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Issue Links: Mindfulness-Based Therapy 5887

Topics: Psychotherapy

Approximately half of Americans will have a psychiatric disorder that will meet DSM-IV criteria in their lifetime, with the first onset usually occurring in childhood or adolescence (Kessler RC et al, Arch Gen Psychiatry 2005;62(6):593–603). While there have been many pharmacological and psychotherapeutic advances in treating psychiatric disorders, there remains a significant need for improvement.

For example, the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Study—funded by the National Institute of Mental Health to determine the effectiveness of different treatments for people with major depression—found that nearly one-third of depressed patients never enter remission with antidepressant treatment, even with four treatment attempts (Warden D et al, Curr Psychiatry Rep 2007;9(6):449–459). And of the patients who do achieve remission, 35% to 50% relapse within one year. Cognitive behavioral therapy (CBT), often cited as the most evidence-based treatment for major depressive disorder (Department of Health 2001, Treatment Choice in Psychological Therapies and Counselling: Evidence-Based Clinical Practice Guideline. London: Stationery Office), has even less evidence for efficacy than pharmacotherapy (Vittengl JR et al, J Consult Clin Psychol 2007;75(3):475–488).

Help for a Broad Range of Disorders

Into this treatment void comes mindfulness-based therapy. As the evidence for their efficacy grows, mindfulness-based therapies are increasingly being used to treat a variety of psychiatric disorders.

In 2010, researchers Ruth Baer and Stefan G Hoffman conducted meta-analyses of the limited studies on mindfulness therapy that met adequate methodological criteria (Baer RA, Clin Psychol-Sci Pr 2003;10:125–143; Hofmann SG et al, J Consult Clin Psychol 2010;78(2):169–183). They found that most of the studies were small prospective treatment evaluations that needed supplementation with large randomized controlled trials. However, they also noted preliminary evidence that mindfulness may help improve a broad range of symptoms in adults. These include depression (Segal ZV et al, Arch Gen Psychiatry 2010; 67(12):1256–1264), anxiety (Hoffman op cit), chronic pain (Kabat-Zinn J, Gen Hosp Psychiatry 1982;4(1):33–47), and ADHD (Zylowska L et al, J Atten Disord 2008;11(6):737–746).

In addition, neuroscience findings are helping to establish the impact of mindfulness on the brain (Davidson RJ et al, Psychosom Med 2003;65(4):564–570; and Holzel BK et al, Soc Cogn Affect Neurosci 2010;5(1):11–17) and to identify the mechanisms underlying mindfulness (Creswell JD et al, Psychosom Med 2007;69(6):560–565).

Researchers are linking mindfulness meditation practice with actual physical changes in the brain, such as an increase in the number of signaling connections, called axonal density. The Davidson study, for instance, suggests that mindfulness meditation may change brain and immune function in positive ways.

Neuropsychologist Eileen Luders and colleagues found preliminary evidence for correlations between mindfulness training (MT) and larger gray matter volumes in the right orbito-frontal cortex and right hippocampus, which are associated with emotional regulation and response control (Luders E et al, Neuroimage 2009;45(3):672–678). This may account for MT’s impact on cultivating positive emotions and retaining emotional stability. Psychologist Britta Holzel and colleagues found that MT was associated with decreased perceived stress. And the decreases in perceived stress correlated positively with decreases in the gray matter density of the right basolateral amygdala, which is believed to initiate the stress response (Holzel BK et al, Soc Cogn Affect Neurosc 2010;5(1):11–17).

Psychiatrist Judson Brewer and colleagues found that experienced meditators have an increased deactivation of the typical person’s default mode of brain activity (Brewer JA et al, Proc Natl Acad Sci USA 2011;108(50):20254–20259). This default mode consists of an active network of brain areas (medial prefrontal and posterior cingulated cortices) that correlate with mind-wandering, which has been associated with unhappiness (Killingsworth MA and Gilbert DT, Science 2010;330(6006):932). These experienced meditators also have stronger coupling in brain regions (posterior cingulated, dorsal anterior cingulated, and dorsolateral prefrontal cortices) associated with self-monitoring and cognitive control, both at baseline and during meditation. Thus, Brewer’s findings suggest a possible neural mechanism for meditation.

Effectiveness for Children and Adolescents

There is a small, but growing, body of research that supports the use of mindfulness-based treatments in children and adolescents (Burke CA, J Child Fam Stud 2010;19(2):133–144; Black DS et al, Pediatrics 2009;124(3):532–541).

Psychotherapist Gina M. Biegel and colleagues conducted the first randomized clinical trial to assess the efficacy of a mindfulness-based treatment for adolescents in an outpatient psychiatric facility. Biegel found that participants who received the mindfulness-based treatment experienced improvements in anxiety, depression, somatic distress, self-esteem, sleep quality, and global assessment of functioning (GAF) scores (Biegel GM et al, J Consult Clin Pscyhol 2009;77(5):855–866).

A Variety of Treatments

Mindfulness-based treatments focus primarily on MT and have gained increasing attention for the potential benefits of enhancing cognitive, emotional, and behavioral well-being. (For more about mindfulness training see “How Mindfulness Training Works.”)

MT fosters mindfulness, which is defined by Canadian psychologist Scott R. Bishop as having two components: “The first component involves the self-regulation of attention so that it is maintained on immediate experience, thereby allowing for increased recognition of mental events in the present moment. The second component involves adopting a particular orientation toward one’s experiences in the present moment…that is characterized by curiosity, openness, and acceptance” (Bishop SR et al, Clin Psychol-Sci Pr 2004;11(32):230–241). Mindfulness is often affiliated with Buddhism, yet its phenomenological aspects are present in most religious and spiritual traditions, in addition to Western philosophical and psychological schools of thought (Shapiro SL, J Clin Psychol 2009;65(6):555–560).

The many MT studies have helped establish that mindfulness-based treatments are feasible in treating a variety of psychiatric disorders in various age groups, and a growing body of preliminary research supports its efficacy. Further stringent empirical research will help elucidate the full potential of MT as a treatment for psychiatric disorders.

TCRBH’s Take: These encouraging research findings are likely a major reason for the development and availability of mindfulness-based psychotherapies. It is especially exciting that the research is addressing not only how MT can be used to treat a broad range of problems, but also how it can be used to enhance quality of life. It is hoped that continued research will further clarify the specific contributions of the various components of MT.