A Randomized Controlled Pilot Study on Mindfulness-Based Cognitive Therapy for Unipolar Depression in Patients With Chronic Pain

Marasha de Jong; Frenk Peeters; Tim Gard; Heidi Ashih; Jim Doorley; Rosemary Walker; Laurie Rhoades; Ronald J. Kulich; Karsten D. Kueppenbender; Jonathan E. Alpert; Elizabeth A. Hoge; Willoughby B. Britton; Sara W. Lazar; Maurizio Fava; David Mischoulon

doi:10.4088/JCP.15m10160

A Randomized Controlled Pilot Study on Mindfulness-Based Cognitive Therapy for Unipolar Depression in Patients With Chronic Pain

Marasha de Jong^*, Frenk Peeters, Tim Gard, Heidi Ashih, Jim Doorley, Rosemary Walker, Laurie Rhoades, Ronald J. Kulich, Karsten D. Kueppenbender, Jonathan E. Alpert, Elizabeth A. Hoge, Willoughby B. Britton, Sara W. Lazar, Maurizio Fava, David Mischoulon

^*Corresponding author for this work

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Abstract

OBJECTIVE: Chronic pain is a disabling illness, often comorbid with depression. We performed a randomized controlled pilot study on mindfulness-based cognitive therapy (MBCT) targeting depression in a chronic pain population.

METHOD: Participants with chronic pain lasting ≥ 3 months; DSM-IV major depressive disorder (MDD), dysthymic disorder, or depressive disorder not otherwise specified; and a 16-item Quick Inventory of Depressive Symptomatology-Clinician Rated (QIDS-C₁₆) score ≥ 6 were randomly assigned to MBCT (n = 26) or waitlist (n = 14). We adapted the original MBCT intervention for depression relapse prevention by modifying the psychoeducation and cognitive-behavioral therapy elements to an actively depressed chronic pain population. We analyzed an intent-to-treat (ITT) and a per-protocol sample; the per-protocol sample included participants in the MBCT group who completed at least 4 of 8 sessions. Changes in scores on the QIDS-C₁₆ and 17-item Hamilton Depression Rating Sale (HDRS₁₇) were the primary outcome measures. Pain, quality of life, and anxiety were secondary outcome measures. Data collection took place between January 2012 and July 2013.

RESULTS: Nineteen participants (73%) completed the MBCT program. No significant adverse events were reported in either treatment group. ITT analysis (n = 40) revealed no significant differences. Repeated-measures analyses of variance for the per-protocol sample (n = 33) revealed a significant treatment × time interaction (F₁,₃₁ = 4.67, P = .039, η²p = 0.13) for QIDS-C₁₆ score, driven by a significant decrease in the MBCT group (t₁₈ = 5.15, P < .001, d = >1.6), but not in the control group (t₁₃ = 2.01, P = .066). The HDRS₁₇ scores did not differ significantly between groups. The study ended before the projected sample size was obtained, which might have prevented effect detection in some outcome measures.

CONCLUSIONS: MBCT shows potential as a treatment for depression in individuals with chronic pain, but larger controlled trials are needed.

TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01473615.

Original language	English
Article number	ARTN 15m10160
Pages (from-to)	26-34
Number of pages	9
Journal	Journal of Clinical Psychiatry
Volume	79
Issue number	1
DOIs	https://doi.org/10.4088/JCP.15m10160
Publication status	Published - 1 Jan 2018

Keywords

CONTROLLED-TRIAL
PSYCHOMETRIC PROPERTIES
MAJOR DEPRESSION
OUTCOME MEASURES
RATING-SCALE
BACK-PAIN
RELAPSE
MEDITATION
PREVENTION
INVENTORY

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de Jong, M., Peeters, F., Gard, T., Ashih, H., Doorley, J., Walker, R., Rhoades, L., Kulich, R. J., Kueppenbender, K. D., Alpert, J. E., Hoge, E. A., Britton, W. B., Lazar, S. W., Fava, M., & Mischoulon, D. (2018). A Randomized Controlled Pilot Study on Mindfulness-Based Cognitive Therapy for Unipolar Depression in Patients With Chronic Pain. Journal of Clinical Psychiatry, 79(1), 26-34. Article ARTN 15m10160. https://doi.org/10.4088/JCP.15m10160

