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

Research output: Contribution to journalArticle

3 Citations (Scopus)

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, ?2 p = 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.

Original languageEnglish (US)
Pages (from-to)26-34
Number of pages9
JournalJournal of Clinical Psychiatry
Volume79
Issue number1
DOIs
StatePublished - Jan 1 2018
Externally publishedYes

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Mindfulness
Cognitive Therapy
Depressive Disorder
Chronic Pain
Depression
Outcome Assessment (Health Care)
Dysthymic Disorder
Major Depressive Disorder
Secondary Prevention
Diagnostic and Statistical Manual of Mental Disorders
Sample Size
Population
Analysis of Variance
Therapeutics
Anxiety
Quality of Life
Pain
Equipment and Supplies
Control Groups

ASJC Scopus subject areas

  • Psychiatry and Mental health

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A randomized controlled pilot study on mindfulness-based cognitive therapy for unipolar depression in patients with chronic pain. / De Jong, Marasha; Peeters, Frenk; Gard, Tim; Ashih, Heidi; Doorley, Jim; Walker, Rosemary; Rhoades, Laurie; Kulich, Ronald J.; Kueppenbender, Karsten D.; Alpert, Jonathan E.; Hoge, Elizabeth A.; Britton, Willoughby B.; Lazar, Sara W.; Fava, Maurizio; Mischoulon, David.

In: Journal of Clinical Psychiatry, Vol. 79, No. 1, 01.01.2018, p. 26-34.

Research output: Contribution to journalArticle

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, pp. 26-34. https://doi.org/10.4088/JCP.15m10160
De Jong, Marasha ; Peeters, Frenk ; Gard, Tim ; Ashih, Heidi ; Doorley, Jim ; Walker, Rosemary ; Rhoades, Laurie ; Kulich, Ronald J. ; Kueppenbender, Karsten D. ; Alpert, Jonathan E. ; Hoge, Elizabeth A. ; Britton, Willoughby B. ; Lazar, Sara W. ; Fava, Maurizio ; Mischoulon, David. / A randomized controlled pilot study on mindfulness-based cognitive therapy for unipolar depression in patients with chronic pain. In: Journal of Clinical Psychiatry. 2018 ; Vol. 79, No. 1. pp. 26-34.
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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, ?2 p = 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.",
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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

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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, ?2 p = 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.

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, ?2 p = 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.

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