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 language | English (US) |
|---|---|
| Pages (from-to) | 26-34 |
| Number of pages | 9 |
| Journal | Journal of Clinical Psychiatry |
| Volume | 79 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 1 2018 |
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 journal › Article › peer-review
}
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
N1 - Funding Information: aDepression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts bDepartment of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands cPsyQ Department of Mood Disorders, Mondriaan, Institute of Mental Health, Maastricht, the Netherlands dInstitute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Switzerland eDepartment of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts fTranslational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Switzerland gPrivate practice, LaurieRhoadesTherapy.com hCenter for Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts iCenter for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts jWarren Alpert Medical School at Brown University, Providence, Rhode Island *Corresponding author: Marasha de Jong, MD, Mondriaan, Institute of Mental Health, PsyQ Department of Mood Disorders, Oranjeplein 10, 6224 KD Maastricht, the Netherlands (marasha.dejong@maastrichtuniversity.nl). Funding Information: Online first:February 28, 2017. Advanced Meeting Partners, American Psychiatric Mental Health Surveys. Pain. Drug names:bupropion(Wellbutrinandothers). Association, American Society of Clinical 2007;129(3):332–342.PubMed doi:10.1016/j.pain.2007.01.022 Psychopharmacology, AstraZeneca, Belvoir Media Bair MJ, Robinson RL, Katon W, et al. Potential conflicts of interest:DrPeetersreceived Group, Boehringer Ingelheim, Bristol-Myers Squibb, Depression and pain comorbidity: a literature financialcompensationasanindependent Cephalon, CME Institute/Physicians Postgraduate review. Arch Intern Med. symposium speaker from Astra-Zeneca, Eli Lilly, Press, Eli Lilly, Forest, GlaxoSmithKline, Imedex, 2003;163(20):2433–2445.PubMed doi:10.1001/archinte.163.20.2433 GlaxoSmithKline,Janssen-Cilag,Lundbeck, MGH Psychiatry Academy/Primedia, MGH Haythornthwaite JA, Sieber WJ, Kerns RD. SCEMConferenceServices,Benecke,Servier. Psychiatry Academy/Reed Elsevier, Novartis, Depression and the chronic pain experience. Dr Alperthas received research support from Organon, Pfizer, PharmaStar, United BioSource, Pain. 1991;46(2):177–184.PubMed doi:10.1016/0304-3959(91)90073-7 Abbott, Alkermes, Lichtwer, Lorex; Aspect and Wyeth-Ayerst; has equity holdings in Kerns RD, Haythornthwaite J, Rosenberg R, et MedicalSystems,Astra-Zeneca,Bristol-Myers Compellis and PsyBrain; holds a patent for al. The Pain Behavior Check List (PBCL): factor Squibb, Cephalon, Cyberonics, Eli Lilly, Forest, Sequential Parallel Comparison Design, licensed structure and psychometric properties. J Behav GlaxoSmithKline, Johnson & Johnson, National by MGH to PPD, and a patent application for a Med. 1991;14(2):155–167.PubMed doi:10.1007/BF00846177 InstitutesofHealth,NationalAllianceforResearch combination of ketamine plus scopolamine in Sullivan MJ, Reesor K, Mikail S, et al. The on Schizophrenia and Depression (NARSAD), major depressive disorder, licensed by MGH to treatment of depression in chronic low back Novartis,Organon,PamLab,Pfizer,Pharmavite, Biohaven; holds copyrights for the MGH Cognitive pain: review and recommendations. Pain. Roche, Sanofi/Synthelabo, Solvay, and Wyeth- & Physical Functioning Questionnaire (CPFQ), 1992;50(1):5–13.PubMed doi:10.1016/0304-3959(92)90107-M Ayerst; has participated on advisory boards Sexual Functioning Inventory (SFI), Antidepressant Holroyd KA, Stensland M, Lipchik GL, et al. for or consulted to Eli Lilly, Luye, Pamlab, and Treatment Response Questionnaire (ATRQ), Psychosocial correlates and impact of chronic Pharmavite; has received speakers’ honoraria Discontinuation-Emergent Signs & Symptoms tension-type headaches. Headache. fromEliLilly,Xian-Janssen,Organon,Psicofarma, (DESS), Symptoms