Mindfulness to tackle depression: Hype, history, or here to stay? Filip Raes CLEP PraxisP KU Leuven

Transcription

1 Mindfulness to tackle depression: Hype, history, or here to stay? Filip Raes CLEP PraxisP KU Leuven LIPS Leuven

2 what is mindfulness? definition paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally. John Kabat-Zinn (1994, p. 4) trait, state, process, intervention, meditation (formal vs. informal mindfulness)

3 mindfulness is all around

4 mindfulness is all around! mixed feelings o o it has (potential) value, not per se woo-woo airy-fairy (cf. new age, esotericism, ) so dissemination can be okay (even in those circles) danger affects reputation of mindfulness in wrong hands misconceptions it has (potential) value, but. evidence less (strong) than some (make us) believe definitely no cure-all

5 mindfulness is all around! how did we come this far? introduction of mindfulness in western society/psychotherapy o development of MBCT o research on impact on depression (?) benefits beyond depression (?) mindfulness for adolescents and children (?)

6 development of MBCT Mindfulness-Based Cognitive Therapy (2002) early 90 prevention of depressive relapse Zindel Segal Mark Williams John Teasdale

7 depression 17% lifetime prevalence 15% suïcide personal, social, economical cost

8 depressie Mathers & Loncar (2006); WHO; PlosMedicine

9 depression 17% lifetime prevalence 15% suïcide personal, social, economical cost relapse: 50%-80% depression = chronic, multiple depressive episodes vulnerability for relapse?

10 development of MBCT relapse prevention program scientific research cognitive reactivity Zindel Segal Mark Williams John Teasdale

11 cognitive reactivity (rumination)

12 cognitive reactivity (experiment) Dysfunctional Attitude Scale (DAS; Beck & Weissman, 1978)

13 cognitive reactivity (experiment) MOOD INDUCTION

14 MBCT: depression relapse prevention does it work? two large RCT-studies: o Randomized Controlled Trial o Teasdale et al. (2000), Ma & Teasdale (2004) o MBCT (vs. TAU) halves the rates of depression relapse in patients with three or more previous major depressive episodes Kuyken et al. (2008) trial: as effective as antidepressants in preventing episodes Geschwind et al. (2012): MBCT reduces residual dep symptoms irrespective of number of previous episodes

15 cognitive reactivity (rumination) 1 notice 2 step back, don t try to change, don t re-act Marsha Linehan: mindfulness? >> John Kabat-Zinn (UMass Stress Reduction; MBSR) >> MBCT

16 MBCT: depression better than what we have? o e.g., cognitive therapy good (active) control conditions o vs. waitlist controls how/why does it work? o cognitive reactivity Raes et al. (2009), Kuyken et al. (2010)

17 MBT (MBCT/MBSR): depression/anxiety

18 MBT: depression/anxiety MBT improves mood and anxiety symptoms maintained at follow-up (12 wks) clinical groups/patients (psychological or physical/medical disorder) especially in patients with mood/anxiety disorder MBT: promising intervention for treating anxiety and mood problems in clinical populations

19 MBT: depression/anxiety but (caution!!) incl. studies without (active) control need for method. stronger research greater than placebo effect-sizes Exluded studies in which the intervention differed significantly from MBCT/MBSR protocol and/or was not delivered in person

20 MBT: psychological health

21 MBT: psychological health correlationael research, interventions (*), lab mindfulness brings about various positive psychological effects caution!! correlational, rarely (acteve) controls, encouraging, but certainly no cure-all also community samples (preventive? follow-up) majority of studies: adults (*) MBT = MBCT, MBSR, DBT, ACT, (cf. formal vs. informal mindfulness)

22 MBT: MBT: jongeren? children and adolescents? feasible and acceptable? Yes! effects? preliminary evidence from (small) studies o o clinical groups (ADHD, angst, ) normative, community samples (e.g., school context)

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24 MBT: MBT: jongeren? children and adolescents? feasible and acceptable? Yes! effects? preliminary evidence from (small) studies o o clinical groups (ADHD, angst, ) normative, community samples (e.g., school context) teaching MBT to teachers : research still in its infancy caution!! often self-selected, no control group, not randomized, no follow-up, our study: large sample, control, randomisation, and follow-up

25 MBT: for voor adolescents jongeren in in Vlaamse Flemish scholen schools 5 schools ages year 3-6 St-Maarten Bovenschool (Beveren-Waas) Burgerschool (Roeselare) Abdijschool van Zevenkerken (Brugge) Groenendaalcollege (Campus St-Jan; Merksem-A pen) Sint-Ludgardisschool (A pen Stad) STICHTING GA VOOR GELUK VZW MINDFULNESS

26 MBT: voor jongeren in Vlaamse scholen MBT for adolescents in Flemish schools

27 MBT: voor jongeren in Vlaamse scholen MBT for adolescents in Flemish schools

28 MBT: for voor adolescents jongeren in in Vlaamse Flemish scholen schools 5 schools ages x 3 rd year 8x ASO 4x 4 year 3-6 th year 2x TSO 4x 5 th year 2x BSO 408 participants 1x 6 th year 12 pairs of classes for each pair: 1 mindfulness, 1 control (random) 201 mindfulness; 207 control depressive symptoms before (T1), after (T2), 6 months FU (T3) STICHTING GA VOOR GELUK VZW MINDFULNESS

29 MBT for adolescents in Flemish schools Session [1] attention to the breath and the moment Session [2] attention to the body and for pleasant moments Session [3] attention to your inner boundaries and to unpleasant moments Session [4] attention to stress and space Session [5] attention to thoughts and emotions Session [6] attention to interpretations and communication Session [7] attention to your attitudes and your moods Session [8] attention to yourself and your heartfulness

30 depressive symptoms CON: N= 199, 175, 168 MBT: N = 194, 182, 167

31 MBT for adolescents in Flemish schools

32 MBT: MBT for voor adolescents jongeren in in Vlaamse Flemish Flanders scholen schools

33 MBT for adolescents in Flemish schools

34 MBT for adolescents in Flemish schools effect on depressieve complaints: statistically and clinically significant (curative and preventive effect) other effects besides reduction in depression symptomatology? critical notes / limitations o no intervention control non-specific factors, placebo, and if mindfulness program: what aspect or part? future plans?

35 mindfulness in all schools? (more) attention for mental health mental hygiene not necessarily mindfulness! (e.g., gelukzoekers CM) psycho-education a regular course?

36 paradigm shift in mental health care dominant model: individual psychotherapy (curative) shift focus (extend) to: others methods of delivery (e.g., groups) and prevention see LIPS lecture by Deb Vansteenwegen on e-mental health

37 a final thought mindfulness-therapist? psychotherapist?

38 take-home message mindfulness has (potential) value o too many indications to ignore it but: hold your horses! o no cure-all o caution hype o victim of its own success?

39 references Segal, Z.V. Williams, J.M.G. & Teasdale, J.D. (2002, 2013). Mindfulness-based cognitive therapy for depression. New York: Guilford. Williams, M., Teasdale, J., Segal, Z., & Kabat-Zinn, J. (2007). The mindful way through depression. New York: Guilford. o Williams, M., Teasdale, J., Segal, Z., & Kabat-Zinn, J. (2007). Mindfulness en bevrijding van depressie. Amsterdam: Uitgeverij Nieuwezijds. Williams, M., & Penman, D. (2011). Mindfulness: A practical guide to finding peace in a frantic world. London: Piatkus. o Williams, M., & Penman, D. (2011). Mindfulness: Een praktische gids om rust te vinden in een hectische wereld. Amsterdam: Uitgeverij Nieuwezijds.

40 questions?