Treating Depression Mindfully in a Day Hospital:a Randomised Controlled Pilot Study

Objectives: Recent preliminary evidence suggests that mindfulness-based programmes may be beneficial in the treatment of patients suffering from current depression. Due to the heterogeneity of patients with this diagnosis, a specialisation in treatment concepts for subgroups of patients may be beneficial. Methods: This randomised controlled pilot study investigated the effectiveness of an eight-week mindfulness-based day hospital treatment for patients with current depression and work-related conflicts (MDT-DH) under naturalistic conditions. Eighty-one currently depressed patients with work-related conflicts were randomly assigned to either MDT-DH (including personalised psychopharmacological treatment if necessary) or a waitlist condition including a psychopharmacological consultation (PCC). Outcomes were assessed at post-treatment and at 8-month follow-up. The primary outcome was depression severity (Beck Depression Inventory) at post-treatment. Secondary outcomes were work ability (Work Ability Index) and mindfulness (Kentucky Inventory of Mindfulness Skills). Results: A multilevel analysis revealed that compared with patients in PCC, patients in the MDT-DH group showed a greater reduction in depression severity, higher work ability and heightened levels of mindfulness after 8 weeks than patients in the PCC group. These improvements were stable during the 8-month follow-up period. Conclusions: Findings of the present pilot study suggest that a treatment concept involving intensive training in mindfulness can be successfully established in a day hospital and leads to clinically meaningful reductions in depression severity and increases in work ability in patients suffering from current depression. The generalisability of the findings may be limited due to small sample size, selective patient group and study design

Loosing gut feeling? Intuition in Depression

Whereas in basic research, intuition has become a topic of great interest, clinical research and depression research in specific have not applied to the topic of intuition, yet. This is astonishing because a well-known phenomenon during depression is that patients have difficulties to judge and decide. In contrast to healthy individuals who take most daily-life decisions intuitively (Kahneman, 2011), depressed individuals seem to have difficulties to come to fast and adaptive decisions. The current article pursues three goals. First, our aim is to establish the hypothesis that intuition is impaired in depression against the background of influential theoretical accounts as well as empirical evidence from basic and clinical research. The second aim of the current paper is to provide explanations for recent findings on the depression-intuition interplay and to present directions for future research that may help to broaden our understanding of decision difficulties in depression. Third, we seek to propose ideas on how therapeutic interventions can support depressed individuals in taking better decisions. Even though our knowledge regarding this topic is still limited, we will tentatively launch the idea that an important first step may be to enhance patients’ access to intuitions. Overall, this paper seeks to introduce the topic of intuition to clinical research on depression and to hereby set the stage for upcoming theory and practice

Mind your Intuition. Impaired intuition in patients with depression and the influence of mindfulness on intuitive judgments

