Effectiveness of mindfulness-based stress reduction and mindfulness based cognitive therapy in vascular disease: A systematic review and meta-analysis of randomised controlled trials

Objective

To determine the effectiveness of mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) on psychological and physical outcomes for people with vascular disease.

Design

Systematic review and meta-analysis of randomised controlled trials.

Data sources

AMED, CINAHL, EMBASE, British Nursing Index, Medline, Web of Science, PsycINFO, Cochrane Database of Systematic Reviews, Central, Social Sciences Citation Index, Social Policy and Practice, and HMIC from inception to January 2013.

Review methods

Articles were screened for inclusion independently by two reviewers. Data extraction and quality appraisal were performed by one reviewer and checked by a second with discrepancies resolved by discussion with a third if necessary. Random-effects meta-analyses were performed.

Results

Nine articles (from eight original randomised controlled trials) met eligibility criteria and were included in the final review. In total, 578 participants were enrolled across the trials, with participants presenting with prehypertension/hypertension (n = 3 trials), type 1 or 2 diabetes (n = 2), heart disease (n = 2) and stroke (n = 1). Meta-analyses, using standardised mean differences, showed evidence of reductions in stress (− 0.36; 95% CI − 0.67 to − 0.09; p = 0.01), depression (− 0.35; 95% CI − 0.53 to − 0.16; p = 0.003) and anxiety (− 0.50; 95% CI − 0.70 to − 0.29; p < 0.001). Effects on physical outcomes (blood pressure, albuminuria, stress hormones) were mixed.

Conclusion

Whilst populations with vascular disease appear to derive a range of psychological benefits from MBSR/MBCT intervention, the effects on physical parameters of disease are not yet established. More robust studies, with longer term follow-up, are required to ascertain full effectiveness of such intervention.     

A systematic review and meta-analysis of mindfulness-based stress reduction for the fibromyalgia syndrome

Objectives

This paper presents a systematic review and meta-analysis of the effectiveness of mindfulness-based stress reduction (MBSR) for FMS.

Methods

The PubMed/MEDLINE, Cochrane Library, EMBASE, PsychINFO and CAMBASE databases were screened in September 2013 to identify randomized and non-randomized controlled trials comparing MBSR to control interventions. Major outcome measures were quality of life and pain; secondary outcomes included sleep quality, fatigue, depression and safety. Standardized mean differences and 95% confidence intervals were calculated.

Results

Six trials were located with a total of 674 FMS patients. Analyses revealed low quality evidence for short-term improvement of quality of life (SMD = − 0.35; 95% CI − 0.57 to − 0.12; P = 0.002) and pain (SMD = − 0.23; 95% CI − 0.46 to − 0.01; P = 0.04) after MBSR, when compared to usual care; and for short-term improvement of quality of life (SMD = − 0.32; 95% CI − 0.59 to − 0.04; P = 0.02) and pain (SMD = − 0.44; 95% CI − 0.73 to − 0.16; P = 0.002) after MBSR, when compared to active control interventions. Effects were not robust against bias. No evidence was further found for secondary outcomes or long-term effects of MBSR. Safety data were not reported in any trial.

Conclusions

This systematic review found that MBSR might be a useful approach for FMS patients. According to the quality of evidence only a weak recommendation for MBSR can be made at this point. Further high quality RCTs are required for a conclusive judgment of its effects.     

Technology supported mindfulness for obsessive compulsive disorder: The role of obsessive beliefs

The current study examined the association of OCD symptoms and OCD belief domains, for individuals engaged in Technology Supported Mindfulness training (TSM) using an EEG-based biofeedback device (called “Muse”) that permits individuals to engage in home based mindfulness meditation practices. In this randomized controlled study, treatment-seeking participants with a principal DSM-5 diagnosis of OCD (N = 71) were randomly assigned to eight weeks of: 1) a meditation program involving daily use of the “Muse” device, or 2) wait list control. At weeks 1, 4, and 8, participants completed self-report measures of OCD symptoms (YBOCS: Yale-Brown Obsessive Compulsive Scale) and OCD beliefs (OBQ; OCCWG, 2005). Latent Difference Score (LDS) models indicated that there was no significant longitudinal relationship between OBQ “Responsibility/Threat” (OBQ R/T) scores and OCD symptoms. The analysis of OBQ “Perfectionism/Certainty” (OBQ P/C) and OCD symptoms demonstrated a significant reciprocal relationship between these two variables, in which OCD symptoms predicted subsequent increases in OBQ P/C and vice versa. The analysis of OBQ “Importance/Control of Thoughts” (OBQ I/C) and OCD symptoms demonstrated a significant reciprocal relationship between these two variables, in which OCD symptoms predicted subsequent increases in OBQ I/C and vice versa. The analysis of OBQ domains and EEG derived attentional changes demonstrated a significant association between OBQ P/C and Alpha band frequencies. These results clarify the association of OBQ belief domains, OCD symptom change and EEG derived indicators of attention during TSM.     

