An Open Trial of Telephone-Delivered Mindfulness-Based Cognitive Therapy: Feasibility, Acceptability, and Preliminary Efficacy for Reducing Depressive Symptoms

Feasibility, acceptability, and fidelity of remote-delivered abbreviated mindfulness-based cognitive therapy interventions for patients with migraine and depressive symptoms

OBJECTIVE

This study was an open-label single-arm clinical trial evaluating the fidelity, feasibility, acceptability, and clinical signal of abbreviated mindfulness-based cognitive therapy (MBCT-brief) delivered either via telephone (MBCT-T) or by video conferencing (MBCT-V) for people with migraine and comorbid depressive symptoms.

BACKGROUND

Migraine is commonly comorbid with elevated depressive symptoms. MBCT reduces depressive symptoms and shows promise to reduce migraine-related disability. An abbreviated and remotely delivered version of MBCT could increase access to care.

METHODS

People with migraine and elevated depressive symptoms were recruited from a large urban health system. Participants were assigned in blocks of eight to receive an evidence-based MBCT-brief treatment, including eight weekly group classes and home practice delivered via telephone (MBCT-T) or video (MBCT-V); MBCT-T was randomly selected for the first block. Sessions were recorded and coded for treatment fidelity. Feasibility was assessed via session attendance (primary), homework completion, recruitment rate, and survey completion rate. Acceptability was assessed via the eight-item Client Satisfaction Questionnaire (CSQ-8; primary), the Credibility/Expectancy Questionnaire (CEQ), the System Usability Scale (SUS), and items assessing survey acceptability. Participants completed the Headache Disability Inventory (HDI) and Quick Inventory of Depressive Symptomatology-Self Report 16-item (QIDS-SR16) at baseline, mid-treatment, and post-treatment. Feasibility and acceptability rates were compared to a priori benchmarks.

RESULTS

Participants (n = 16) were all female with a mean (standard deviation [SD]) age of 45 (13) years, the majority of whom identified as White (13/16, 81%) and non-Hispanic (14/16, 88%). The intervention met the a priori criteria set for therapist fidelity to treatment protocol (mean [SD] MBCT-Treatment Acceptability and Competence Scale Adherence score 2.9 [0.2]), feasibility (mean [SD] session attendance was 7.9/8 [0.3]), and acceptability (mean [SD] CSQ-8 score 28.8 [3.3]) for the entire sample and for each treatment arm. The usability of the remote-delivery system was high across study participants (mean [SD] SUS score 84.8 [11.0]). Survey procedures were broadly deemed acceptable, with at least 80% participants either endorsing "Agree" or "Strongly Agree" across all items. Using Wilcoxon tests, we observed significant reductions in both the HDI (pre-treatment median [interquartile range] score 63 [40, 70] vs. post-treatment 36 [26, 54], p = 0.004) and the QIDS-SR16 (pre-treatment median [interquartile range] score 8 [5, 13] vs. post-treatment 4 [3, 6], p = 0.003).

CONCLUSION

We found that remotely delivered MBCT-brief for migraine and depressive symptoms was feasible and acceptable to patients in both the telephone and video modalities. Intervention was associated with significant post-treatment reductions in headache-related disability and depressive symptomatology, findings that must be interpreted cautiously in the absence of a control group.

Brief Mindfulness-Based Cognitive Therapy in Women With Myocardial Infarction: Results of a Multicenter Randomized Controlled Trial

Background

Elevated perceived stress is associated with adverse outcomes following myocardial infarction (MI) and may account for poorer recovery among women vs men.

Objectives

This randomized controlled trial tested effects of a mindfulness-based intervention on stress levels among women with MI.

Methods

Women with elevated stress (Perceived Stress Scale [PSS-4]≥6) at least 2 months after MI were enrolled from 12 hospitals in the United States and Canada and via community advertising. Participants were randomized to a remotely delivered mindfulness intervention (MBCT-Brief) or heart disease education, both 8 weeks long. Follow-up was 6 months. Changes in stress (PSS-10; primary outcome) and secondary outcomes (depressive symptoms, anxiety, quality of life, disease-specific health status, actigraphy-assessed sleep) were compared between groups.

Results

The sample included 130 women with MI (mean age 59.8 ± 12.8 years, 34% racial/ethnic minorities). In intention-to-treat analysis, PSS-10 scores declined in the MBCT-Brief arm (-0.52 [95% CI: -0.77 to -0.28]) but not the heart disease education arm (-0.19 [95% CI: -0.45 to 0.06]; group×time interaction P = 0.070). The effect was stronger in per-protocol analysis of participants who completed ≥4 intervention sessions (P = 0.049). There were no significant differences in secondary outcomes in intention-to-treat or per-protocol analyses. Within the MBCT-Brief arm, more frequent mindfulness practice was associated with greater reductions in stress (P = 0.007), depressive symptoms (P = 0.017), and anxiety (P = 0.036).

