Mindfulness-Based Interventions to Depressive Symptomatology III: Efficacy of Mindfulness
by Stefanie Gobin, MPsy
This series was originally completed as a Major Research Project in partial fulfillment of Adler Graduate Professional School’s Master of Psychology degree.
Efficacy of Mindfulness (cont.)
Efficacy of MBSR in treatment of depression. Segal et al. (2013) described that engaging in mindfulness-based approaches is useful for participants even after ending the program in that if one encounters a relapse in relation to depressive conditions, then one can rely on the tools that one has learned in the program (Segal et al., 2013). Practice in MBSR allows people to identify signs of depressive symptoms so that they can detect this before a full-blown relapse occurs (Segal et al., 2013). Segal et al. maintain that MBSR is also useful in that it teaches clients to understand that fighting against thoughts and sensations in the body that are unwanted creates more inner tension and turmoil. Depressive relapse is said to entail reactivation of mind states on the basis of old mental habits (Segal et al., 2013). More particularly, Segal et al. stated that the mind holds onto these old mental habits even though they are destructive because they can offer a prevention and reduction of similar states of mind in the future. Overall, these processes, such as mental rumination, can serve to be divisive to an individual (Segal et al., 2013).
There have been a multitude of studies that have been conducted on the efficacy of MBSR in relation to treatment of depression as a psychopathology. Joo, Lee, Chung, and Shin (2010) conducted a study examining the effectiveness of MBSR programs on patients with depression and anxiety postsurgery for hemorrhage in the spontaneous subarachnoid region. Joo et al. determined that after exposure to the MBSR program, a decrease in anxiety and depressive symptoms was observed. A limitation of this study is its small sample size of only 11 people. Grossman et al. (2004) similarly have reported that MBSR has effectiveness for a range of clinical or nonclinical issues including those relating to anxiety, depression, and pain (as cited in Kang & Whittingham, 2010). As well, Deyo, Wilson, Ong, and Koopman (2009) described that in treatment of depression, it is especially important to examine ruminative thought patterns because proclivities towards rumination in populations that are devoid of depression has been shown to augment likelihood that depressive symptoms emerge. Deyo et al. also report that individuals who complete MBSR classes tend to show augmented levels of mindfulness in addition to higher levels of overall well-being. Furthermore, individuals who have engaged in MBSR programs also exhibit decreased tendencies to engage in rumination and also decreased depressive symptoms (Deyo et al., 2009).
Bohlmeijer, Prenger, Taal, and Cuijpers (2010) conducted a meta-analytic study in order to determine if MBSR has an effect on psychopathology of depression, psychological distress, and anxiety in individuals suffering from somatic diseases of a chronic nature. To conduct this study, eight studies of a randomized control basis were studied. In relation to depression, an effect size of 0.26 was exhibited. In relation to psychological distress, an effect size of 0.32 was yielded. In relation to anxiety, an effect size of 0.47 was ascertained. Overall, this study deduced that MBSR induces small effects in relation to the psychopathology of anxiety, psychological distress, and depression in individuals suffering from somatic diseases of a chronic nature (Bohlmeijer et al., 2010). As well, Bohlmeijer et al. asserted that integrating MBSR into behavioral therapy can augment the efficacy that is affiliated with interventions of a mindfulness-based nature. However, this study exhibits limitations in that it utilized only eight studies for a meta-analysis, making it a relatively limited sample in comparison the available research.
A study conducted by Miller, Fletcher and Kabat-Zinn (1995) tested 22 medical patients who met the diagnostic criteria for anxiety disorders who showed improvement in relation to their panic and anxiety symptoms after an 8-week outpatient group in MBSR. Twenty of these subjects were shown to have reductions of a significant nature in relation to their Beck and Hamilton depression and anxiety scores after the intervention in addition to 3 months after the intervention occurred. A 3-year follow-up was conducted in which 18 of the 22 individuals were analyzed in order to determine long-term effects affiliated with the intervention. The results of this study indicated that there was maintenance in stable anxiety and depression levels as noted in the Hamilton and Beck scales in addition to the quantity and severity affiliated with panic attacks. Thus, Miller et al. advocated that long-term beneficial effects can occur for individuals exposed to a mindfulness-based stress intervention. A potential limitation of this study is that if individuals know that they are going to be referred to a group, then they may perceive it as something that will be clinically useful for them, which can influence the likelihood of their feeling that their psychological symptoms will improve. As well, outpatient individuals were studied in this study, and these individuals may have been more stabilized in nature as compared to inpatients.
Carmody and Baer’s (2008) study attempted to determine if a relationship existed between practice of mindfulness meditation exercises at home and levels of mindfulness exhibited in individuals in addition to psychological symptoms and stress levels. Carmody and Baer stated that this study was conducted with 174 individuals who were immersed in a MBSR program. Participants were monitored through completing measures pertaining to mindfulness, stress, and well-being before and after MBSR. The results of this study indicated that after the MBSR program there were increases in relation to mindfulness and well-being. As well, there was also a reduction of stress and stress-related symptoms observed. This study also found that the temporal length that individuals spent in relation to their home practice of formal meditation engagement, such as yoga or the body scan, had a significant correlation to the extent of improvement that they exhibited in relation to development of mindfulness and improved well-being. Increases in mindfulness were also found to be a mediating variable between mindfulness practice of a formal nature and improvements in functioning of a psychological quality. Carmody and Baer therefore overall advocated that mindfulness meditation practice engagement tends to lead to an overall increase in mindfulness in one’s life, which leads to a reduction of symptoms of stress and improvements in well-being. A criticism of mindfulness that one can infer from examining the results of this study is that longer mindfulness meditation based practices are central to increased improvement of an individual’s psychological health. Therefore, this can be problematic because many individuals have time constraints in their schedule and may be reluctant to integrate a lengthy practice into their schedule, such as the body scan which is normally 30 minutes in length.