Contemplative sciences: A future beyond mindfulness

Mindfulness is a psychological technique based on Eastern meditative practices that was developed in the late 1970s by Kabat-Zinn at the University of Massachusetts. Initially, there was a debate over whether it should be considered a scientific technique or labelled as part of the “new wave” practices. Today, mindfulness is omnipresent in modern societies but has suffered from merchandising and banalization, which has been strongly criticized. Despite some limitations regarding methodological aspects of mindfulness research, it is considered effective for treating many physical and psychological disorders, and even it is recommended in clinical guidelines such the British National Institute for Health and Care Excellence. During the last 2500 years, mindfulness practices have moved from Northern India across most of Asia, but their mixing with Western science and culture at the end of the 20^th century is considered a key event in recent history. For the first time in human history, due to globalization, the wisdom of all contemplative traditions can be shared with all human beings and assessed by science. Mindfulness practices, yoga included, are giving birth to a new field of knowledge, contemplative sciences, which go beyond mindfulness and is devoted to helping humanity to reach higher levels of happiness and mental peace.     

Mindfulness based cognitive therapy for psychiatric disorders: A systematic review and meta-analysis

Mindfulness- based Cognitive Therapy (MBCT) is a meditation program based on an integration of Cognitive behavioural therapy and Mindfulness-based stress reduction. The aim of the present work is to review and conduct a meta-analysis of the current findings about the efficacy of MBCT for psychiatric patients. A literature search was undertaken using five electronic databases and references of retrieved articles. Main findings included the following: 1) MBCT in adjunct to usual care was significantly better than usual care alone for reducing major depression (MD) relapses in patients with three or more prior depressive episodes (4 studies), 2) MBCT plus gradual discontinuation of maintenance ADs was associated to similar relapse rates at 1 year as compared with continuation of maintenance antidepressants (1 study), 3) the augmentation of MBCT could be useful for reducing residual depressive symptoms in patients with MD (2 studies) and for reducing anxiety symptoms in patients with bipolar disorder in remission (1 study) and in patients with some anxiety disorders (2 studies). However, several methodological shortcomings including small sample sizes, non-randomized design of some studies and the absence of studies comparing MBCT to control groups designed to distinguish specific from non-specific effects of such practice underscore the necessity for further research.     

The neural substrates of mindfulness: An fMRI investigation

“Mindfulness” is a capacity for heightened present-moment awareness that we all possess to a greater or lesser extent. Enhancing this capacity through training has been shown to alleviate stress and promote physical and mental well-being. As a consequence, interest in mindfulness is growing and so is the need to better understand it. This study employed functional magnetic resonance imaging (fMRI) to identify the brain regions involved in state mindfulness and to shed light on its mechanisms of action. Significant signal decreases were observed during mindfulness meditation in midline cortical structures associated with interoception, including bilateral anterior insula, left ventral anterior cingulate cortex, right medial prefrontal cortex, and bilateral precuneus. Significant signal increase was noted in the right posterior cingulate cortex. These findings lend support to the theory that mindfulness achieves its positive outcomes through a process of disidentification.     

