The Efficacy of Mindfulness-Based Cognitive Therapy as a Public Mental Health Intervention for Adults with Mild to Moderate Depressive Symptomatology: A Randomized Controlled Trial

Objective Although there has been growing evidence for the efficacy of mindfulness-based cognitive therapy (MBCT) for different clinical populations, its effectiveness as a public mental health intervention has not been studied. The present study evaluates a community-based MBCT intervention for adults with mild to moderate depressive symptomatology in a large multi-site, pragmatic randomized controlled trial. Method The participants with mild to moderate depressive symptomatology were recruited from the general population and randomized to the MBCT intervention (n = 76) or to a waiting list control group (n = 75). Participants completed measures before and after the intervention. Participants in the experimental condition also completed these measures at a 3-month follow-up. Results In the experimental condition significant reductions in depression, anxiety, and experiential avoidance, and improvements in mindfulness and emotional- and psychological mental health were found, compared to the waiting list (effect sizes Cohen's d = 0.31–0.56). These effects were sustained at the 3-month follow-up. The likelihood of a clinically significant change in depressive symptoms was significantly higher for the MBCT group [odds ratio (OR) 3.026, p<0.01 at post-treatment; NNT = 5.10]. Discussion MBCT as a public mental health intervention for adults with mild to moderate depressive symptoms seems effective and applicable in a natural setting

Psychometric properties of the Dutch Five Facet Mindfulness Questionnaire (FFMQ) in patients with fibromyalgia

Mindfulness-based interventions are increasingly being used in clinical populations to reduce psychological distress and improve functioning. The Five Facet Mindfulness Questionnaire (FFMQ) is a questionnaire that measures five facets of mindfulness: observe, describe, actaware, nonjudge and nonreact. The goal of this study was to examine the psychometric properties of the FFMQ in a clinical population of fibromyalgia patients. A total of 141 patients completed an online questionnaire on mindfulness (FFMQ) and theoretically related (e.g. acceptance, openness, alexithymia) and unrelated (physical health) constructs. Thirty-eight patients filled in the FFMQ twice. A confirmatory factor analysis (CFA) was conducted to test the five-factor structure of the FFMQ. Internal consistency and test–retest reliability were respectively assessed with Cronbach’s α and intraclass correlation coefficients. Construct validity was examined by correlating FFMQ facets with theoretically related and unrelated constructs. Incremental validity in predicting mental health and psychological symptoms was examined with regression analyses. CFA confirmed the correlated five-factor structure of the FFMQ. Internal consistency of the five facets was satisfactory and test–retest reliability was good to excellent. Construct validity was excellent, as shown by the moderate to large correlations with related constructs (except observe facet) and weak correlation with a theoretically unrelated construct. Two of the five facets (actaware and nonjudge) had incremental validity over the others in predicting mental health and psychological symptoms. After controlling for related constructs, the actaware facet remained a significant predictor. This study showed satisfactory psychometric properties of the Dutch FFMQ in fibromyalgia patients. The observe facet, however, should be used with caution given its deviant relationship with theoretically related constructs

Acceptance-based interventions for the treatment of chronic pain: A systematic review and meta-analysis

AbstractAcceptance-based interventions such as mindfulness-based stress reduction program and acceptance and commitment therapy are alternative therapies for cognitive behavioral therapy for treating chronic pain patients. To assess the effects of acceptance-based interventions on patients with chronic pain, we conducted a systematic review and meta-analysis of controlled and noncontrolled studies reporting effects on mental and physical health of pain patients. All studies were rated for quality. Primary outcome measures were pain intensity and depression. Secondary outcomes were anxiety, physical wellbeing, and quality of life. Twenty-two studies (9 randomized controlled studies, 5 clinical controlled studies [without randomization] and 8 noncontrolled studies) were included, totaling 1235 patients with chronic pain. An effect size on pain of 0.37 was found for the controlled studies. The effect on depression was 0.32. The quality of the studies was not found to moderate the effects of acceptance-based interventions. The results suggest that at present mindfulness-based stress reduction program and acceptance and commitment therapy are not superior to cognitive behavioral therapy but can be good alternatives. More high-quality studies are needed. It is recommended to focus on therapies that integrate mindfulness and behavioral therapy.Acceptance-based therapies have small to medium effects on physical and mental health in chronic pain patients. These effects are comparable to those of cognitive behavioral therapy

