Several studies of mindfulness

Here I am going to briefly describe six different articles on mindfulness, with a general one followed by specific research on the therapeutic bond, depression, Black clients, mood and psychosis symptoms in youth, and pain management. The first, distributed by APA in October 2019 is titled “Mindfulness meditation: A research-proven way to reduce stress.” Supported by assistance from Creswell and Khoury, the article begins by describing the thousands of years of history of mindfulness, then define mindfulness as “ training your attention to achieve a mental state of calm concentration and positive emotions.” Mindfulness is one of the most popular meditation techniques. It has two main parts: attention and acceptance. They proceed to describe mindfulness-based stress reduction (MBSR) as typically an eight-week long group training with daily meditation assignments. They then describe mindfulness-based cognitive therapy (MBCT) which combines MBSR with cognitive behavioral therapy (CBT), especially to treat depression. Over 200 studies of mindfulness-based therapy reveal (1) it is especially effective for reducing stress, anxiety and depression and (2) it can help with pain (reducing pain, fatigue, and stress in clients with chronic pain), smoking, and addiction. MBCT significantly reduces likelihood of relapse with people who have had major depression.

In the second study Garrote-Caparrós, Lecuona, Bellosta-Batalla,  Moya-Albiol, & Cebolla published (2022) “Efficacy of a mindfulness and compassion-based intervention in psychotherapists and their patients: Empathy, symptomatology, and mechanisms of change in a randomized controlled trial” published in Psychotherapy. Here’s their abstract:

In recent years, mindfulness and compassion-based interventions (MCBI) have been found to beneficially influence the acquisition of essential skills in psychotherapy and are a promising way to improve relationships with patients. In this regard, new studies are needed to evaluate the effects of MCBI on psychotherapists and their patients and to analyze the influence of these effects on the processes and outcomes of psychotherapy. A group of psychotherapists (N = 63) were randomized to an MCBI or an active control group (empathy diary). We assessed psychotherapists and their patients (N = 121) before and after the MCBI and at follow-up evaluation. Psychotherapists’ results showed an increase in psychotherapeutic mindfulness skills (PMS) after the MCBI and at follow-up, whereas self-reported empathy improved at follow-up. Patients’ results showed an improvement in perceived empathy, therapeutic bond, and symptomatology after the MCBI. The improvements in symptomatology were maintained for somatization and anxiety at follow-up. wzs These results support the benefits of introducing MCBI in psychotherapists’ training to improve the psychotherapy outcomes.

This illustrates the benefits of quality research on MCBI on both therapists and their patients.

The third study is a meta-analysis of therapies for depression intended to study improved quality of life and functioning in patients with depression. McPherson & Senra (2022) published “Psychological treatments for persistent depression: A systematic review and meta-analysis of quality of life and functioning outcomes” in Psychotherapy. They ultimately used 14 studies of a total of 1898 patients. They conclude, “This meta-analysis highlights the potential benefits of psychological therapies for improving quality of life and functioning in patients with persistent depression, with strongest long-term effects for mindfulness-based cognitive therapy, interpersonal therapy in combination with anti-depression medication, and long-term psychoanalytic psychotherapy.”

The fourth study incorporates Black clients with trauma histories and low socioeconomic resources. Powers et al. (2022) published “Primary care-based mindfulness intervention for posttraumatic stress disorder and depression symptoms among Black adults: A pilot feasibility and acceptability randomized controlled trial” in Psychological Trauma: Theory, Research, Practice, and Policy. Here’s an edited version of their abstract:

The present randomized pilot study evaluated the feasibility and acceptability of an 8-week adapted mindfulness-based cognitive therapy (MBCT) group for trauma-exposed Black adults who screened positive for posttraumatic stress disorder (PTSD) and depression in an urban primary care clinic setting. Participants were randomized to waitlist control (WLC) or MBCT. Feasibility and acceptability were assessed through examination of retention rates, measures of group satisfaction and treatment barriers, and qualitative interview. Forty-two Black adults (85% women) were consented; of those, 34 (81%) completed pre-assessment and randomization. Feasibility of study design was shown, with > 75% (n = 26) of randomized participants completing the study through post-assessment. Twenty-four individuals (70.5%) completed through 1-month follow-up. Results showed high levels of group acceptability across quantitative and qualitative measures. Perceived barriers to psychological treatment were high, with an average of > 6 barriers present. The findings indicate feasibility and acceptability of MBCT group interventions in urban primary care settings with trauma-exposed patients with significant psychopathology. However, substantial barriers to treatment engagement were endorsed and to improve numbers for successful engagement in the intervention, continued efforts to reduce treatment barriers and increase access to mindfulness-based interventions in under-resourced communities are needed.