A systematic review and critical evaluation of the immunology of chronic fatigue syndrome

OBJECTIVE: Immune dysfunction in patients with chronic fatigue syndrome (CFS) has been widely but inconsistently reported. Traditional reviews of the literature have produced a variety of conclusions. We present the results of the first systematic review of the subject. METHODS: EMBASE, MEDLINE and PSYCHINFO databases were searched, and leading researchers in the field were contacted. Inclusion criteria were applied, and studies were then divided into groups based on the quality of their methodology. Study results were collated and described. RESULTS: Studies ranged widely in quality. There was an inverse association between study quality and finding low levels of natural killer cells, suggesting that the association may be related to study methodology. On the other hand, reports of abnormalities in T cells and cytokine levels were not related to study quality. CONCLUSIONS: The conclusions of this systematic review differ from a recent traditional narrative review of the immunology of CFS. No consistent pattern of immunological abnormalities is identified.     

A systematic review on MEG and its use in the presurgical evaluation of localization-related epilepsy

BACKGROUND: Magnetoencephalography (MEG), also referred to as magnetic source imaging (MSI) when combined with structural imaging, provides a new, noninvasive tool for epilepsy localization. In contrast to EEG, the magnetic fields generated by electrical discharges are minimally affected by intervening tissue layers. The purpose of this study was to determine the effectiveness of MEG/MSI in the presurgical evaluation of localization-related epilepsies by means of a systematic review. METHODS: We searched MEDLINE, the Cochrane library, and EMBASE between 1987 and 2006 for English articles. References of reviews and book chapters were searched. In addition, we contacted experts in MEG and epilepsy. Studies including a minimum of four patients with at least 6 months follow-up after surgery were reviewed. In each study, surgical outcome (seizure freedom) was correlated with the concordance of MEG source localization and resection area. RESULTS: The literature search generated 192 articles. Twenty-eight papers satisfied the inclusion criteria. Eleven of the 28 articles were excluded due to an inability to determine the concordance between the MEG epileptic focus and the resected area based on the published data. Analysis of the 17 remaining studies allowed us to obtain sensitivity (range: 0.20-1.0) values for all articles, and specificity (0.06-1.00) values, positive likelihood ratios (0.67-2.0) and negative likelihood ratios (0.40-2.13) for some articles. CONCLUSIONS: There is insufficient evidence in the current literature to support the relationship between the use of MEG in surgical planning and seizure-free outcome after epilepsy surgery. Additional studies are needed.     

硅凝胶膜治疗病理性瘢痕的系统评价

背景：评价硅凝胶膜治疗病理性瘢痕的有效性及安全性。 资料来源：计算机检索Cochrane图书馆临床对照试验数据库(Cochrane Central Register of Controlled Trials, 2009年第3期)、 MEDLINE光盘数据库(1966/2009-09)、EMBASE光盘数据库(1984/2009-09)、中国生物医学文献数据库(CBM, 1979/2009-09)、维普中文数据库(VIP, 1989/2009-09)、中国期刊全文数据库(CNKI, 1979/2009-09)及所获文献的参考文献。 资料选择：筛选所有应用硅凝胶膜治疗病理性瘢痕,对照组为空白或其他治疗的随机、半随机对照试验及临床对照试验,使用Cochrane协作网提供的RevMan4.2.10软件对纳入文献进行统计分析。 结局评价指标：主要指标为瘢痕大小,次要指标包括瘢痕颜色、弹性或质地,患者对外观的主观评价,痛、痒等临床症状改善情况,症状改善时间等。 结果：硅凝胶膜在改善瘢痕弹性、颜色、患者主观评价方面优于空白对照组,差异有显著性意义(RR弹性=8.60,95%CI 2.55~29.02),(RR颜色=21.33,95%CI 4.33~104.99),(RR患者主观评价=32.33,95% CI 6.63~157.59)。硅凝胶膜不良反应一般较轻,易缓解。 结论：硅凝胶膜在改善病理性瘢痕颜色、弹性及患者主观评价方面可能具有一定的疗效,但硅凝胶在改善瘢痕大小方面并无显著疗效。硅凝胶膜并不优于其他治疗方法。可以认为硅凝胶膜治疗病理性瘢痕是安全的。由于纳入的研究质量均低,结果具有高度的偏倚性。 关键词：硅凝胶膜;病理性瘢痕;系统评价     

