Effectiveness of myofascial release for adults with chronic neck pain: a meta-analysis.

BACKGROUND: Every second human will experience a phase of neck pain in their lifetime and a high rate of chronicity exists. Because of the complexity and multiple influencing factors, chronic pain conditions are associated with a long treatment and diagnostic process. This leads to a prolonged healing process and high costs. OBJECTIVE: To evaluate the effect of myofascial release on the variables of pain and range of motion in patients with chronic neck pain. METHOD: Selection criteria were set to create a search algorithm for a systematic search in the databases: PubMed, Google Scholar, EBM Reviews, Medline, CINAHL, PEDro, and Science Direct. The risk of bias and the methodological quality was analyzed with the PEDro scale. RESULT: Ten randomized controlled trials, with 549 participants met the eligibility criteria. The methodological quality was ranked from good to excellent. The myofascial release showed a significant difference in pain (p =  0.03), rotation to the right (p =  0.05), and lateral flexion to the right (p =  0.04), compared to other treatment methods. No significant effect was found for improvements in pressure pain threshold. CONCLUSION: Modest effects are observed in pain reduction, suggesting potential benefits of myofascial release in managing chronic neck pain. Further research with standardized protocols and direct comparisons to established therapies is crucial for a comprehensive understanding of myofascial release efficacy. CONTRIBUTION OF THE PAPER: What does the meta-analysis add to the current literature.

When depressed-be mindful of and kind to yourself: Self-compassion as mediator of change in a mindful depression treatment.

Self-compassion as an outcome and potential mediator in mindfulness-based interventions has gained increased attention in the last years. However, most mediation studies had several methodological shortcomings which precluded robust conclusions regarding its mediating role. This randomized controlled study aimed to address these issues by assessing self-compassion, as proposed mediator and outcome, in a temporal sequence.Eighty-one patients with current depression and work-related conflicts were randomly assigned to either an eight-week mindfulness-based day hospital treatment (MDT-DH; n = 47; including psychopharmacological treatment if necessary) or a waitlist control condition including a psychopharmacological consultation (PCC; n = 34). The outcome, depression severity, was assessed before, at mid-treatment and after the treatment while the proposed mediator, self-compassion, was measured at two week-intervals from before treatment until directly after treatment. Within-person and between-person mediation effects were analysed using multilevel structural equation modelling.The results from the mediation models show that self-compassion (as a general factor) and two of its components (mindfulness of personal suffering and common humanity) increased and mediated the change in depressive symptoms over time.This study provides preliminary support for self-compassion as a mediator of treatment effects on depression in a mindful depression treatment.

Myofascial Tissue and Depression.

Background: The myofascial system plays a fundamental role in the mechanics of the body, in body tension regulation and the etiology of pathological states like chronic pain. Moreover, it contains contractile elements and preliminary evidence suggests that its properties are linked to psychological factors. The aim of the present research was to investigate characteristics of the myofascial tissue in patients with Major Depressive Disorder (MDD) and to examine whether the state of the myofascial tissue causally affects pathopsychological processes in MDD. Methods: In Study 1, stiffness and elasticity of the myofascial tissue of 40 inpatients suffering from MDD measured with a tissue compliance meter were compared with those of 40 matched never-depressed participants. In Study 2, 69 MDD patients were randomly assigned to single-session self-myofascial release intervention (SMRI) or a placebo intervention. Effects on memory bias and affect were investigated. Results: Results showed that MDD patients displayed heightened stiffness and reduced elasticity of the myofascial tissue and that patients in the SMRI group showed a reduced negative memory bias and more positive affect compared to patients in the placebo condition. Conclusions: The preliminary results of our studies indicate that the myofascial tissue might be part of a dysfunctional body-mind dynamic that maintains MDD. Supplementary Information: The online version contains supplementary material available at 10.1007/s10608-021-10282-w.

Patients' interpersonal problems as moderators of depression outcomes in a randomized controlled trial comparing mindfulness-based cognitive therapy and a group version of the cognitive-behavioral analysis system of psychotherapy in chronic depression.

