Mindfulness Therapy Reduces Depressive Symptoms in TBI

Daniel M. Keller, PhD

April 08, 2013

NICE, France — Mindfulness-based cognitive therapy (MBCT) reduces symptoms of depression in individuals with traumatic brain injury (TBI), new research suggests.

A randomized controlled trial conducted by investigators at Lakehead University and St. Joseph's Care Group in Thunder Bay, Canada, showed that compared with a wait-list control group, the MBCT group experienced a significantly greater reduction in total and somatic depressive symptoms.

The findings were presented here at EPA 2013: 21st European Congress of Psychiatry.

According to study investigator Michel Bédard, PhD, TBI can be a life-changing event: Depression is common, and pharmacologic and other interventions may not relieve depressive symptoms.

Previous research conducted by the team "strongly suggested" that mindfulness-based interventions for depression in TBI all showed strong effect sizes, so the "logical next step was to conduct a randomized controlled trial to determine the efficacy of MCBT in this patient population."

Durable Effect

MBCT facilitators were trained in an initial 2-day retreat. This was followed by development of a personal meditation practice, biweekly conference calls, and a 5-day professional training program at the Center for Mindfulness at the University of California, San Diego.

Dr. Bédard said that most of the injuries in the study were from crashes or falls. Patients with too-severe TBI who could not adequately participate were excluded.

Patient interventions consisted of 10 weekly sessions of 1.5 hours with consideration of issues associated with TBI, such as memory, fatigue, and concentration, using simplified language and repetition to reinforce learning. A book and compact disk were provided to facilitate meditation, which was recommended for 20 to 30 minutes a day.

Participants were randomly assigned to MBCT (n = 57) or to the control group (n = 46), but because of the small sample size, groups were balanced on the basis of Beck Depression Inventory–II (BDI-II) scores, age, and sex.

Twenty-seven participants dropped out during the course of the study, leaving 38 in each group. The investigators saw no differences between those individuals who completed the study and those who dropped out.

The groups of completers and control participants were fairly well matched for age (about 46 years), sex (50% - 60% men), marital status, employment (21%), and education (56% - 66% having gone beyond high school).

The MBCT group experienced a significantly greater reduction in total and somatic depressive symptoms on treatment, as measured on the BDI-II, compared with control individuals. Cognitive symptoms trended toward improvement, but the difference between the treatment group and the control group was not significant.

Table. Reduction in Depression Symptoms (BDI-II) on Treatment

  MBCT (n = 38) Control (n = 38)
Total (P = .029) 6.63 2.13
Cognitive (P = .06) 2.53 0.95
Somatic (P = .039) 4.11 1.19

The effect held for total scores at 3 months, which was the maximum follow-up period (P < .001). "Both the cognitive and somatic subscales have shown a similar type of pattern," said Dr. Bédard.

"Interestingly, the [Patient Health Questionnaire-9] and the [Symptom Checklist-90] then showed a significant decrease in terms of symptoms. That's very encouraging."

A plot of BDI-II vs mindfulness, as measured by the Philadelphia Mindfulness Scale, showed a correlation, indicating that greater mindfulness was associated with improvements in depression symptoms and suggesting that MBCT may be the mechanism for the improvement in symptoms.

The study was limited by the relatively small sample size, the number of dropouts, the impossibility of blinding the participants to the treatment/control assignments, and the possibility of nonspecific therapist effects in the control group.

Dr. Bédard concluded that the changes in the BDI-II scores could be considered clinically significant and that this study may be the first randomized controlled trial of MBCT in treating people with TBI in a realistic clinical setting.

"Natural, Noninvasive Treatment"

Session chair Antoine Pelissolo, MD, PhD, professor of psychiatry at Pitié-Salpêtrière Hospital in Paris, France, told Medscape Medical News that MBCT is important because it is considered a natural, noninvasive treatment without drugs.

"Many patients with a somatic condition like that have a problem to accept medical treatment and especially drug treatment," he said. "So they can learn some psychological strategies to cope with their symptoms."

Although praising the treatment as far as it goes, Dr. Pelissolo questioned its efficacy in the long term. "We saw that there was follow-up at 3 months. It's good, it's important, but we have to see afterwards," he cautioned.

Dr. Bédard and Dr. Pelissolo have disclosed no relevant financial relationships. Dr. Pelissolo was not involved in the study.

EPA 2013: 21st European Congress of Psychiatry: Abstract 1494. Presented April 7, 2013.

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