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Mindfulness-based cognitive therapy v. group psychoeducation for people with generalised anxiety disorder: Randomised controlled trial

  • Samuel Yeung Shan Wong (a1), Benjamin Hon Kei Yip (a1), Winnie Wing Sze Mak (a2), Stewart Mercer (a3), Eliza Yee Lai Cheung (a4), Candy Yuet Man Ling (a5), Wacy Wai Sze Lui (a6), Wai Kwong Tang (a7), Herman Hay Ming Lo (a8), Justin Che Yuen Wu (a9), Tatia Mei Chun Lee (a10), Ting Gao (a1), Sian M. Griffiths (a1), Peter Hoi Sing Chan (a11) and Helen Shuk Wah Ma (a12)...
Abstract
Background

Research suggests that an 8-week mindfulness-based cognitive therapy (MBCT) course may be effective for generalised anxiety disorder (GAD).

Aims

To compare changes in anxiety levels among participants with GAD randomly assigned to MBCT, cognitive–behavioural therapy-based psychoeducation and usual care.

Method

In total, 182 participants with GAD were recruited (trial registration number: CUHK_CCT00267) and assigned to the three groups and followed for 5 months after baseline assessment with the two intervention groups followed for an additional 6 months. Primary outcomes were anxiety and worry levels.

Results

Linear mixed models demonstrated significant group × time interaction (F(4,148) = 5.10, P = 0.001) effects for decreased anxiety for both the intervention groups relative to usual care. Significant group × time interaction effects were observed for worry and depressive symptoms and mental health-related quality of life for the psychoeducation group only.

Conclusions

These results suggest that both of the interventions appear to be superior to usual care for the reduction of anxiety symptoms.

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Copyright
Corresponding author
Samuel Yeung Shan Wong, 4/F, School of Public Health, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China. Email: yeungshanwong@cuhk.edu.hk
Footnotes
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Declaration of interest

None.

Footnotes
References
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Mindfulness-based cognitive therapy v. group psychoeducation for people with generalised anxiety disorder: Randomised controlled trial

  • Samuel Yeung Shan Wong (a1), Benjamin Hon Kei Yip (a1), Winnie Wing Sze Mak (a2), Stewart Mercer (a3), Eliza Yee Lai Cheung (a4), Candy Yuet Man Ling (a5), Wacy Wai Sze Lui (a6), Wai Kwong Tang (a7), Herman Hay Ming Lo (a8), Justin Che Yuen Wu (a9), Tatia Mei Chun Lee (a10), Ting Gao (a1), Sian M. Griffiths (a1), Peter Hoi Sing Chan (a11) and Helen Shuk Wah Ma (a12)...
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eLetters

Measuring outcomes of mindfulness interventions

Rathi Mahendran, Senior Consultant Psychiatrist and Associate Professor, Department of Psychological Medicine, National University of Singapore
Ee Heok Kua, Senior Consultant Psychiatrist and Professor, Department of Psychological Medicine, National University of Singapore
13 September 2016

Wong and colleagues are to be congratulated for the large scale randomized controlled trial on mindfulness-based cognitive therapy versus group psychoeducation for people with generalized anxiety disorder.1 We have studied mindfulness awareness practice (MAP) amongst elderly individuals in an open label study (Rawtaer et al2) and more recently in a randomized controlled trial3 and would like to share our experiences. Both studies were in community-living elderly with the second study involving subjects with mild cognitive impairment.

Wong highlights one of the limitations of the study as the use of self-reported questionnaires. We do agree and suggest that measurement of ‘psychobiomarkers’ may be the solution. Self-reports are useful for estimating psychological efficacy with task-based or behavioral approaches.4 But much of the mental changes achieved even in short-term meditative practice, are better measured through the physiological changes associated with achieving mental balance (conative, attentional, cognitive and affective)5 in contemplative practices. These are at the structural, cellular and biochemical level and in preliminary findings in our study, changes in functional brain activity, neuropsychological tests, telomere lengths and oxidative stress markers were noted after 12 weeks of mindfulness practice (manuscript in preparation).

But like Wong and his colleagues, we too noted similar improvements in the control group which was provided weekly health education talks. We hold similar views that these resulted from the benefits of the group activity and the time and attention provided. Despite improvements in the control group, the changes were more significant in the MAP intervention arm.

Till we have identified the best biological measurement tools to identify the changes brought about by meditative practices, it may be too soon to dismiss mindfulness-based interventions for our patients. We agree that specific groups of patients with targeted needs would be better suited for mindfulness-based clinical programs and the challenge would be in identifying these patients and conditions. Would the authors comment on the implications of cultural factors and religious and spiritual beliefs in the usefulness of mindfulness interventions?

1.Wong s YS, Hon B KY, Mak W WS, Mercer S, Cheung E YL, Ling C YM et al. Mindfulness-based cognitive therapy v. group psychoeducation for people with generalised anxiety disorder: randomized controlled trial. BJP 2016; 209:68-75.

2.Rawtaer I, R Mahendran, Yu JH, J Fam, Feng L, EH Kua. Psychosocial Interventions with art, music, Tai Chi and mindfulness for subsyndromal depression and anxiety in older adults: A naturalistic study in Singapore. Asia Pacific J Psychiatry 2015;7(3):240-250.

3.Mindful Awareness program for the prevention of Dementia: A Randomized Controlled Trial. Protocol ID: b-14-110. ClinicalTrials.gov ID: NCT02286791.

4.Kemeny ME, Foltz C, Cavanagh JF, Cullen M, Giese-Davis J, Jennings P, Rosenberg EL, Gillath O, Shaver PR, Wallace A, Ekman P. Contemplative/emotion Training Reduces Negative Emotional Behavior and Promotes Prosocial Responses. Emotion 2012;Vol12(2):338-350.

5.Wallce B A, Shapiro SL. Mental Balance and Well-Being. American psychologist 2006;61(7):690-701.

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Conflict of interest: None Declared

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What about older people?

Rory E O'Shea, Consultant Psychiatrist, Northumberland, Tyne and Wear NHS Trust
22 July 2016

Thank you for an interesting article, further highlighting the importance of therspies in Generalised Anxiety Disorder, and giving suggestions for perhaps targeting symptoms with particular therapies.

But whay exclude people aged over 65? Anxiety is very common in this age-group.

Conflict of interest: None Declared

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