Sexual dysfunction after treatment for testicular cancer: A systematic review

Objectives: We aimed to assess the nature and risk of sexual dysfunction in men after treatment for testicular cancer. Method: Systematic review of sexual dysfunction in men treated for testicular cancer. The odds ratio or proportions of subjects with reduced sexual drive, erectile dysfunction or orgasmic/ejaculatory dysfunction was calculated. Results: A detailed review of 79 of the 227 citations was conducted. The highest level of evidence found, were controlled studies. Six controlled studies examined sexual function in 709 patients after they had received treatment. Seven uncontrolled studies examined sexual function in 337 subjects before and after treatment for testicular cancer. Most studies were limited by low response rates, use of unvalidated questionnaires and inclusion of a variety of treatment modalities. Few assessed psychological function and none examined its possible interaction with sexual dysfunction. Meta-analysis of the controlled studies indicated significantly reduced or absent orgasm (OR=4.62, 95% CI=2.47–8.63) together with erectile (OR=2.47, 95% CI=1.54–3.96) and ejaculatory dysfunction (OR=28.57, 95% CI=1.75–464.78) up to 2 years after treatment. Effects on sexual function were less consistent in the uncontrolled studies. Conclusions: The controlled studies indicate that sexual dysfunction persists for up to 2 years after treatment. However, better evidence is needed in studies that control for the impact of the testicular cancer, the treatment modality and psychological reactions to both.     

Moderators of psychological and psychoeducational interventions for the prevention of anxiety: A systematic review

The aim of this study was to assess the available evidence on potential moderators of psychological and psychoeducational interventions for the prevention of anxiety. A systematic review using PubMed, PsycINFO, Web of Science, Embase, OpenGrey, and CENTRAL was performed up to October 2019. Two independent researchers assessed the fulfillment of eligibility criteria, extracted the data and performed a quality assessment of the included studies. Outcomes were moderators of the reduction of anxious symptoms or the incidence of anxiety disorders. Fourteen studies reporting results on moderator analyses performed in 13 randomized controlled trials were included. Twenty-seven potential moderators were organized into six categories: sociodemographic, clinical characteristics, cognitive variables, life events, interpersonal functioning and intervention characteristics. The most frequently examined variables were gender, age and baseline anxiety. We found insufficient evidence for all moderator categories studied. In children and adolescents, we found some studies with significant results for the low family support variable and higher levels of anxiety symptoms at baseline, which were both associated with higher effectiveness. Limited conclusions can be drawn about for whom and under what conditions interventions work in the prevention of anxiety. A strong need to improve the methodological quality and the number of moderator studies was identified.     

A systematic review of community-based parenting interventions for adolescents with challenging behaviours

Parenting skills training is an established means of treating challenging behaviours among young children, but there has been limited research on its efficacy when used to treat challenging adolescent behaviour. The aim of this systematic review was to evaluate the efficacy and effectiveness of community-based parenting interventions designed for families with adolescents, as judged in terms of increased knowledge and skills among parents, improvements in adolescent behaviour, and program feasibility within community settings. Results indicated that intervention group parents typically made greater gains than did control group parents on measures of good parenting, with positive flow-on effects to some aspects of challenging adolescent behaviours. Limited evidence suggests that group and individual intervention formats may be equally effective and that there is no advantage to the participation of the target adolescent in the intervention.     

对氧磷酶基因与阿尔茨海默病发病风险的Meta分析

目的使用系统评价方法评估对氧磷酶(paraoxonase,PON)基因与阿尔茨海默病(Alzheimer's disease,AD)发病的相关性。方法检索中英文数据库以发现合格研究,使用纽卡斯尔-渥太华量表(Newcastle-Ottawa Scale,NOS)评价纳入研究质量,采用随机或固定效应模型计算合并比值比(odds ratio,OR),使用Q检验评估研究之间的异质性,失安全系数、Egger's检验和漏斗图评估发表偏倚。结果总共15项研究符合Meta分析纳入标准。所有研究NOS评分均为7分以上,纳入研究质量较高。共涉及4个位点,最多一个位点(PON1Q192R)涉及11项研究,累计病例2366例和对照2579例。结果显示,PON2 S311C多态性SS基因型降低了总人群AD发病风险(OR=0.82,95%CI:0.68~0.99,P=0.04)。没有发现其它遗传多态性与AD具有相关性。结论现有证据表明,PON2 S311C多态性与AD发病风险具有相关性,本结论亟待大样本重复研究进一步验证。     

