Abstract and Introduction
Abstract
Background: Patients with acromegaly have often several comorbidities, including decreased quality of life, mood alterations and chronic pain. Mindfulness is effective at improving mood, quality of life and pain management; however, there is no data available on its effect in patients with acromegaly.
Objective: We aimed at evaluating changes in quality of life, mood, pain, sleep, self-compassion, life satisfaction, blood pressure and heart rate after a mindfulness program.
Design and Patients: This was a randomized, multicentre, international clinical trial (Barcelona-BCN and Bergamo-BG) of 60 patients, 30 per centre.
Measurements: The intervention group participated in an 8-week face-to-face group program; the control group followed normal clinical routine. In BG, patients performed a classic Mindfulness Based Stress Reduction program; in BCN they performed an adapted program including elements of mindfulness and compassion with a greater focus on daily life.
Results: In the BCN intervention group there was an increase in night-time hours in bed (p = 0.05) after the program. In both centres there was a trend to a reduction of the time to start sleeping (p = 0.06 BCN, p = 0.07 BG). In BCN, the intervention group reduced the pain score compared to the control group (p = .02), and an improvement in self-compassion was found (p = .04). In both centres, heart rate decreased significantly in the intervention group during a single 2-hour session. This was evidenced at the first and the last program session (BCN p = .013 and p = .009; BG < 0.001 and p = .04). A training effect was found in BG, where heart rate fell more in the last session than in the first (p = 002).
Conclusions: We have demonstrated for the first time the value of a mindfulness program in patients with acromegaly, analysing possible effects and advantages, and clarifying the usefulness of a specific protocol for the disease.
Introduction
Acromegaly is a rare disease mainly caused by a growth hormone-producing pituitary adenoma and is associated with a range of comorbidities, such as cardiovascular, metabolic, respiratory or musculoskeletal alterations.[1] The presence of psychological disturbances is also frequent.[2–4] Acromegaly is often diagnosed late, when patients already have a wide range of comorbidities, contributing significantly to patient morbidity/mortality and impaired quality of life.[1,5]
Affective disorders, psychological distress, maladaptive personality traits, anxiety-related traits, anxiety disorders and major depression have also been described in patients with acromegaly.[2–4,6] Moreover, impairments in decision-making and delayed memory related to anxiety and depressive symptoms, could be present even after disease control.[7]
Mortality and morbidities can be reduced successfully if patients are treated using a multimodal approach with comprehensive comorbidity management, as biochemical control should not be the only treatment goal.[1,8] A survey has recently highlighted that patients with rare diseases often do not have access to psychological support.[9]
Patients with acromegaly usually show poor scores in psychopathology/psychosocial questionnaires.[2–4] In other diseases, Mindfulness interventions have improved altered scores, in particular mood, cognitive performance and quality of life.[10] There is a need for new interventions to treat patients with acromegaly globally and whether a Mindfulness protocol can improve ongoing dysfunctions has not been investigated. Furthermore, the group format of this intervention and the length (usually eight sessions, on a weekly basis) makes it cost-effective and possibly more feasible than individual sessions in clinical practice.[11]
Mindfulness can be defined as the ability of being consciously present and aware, paying attention to the present moment on purpose, with acceptance and without judgement.[12] Interventions based on mindfulness are programmes performed by expert trainers where the patients learn different practices to increase their attention to the present moment, which can also help them in daily life and in emotional management. Practices are usually divided into the following: (a) formal meditation, which involves listening to some audios and following the corresponding instructions (which may involve, for instance, paying attention to the sensations related to breathing or physical sensations, among others); (b) informal meditation, which involves trying to increase awareness and attention in daily life, with acceptance and nonjudgement.
Some programmes also combine mindfulness practices with others based on self-compassion, which can be defined as 'a sensitivity to suffering (…) with a commitment to try to alleviate and prevent it'.[13] This would refer to the suffering of others, but also to self-suffering. Compassion practices may involve visualizations, to increase well-being and emotional self-regulation (as, for instance, imagining oneself in a safe place).
Mindfulness interventions have been proved to be successful when treating both healthy and clinical populations, including anxiety disorders, major depression, substance abuse, chronic pain, fibromyalgia, cancer or cardiovascular disease, among others. More specifically, studies report improvement in depressive symptoms, anxiety, stress, quality of life or physical functioning.[14,15] Despite these evidence, to date, no specific interventions have been studied in patients with acromegaly.
The aim of the study was to evaluate the effects of Mindfulness in quality of life, mood, pain, sleep, self-compassion, life satisfaction, blood pressure and heart rate (HR) in patients with acromegaly.
Clin Endocrinol. 2023;98(3):363-674. © 2023 Blackwell Publishing
