Effects of Mindfulness-Based Cognitive Therapy on the experience of positive emotions in daily life: A randomized controlled trial

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Effects of Mindfulness-Based Cognitive Therapy on the experience of positive emotions in daily life:

A randomized controlled trial

Nicole Geschwind

[email protected]

Centre for Psychology of Learning and

Psychopathology; Research Group on Health Psychology

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Overview

• Positive emotions, why bother? • Experience Sampling Method

• Mindfulness-Based Cognitive Therapy • MindMaastricht trial

• Results

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Faculty of Health, Medicine, and Life Sciences

MHeNS School for Mental Health and Neuroscience

Introduction: Positive Emotions

• Associated with longevity and health

• Positive and negative emotions = different subsystems •

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Emotions

Negative emotions Positive Emotions time in tensi ty

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Experience Sampling Method

• At random

• 10 times per day • 6 days

• Emotions

• Situation / activity

Right now, I feel…

not at all moderately very

Cheerful 1 2 3 4 5 6 7

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Daily life person-context interaction

Experience sampling procedure

Day 1 Day 2 Day 3 Day 4 Day 5

beep beep beep beep beep beep beep beep beep beep

one ESM day

7.30 22.30 Positive emotions Activity Pleasantness Day 6 Daily-life context

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Daily-Life Reward Experience

Daily life P ositi ve emotions

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How to increase positive emotions?

a t t e n t i o n a l b r o a d e n i n g Positive emotions Reward

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Mindfulness-Based Cognitive Therapy

• 8 week training, 10-15 participants

• In touch with and aware of the present moment • Non-evaluative and non-judgmental

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MindMaastricht RCT

• Sample: 130 participants with residual symptoms of depression, not currently depressed 6 days Experience Sampling 6 days Experience Sampling Mindfulness Training (MBCT) Control

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Positive emotions

• Happy • Satisfied • Strong • Enthusiastic alpha = 0.89 • Curious • Animated • Inspired • [Relaxed]

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Pleasantness of current activity

• Factor analysis:

– I enjoy this activity

– I am skilled at doing this – This activity requires effort – I would prefer to do s.th. else – [I feel I’m being active]

– [This is a challenge]

Activity

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Results

Total Entries Invalid Participants Entries per participant

12.453 559 (4 %) 130;

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After mindfulness training…

• More positive emotions

• Activities appraised as more pleasant

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Also: Increased reward experience

Daily life P ositi ve emotions before after

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PA change

CONTROL MBCT

pre post

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Activity pleasantness change

CONTROL MBCT

pre post

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Reward Experience change

CONTROL MBCT

pre post

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low medium high

Reduction in residual symptoms

Related to reduction in residual symptoms?

***

pre post

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low medium high

pre post

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pre post

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But…

• Original idea behind MBCT: learn to disengage from automatic negative thinking patterns that arise during dysphoric mood and facilitate

relapse (Teasdale, 2000)

• So: Rumination, worry, NA  PA etc. ?

• Independent of changes in rumination, worry, NA, and stress sensitivity

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Conclusions

• Reward experience can be learned

• Living in the moment

 more receptive

_{higher experience of positive}

emotions during pleasant activities

• More research necessary into underlying mechanisms!

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• MBCT has another, less often studied face: it facilitates the experience of positive

emotions.

• Changes in PA-related variables possibly contribute to the protective effects of MBCT against future relapse

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Thanks to:

(VENI grant nr 916.76.147 to Dr Wichers) Marieke Wichers Jim van Os Frenk Peeters

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[email protected]

Geschwind, N., Peeters, F., Drukker, M., van Os, J., & Wichers, M. (2011). Mindfulness training increases momentary positive emotions and reward experience in adults vulnerable to depression: A randomized controlled trial.

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References

• Geschwind et al. (2010). Meeting risk with resilience: high daily life reward experience preserves mental health. Acta Psychiatrica Scandinavica.

• Geschwind et al. (2009). The role of affective processing in vulnerability to and resilience against depression. In C. M. Pariante, R. M. Nesse, D. Nutt & L. Wolpert (Eds.), Understanding Depression: A translational approach (pp. 181-192). NY: New York: Oxford University Press Inc.

• Wichers et al. (2007). Evidence that moment-to-moment variation in positive emotions buffer genetic risk for depression: a momentary assessment twin study. Acta Psychiatrica Scandinavica, 115, 451-457.

• Wichers et al. (2009). Reduced stress-sensitivity or increased reward experience: The psychological mechanism of response to antidepressant medication. Neuropsychopharmacology, 34, 923-931.

• Wichers et al. (2007). Genetic risk of depression and stress-induced negative affect in daily life. British Journal of Psychiatry, 191, 218-223.

• Wichers, Schrijvers, Geschwind et al. (2009). Mechanisms of gene-environment interactions in depression: Evidence that genes potentiate multiple sources of adversity. Psychological Medicine, 39, 1077–1086.

• Wichers et al. (2008). The psychology of psychiatric genetics: Evidence that positive emotions in females moderate genetic sensitivity to social stress associated with the BDNF Val(66)Met polymorphism. Journal of Abnormal Psychology, 117, 699-704.

• Wichers, et al. (2008). Susceptibility to depression expressed as alterations in cortisol day curve: a cross-twin, cross-trait study.

Psychosomatic Medicine, 70, 314-318.

• Wichers, Geschwind et al. (2009). Transition from stress sensitivity to a depressive state: longitudinal twin study. The British Journal of Psychiatry, 195(6), 498-503.

