Mindfulness-based cognitive therapy improves insomnia symptoms in individuals with recurrent depression: secondary analyses from a randomized controlled trial

Background: Embedded within a randomized efficacy trial, the present study aimed to investigate whether mindfulness-based cognitive therapy (MBCT) for recurrent depression improved symptoms of insomnia. Methods: Sixty-eight remitted participants with at least three prior episodes of depression were randomized to 8 weeks of MBCT (n = 33) or a waitlist control condition (n = 35). The Bergen Insomnia Scale was used to screen for insomnia symptoms before and after the intervention. The analyses were conducted using one-way between-groups analyses of covariance. Results: Twenty-five MBCT participants and 30 waitlist controls completed the study (74.5% females; mean age 40.7 ± 12.9 years). At baseline, 83.6% screened positive for the insomnia diagnosis. Following the intervention and after controlling for corresponding insomnia parameters at baseline, MBCT completers reported significantly less severe insomnia symptoms (p = 0.017), as well as less problems with prolonged sleep onset (p = 0.047) and nocturnal awakenings (p = 0.023), relative to controls. No group differences were found on early morning awakening, daytime impairment, or dissatisfaction with sleep. Conclusion: The results suggest that MBCT improves certain insomnia symptoms. However, additional sleep-specific interventions may be needed to further improve this population’s sleep.publishedVersio

Unified Protocol. Transdiagnostisk behandling for emosjonelle lidelser

Unified Protocol (UP) is a transdiagnostic treatment aimed at promoting emotion regulation skills in patients with emotional disorders. The approach targets maintaining factors common to many disorders, in line with recent knowledge about broad dimensions of personality underlying various diagnoses. It allows for the simultaneous treatment of comorbid disorders and can simplify training and treatment implementation. Central to emotional disorders is the individual’s negative reaction to their own emotions, and attempts to cope with them through avoidance or suppression. The goal of UP is to strengthen core skills that enable more adaptive ways of dealing with one’s emotions. These skills include understanding emotions, non-judgemental awareness, flexible thinking, the ability to do the opposite of avoidance behaviours, increased tolerance for physical sensations, and the ability to plan and carry out emotional exposure. In this article, we provide an overview of what a UP approach entails and illustrate this through the case of ‘Nadine’.publishedVersio

Mindfulness-based cognitive therapy improves insomnia symptoms in individuals with recurrent depression: secondary analyses from a randomized controlled trial

BackgroundEmbedded within a randomized efficacy trial, the present study aimed to investigate whether mindfulness-based cognitive therapy (MBCT) for recurrent depression improved symptoms of insomnia.MethodsSixty-eight remitted participants with at least three prior episodes of depression were randomized to 8 weeks of MBCT (n = 33) or a waitlist control condition (n = 35). The Bergen Insomnia Scale was used to screen for insomnia symptoms before and after the intervention. The analyses were conducted using one-way between-groups analyses of covariance.ResultsTwenty-five MBCT participants and 30 waitlist controls completed the study (74.5% females; mean age 40.7 ± 12.9 years). At baseline, 83.6% screened positive for the insomnia diagnosis. Following the intervention and after controlling for corresponding insomnia parameters at baseline, MBCT completers reported significantly less severe insomnia symptoms (p = 0.017), as well as less problems with prolonged sleep onset (p = 0.047) and nocturnal awakenings (p = 0.023), relative to controls. No group differences were found on early morning awakening, daytime impairment, or dissatisfaction with sleep.ConclusionThe results suggest that MBCT improves certain insomnia symptoms. However, additional sleep-specific interventions may be needed to further improve this population’s sleep.Clinical Trial Registration: ISRCTN, ISRCTN18001392, registered 22/11/2018. URL: 10.1186/ISRCTN18001392

Clients’ Perspective on Predetermined Time Limits for Therapy in the Context of the Norwegian Welfare System

Limited capacity and high demand for mental health care drive efforts to improve the efficiency of treatment and increasingly result in predetermined time limits for treatment, even in government-covered treatment in welfare systems. How do clients experience having predetermined time limits for psychotherapy? We analyzed the transcripts of interviews with 18 participants who had completed a return to work (RTW) intervention based on emotion-focused therapy (EFT) that had predetermined time limits. The analysis identified four experiential trajectories through therapy with predetermined time limits, representing four narrative themes: Trajectory A: It is ok to stop here—Not wanting more therapy; Trajectory B: Seeing the benefits of continued therapy, but ready to give life a go without treatment; Trajectory C: Being on one’s own too early—Economic obstacles hindering the continuation of therapy; and Trajectory D: I need more than this—Securing continued therapy. Having the therapist communicate the timeframes for therapy clearly, while leaving room for individual tailoring of therapy, was experienced as very important by clients receiving psychotherapy with predetermined time limits.publishedVersio