OBJECTIVES: Interpersonal problems were examined as moderators of depression outcomes between mindfulness-based cognitive therapy (MBCT) and cognitive behavioral analysis system of psychotherapy (CBASP) in patients with chronic depression. METHODS: Patients received treatment-as-usual and, in addition, were randomized to 8-weeks of MBCT (n = 34) or 8-weeks of CBASP (n = 34). MBCT and CBASP were given in a group format. The Hamilton depression rating scale (HAM-D) was the primary and the Beck Depression Inventory (BDI-II) the secondary outcome. The subscales of the Inventory of interpersonal problems (IIP-32) were moderators. Multilevel models were performed. RESULTS: Higher scores on the "vindictive/self-centered" subscale were associated with a better outcome in MBCT than in CBASP (HAM-D: p < .01; BDI-II: p < .01). Higher scores on the "nonassertive" subscale were associated with a better outcome in CBASP than in MBCT (HAM-D: p < .01; BDI-II: p < .01). CONCLUSIONS: If these results can be replicated in larger trials, MBCT should be preferred to CBASP in chronically depressed patients being vindictive/self-centered, whereas CBASP should be preferred to MBCT in chronically depressed patients being nonassertive.

How specific is cognitive change? A randomized controlled trial comparing brief cognitive and mindfulness interventions for depression.

Objective: There is a debate in psychotherapy research as to whether different kinds of psychotherapy work through specific mechanisms of change. Particularly, it is questioned whether cognitive change is specific to cognitive therapy. This study aimed to answer this question by comparing a brief cognitive intervention with an active comparison intervention (i.e., brief mindfulness-based intervention) and by following strict methodological guidelines. Method: 72 currently depressed outpatients were randomized to either cognitive intervention (n = 39) or mindfulness-based intervention (n = 33). Automatic thoughts (negative self-statements, well-being, and self-confidence), dysfunctional attitudes (performance evaluation and approval by others) and depressive symptoms were assessed before and six times during treatment. Within-person and between-person mediation effects were analyzed using multilevel structural equation modeling. Results: There was no difference in cognitive change between the interventions. Negative self-statements and performance evaluations were significant mediators of the within-person effect of time on depressive symptoms, while the three other cognitive variables did not change. Conversely, change in depressive symptoms also mediated within-person cognitive change. Conclusion: Cognitive change seems to be a general rather than a specific mechanism of change. However, the mutual impact of cognitive and depressive change does not support a unidirectional causal model.

The Impact of Upward versus Downward Movement Patterns on Memory Characteristics of Depressed Individuals.

BACKGROUND/AIMS: Basic research on embodiment has demonstrated that manipulating the motoric system has broad effects on cognitive and emotional processes. The aim of the present study was to investigate the effects of an embodiment manipulation on the affective memory bias and specificity of autobiographic memories of depressed individuals. METHODS: Forty currently depressed patients practiced either an upward-opening Qi Gong movement, which runs counter to the habitual slumped and downward depressive movement style, or a downward-closing Qi Gong movement. They were required to retrieve specific personal memories to positive or negative cue words during movement. Moreover, an incidental recall of the cue words was conducted. RESULTS: Patients in the upward-opening movement condition in contrast to the downward-closing movement condition showed a more positively biased recall of affective words and recalled more specific autobiographical memories. CONCLUSIONS: Results indicate that the motoric system and key maintaining cognitive factors in depressive disorders are closely interrelated.

Emotionally aligned: Preliminary results on the effects of a mindfulness-based intervention for depression on congruence between implicit and explicit mood.

BACKGROUND: Mindfulness-based interventions (MBIs) are effective in treating major depression. Because mindfulness involves monitoring and accepting current experiences, it may lead people resolve incongruencies between emotional responses that would otherwise remain unnoticed. Mindfulness may thus foster congruence between implicit and explicit emotions. The current randomized controlled trial tested this notion. METHODS: N = 39 patients with an acute depressive episode were randomly assigned to an 8-week MBI (n = 24) or a psychopharmacological consultation condition (n = 15). Explicit and implicit mood and depressive symptoms were assessed before treatment and at the end of treatment. RESULTS: Compared with the control condition, patients receiving MBI demonstrated higher congruence between implicit and explicit negative mood after treatment. There was no such difference in congruence of implicit and explicit positive mood. Additional analyses showed that only within the MBI group, individual differences in explicit mood became less stable. In contrast, individual differences in implicit mood remained stable in both groups. LIMITATIONS: There was no control group including an active psychological intervention, the sample was small, and emotional congruence was not assessed within persons. CONCLUSIONS: These findings correspond with the idea that mindfulness reduces incongruencies between implicit and explicit emotional responses. We found preliminary evidence for this effect for negative emotional responses. There was suggestive evidence that congruence arose from the alignment of explicit responses (which became less stable) to implicit responses (which remained stable). Studying the interplay between implicit and explicit processes may shed light on the working mechanisms of clinical-psychological interventions.