of Depression Questionnaire 2000;40(1):3–16.PubMed doi:10.1046/j.1526-4610.2000.00001.x Massachusetts General Hospital (MGH) Academy, (SDQ), and SAFER; and receives royalties from Engel CC, von Korff M, Katon WJ. Back pain in Reed Medical Education, Primedia, Nevada Lippincott, Williams & Wilkins; Wolkers Kluwer; primary care: predictors of high health-care Psychiatric Association, American Society of and World Scientific Publishing. Dr Mischoulon costs. Pain. 1996;65(2–3):197–204.PubMed doi:10.1016/0304-3959(95)00164-6 ClinicalPsychopharmacology,andtheAmerican has received research support from the Bowman Tang NK, Crane C. Suicidality in chronic pain: a Psychiatric Association; and has received editorial Family Foundation, FisherWallace, Nordic Naturals, review of the prevalence, risk factors and feesfromBelvoirPublishing.DrFavahas received Methylation Sciences, and PharmoRx Therapeutics; psychological links. Psychol Med. research support from Abbott, Alkermes, American has received honoraria for consulting, speaking, 2006;36(5):575–586.PubMed doi:10.1017/S0033291705006859 Cyanamid,AspectMedicalSystems,AstraZeneca, and writing from Pamlab and the Massachusetts 10. Kabat-Zinn J. An outpatient program in Avanir,BioResearch,BrainCells,Bristol-Myers General Hospital Psychiatry Academy; and has behavioral medicine for chronic pain patients Squibb, CeNeRx BioPharma, Cephalon, Cerecor, received royalties from Lippincott Williams & based on the practice of mindfulness Clintara, Covance, Covidien, Eli Lilly, EnVivo, Wilkins for published book Natural Medications for meditation: theoretical considerations and Euthymics Bioscience, Forest, Forum, Ganeden Psychiatric Disorders: Considering the Alternatives. preliminary results. Gen Hosp Psychiatry. Biotech,GlaxoSmithKline,HarvardClinical Drs de Jong, Gard, Ashih, Kulich, Kueppenbender, 1982;4(1):33–47.PubMed doi:10.1016/0163-8343(82)90026-3 Research Institute, Hoffman-LaRoche, Icon Clinical Hoge, Britton, and Lazar and Mr Doorley and Mss Segal ZV, Williams JMG, Teasdale JD. Research, i3 Innovus/Ingenix, Janssen R&D, Jed Walker and Rhoades have no personal affiliations Mindfulness-Based Cognitive Therapy for Foundation, Johnson & Johnson Pharmaceutical or financial relationships with any commercial Depression: A New Approach to Preventing Research & Development, Lichtwer, Lorex, interest to disclose relative to this article. Relapse. New York, NY: The Guilford Press; 2002. Funding/support:This study was partially funded Lundbeck, MedAvante, Methylation Sciences, 12. Bishop SR, Lau M, Shapiro S, et al. Mindfulness: NARSAD, National Center for Complementary A proposed operational definition. Clin Psychol andAlternativeMedicine,NationalCoordinatingby an anonymous bequest and partially funded by SciPract. 2004;11(3):230–241. doi:10.1093/clipsy.bph077 Center for Integrated Medicine, National Institute Kabat-Zinn J. Full Catastrophe Living: Using the the Mind and Life Francisco J. Varela Grant 2010- on Drug Abuse, National Institute of Mental Health, Wisdom of Your Body and Mind to Face Stress, 01-010 and the Brach Family Charitable Foundation. Neuralstem, Novartis, Organon, PamLab, Pfizer, Role of the sponsor: The sponsors had no further Pain, and Illness. New York, NY: Delta Trade Pharmacia-Upjohn, Pharmaceutical Research role in the study design, collection, analysis and Paperbacks; 1990. Associates, Pharmavite, PharmoRx Therapeutics, interpretation of data; the writing ofthe report; or 14. Fresco DM, Segal ZV, Buis T, et al. Relationship Photothera, Reckitt Benckiser, Roche, RCT Logic the decision to submit the paper for publication. of posttreatment decentering and cognitive (formerly Clinical Trials Solutions), Sanofi-Aventis Acknowledgments: The authors thank Kiran K. reactivity to relapse in major depression. US, Shire, Solvay , Stanley Medical Research Hug, BA (Department of Psychosomatic Medicine, J Consult Clin Psychol. 