Entscheidungen und Urteile werden im Alltag häufig intuitiv gefällt. Die Prozesse auf denen Intuitionen basieren operieren schnell, unbewusst und assoziativ. Da Intuitionen auf Informationen basieren, die aktiviert, jedoch bewusst nicht zugänglich sind, können sie mit dem Phänomen knowing without knowing how beschrieben werden. Intuitionen bilden demnach eine eindrucksvolle, in vielen Situationen effektive Leistung menschlicher Kognition. Patienten, die unter Depressionen leiden, berichten häufig von Schwierigkeiten, Entscheidungen im Alltag zu fällen. Es liegt daher die Annahme nahe, dass Depression mit verminderter Intuition einhergeht. Auch Ergebnisse der Grundlagenforschung zum Einfluss von negativer Stimmung auf intuitive Urteile unterstützen diese Hypothese. In Einklang damit konnte die vorliegende Forschung bei Patienten mit Depression ein Intuitionsdefizit im Vergleich zu gesunden Kontrollprobanden feststellen. Die vorliegenden Ergebnisse deuten weiterhin darauf hin, dass auch die häufig berichtete Entscheidungsunfähigkeit von Depressiven in Zusammenhangmit verminderter Intuition zu stehen scheint. Insgesamt erweitert die vorliegende Arbeit die klinische Depressionsforschung, indem sie das Thema Intuition in den klinisch-psychologischen Forschungskontext einführt. Hierbei wird ein etabliertes Verfahren aus der kognitiven Psychologie zur Messung intuitiver Urteile verwendet. Vor dem Hintergrund des Ergebnisses, dass Patienten mit Depression Einschränkungen beim Fällen intuitiver Urteile aufweisen, beschäftigt sich die vorliegende Arbeit weiterhin mit der Frage, wie Intuition gefördert werden kann. Eine Reihe methodisch hochwertiger klinischer Studien konnte die Wirksamkeit achtsamkeitsbasierter Interventionen im Rahmen der Depressionsbehandlung nachweisen. Die zugrunde liegenden Wirkmechanismen sind allerdings noch weitestgehend unerforscht. In der vorliegenden Arbeit wird daher Intuition als potentieller Faktor, über den das Prinzip Achtsamkeit seine Wirkung entfaltet, untersucht. Diese Hypothese, dass Achtsamkeit Intuition fördert, basiert auf einem der Hauptmerkmale einer achtsamen Haltung: die verbesserte Wahrnehmung von Körperempfindungen, Gedanken, Gefühlen und - so die vorliegende Hypothese – Intuitionen. Insgesamt soll die vorliegende Arbeit einen Beitrag zur Erforschung relevanter kognitiver Prozesse im Rahmen der Depression leisten und der Frage nachgehen, ob Achtsamkeit den Kontakt zu Intuitionen verbessern kann. Damit leistet die vorliegende Forschung auch einen Beitrag zur Erforschung potentieller Wirkmechanismen dieses immer mehr an Bedeutung gewinnenden Behandlungsprinzips.In daily life decisions and judgments are oft made intuitively. The processes that intuitions rely on are fast, unconscious and associative. As intuitions are based on information, which is activated but not consciously accessible, they can be described with the phenomenon of knowing without knowing how. Therefore, intuitions present an impressive cognitive ability, which is effective and helpful in many situations. Patients who suffer from depression often report to have difficulties to come to decisions in daily life. Therefore, it is assumed that depression is associated with impaired intuition. Results of basic psychological research concerning the interplay between negative mood and intuition support this hypothesis. In line with these assumptions, it was found in the current study that patients with depression show impaired intuitive performance compared to healthy control participants. The current results also indicate that there is a link between indecisiveness of depressed patients and impaired intuitive performance. Overall, the current work introduces the phenomenon of intuition to clinical-psychological research. Hereby, an established paradigm from basic cognitive psychology to elicit and measure intuition is used. Against the background of the finding that patients with depression show diminished intuitive performance, the current paper further explores the question how intuition may be enhanced. There is a wide range of methodological high quality studies, which have shown that mindfulness-based treatments are effective for the treatment of depression. However, the underlying mechanisms have not been fully understood until today. Therefore, the current paper investigates whether intuition is one potential mechanism by which mindfulness unfolds its effects. The hypothesis that mindfulness is associated with enhanced intuition is based on one of the main characteristics of a mindful state: the improved perception of body sensations, thoughts, feelings and – supposedly – intuitions. Altogether, the current paper aims to make a contribution to the investigation of cognitive processes relevant in depression and to explore the question whether mindfulness fosters the access to intuitions. Herby, the current paper also contributes to research, which explores the mechanisms by which mindfulness, a therapeutic principle which becomes increasingly important and implemented in clinical science and practice, unfolds its effects

Why Being Mindful May Have More Benefits Than You Realize: Mindfulness Improves Both Explicit and Implicit Mood Regulation

Prior research has consistently observed that mindfulness facilitates emotion regulation. However, this research mainly examined explicit, self-reported emotion. Does mindfulness also facilitate regulation of implicit emotional responses? To address this question, the authors induced sadness among a group of healthy volunteers (N = 72), after which participants performed a mindfulness, distraction, or rumination exercise. Implicit mood changes were assessed with the Implicit Positive and Negative Affect Test and explicit mood changes were assessed with the Positive and Negative Affect Schedule. Participants' implicit and explicit negative mood improved in the mindfulness and distraction groups, but not in the rumination group. The mindfulness group displayed greater congruence between implicit and explicit mood than the other groups. Trait mindfulness was associated with lower implicit-but not explicit-negative mood across the whole sample both before and after the strategy induction but did not moderate the effects of the strategy induction on mood improvement. These findings indicate that mindfulness can facilitate emotion regulation on both implicit and explicit levels

Einfluss einer achtsamkeitsbasierten Depressionsbehandlung in einer Tagesklinik auf arbeitsbezogene Bewältigungsmuster bei depressiven Patientinnen und Patienten mit berufsbezogenen Konflikten

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