The Effects of Mindfulness-Based Cognitive Therapy and Cognitive Behavioral Analysis System of Psychotherapy added to Treatment as Usual on suicidal ideation in chronic depression: Results of a randomized-clinical trial.

BACKGROUND: Suicidal ideation (SI) is common in chronic depression, but only limited evidence exists for the assumption that psychological treatments for depression are effective for reducing SI. METHODS: In the present study, the effects of Mindfulness-based Cognitive Therapy (MBCT; group version) plus treatment-as-usual (TAU: individual treatment by either a psychiatrist or a licensed psychotherapist, including medication when indicated) and Cognitive Behavioral Analysis System of Psychotherapy (CBASP; group version) plus TAU on SI was compared to TAU alone in a prospective, bi-center, randomized controlled trial. The sample consisted of 106 outpatients with chronic depression. RESULTS: Multivariate regression analyses revealed different results, depending on whether SI was assessed via self-report (Beck Depression Inventory suicide item) or via clinician rating (Hamilton Depression Rating Scale suicide item). Whereas significant reduction of SI emerged when assessed via clinician rating in the MBCT and CBASP group, but not in the TAU group while controlling for changes in depression, there was no significant effect of treatment on SI when assessed via self-report. LIMITATIONS: SI was measured with only two single items. CONCLUSIONS: Because all effects were of small to medium size and were independent of effects from other depression symptoms, the present results warrant the application of such psychotherapeutical treatment strategies like MBCT and CBASP for SI in patients with chronic depression.

Sleep quality changes in chronically depressed patients treated with Mindfulness-based Cognitive Therapy or the Cognitive Behavioral Analysis System of Psychotherapy: a pilot study.

OBJECTIVE: To capture any sleep quality changes associated with group psychotherapy. PATIENTS/METHODS: Physician-referred, chronically depressed patients (n = 25) were randomized to either eight group sessions of Mindfulness-based Cognitive Therapy (MBCT, n = 9) plus Treatment As Usual (TAU), or the Cognitive Behavioral Analysis System of Psychotherapy (CBASP, n = 8) plus TAU, or to TAU only (control group, n = 8). Participants recorded their sleep at home. The primary outcome variables were: stable and unstable sleep, which were assessed using cardiopulmonary coupling (CPC) analysis, and estimated total sleep and wake time (minutes). Cardiopulmonary coupling measures heart rate variability and the electrocardiogram's R-wave amplitude fluctuations associated with respiration. RESULTS: By post-treatment night 6, the CBASP group had more stable sleep (p= 0.044) and less wake (p = 0.004) compared with TAU, and less wake vs MBCT (p = 0.039). CONCLUSION: The CBASP group psychotherapy treatment improved sleep quality compared with Treatment As Usual.

A randomized controlled trial on the efficacy of mindfulness-based cognitive therapy and a group version of cognitive behavioral analysis system of psychotherapy for chronically depressed patients.

OBJECTIVE: Mindfulness-based cognitive therapy (MBCT) has recently been proposed as a treatment option for chronic depression. The cognitive behavioral analysis system of psychotherapy (CBASP) is the only approach specifically developed to date for the treatment of chronically depressed patients. The efficacy of MBCT plus treatment-as-usual (TAU), and CBASP (group version) plus TAU, was compared to TAU alone in a prospective, bicenter, randomized controlled trial. METHOD: One hundred and six patients with a current DSM-IV defined major depressive episode and persistent depressive symptoms for more than 2 years were randomized to TAU only (N = 35), or to TAU with additional 8-week group therapy of either 8 sessions of MBCT (n = 36) or CBASP (n = 35). The primary outcome measure was the Hamilton Depression Rating Scale (24-item HAM-D, Hamilton, 1967) at the end of treatment. Secondary outcome measures were the Beck Depression Inventory (BDI; Beck, Steer, & Brown, 1996) and measures of social functioning and quality of life. RESULTS: In the overall sample as well as at 1 treatment site, MBCT was no more effective than TAU in reducing depressive symptoms, although it was significantly superior to TAU at the other treatment site. CBASP was significantly more effective than TAU in reducing depressive symptoms in the overall sample and at both treatment sites. Both treatments had only small to medium effects on social functioning and quality of life. CONCLUSIONS: Further studies should inquire whether the superiority of CBASP in this trial might be explained by the more active, problem-solving, and interpersonal focus of CBASP.