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title = "A Randomized Controlled Pilot Study on Mindfulness-Based Cognitive Therapy for Unipolar Depression in Patients With Chronic Pain",

abstract = "OBJECTIVE: Chronic pain is a disabling illness, often comorbid with depression. We performed a randomized controlled pilot study on mindfulness-based cognitive therapy (MBCT) targeting depression in a chronic pain population.METHOD: Participants with chronic pain lasting ≥ 3 months; DSM-IV major depressive disorder (MDD), dysthymic disorder, or depressive disorder not otherwise specified; and a 16-item Quick Inventory of Depressive Symptomatology-Clinician Rated (QIDS-C₁₆) score ≥ 6 were randomly assigned to MBCT (n = 26) or waitlist (n = 14). We adapted the original MBCT intervention for depression relapse prevention by modifying the psychoeducation and cognitive-behavioral therapy elements to an actively depressed chronic pain population. We analyzed an intent-to-treat (ITT) and a per-protocol sample; the per-protocol sample included participants in the MBCT group who completed at least 4 of 8 sessions. Changes in scores on the QIDS-C₁₆ and 17-item Hamilton Depression Rating Sale (HDRS₁₇) were the primary outcome measures. Pain, quality of life, and anxiety were secondary outcome measures. Data collection took place between January 2012 and July 2013.RESULTS: Nineteen participants (73%) completed the MBCT program. No significant adverse events were reported in either treatment group. ITT analysis (n = 40) revealed no significant differences. Repeated-measures analyses of variance for the per-protocol sample (n = 33) revealed a significant treatment × time interaction (F₁,₃₁ = 4.67, P = .039, η²p = 0.13) for QIDS-C₁₆ score, driven by a significant decrease in the MBCT group (t₁₈ = 5.15, P < .001, d = >1.6), but not in the control group (t₁₃ = 2.01, P = .066). The HDRS₁₇ scores did not differ significantly between groups. The study ended before the projected sample size was obtained, which might have prevented effect detection in some outcome measures.CONCLUSIONS: MBCT shows potential as a treatment for depression in individuals with chronic pain, but larger controlled trials are needed.TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01473615.",

keywords = "CONTROLLED-TRIAL, PSYCHOMETRIC PROPERTIES, MAJOR DEPRESSION, OUTCOME MEASURES, RATING-SCALE, BACK-PAIN, RELAPSE, MEDITATION, PREVENTION, INVENTORY",

author = "{de Jong}, Marasha and Frenk Peeters and Tim Gard and Heidi Ashih and Jim Doorley and Rosemary Walker and Laurie Rhoades and Kulich, {Ronald J.} and Kueppenbender, {Karsten D.} and Alpert, {Jonathan E.} and Hoge, {Elizabeth A.} and Britton, {Willoughby B.} and Lazar, {Sara W.} and Maurizio Fava and David Mischoulon",

year = "2018",

month = jan,

day = "1",

doi = "10.4088/JCP.15m10160",

language = "English",

volume = "79",

pages = "26--34",

journal = "Journal of Clinical Psychiatry",

issn = "0160-6689",

publisher = "Physicians Postgraduate Press Inc.",

number = "1",

}

de Jong, M, Peeters, F, Gard, T, Ashih, H, Doorley, J, Walker, R, Rhoades, L, Kulich, RJ, Kueppenbender, KD, Alpert, JE, Hoge, EA, Britton, WB, Lazar, SW, Fava, M & Mischoulon, D 2018, 'A Randomized Controlled Pilot Study on Mindfulness-Based Cognitive Therapy for Unipolar Depression in Patients With Chronic Pain', Journal of Clinical Psychiatry, vol. 79, no. 1, ARTN 15m10160, pp. 26-34. https://doi.org/10.4088/JCP.15m10160

TY - JOUR

T1 - A Randomized Controlled Pilot Study on Mindfulness-Based Cognitive Therapy for Unipolar Depression in Patients With Chronic Pain

AU - de Jong, Marasha

AU - Peeters, Frenk

AU - Gard, Tim

AU - Ashih, Heidi

AU - Doorley, Jim

AU - Walker, Rosemary

AU - Rhoades, Laurie

AU - Kulich, Ronald J.

AU - Kueppenbender, Karsten D.

AU - Alpert, Jonathan E.

AU - Hoge, Elizabeth A.

AU - Britton, Willoughby B.

AU - Lazar, Sara W.