2007;75(3):447–455.PubMed doi:10.1037/0022-006X.75.3.447 Institute, Synthelabo, Takeda, Tal Medical, and University Medical Center Freiburg, Freiburg, Teasdale JD, Segal ZV, Williams JM, et al. Wyeth-Ayerst; has been an advisor/consultant for Germany), for helping with data entry; Lee Baer, Prevention of relapse/recurrence in major Abbott, Acadia, Affectis, Alkermes, Amarin, Aspect PhD (Depression Clinical and Research Program, depression by mindfulness-based cognitive Medical Systems, AstraZeneca, Auspex, Avanir, Massachusetts General Hospital, Harvard Medical therapy. J Consult Clin Psychol. AXSOME Therapeutics, Bayer, Best Practice Project School, Boston, Massachusetts), and Alisabet 2000;68(4):615–623.PubMed doi:10.1037/0022-006X.68.4.615 Management, Biogen, BioMarin, Biovail, BrainCells, J. Clain, MS (Depression Clinical and Research Ma SH, Teasdale JD. Mindfulness-based Bristol-Myers Squibb, CeNeRx BioPharma, Program, Massachusetts General Hospital, cognitive therapy for depression: replication Cephalon, Cerecor, CNS Response, Compellis, Harvard Medical School, Boston, Massachusetts) and exploration of differential relapse Cypress, DiagnoSearch Life Sciences, Dinippon for assistance with database conversion and preventioneffects.J Consult Clin Psychol. Sumitomo, Dov, Edgemont, Eisai, Eli Lilly, EnVivo, general statistical questions, and Egilius Spierings, 2004;72(1):31–40.PubMed doi:10.1037/0022-006X.72.1.31 ePharmaSolutions, EPIX, Euthymics Bioscience, MD, PhD (Department of Neurology, Brigham Kuyken W, Byford S, Taylor RS, et al. Fabre-Kramer, Forest, Forum, GenOmind, and Women’s Hospital, Harvard Medical School, Mindfulness-based cognitive therapy to GlaxoSmithKline, Grunenthal GmbH, i3 Innovus/ Boston, Massachusetts) for assistance with patient prevent relapse in recurrent depression. Ingenis, Intracellular, Janssen, Jazz, Johnson & recruitment.DrSpieringshas received research J Consult Clin Psychol. 2008;76(6):966–978.PubMeddoi:10.1037/a0013786 Johnson Pharmaceutical Research & Development, support from Amgen, Alder BioPharmaceuticals, Godfrin KA, van Heeringen C. The effects of Knoll, Labopharm, Lorex, Lundbeck, MedAvante, Teva, Pfizer, Allergan, Daiichi Sankyo, Seres mindfulness-based cognitive therapy on Merck, MSI Methylation Sciences, Naurex, Nestle Therapeutics, and Dr Reddy’s Laboratories. Dr recurrence of depressive episodes, mental Health Sciences, Neuralstem, Neuronetics, Baer and Mss Hug and Clain have no personal health and quality of life: a randomized NextWave, Novartis, Nutrition 21, Orexigen, affiliations or financial relationships with any controlled study. Behav Res Ther. Organon, Osmotica, Otsuka, Pamlab, Pfizer, commercial interest to disclose relative to this 2010;48(8):738–746.PubMed doi:10.1016/j.brat.2010.04.006 PharmaStar, Pharmavite, PharmoRx, Precision article. Geschwind N, Peeters F, Huibers M, et al. Human Biolaboratory, Prexa, Pharmaceutical Efficacy of mindfulness-based cognitive Product Development (PPD), Puretech Ventures, therapy in relation to prior history of PsychoGenics, Psylin Neurosciences, RCT Logic depression: randomised controlled trial. Br J (formerly Clinical Trials Solutions), Rexahn, Ridge Psychiatry. 2012;201(4):320–325.PubMed doi:10.1192/bjp.bp.111.104851 Diagnostics, Roche, Sanofi-Aventis, Sepracor, Kuyken W, Hayes R, Barrett B, et al. Servier, Schering-Plough, Solvay, Somaxon, Effectiveness and cost-effectiveness of Somerset, Sunovion, Supernus, Synthelabo, mindfulness-based cognitive therapy Taisho, Takeda, Tal Medical, Tetragenex, compared with maintenance antidepressant TransForm, Transcept, Vanda, and VistaGen; has treatment in the prevention of depressive
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, ?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.
UR - http://www.scopus.com/inward/record.url?scp=85046872149&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85046872149&partnerID=8YFLogxK
U2 - 10.4088/JCP.15m10160
DO - 10.4088/JCP.15m10160
M3 - Article
C2 - 28252881
AN - SCOPUS:85046872149
VL - 79
SP - 26
EP - 34
JO - Journal of Clinical Psychiatry
JF - Journal of Clinical Psychiatry
SN - 0160-6689
IS - 1
ER -