Comparison of internal and external responsiveness of the generic Medical Outcome Study Short Form-36 (SF-36) with disease-specific measures in rheumatoid arthritis

OBJECTIVE: To examine the comparative internal and external responsiveness of the generic Medical Outcome Study Short Form-36 Health Survey (SF-36) and disease-specific measures in patients with rheumatoid arthritis (RA).\ud METHODS: Data were collected from 280 RA patients starting anti-tumor necrosis factor treatment. A total of 168 patients completed a questionnaire including the SF-36, the Arthritis Impact Measurement Scales 2 (AIMS2), the Health Assessment Questionnaire (HAQ), a visual analog scale for general health (VAS-GH), and an 11-point numerical rating scale for pain (NRS pain) at baseline and after 12 months. Internal responsiveness was evaluated with paired samples t-tests and standardized response means (SRM). External responsiveness was investigated with receiver-operating characteristic statistics and Spearman rank-order correlation coefficients. A health transition item was used as the external indicator of change.\ud RESULTS: No significant differences in internal and external responsiveness were found between the SF-36 and disease-specific measures within the domains physical function, pain, and psychological function. In the domain social function, the SF-36 was more responsive than the AIMS2. In the domain general health, the SF-36 was less responsive (only internal) than the AIMS2 and VAS-GH.\ud CONCLUSION: Our study showed comparable internal and external responsiveness of the SF-36 compared with disease-specific measures (AIMS2, HAQ, NRS pain) in all health domains, except social function and general health domains. The assumption that disease-specific measures are more responsive to detect intervention-related changes over time is not confirmed by our data

Changes in priorities for improvement in patients with rheumatoid arthritis during 1 year of anti-tumour necrosis factor treatment

Objectives: To examine priorities for health status improvement in patients with active rheumatoid arthritis (RA) during anti-tumour necrosis factor (TNF) treatment.\ud \ud Methods: Data were used from 173 patients with RA starting treatment with TNF-blocking agents. Outcome measures included assessment of health status with the Arthritis Impact Measurement Scales 2 (AIMS2) at baseline and after 3 and 12 months. The AIMS2 contains a priority list from which patients are asked to select from 12 areas of health the 3 in which they would most like to see improvement.\ud \ud Results: After 1 year of treatment, 10 out of 12 areas of health on the AIMS2 were significantly improved. The most commonly selected priorities for improvement at baseline were pain (88%), hand and finger function (57%), walking and bending (42%), mobility (33%), and work (29%). At group level, this priority ranking remained largely unchanged during treatment. After adjustment for multiple comparisons, only pain was selected significantly less often at 3 and 12 months (71% at both assessments). Within individual patients, however, priorities often changed. Changes in the priority of pain were related to the achieved level of patient-perceived pain and disease activity.\ud \ud Conclusions: This study shows that, at the group level, patients’ priorities for improvement are fairly stable during 12 months of anti-TNF therapy, despite major improvements in health status. Although pain reduction becomes somewhat less important, it remains the most commonly selected priority. In contrast, individual patient priorities are not stable over the course of treatment and appear to be associated with differences in disease state

Participant flow.

<p>MDE  =  major depressive episode.</p

Means and standard deviations for outcome measures and results of ANCOVA for intervention effects, and Cohen's d.

<p><i>Note</i>. ANCOVA, Analysis of covariance; CES-D, Center for Epidemiologic Studies - Depression.</p><p>Scale; HADS-A, Hospital Anxiety and Depression Scale - Anxiety subscale; MHC-SF, Mental Health Continuum - Short form; EM, emotional; SOC, social; PSY, psychological.</p>a<p> Unadjusted condition means and standard deviations (SD).</p>b<p> F-value, corrected for baseline values.</p>c<p> Follow-up for intervention group and post-treatment for waiting list group.</p><p>Means and standard deviations for outcome measures and results of ANCOVA for intervention effects, and Cohen's d.</p

Means and standard deviations for process measures, results of ANOVA and Cohen's d for intervention effects.

<p><i>Note</i>. AAQ-II, Acceptance and Action Questionnaire-II; ANOVA, Analysis of variance; FFMQ, Five Facet Mindfulness Questionnaire; Observe, observing; Describe, describing; ActAware, acting with awareness; NonJudge, non-judging of inner experience; NonReact, non-reactivity to inner experience.</p>a<p> Follow-up for intervention group and post-treatment for waiting list group.</p><p>Means and standard deviations for process measures, results of ANOVA and Cohen's d for intervention effects.</p