Conclusions

MBCT-Brief was associated with greater 6-month reductions in stress than an active control among adherent participants. More frequent mindfulness practice was associated with greater improvements in psychological outcomes. Strategies to engage women with MI in mindfulness training and support regular home practice may enhance these effects.

Feasibility study of the psychosocial effects of an online mindfulness intervention in children and adolescents with achondroplasia and their parents

INTRODUCTION

Achondroplasia is a common skeletal dysplasia caused by a mutation in the FGFR3 gene, leading to disproportionate short stature and various clinical features. Despite the absence of definitive pharmacological treatments, mindfulness-based interventions may offer psychosocial benefits for affected individuals and their families.

OBJECTIVES

This study aimed to assess the feasibility and psychosocial effects of an online mindfulness intervention for children and adolescents with achondroplasia and their parents.

METHODOLOGY

The intervention was an eight-week, synchronous online program with 15 participants: seven children and adolescents with achondroplasia and eight parents. Quantitative outcomes were assessed pre-and post-intervention using the State-Trait Anxiety Inventory for Children (STAIC) and the Multifactorial Self-Assessment Child Adaptation Test (TAMAI) for the younger participants, along with the Brief Symptom Inventory (BSI-18) for parents. Participant satisfaction was assessed using a customized survey, and qualitative data were collected through semi-structured interviews.

RESULTS

The study demonstrated high feasibility, with 84.61% adherence and 93.75% participant satisfaction. Average anxiety levels decreased in children and adolescents (30.60 ± 5.12 to 26.80 ± 6.94, p = .285) and parents (3.67 ± 3.98 to 1.00 ± .89, p = .066). Emotional regulation was the most reported improvement category by children and adolescents (31.4%), while general well-being was the most noted by parents (29.63%).

CONCLUSIONS

The results support the feasibility of this online mindfulness intervention for individuals with achondroplasia and their parents, indicating benefits for psychosocial well-being. Future studies should address these limitations by expanding sample sizes, exploring hybrid intervention models, and ensuring data anonymity. Integrating mindfulness into comprehensive psychosocial care strategies could enhance the quality of life for these populations.

Primary care-based mindfulness intervention for posttraumatic stress disorder and depression symptoms among Black adults: A pilot feasibility and acceptability randomized controlled trial

OBJECTIVE

There is support for the use of mindfulness-based approaches with trauma-exposed adults. However, limited data are available on feasibility and acceptability of group-based mindfulness interventions in urban medical clinics serving primarily Black adults with low socioeconomic resources, where rates of trauma exposure are high. 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.

METHOD

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 preassessment and randomization.

RESULTS

Feasibility of study design was shown, with > 75% (n = 26) of randomized participants completing the study through postassessment. 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.

CONCLUSIONS

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 underresourced communities are needed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A systematic review of the barriers and facilitators to adherence to mindfulness‐based cognitive therapy for those with chronic conditions

PURPOSE

Mindfulness-Based Cognitive Therapy (MBCT) can improve the lives of those with a chronic condition and psychological distress, however, high drop-out rates limit benefits. MBCT might be a candidate treatment for this population if nonadherence can be overcome. This review explores the existing literature on the barriers and facilitators to adherence to MBCT for those with chronic conditions.

METHOD

Databases MEDLINE, PsycINFO, CINAHL and Scopus were searched between 28^th May and 11th June 2021. We included empirical papers that identified barriers and/or facilitators to MBCT adherence in patients with chronic conditions-excluding non-English and grey literature. Papers were screened and duplicates removed. Extracted data included: setting, design, aim, sample-size, population and identified barriers/facilitators to MBCT adherence. The Mixed Methods Appraisal Tool (MMAT) was adapted and used to appraise the quality of studies RESULTS: Twenty papers were eligible for review. Synthesis identified six themes (in prevalence order): (1) Practical Factors (e.g., time and other commitments), (2) Motivation (e.g., change-readiness), (3) Patient clinical and demographic characteristics (e.g., current physical health), (4) Connection with Others (facilitators and group members), (5) Credibility (perception of the intervention) and (6) Content difficulty (intervention accessibility). Findings highlight potential adaptations to implementation (e.g., clear treatment rationale, preference matching, and eliciting and responding to individual concerns or obstructive assumptions) that could address barriers and harness facilitators.

CONCLUSION

This review contributes a higher order understanding of factors that may support/obstruct client adherence to MBCT with implications for future implementation in research and practice. Future research should prioritize open exploration of barriers/facilitators.