Effects of a 12-Week Mindfulness, Compassion and Loving Kindness Program on Chronic Depression: A Pilot Within-Subjects-Waitlist- Controlled Trial

Transcription

1 Effects of a 12-Week Mindfulness, Compassion and Loving Kindness Program on Chronic Depression: A Pilot Within-Subjects-Waitlist- Controlled Trial Johannes Graser, Volkmar Höfling, Charlotte Weßlau, Adriana Mendes & Ulrich Stangier (Goethe University Frankfurt, Germany) 4th International Conference On Compassion Focused Therapy, 2015

2 Introduction Depression develops chronic course in almost 30% of the patients (Murphy & Byrne, 2012) more severe impairment (Blanco et al., 2010) higher risk of suicide (Torpey & Klein, 2008) slower and poorer response to established treatments (Cuijpers et al., 2010; Klein, Shankman, & Rose, 2006) Cuijpers et al., (2010) meta-analysis for efficacy of psychological treatments for chronic depression d =.23. Promising MBCT-trials by Barnhofer and colleagues (2009) and Kenny and Williams (2007)

3 Introduction Self-criticism has shown to be a risk factor for developing a chronic course of depression (Ehret, Joormann, & Berking, 2014) and for depression severity (Dinger et al., 2015) Adding techniques to MBCT that enhance positive attitudes toward oneself may be helpful Compassion Loving Kindness Meditation

4 Treatment: 12 sessions / 100 min. Session1: MBCT (raisin exercise, body scan) Session2: MBCT (body scan, mindful stretching) Session3: MBCT (sitting meditation with focus on breath) Session4: MBCT (sitting meditation with focus on sounds and thoughts) Session5: CFT (evolutionary ER model, soothing rhythm breathing) Session6: CFT (compassionate colour meditation/impact of neg. thoughts) Session7: CFT (Functions of self-criticism) Session8: CFT (breathing compassion in and out) Session9: Loving Kindness Meditation (to known/fictional person&oneself) Session10: LKM (to known/fictional person&oneself) Session11: LKM (to unknown/neutral person&oneself, personal LKM phrases) Session12: LKM (to unknown/neutral person&oneself personal LKM phrases)

5 Inclusion criteria Screening with SKID-I&II, HRSD, PSR diagnosis of one of the following disorders dysthymia double depression recurrent depressive disorder without sufficient remission for at least 2 years Continuing psychopharmacological treatment was allowed, changes during all stages of the study were to be reported

6 Exclusion criteria Exclusion criteria were: current addictions or ongoing substance abuse acute or past manic or psychotic symptoms PTSD OCD eating disorders the following personality disorders: paranoid, schizotypal, histrionic, borderline, antisocial, narcissistic acute suicidality severe medical conditions like dementia or traumatic brain injury current psychotherapeutic treatment

7 Participants N = 11 (4 female, 7 male) diagnosed with chronic depression Mean age years (SD = 9.75; Range 34-65) Mean duration of the disorder of M = years (SD = 7.15; range 2-27) One patient with meditation experience One dropout after two weeks

8 Results main outcome variables BDI-II (10.68) (7.00) (9.85) (8.75) (9.00) (6.70) Waiting condition: F (1, 9) =.17; p =.69; Time effect treatment: F (4, 36) = 5.49; p =.001 Treatment pre post: p =.024; d =.48 Treatment pre follow-up: p =.007; d = baseline pre therapy 4 weeks 8 weeks post therapy 3-month FU

9 Results main outcome variables HRSD (7.08) (6.51) (5.40) (4.25) Waiting condition: F (1, 9) =.05; p =.83 Time effect treatment: F (2, 18) = 7.26; p =.005 Treatment pre post: p =.04; d =.40 Treatment pre follow-up: p =.007; d =.85 baseline pre therapy post therapy 3-month FU

10 Results further outcome variables Scale Pre Post d Follow-up d ASQ Acceptance 2.43 (.64) 2.57 (.60) (.76)*.47 ASQ Suppression 3.37 (.52) 3.16 (.50) (.61)*.63 ASQ Adjusting/Reappraisal RSQ Self RSQ Symptoms 2.02 (.45) 1.84 (.60) (.41) (3.17) (4.22) (3.38)* (3.43) (4.64) (4.03) - RSQ Distraction (5.20) (3.80) (3.81) - Compassionate Love Scale (24.34) (27.55) (22.05)* Self-Compassion Scale (SCS) 2.66 (.35) 2.43 (.55) (.40) - MAAS (6.34) (8.62) (8.48)*.36 RSESGraser, Höfling, Weßlau, Mendes & Stangier (Goethe (5.51) University (6.10) Frankfurt) - 4th International (5.90) - Conference on CFT.24

11 Discussion Treatment significantly reduced depression Comparable or slightly lower effects at post treatment, higher effects at follow up as found in meta-analyses for MBIs (Hofmann et al., 2010; Khoury et al., 2013) Higher effects than reported in Cuijpers` and colleagues (2010) meta-analysis Acceptance, Mindfulness, Compassionate Love were significantly increased at follow-up, Rumination about oneself and suppression of emotions significantly decreased Fear of / resistance to compassion

12 Discussion 6 patients started individual psychotherapy after followup period

13 Limitations Small sample size Unspecific group effects Established MBCT components could be responsible for the effect

14 Results main outcome variables BDI-II (10.68) (7.00) (9.85) (8.75) (9.00) (6.70) Waiting condition: F (1, 9) =.17; p =.69; Time effect treatment: F (4, 36) = 5.49; p =.001 Treatment pre post: p =.024; d =.48 Treatment pre follow-up: p =.007; d = baseline pre therapy 4 weeks 8 weeks post therapy 3-month FU

15 Thank you for your attention Questions?