This is an important study, especially by incorporating barriers to treatment, but it is a largely female population of Black adults and a small sample. 

In the fifth study, Weintraub et al. (2023) published “A Randomized Trial of Telehealth Mindfulness-Based Cognitive Therapy and Cognitive Behavioral Therapy Groups for Adolescents with Mood or Attenuated Psychosis Symptoms” in Journal of Consulting and Clinical Psychology. Here’s the edited abstract and impact statement:

There is substantial evidence that cognitive behavioral therapy (CBT) and mindfulness-based cognitive therapy (MBCT) improve symptoms and functioning in adults with mood and psychotic disorders. There has been little work directly comparing these treatments among adolescents with early-onset mood or psychosis symptoms. We conducted a randomized controlled trial comparing remotely administered group CBT to group MBCT for adolescents (ages 13–17) with a mood disorder or attenuated psychosis symptoms. Adolescents attended nine sessions over 2 months; their parents attended parallel groups focused on the same skill practices. Participants were assessed for psychiatric symptoms and functioning at posttreatment and 3 months posttreatment. Sixty-six youth (Mage = 15.1 years, SD = 1.4; 44 females [66.7%]) initiated the trial (32 in CBT and 34 in MBCT), with 54 retained at posttreatment and 53 at the 3-month follow-up. The treatments were associated with comparable improvements in adolescents’ mood, anxiety, attenuated psychosis symptoms, and psychosocial functioning over 5 months. CBT was associated with greater improvements than MBCT in emotion regulation and well-being during the posttreatment period. MBCT (compared to CBT) was associated with greater improvements in social functioning among adolescents with greater childhood adversity. Both treatments had comparable rates of retention, but youth and parents reported more satisfaction with CBT than MBCT. The beneficial effect of both treatments in a group telehealth format is encouraging. Due to our limited sample, future research should investigate whether adolescents’ history of adversity and treatment preferences replicate as treatment moderators for youth with mood or psychosis symptoms. 

This study found that remote delivery of mindfulness-based cognitive therapy (MBCT) and cognitive behavioral therapy (CBT) was associated with comparable improvements in adolescents’ mood, anxiety, attenuated psychosis symptoms, and psychosocial functioning over the 5-month study period. However, MBCT was associated with greater improvements than CBT in social functioning among adolescents with greater childhood adversity, whereas CBT was associated with greater improvements than MBCT in emotion regulation and well-being during the posttreatment period and had higher rates of treatment satisfaction. The beneficial effects of these treatments in a group telehealth format are encouraging, particularly during a period in which therapy is in high demand and community care relies extensively on remote formats. 

In the final study, Burns et al. (2023) published “Cognitive Therapy, Mindfulness-Based Stress Reduction, and Behavior Therapy for People with Chronic Low Back Pain: A comparative mechanisms study” in Journal of Consulting and Clinical Psychology.  

Cognitive therapy (CT), mindfulness-based stress reduction (MBSR), and behavior therapy (BT) for chronic pain treatment produce outcome improvements. Evidence also suggests that changes in putative therapeutic mechanisms are associated with changes in outcomes. In this comparative mechanism study, we examined evidence for specific and shared mechanism effects across the three treatments. CT, MBSR, BT, and treatment as usual (TAU) were compared in people with chronic low back pain (N = 521). Eight individual sessions were administered with weekly assessments of “specific” mechanisms (pain catastrophizing, mindfulness, behavior activation) and outcomes. CT, MBSR, and BT produced similar pre- to posttreatment effects on all mechanism variables, and all three active treatments produced greater improvements than TAU. Participant ratings of expectations of benefit and working alliance were similar across treatments. Lagged and cross-lagged analyses revealed that prior week changes in both mechanism and outcome factors predicted next week changes in their counterparts. Analyses of variance contributions suggested that changes in pain catastrophizing and pain self-efficacy were consistent unique predictors of subsequent outcome changes. Findings support the operation of shared mechanisms over specific ones. Given significant lagged and cross-lagged effects, unidirectional conceptualizations—mechanism to outcome—need to be expanded to include reciprocal effects. Thus, prior week changes in pain-related cognitions could predict next week changes in pain interference which in turn could predict next week changes in pain-related cognitions, in what may be an upward spiral of improvement. 

Results suggest that cognitive therapy (CT), mindfulness-based stress reduction (MBSR), and behavior therapy (BT) for the treatment of chronic pain may share critical mechanisms by which they, in part, produce salutary outcomes; namely, altering pain-related cognitions, and fostering positive expectations of benefit and sound working alliances. 

This has been a long post but I think it’s helpful both in indicating the value of mindfulness interventions and the ways in which it compares with alternatives. It is not a panacea but can be beneficial.