AU - Fava, Maurizio

AU - Mischoulon, David

PY - 2018/1/1

Y1 - 2018/1/1

N2 - OBJECTIVE: Chronic pain is a disabling illness, often comorbid with depression. We performed a randomized controlled pilot study on mindfulness-based cognitive therapy (MBCT) targeting depression in a chronic pain population.METHOD: Participants with chronic pain lasting ≥ 3 months; DSM-IV major depressive disorder (MDD), dysthymic disorder, or depressive disorder not otherwise specified; and a 16-item Quick Inventory of Depressive Symptomatology-Clinician Rated (QIDS-C₁₆) score ≥ 6 were randomly assigned to MBCT (n = 26) or waitlist (n = 14). We adapted the original MBCT intervention for depression relapse prevention by modifying the psychoeducation and cognitive-behavioral therapy elements to an actively depressed chronic pain population. We analyzed an intent-to-treat (ITT) and a per-protocol sample; the per-protocol sample included participants in the MBCT group who completed at least 4 of 8 sessions. Changes in scores on the QIDS-C₁₆ and 17-item Hamilton Depression Rating Sale (HDRS₁₇) were the primary outcome measures. Pain, quality of life, and anxiety were secondary outcome measures. Data collection took place between January 2012 and July 2013.RESULTS: Nineteen participants (73%) completed the MBCT program. No significant adverse events were reported in either treatment group. ITT analysis (n = 40) revealed no significant differences. Repeated-measures analyses of variance for the per-protocol sample (n = 33) revealed a significant treatment × time interaction (F₁,₃₁ = 4.67, P = .039, η²p = 0.13) for QIDS-C₁₆ score, driven by a significant decrease in the MBCT group (t₁₈ = 5.15, P < .001, d = >1.6), but not in the control group (t₁₃ = 2.01, P = .066). The HDRS₁₇ scores did not differ significantly between groups. The study ended before the projected sample size was obtained, which might have prevented effect detection in some outcome measures.CONCLUSIONS: MBCT shows potential as a treatment for depression in individuals with chronic pain, but larger controlled trials are needed.TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01473615.

AB - OBJECTIVE: Chronic pain is a disabling illness, often comorbid with depression. We performed a randomized controlled pilot study on mindfulness-based cognitive therapy (MBCT) targeting depression in a chronic pain population.METHOD: Participants with chronic pain lasting ≥ 3 months; DSM-IV major depressive disorder (MDD), dysthymic disorder, or depressive disorder not otherwise specified; and a 16-item Quick Inventory of Depressive Symptomatology-Clinician Rated (QIDS-C₁₆) score ≥ 6 were randomly assigned to MBCT (n = 26) or waitlist (n = 14). We adapted the original MBCT intervention for depression relapse prevention by modifying the psychoeducation and cognitive-behavioral therapy elements to an actively depressed chronic pain population. We analyzed an intent-to-treat (ITT) and a per-protocol sample; the per-protocol sample included participants in the MBCT group who completed at least 4 of 8 sessions. Changes in scores on the QIDS-C₁₆ and 17-item Hamilton Depression Rating Sale (HDRS₁₇) were the primary outcome measures. Pain, quality of life, and anxiety were secondary outcome measures. Data collection took place between January 2012 and July 2013.RESULTS: Nineteen participants (73%) completed the MBCT program. No significant adverse events were reported in either treatment group. ITT analysis (n = 40) revealed no significant differences. Repeated-measures analyses of variance for the per-protocol sample (n = 33) revealed a significant treatment × time interaction (F₁,₃₁ = 4.67, P = .039, η²p = 0.13) for QIDS-C₁₆ score, driven by a significant decrease in the MBCT group (t₁₈ = 5.15, P < .001, d = >1.6), but not in the control group (t₁₃ = 2.01, P = .066). The HDRS₁₇ scores did not differ significantly between groups. The study ended before the projected sample size was obtained, which might have prevented effect detection in some outcome measures.CONCLUSIONS: MBCT shows potential as a treatment for depression in individuals with chronic pain, but larger controlled trials are needed.TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01473615.

KW - CONTROLLED-TRIAL

KW - PSYCHOMETRIC PROPERTIES

KW - MAJOR DEPRESSION

KW - OUTCOME MEASURES

KW - RATING-SCALE

KW - BACK-PAIN

KW - RELAPSE

KW - MEDITATION

KW - PREVENTION

KW - INVENTORY

U2 - 10.4088/JCP.15m10160

DO - 10.4088/JCP.15m10160

M3 - Article

C2 - 28252881

SN - 0160-6689

VL - 79

SP - 26

EP - 34

JO - Journal of Clinical Psychiatry

JF - Journal of Clinical Psychiatry

IS - 1

M1 - ARTN 15m10160

ER -