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The assessment of psychotherapies, for reasons related both to the respect of public health rules and to the improvement of our knowledge and our practices, has become an unavoidable stage. The effectiveness of psychotherapies, and particularly of Cognitive and Behavioral Therapies (CBT), is now widely documented in the treatment of depressive episodes and in the prevention of relapses. Recent work focuses on improving care to further optimize the gain in relapse prevention. It is within this framework that the MBCT approach takes its place. Studies have shown that joining an MBCT approach further improves the gain in relapses after CBT to which the patient had responded (Vittengl et Jarrett, 2015). On the other hand, the question of why they work, under what conditions, for which particular individuals and the identification of the mechanisms and processes of change are still very current. In order to do this, the evaluation of the effect of a practice in MBCT used both direct measures (self-questionnaires) and more indirect measures of change (neuropsychological tests, psychological measures, brain imaging, etc.). The purpose of this paper is to review the results of these measures, the results they have produced and the hypotheses they have raised in the international literature on unipolar disorder.
Objectives: This study focused on patients with bipolar disorder (BD), several years after their participation in mindfulness-based cognitive therapy (MBCT). It aimed at documenting sustained mindfulness practice, perceived long-term benefit from the program, and changes regarded as direct consequences of the intervention.Design: This cross-sectional survey took place at least 2 years after MBCT for 70.4% of participants.
Location: It was conducted in two specialized outpatient units for BDs that are part of the Geneva University Hospitals (Switzerland) and the Sainte-Anne Hospital in Paris (France).
Subjects: Eligibility criteria were a diagnosis of BD according to DSM-IV and participation in at least four MBCT sessions. Response rate was 66.4%. The final sample included 71 outpatients (71.8% bipolar I, 28.2% bipolar II).
Outcome measures: A questionnaire retrospectively assessed patient-perceived change, benefit from MBCT, and current mindfulness practice.
Results: Proportions of respondents who practiced mindfulness at least once a week were 54.9% for formal practice (body scan, sitting meditation, mindful walking, or movements) and 57.7% for informal practice (mindful daily activities). Perceived benefit for the prevention of relapse was moderate, but patients acknowledged long-lasting effects and persistent changes in their way of life. Formal mindfulness practice at least once a week tended to be associated with increased long-lasting effects (p = 0.052), whereas regular informal practice and mindful breathing were significantly associated with persistent changes in daily life (p = 0.038) and better prevention of depressive relapse (p = 0.035), respectively. The most frequently reported positive change was increased awareness of being able to improve one's health.
Conclusions: Despite methodological limitations, this survey allowed documenting mindfulness practice and perceived sustained benefit from MBCT in patients with BD. Participants particularly valued increased awareness that they can influence their own health. Both informal and formal practices, when sustained in the long term, might promote long-lasting changes.