What’s Old Is New: Scientific Examination of Meditation In Mood

Saundra Jain, MA, PsyD, LPCAdjunct Clinical AffiliateUniversity of Texas at AustinSchool of NursingAustin, Texas

Executive DirectorMental Aerobics Project (MAP)Austin, Texas

Are We Winning The Battle Against Depression?

Let’s Examine Depression

STAR*D Results: Are Current Treatment Options Giving Us All That We Want?

1Trivedi MH et al. Am J Psychiatry. 2006;163(1):28-40; 2Trivedi MH et al. N Engl J Med. 2006;354(12):1243-1252; 3Rush AJ et al. N Engl J Med. 2006;354(12):1231-1242; 4Nierenberg AA et al. Am J Psychiatry. 2006;163(9):1519-1530; 5Fava M et al. Am J Psychiatry. 2006;163(7):1161-1172; 6McGrath PJ et al. Am J Psychiatry. 2006;163(9):1531-1541.

Mono Aug Switch Aug Switch Aug Switch0%

10%

20%

30%

40%

High LowWindow of Opportunity

Patie

nts

in R

emis

sion

Remission: (HAM-D17 ≤7)

Level 1 Level 2 Level 3 Level 4

27.5%29.9%

21.2% 20.3%

16.1%13.7%

6.9%

STAR*D Remission Rates1-6

Mono Aug Switch Aug Switch Aug Switch

STAR*D Reveals 2 Striking Shortcomings of Current Therapy

1. Low rates of remission

2. High rates of relapse

STAR*D, Sequenced Treatment Alternatives to Relieve Depression.

As Clinicians Dealing With Depression, We Must Ask Ourselves A Few Questions:

• Is there an urgent need for other treatment options (as alternatives or as add-ons)?• Is meditation potentially an option that

meets both of these needs?• And if so, how do we incorporate meditation

into our clinical practices?

Neurobiology and MBCT

Is MBCT Good For The Brain?

Volumetric Changes in Meditators

Hölzel BK et al. Soc Cogn Affect Neurosci. 2008;3(1):51-61.

MRI brain images of 20 mindfulness

(Vipassana) meditators (mean practice 8.6 years;

2 h daily) and compared the

regional gray matter concentration to that

of non-meditators matched for sex,

age, education, and handedness.

Volumetric Changes Over 8 Weeks of Mindfulness-Based Therapy: Focus on Amygdala

Hölzel BK et al. Soc Cogn Affect Neurosci. 2010;5(1):11-17.

Stressed but otherwise healthy individuals (N=26) participated in an 8-week mindfulness-based stress reduction intervention.

Volumetric Changes In The Hippocampus With 8 Weeks of Mindfulness-Based Therapy

Hölzel BK et al. Psychiatry Res. 2011;191(1):36-43.

16 healthy, meditation-naive participants were obtained before and after they underwent the 8-week program. Changes in gray matter concentration were investigated using voxel-

based morphometry, and compared with a waiting list control group of 17 individuals.

50 healthy women (mean age=41.32, range=30-65), 25 novices and 25 experts, were exposed to each of the conditions (yoga, movement control, and passive-video control) during 3 separate visits.

Autonomic Nervous System And Inflammatory Responses, Stress, And Meditation

Kiecolt-Glaser JK et al. Psychosom Med. 201;72(2):113-121.

Meditation As An Intervention:

How Does It Work?

HRSD15m, Hamilton Rating Scale for Depression scores at 15-month follow-up; MBCT, Mindfulness-Based Cognitive Therapy (n=43); M-ADM, Maintenance Antidepressant Medication (n=37).

Answer: By Reducing Cognitive ReactivityHow Does MBCT Work?

Kuyken W et al. Behav Res Ther. 2010;48(11):1105-1112.

What Does Emotional Regulation Have To Do With Depression?

My life is ruined

I feel hopeless

My life is worthless

I can’t function

I’m desperate

Evidence-Based MBCT

Does MBCT Really Help Our Patients?

MBCT in Generalized Anxiety Disorder

BAI, Beck Anxiety Inventory; BDI, Beck Depression Inventory; PSWQ, Penn State Worry Questionnaire; POMS, Profile of Mood States.

Evans S et al. J Anxiety Disord. 2008;22(4):716-722.

BAI PSWQ POMS tension-anxiety BDI0

10

20

30

40

50

60

70

19

60.82

16.913.8

8.91

48.82

9.7 8.82

Baseline Post-intervention

Mea

n Sc

ore

P<0.05

MBCT and Panic Disorder

HAM-A, Hamilton Anxiety Rating Scale; PDSS, Panic Disorder Specific Scale.Kim B et al. J Anxiety Disord. 2010;24(6):590-595.

HAM-A PDSS0

2

4

6

8

10

12

14

16

18 16.8

10.0

12.6

6.2

12.5

4.23.3 3.3

0 week

2nd week

4th week

8th week

Mea

n Sc

ores

P<0.01

MBCT In Treatment-Resistant Depression

Kenny MA, Williams JM. Behav Res Ther. 2007;45(3):617-625.

79 patients, 8 weeks of MBCT

Pre-post effect size = 1.04

106 recovered depressed patients with a history of at least 3 depressive

episodes continued either with their

treatment as usual (TAU) or received MBCT

in addition to TAU.

MBCT: The Power of Relapse Prevention, The Belgian Experience

Godfrin KA, van Herringan C. Behav Res Ther. 2010;48(8):738-746.

Mean time to first relapse post study:• 39.5 wks for TAU• 53.7 wks MBCT/TAU

MBCT improved time to first

relapse by 35%

MBCT: A Promising New Therapy

M-ADM, medication (antidepressant continuation); Pla+Clin, placebo plus clinical management.Segal ZV et al. Arch Gen Psychiatry. 2010;67(12):1256-1264.