The effects of mindfulness-based cognitive therapy on risk and protective factors of depressive relapse – a randomized wait-list controlled trial

Background The aim of this randomized wait-list controlled trial was to explore the effects of Mindfulness–Based Cognitive Therapy (MBCT) on risk and protective factors for depressive relapse within the domains of cognition, emotion and self-relatedness. Methods Sixty-eight individuals with recurrent depressive disorder were randomized to MBCT or a wait-list control condition (WLC). Results Completers of MBCT (N = 26) improved significantly on measures assessing risk and protective factors of recurrent depression compared to WLC (N = 30) on measures of rumination (d = 0.59, p = .015), emotion regulation (d = 0.50, p = .028), emotional reactivity to stress (d = 0.32, p = .048), self-compassion (d = 1.02, p < .001), mindfulness (d = 0.59, p = .010), and depression (d = 0.40, p = .018). In the Intention To Treat sample, findings were attenuated, but there were still significant results on measures of rumination, self-compassion and depression. Conclusions Findings from the present trial contribute to evidence that MBCT can lead to reduction in risk factors of depressive relapse, and strengthening of factors known to be protective of depressive relapse. The largest changes were found in the domain of self-relatedness, in the form of large effects on the participants’ ability to be less self-judgmental and more self-compassionate.publishedVersio

Etiske dilemmaer for sykehjemsleger under covid-19-pandemien

Bakgrunn: Sykehjemsbeboere var ekstra sårbare for et alvorlig forløp av covid-19. Tidlig i pandemien ble det derfor bestemt at sykehjemmene måtte beskyttes gjennom tiltak som besøksforbud og testing- og isolasjonsregimer. Dette medførte nye rutiner og retningslinjer for sykehjemsleger. Studier nasjonalt og internasjonalt viser at pandemien ga nye etiske dilemmaer for helsepersonell. Målet med denne studien var å bedre forstå sykehjemslegenes etiske problemstillinger under pandemien. Materiale og metode: Ni semistrukturerte dybdeintervju med sykehjemsleger ved fem sykehjem i Bergen ble analysert med Attride-Stirlings tematiske nettverksanalyse. Resultater: Legene fortalte om utfordringer knyttet til det å bestemme behandlingsnivå, sette grenser for lindrende behandling, tilpasse besøksrestriksjoner, og vurdere tvang ved testing og isolasjon. Dette medførte krevende etiske avveielser, der legene sto overfor interessekonflikter og verdivalg. En sentral avveining var hensynet til den enkelte beboer sett mot fellesskapet. Fortolkning: Sykehjemslegene i vår studie opplevde at det var vanskelig å veie sikring av beboernes autonomi mot hindring av smittespredning. Hovedfunn: Å bestemme behandlingsnivå samt å gi adekvat lindring ved livets sluttfase var krevende. Håndhevelse av besøksrestriksjoner førte til etiske dilemmaer spesielt knyttet til omsorg for døende og kreft- og slagpasienter. Bruk av tvang ved testing og isolasjon for å stoppe smittespredning måtte veies mot hensynet til beboernes autonomi. Et sentralt dilemma var hensynet til den enkelte beboer mot hensynet til fellesskapet.publishedVersio

Is Dispositional Self-Compassion Associated With Psychophysiological Flexibility Beyond Mindfulness? An Exploratory Pilot Study

Background: Dispositional mindfulness and self-compassion are shown to associate with less self-reported emotional distress. However, previous studies have indicated that dispositional self-compassion may be an even more important buffer against such distress than dispositional mindfulness. To our knowledge, no study has yet disentangled the relationship between dispositional self-compassion and mindfulness and level of psychophysiological flexibility as measured with vagally mediated heart rate variability (vmHRV). The aim was thus to provide a first exploratory effort to expand previous research relying on self-report measures by including a psychophysiological measure indicative of emotional stress reactivity. Methods: Fifty-three university students filled out the “Five Facet Mindfulness Questionnaire” (FFMQ) and the “Self-Compassion Scale” (SCS), and their heart rate was measured during a 5 min resting electrocardiogram. Linear hierarchical regression analyses were conducted to examine the common and unique variance explained by the total scores of the FFMQ and the SCS on level of resting vmHRV. Results: Higher SCS total scores associated significantly with higher levels of vmHRV also when controlling for the FFMQ total scores. The SCS uniquely explained 7% of the vmHRV. The FFMQ total scores did not associate with level of vmHRV. Conclusion: These results offer preliminary support that dispositional self-compassion associates with better psychophysiological regulation of emotional arousal above and beyond mindfulness.publishedVersio

Self-Compassion and Its Association With Ruminative Tendencies and Vagally Mediated Heart Rate Variability in Recurrent Major Depression