Prognosis of fatigue. A systematic review

OBJECTIVE: The objective of the study was to summarize evidence on the course and prognostic factors of fatigue in primary care patients and in the community. METHODS: Two reviewers independently screened identified citations, discussed eligible studies, and assessed methodological quality of selected studies. Data concerning study population, duration of follow-up, measurement of fatigue, outcome, and prognostic factors were extracted. Studies with populations selected by a specific disease or postpartum condition were excluded. RESULTS: We selected 21 articles reporting on 11 (partly) primary care cohorts and six community cohorts. Follow-up was up to 1 year in primary care and up to 4 years in the community, and in most studies that presented duration of fatigue, participants were chronically fatigued. Because of wide heterogeneity of studies, a qualitative analysis was performed. Recovery of fatigue varied widely, but no differences were found between settings. Sufficient evidence for an association with recovery was found for lower severity of fatigue, and limited evidence was found for good self-reported health, mental health, and psychological attributions. A major deficit in methodological quality of most studies was a potential bias due to low or selective response or loss to follow-up. CONCLUSION: Most studies on fatigue included patients with long symptom duration at baseline, making it difficult to study prognosis early in the course of fatigue. To provide clear evidence on prognosis in fatigued persons, prognostic studies should use an optimal design including selection of an inception cohort with limited duration of fatigue at baseline, a sufficient sample size, and information on rates and selectivity of response and loss to follow-up.     

A systematic review of studies of depression prevalence in university students

Background

Depression is a common health problem, ranking third after cardiac and respiratory diseases as a major cause of disability. There is evidence to suggest that university students are at higher risk of depression, despite being a socially advantaged population, but the reported rates have shown wide variability across settings.

Purpose

To explore the prevalence of depression in university students.

Method

PubMed, PsycINFO, BioMed Central and Medline were searched to identify studies published between 1990 and 2010 reporting on depression prevalence among university students. Searches used a combination of the terms depression, depressive symptoms, depressive disorders, prevalence, university students, college students, undergraduate students, adolescents and/or young adults. Studies were evaluated with a quality rating.

Results

Twenty-four articles were identified that met the inclusion and exclusion criteria. Reported prevalence rates ranged from 10% to 85% with a weighted mean prevalence of 30.6%.

Conclusions

The results suggest that university students experience rates of depression that are substantially higher than those found in the general population. Study quality has not improved since 1990.     

A systematic review of peer-mediated interventions for children with autism spectrum disorder

BackgroundPeer mediated intervention (PMI) is a promising practice used to increase social skills in children with autism spectrum disorder (ASD). PMIs engage typically developing peers as social models to improve social initiations, responses, and interactions.MethodThe current study is a systematic review examining PMIs for children and adolescents with ASD conducted using group designs. Five studies met the pre-specified review inclusion criteria: four randomized controlled trials and one pre- and post-test design.ResultsFour of the studies were conducted in school settings, whereas one study was conducted in a camp setting. The studies all reported that participants improved in social skills (e.g., social initiations, social responses, social communication) post intervention. Additionally, sustainment, generalization, and fidelity of implementation were examined.ConclusionPMI is a promising approach to address social skills in children with ASD, and this approach can be conducted in meaningful real-word contexts, such as schools. Limitations of the studies as well as future directions are discussed.     

多发脑动脉瘤危险因素的系统评价

目的评价性别、吸烟和高血压与多发脑动脉瘤的关系。方法计算机检索medline(1976~2002)、EM(1990~2002),主题词为multiplecerebralaneurysms、riskfactors,同时检索中文CBM(1978~2002),关键词为多发脑动脉瘤、危险因素,同时查阅相关文章的参考文献目录。并应用meta分析方法对检索到的文章进行综合分析。结果共检索到符合条件的文章4篇,分别对性别、吸烟和高血压与多发动脉瘤的关系评价,结果表明,女性、吸烟和高血压均为多发脑动脉瘤的危险因素,其合并OR和95%CI分别为1.92(1.23~3.00);2.66(1.10~6.41);1.85(1.17~2.94)。结论性别、吸烟和高血压与多发脑动脉瘤的形成有密切的关系。