• Wichers, et al. (2008). The catechol-O-methyl transferase Val(158)Met polymorphism and experience of reward in the flow of daily life. Neuropsychopharmacology, 33, 3030-3036.

• Wichers, Geschwind et al. (2010). Scars in depression: is a conceptual shift necessary to solve the puzzle? Psychological Medicine, 40(3), 359-365.

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Introduction: Positive Affect (PA)

• PA reduces stress-induced psychiatric and physiological symptoms

• PA also reduces the expression of genetic vulnerability for affective disorders

• Effects PA > NA on resilience & well-being (Cohn & Fredrickson, 2009)

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0 0,05 0,1 0,15 0,2 0,25 0,3 0,35 0,4

Responders Nonresponders Responders Nonresponders Mindfulness Control In cr ea se in P os it iv e Aff ec t

Activity-related reward experience

pre post

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0 0,05 0,1 0,15 0,2 0,25 0,3 0,35 0,4

Responders Nonresponders Responders Nonresponders Mindfulness Control In cr ea se in Ne ga tiv e Aff ec t

Activity-related stress sensitivity

pre post

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NA change pre/post: Mindfulness vs. Controls 1,00 1,20 1,40 1,60 1,80 2,00 2,20 pre post NA Mindful Control

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Measuring emotions in daily life?

• NA and PA fluctuate…

NA

PA

time intensit y

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• 49 depressed patients (randomized to Imipramine or placebo)

Week 1

• HAM early improvement • PA early change • NA early change

Method

Week 6: • HAM score • Remission • Recovery

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Reward Experience & Resilience

• High reward experience should contribute to the preservation of mental health

– Especially when at risk for low mood • Childhood trauma

• Recent Stressful Life Events • Genetic Risk

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Differential relapse prevention effect

• Finding: MBCT reduces relapse only in 3+ patients, not in 2- (Teasdale et al., 2000; Ma & Teasdale, 2004)

• Assumptions:

1) MBCT works mainly via cognitive processes (Rumination , meta-cognition )

2) Automatic negative thinking patterns stronger and more related to relapse in 3+

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Differential relapse prevention effect

• (Teasdale et al., 2000; Ma & Teasdale, 2004)

2-

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Assumptions

1) MBCT works mainly via cognitive processes (rumination , meta-cognition )

2) Automatic negative thinking patterns stronger and more related to relapse in 3+

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Consequence

• Most later studies excluded 2- patients:

– Bondolfi, et al., 2010; Godfrin & van Heeringen, 2010; Kuyken, et al., 2008; Kuyken, et al., 2010; Segal, et al., 2010

• Even when not directly examining risk for relapse:

– Barnhofer, et al., 2009; Hargus et al., 2010; Kingston et al., 2007

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Exclusion justified?

• Arguments against exclusion:

– Subpopulation overlap argument – Diversity argument

– Continuity argument – Confounder argument

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Subpopulation overlap argument

3+

2-

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Diversity Argument (1)

• Diverse effects:

– Changes in emotion regulation:

• Positive emotions increase (Geschwind et al, submitted; Fredrickson et al., 2008)

• Upward spiral (Garland et al, 2010)

• Related to reduction of dep. symptoms

– Various other reported effects  works on more basal level

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Diversity Argument (2)

• Beneficial for diverse populations not suffering from major depression

• working people, cancer, pregnancy, anxiety, …

ef

fe

ctiv

eness

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Continuity Argument (1)

• Relapse = dichotomous

• Evidence for continuity of symptoms

• Problems with dichotomous classifications •  Useful to examine continuous measures

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Continuity Argument (2)

• Residual depressive symptoms – Continuous

– Predict risk for relapse (Judd et al., 1999; Nierenberg, et al., 2010)

– MBCT associated with reduction residual symptoms (Kenny & Williams, 2007; Kingston, et al., 2007; Mathew et al., 2010)

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Confounder argument

• MBCT vs TAU trial in 3+ patients only (Segal et al., 2010)

– MBCT only effective among unstable remitters = with intermittent residual symptoms

– No effect in stable remitters = residual symptoms <7 – Patients with residual symptoms were actually

excluded in original studies!

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Hypotheses

• MBCT  residual symptoms

• Independent of 2- or 3+ subgroup

= no interaction treatment*subgroup

• Explore whether MBCT works via diff. mechanisms in the 2- and 3+ subgroups

(rumination, worry, mindfulness positive and negative emotions)

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No evidence for interaction

**Treatment*Subgroup**

Measure β p HDRS 0.45 0.162 IDS 0.33 0.240 Rumination 0.34 0.206 Worry 0.23 0.332 KIMS observe 0.09 0.743 KIMS describe 0.25 0.236 KIMS act aware -0.18 0.522 KIMS accept -0.27 0.236 PA 0.08 0.210 NA -0.07 0.284

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By subgroup: Hamilton Depression Rating

Scale

5 6 7 8 9 10 11 12 pre post HD RS 2- TAU 3+ TAU 2- MBCT 3+ MBCT MBCT

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Same for self-report…

10 12 14 16 18 20 22 24 26 28 pre post IDS -SR 2- TAU 3+ TAU 2- MBCT 3+ MBCT

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Effect Size of Treatment per Subgroup

-0,8 -0,7 -0,6 -0,5 -0,4 -0,3 -0,2 -0,1 0

HDRS IDS-SR Rumination Worry

2- 3+

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Conclusions

• Need to re-examine and reconsider:

– MBCT just as effective in 2- as in 3+

– At least when looking at participants with residual symptoms