Shapiro, Oman, Thoresen, Plante, and Flinders (2008) conducted a study on college undergraduates in order to determine if mindfulness, as described in the MAAS, is a skill that can be cultivated and utilized for well-being. Shapiro et al. placed the subjects into groups of either MBSR or treatment. The control group of this study was on a wait list. Groups were roughly equivalent in relation to sample sizes, with approximately 15 people in each and pre, post, and follow-up after 8 weeks of the treatment. In comparison to the control group, participants who were in the treatment groups demonstrated augmented mindfulness levels in the follow-up. Similar to previously mentioned studies, Shapiro et al. also found that increases in mindfulness were a mediating variable in relation to reducing levels of perceived stress as well as ruminative processes. Hence, the results of this study overall offered more evidence that meditation practices have the ability to increase mindfulness, which in turn acts as a mediating variable for augmented psychological health (Shapiro et al., 2008). A limitation of this study can be found in the lack of heterogeneity in the sample group; only college students were included, and so one may argue that it may be difficult to generalize these findings to the general populace.
Ramel, Goldin, Carmona, and McQuaid (2004) also studied the effects of MBSR on individuals experiencing mood symptoms of anxiety and depression, dysfunctional, based attitudes, and ruminative thought processes. In their study, they included individuals who had experienced a lifetime prevalence of mood disorders. These individuals were compared to individuals on a wait list. The results of this study indicated that mindfulness meditation practice assists in reduction of ruminative thinking processes, even subsequent to controlling for reduction in mood symptoms and beliefs of a dysfunctional nature (Ramel et al., 2004).
Weinstein, Brown, and Ryan (2009) examined the impact of mindfulness-based interventions in modulating stress in college students. Weinstein et al. noted that mindful individuals partake in relating to events and experiences in a fashion that is receptive and categorically attentive. Hence, they sought to further understand the role of mindfulness-based perception through conducting four studies that examined mindfulness perspectives on appraising situations, on dealing with stress in the experience of college aged students, and on the overall consequences of processing stress from a mindfulness-based lens for overall well-being. The results of these four studies, comprised of participant numbers ranging from 65 to 141, indicated that individuals who are more mindful tend to formulate more favorable appraisals of situations, report less usage of avoidance as a coping strategy, and also tend to engage in approach coping more often. As well, the relationship between mindfulness and well-being was said to be mediated by adaptive stress responses and coping (Weinstein et al., 2009). Hence, this study again demonstrated the benefits of mindfulness-based approaches to stress. However, again the relative homogeneity of the sample group is a limitation as only college aged students were included, limiting the generalizability of the results.
Wayment, Wilst, Sullivan, and Warren (2011) investigated the effects of integrating mindfulness-based approaches into one’s life in a study with Buddhist practitioners. Wayment et al. conducted a study on 117 individuals with usage of a web-based survey that was administered to practitioners of Buddhism worldwide for 6 months commencing in 2007. Wayment et al. wanted to determine if a relationship exists between experiences in meditation, mindfulness possession, physical health, and quiet ego attributes. The results of this study indicated that higher scores in relation to psychological mindfulness were observed in those who practiced meditation on a more regular basis. As well, psychological mindfulness was affiliated with quiet ego characteristics which contain attributes such as wisdom, understanding how things in life are interdependent, being altruistic, and being devoid of negative affect. Quiet ego characteristics also were shown to correlate positively with self-reports of health. Hence, Wayment et al. concluded that their study showed that psychological mindfulness plays a key role in well-being on physical and mental levels. However, a limitation of this study can be observed in the fact that acquisition of information pertaining to the participants was acquired through a self-report basis; potentially, one could self-identify these attributes without fully understanding what these attributes mean and thus falsely report this process.
Effects of mindfulness on ego were also examined by Emavardhana and Tori (1997), who conducted a study pertaining to the effects that Vipassana meditation has on psychological adjustment. More particularly, changes in relation to ego defense mechanisms and self-concept were examined in young participants in Thailand who attended Vipassana meditation retreats. Positive effects were noted in relation to self-representation in the meditation group as compared to the control group. Ego defense mechanisms were also altered significantly in the meditation group in that more maturity and tolerance in relation to common stressors was developed as coping strategy. As well, more Buddhist belief adoption was affiliated with more self-esteem and less impulsivity (Emavardhana & Tori, 1997). A limitation of this study can be found in the relatively narrow age grouping utilized for this study. The mean age of the participants was close to 18 years, and all were males. Hence, again the results may not be able to be generalizable to other ages and to females.
Marchand (2012) advocated that MBSR and MBCT are recommended to be used as a treatment of adjunct nature in relation to depression treatment. Namely, this is because both of these modalities throughout the literature exhibit antidepressant effects of a broad-spectrum quality (Marchand, 2012). As well, in general, MBSR has been shown to be beneficial at promoting better mental health and management of stress in healthy individuals in addition to those suffering from medical or psychological illnesses (Marchand, 2012). Fjorback, Arendt, Ornbol, Fink, and Walach (2011) conducted a meta-analysis of 21 out of a total of 75 articles. Fjorback et al. found that MBSR promoted improvement in health in 11 of these studies as compared to individuals who were on a wait list in the control group or for those who were receiving treatment as usual for depression. As well, they found that MBSR was as effective as active control group treatment in three of the studies utilized for this analysis. In sum, this study provided further evidence that MBSR assists improvement of mental health (Fjorback et al., 2011). However, Fjorback et al. noted that a limitation to the studies was that a number of the studies were missing an active control group and additionally there was an absence of long-term follow-up.