Does Meditation Practice Change Connectivity In The Brain?

Results of The Xue Study

IBMT, integrative body-mind training; RT, relaxation training.Xue S et al. Neuroreport. 2011;22(12):570-574.

15 experimental participants (8 women) practiced 30-min IBMT from Monday to Friday for 1 month, with a total of 11 h of training; whereas 17 controls (9 women)

received the same amount of RT.

The trainees concentrated on achieving a balanced state of body and mind guided by an IBMT coach and the compact disc, whereas the control group

focused on muscle relaxation guided by a tutor and compact disc.

What Does The Xue Study Show Us?

Xue S et al. Neuroreport. 2011;22(12):570-574.

Complete novices, even with 11 hours of training over a month, are able to ‘change’ brain connectivity in a structure of immense

importance to mood regulation – the Anterior Cingulate Cortex (ACC).

IBMT

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Beyond Reduction of Negative Attributes, Does Meditation Change Positive Mood Attributes?

Let’s Take A Look…

Jung YH et al. Neurosci Lett. 2010;479(2):138-142.

Control (n=57); Meditation group (n= 67)

Findings From The Jung Study

• The meditation group obtained higher scores on positive affect (P=0.019) and lower scores on stress (P<0.001) compared to the control group• Plasma DA levels were higher in the meditation

(P=0.031) than in the control group• Participants that had practiced meditation 48

months or more, showed a positive correlation between positive affect and plasma DA levels (r=0.501, P=0.013)

Jung YH et al. Neurosci Lett. 2010;479(2):138-142.

Let’s Turn Our Attention To The Clinical Aspects of Mindfulness Meditation

Practical Tips For Incorporating Mindfulness Meditation Into Your Clinical Practice

Walking Down the Street

On the other side of the street you see somebody you know.

You smile and wave.

The person does not wave back and keeps walking.

You’re walking down the street.

Raisin ExerciseSENSATIONS

THOUGHTS

FEELINGS

Meditation and CBT = MBCT

Cognitive Behavioral Therapy

Mindfulness Meditation

MindfulnessBased

Cognitive Therapy

“Paying Attention In A Particular Way: On Purpose, In The Present Moment, And Nonjudgementally.”

--- Dr. Jon Kabat-Zinn University of Massachusetts Medical Center

Mindfulness: What Is It?

Kabat-Zinn J. Coming to Our Senses: Healing Ourselves and the World Through Mindfulness. New York, NY: Hyperion; 2005.

Mindlessness and Vulnerability to Depression

NON-AWARENESS

OLD PATTERNS INTRUDE

WISH FOR THINGS TO BE

DIFFERENT

RUMINATION DEPRESSION

MEMORY BIAS

POOR PROBLEM SOLVING

Mindfulness and Prevention of Relapse Into Depression

LOW MOOD

OLD PATTERNS INTRUDE

WISH FOR THINGS TO BE

DIFFERENT

MINDFUL AWARENESS

FREEDOM TO CHOOSE NOT

TO “GO THERE”

SAFE “PLATFORM”

CALMCONNECTED

CREATIVE

Practicing Mindfulness

“If your attention wanders a hundred times, simply bring it back a hundred

times.”

(Present Moment)

(Attention)

(Nonjudgmental)

Mind on chosen target

Attention wanders

Observe wandering

, begin again

MBCT Program Overview

MBCT Outline

• Mindfulness facilitator

• 2 hours a week for 8 weeks

• 1 all day session between weeks 5 and 7

• Daily homework using CDs

• Talk about experiences with home practices, obstacles, and how to deal with them

THOUGHTS

FEELINGS

SENSATIONS

MBCT Class Themes

Class 1: Automatic Pilot

Class 2: Dealing with Barriers

Class 3: Mindfulness of the Breath

Class 4: Staying Present

Class 5: Allowing and Letting Be

Class 6: Thoughts are Not Facts

Class 7: How Can I Best Take Care of Myself

Class 8: Using What’s Been Learned to Deal with Future Moods

• On Purpose• Present

Moment• Without

Judgment

MBCT Classes

The practices help to:• Become familiar with the workings of your mind• Notice the times when you are at risk of getting caught in old

habits that re-activate downward mood spirals• Explore ways of letting go of old habits and, if you choose,

entering a different way of being• Get in touch with a different way of knowing yourself and the

world• Notice small beauties and pleasures in the world instead of

living in your head• Be kind to yourself instead of wishing things were different • Find a way so you don’t have to battle with yourself • Accept yourself as you are, rather than judging yourself

3-Minute Breathing Space:Mini Meditation

First Step in Responding to Challenging Situation & Feelings

3-Minute Breathing Space:Mini Meditation

BecomingAware

Gathering

Expanding

A

G

E

MBCT Resources

MBCT Resources

“The Green Book”Clinician Guide

“The White Book “ Patient Guide

MBCT Resources

Mindfulness iPhone App

MBSR Resources

http://www.umassmed.edu/Content.aspx?id=41254&amp;LinkIdentifier=id; Accessed 04/22/13.

Founded by Dr. Jon Kabat-Zinn in 1979. Eight-week program focusing on how to

use innate resources and

abilities to respond more effectively to

stress, pain, and illness.

Mindful: Another Great Website Resource

http://www.mindful.org; Accessed 04/22/13.

http://sphotos-a.xx.fbcdn.net/hphotos-ash3/p480x480/561813_451199408235422_1571466411_n.jpg ; Accessed 04/12/2013.