

50 HDRS MHeNS School for Mental Health and Neuroscience By subgroup: Hamilton Depression Rating Scale TAU 3+ TAU MBCT MBCT 3+ MBCT pre post

51 IDS-SR MHeNS School for Mental Health and Neuroscience Same for self-report TAU 3+ TAU 2- MBCT 3+ MBCT pre post

52 MHeNS School for Mental Health and Neuroscience Effect Size of Treatment per Subgroup 0 HDRS IDS-SR Rumination Worry -0,1-0,2-0,3-0, ,5-0,6-0,7-0,8

53 MHeNS School for Mental Health and Neuroscience Conclusions Need to re-examine and reconsider: MBCT just as effective in 2- as in 3+ At least when looking at participants with residual symptoms