Background: Recurrent Major Depressive Disorder (MDD) is one of the most disabling mental disorders in modern society. Prior research has shown that self-compassion protects against ruminative tendencies, a key feature of recurrent MDD. In addition, self-compassion has been found to be positively related to higher psychophysiological flexibility (indexed by a higher vagally mediated heart rate variability; vmHRV) in young, healthy adults. To our knowledge, there is a lack of studies on how self-compassion relates to vmHRV in patients with recurrent MDD. The aim of the current study was to investigate whether higher self-compassion would associate with (1) lower ruminative tendencies and (2) higher vmHRV in a sample of adults with recurrent MDD. Methods: We included a sample of 63 patients (46 females) between 20 and 71 years old (M = 40.24, SD = 12.8) with a history of three or more depressive episodes. They filled out the Self-Compassion Scale (SCS), Beck Depression Inventory (BDI), and Rumination Rating Scale (RRS). ECG (used to derive vmHRV) was acquired while resting and the square root of the mean squared differences of successive RR interval values (RMSSD) was calculated as measure of vmHRV. Results: As hypothesized, self-compassion was associated with lower ruminative tendencies. However, self-compassion was not associated with level of vmHRV. Several confounding variables were controlled for in the statistical analyses, and higher age predicted lower vmHRV across all statistical analyses. Conclusion: The results confirmed our hypothesis that higher self-compassion would be associated with lower ruminative tendencies in recurrent MDD. Contrary to our expectation, we did not find that the tendency to be more self-compassionate was associated with higher vmHRV. As such, higher self-compassion seems to relate with a lower tendency to ruminate about past mistakes and events but does not seem to relate to a flexible autonomic stress response (as indexed by higher vmHRV). Other potential explanatory factors for lower vmHRV in recurrent MDD is suggested as focus for exploration in future studies.publishedVersio

The Association between Self-Reported Difficulties in Emotion Regulation and Heart Rate Variability: The Salient Role of Not Accepting Negative Emotions

Difficulties in emotion regulation are associated with development and maintenance of psychopathology. Typically, features of emotion regulation are assessed with self-report questionnaires. Heart rate variability (HRV) is an objective measure proposed as an index of emotional regulation capacity. A limited number of studies have shown that self-reported difficulties in emotion regulation are associated with HRV. However, results from prior studies are inconclusive, and an ecological validation of the association has not yet been tested. Therefore, further exploration of the relation between self-report questionnaires and psychophysiological measures of emotional regulation is needed. The present study investigated the contribution of self-reported emotion regulation difficulties on HRV in a student sample. We expected higher scores on emotion regulation difficulties to be associated with lower vagus-mediated HRV (vmHRV). Sixty-three participants filled out the Difficulties in Emotion Regulation Scale and their resting HRV was assessed. In addition, a subsample of participants provided ambulatory 24-h HRV data, in order to ecologically validate the resting data. Correlation analyses indicated that self-reported difficulties in emotion regulation was negatively associated with vmHRV in both resting HRV and 24-h HRV. Specifically, when exploring the contribution of the different facets of emotion dysregulation, the inability to accept negative emotions showed the strongest association with HRV. The results are discussed and need for future research is described

Dispositional Mindfulness and Attentional Control: The Specific Association Between the Mindfulness Facets of Non-judgment and Describing With Flexibility of Early Operating Orienting in Conflict Detection

Background: A state of mindfulness refers to a present-centered attentional awareness without judging. Being mindful seems to increase the ability to be flexible and adaptive in attention focus according to situational contingencies. The way mindfulness affects such attentional control is often measured with three different but interacting attentional networks of alerting (preparedness), orienting (selection of stimulus), and conflict detection (suppression of irrelevant stimuli). In the current study, the aim was to study the effects of dispositional mindfulness on these attention networks, and specifically the effects on the interactions between these attention networks.Methods: Fifty participants between 19 and 29 years old filled out the questionnaire Five Facet Mindfulness Questionnaire (FFMQ) and performed the revised version of the Attention Network Test (ANT-R). The five FFMQ facets of Describing, Non-Judgment, Orienting, Non-Reactivity, and Acting with Awareness were included as predictors in multiple linear regression analyses with the ANT-R scores of alerting, orienting, conflict detection, and the interaction scores of alerting by conflict detection and orienting by conflict detection as outcome variables, respectively.Results: Higher dispositional mindfulness as measured with the five FFMQ facets predicted interaction scores (faster reaction times) of orienting by conflict detection, but none of the other ANT-R scores. It was specifically the FFMQ facets of Describing and non-judgment that predicted this lower interaction score of orienting by conflict detection.Conclusion: Our findings indicate that being mindful is associated with a more flexible and efficient orienting attention. It is associated with a higher ability to disengage from salient stimuli that is irrelevant to pursue goal-directed behavior (conflict detection)