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
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)
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
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)
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
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
Participants N = 11 (4 female, 7 male) diagnosed with chronic depression Mean age 46.46 years (SD = 9.75; Range 34-65) Mean duration of the disorder of M = 11.55 years (SD = 7.15; range 2-27) One patient with meditation experience One dropout after two weeks
Results main outcome variables BDI-II 35.00 24.40 (10.68) 30.00 25.00 23.56 (7.00) 23.30 (9.85) 21.90 (8.75) 19.70 (9.00) 17.60 (6.70) 20.00 15.00 10.00 5.00 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 =.76 0.00 baseline pre therapy 4 weeks 8 weeks post therapy 3-month FU
Results main outcome variables HRSD 25.00 20.00 16.20 (7.08) 15.80 (6.51) 13.40 (5.40) 15.00 11.10 (4.25) 10.00 5.00 0.00 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
Results further outcome variables Scale Pre Post d Follow-up d ASQ Acceptance 2.43 (.64) 2.57 (.60).26 2.76 (.76)*.47 ASQ Suppression 3.37 (.52) 3.16 (.50).41 3.01 (.61)*.63 ASQ Adjusting/Reappraisal RSQ Self RSQ Symptoms 2.02 (.45) 1.84 (.60).34 2.00 (.41).05 16.40 (3.17) 14.70 (4.22).46 14.90 (3.38)*.46 21.20 (3.43) 19.80 (4.64) - 19.70 (4.03) - RSQ Distraction 16.10 (5.20) 15.30 (3.80) - 15.10 (3.81) - Compassionate Love Scale 83.90 (24.34) 85.40 (27.55).06 89.50 (22.05)* Self-Compassion Scale (SCS) 2.66 (.35) 2.43 (.55) - 2.61 (.40) - MAAS 32.30 (6.34) 31.90 (8.62) -.05 35.10 (8.48)*.36 RSESGraser, Höfling, Weßlau, Mendes & Stangier 24.90 (Goethe (5.51) University 25.00 (6.10) Frankfurt) - 4th International 26.50 (5.90) - Conference on CFT.24
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
Discussion 6 patients started individual psychotherapy after followup period
Limitations Small sample size Unspecific group effects Established MBCT components could be responsible for the effect
Results main outcome variables BDI-II 35.00 24.40 (10.68) 30.00 25.00 23.56 (7.00) 23.30 (9.85) 21.90 (8.75) 19.70 (9.00) 17.60 (6.70) 20.00 15.00 10.00 5.00 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 =.76 0.00 baseline pre therapy 4 weeks 8 weeks post therapy 3-month FU
Thank you for your attention Questions?