How we walk affects what we remember: gait modifications through biofeedback change negative affective memory bias.

BACKGROUND AND OBJECTS: Several studies have shown that physical exercise such as walking has effects on depression. These studies have focused on increasing intensity and amount of physical activity. In the present study, we investigated whether not only the intensity but also the style of physical activity affects depression related processes. METHOD: Using an unobtrusive biofeedback technique, we manipulated participants (39 undergraduates) to change their walking patterns to either reflect the characteristics of depressed patients or a particularly happy walking style. The intensity of walking (i.e. walking speed) was held constant across condition. During walking, participants first encoded and later recalled a series of emotionally loaded terms. RESULTS: The difference between recalled positive and recalled negative words was much lower in participants who adopted a depressed walking style as compared to participants who walked as if they were happy. LIMITATIONS: The effects of gait manipulation were investigated in a non-clinical group of undergraduates. CONCLUSIONS: The observed change in memory bias supports the idea that beyond the intensity of walking the style of walking has effects on the vulnerability to depression.

WITHDRAWN: Sleep quality changes in chronically depressed patients treated with mindfulness-based cognitive therapy or cognitive behavioral analysis system for psychotherapy: a pilot study.

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Mindful attention regulation and non-judgmental orientation in depression: a multi-method approach.

The use of questionnaires to measure two facets of mindfulness, 'regulation of attention' and 'non-judgmental orientation,' has been criticized. Furthermore, the assumption that depressed individuals show deficits in both facets has not yet been proven. In an attempt to minimize several biases associated with mindfulness questionnaires, we asked 43 currently depressed and 36 never-depressed participants to observe their breathing. The 'regulation of attention' facet of mindfulness was measured by the number of times participants' focus drifted off of their breathing. The 'non-judgmental orientation' facet was assessed using skin conductance response (SCR) and corrugator activity measured by electromyography (EMG), as indicators associated with arousal and negative emotions following drifting, and also by a self-report questionnaire. Depressed patients showed deficits in both facets of mindfulness. Specifically, compared to never-depressed controls, depressed patients drifted focus from their breathing more often, had significantly higher self-reported self-criticism, and displayed an increase in corrugator activity after drifting from breathing.

Facing the dreaded: does mindfulness facilitate coping with distressing experiences? A moderator analysis.

Increasing evidence shows that mindfulness is positively related to mental health; however, the nature of this relationship is not fully understood. The current study used structural equation modeling to investigate the hypothesis that mindfulness moderates the association between the occurrence of unavoidable distressing experiences (UDE) and mental health. Participants from a community sample (N = 376) completed the Freiburg Mindfulness Inventory, the Positive and Negative Affect Scale, the Brief Symptom Inventory, the Inventory of Approach and Avoidance Motivation, and the Incongruence Scale. Results indicated that mindfulness moderated the association between unavoidable distressing events and psychopathological symptoms/negative affect. Thus, mindfulness may contribute to enhance the ability to cope with UDE and thus mitigate the detrimental effects of these experiences on mental health.

[Mindfulness-based Stress Reduction (MBSR)]. / Achtsamkeitsbasierte Stressreduktion in der klinischen Anwendung.

In the context of an increasing interest in mindfulness-based approaches both in clinical application as well as in the field of research the present paper introduces MBSR (Mindfulness-based Stress Reduction), illustrates the theoretical background of mindfulness practice and reviews the procedures during the cultivation of mindfulness and possible impacting factors. The article also reviews Mindfulness-based Cognitive Therapy (MBCT), which was specifically developed to prevent relapse in patients with depressive disorders. The paper ends with a conclusion for clinical practice.

A short version of the Kentucky Inventory of Mindfulness Skills.

The Kentucky Inventory of Mindfulness Skills (KIMS; Baer, Smith, & Allen, 2004) is a 39-item self-report measure for the assessment of four different mindfulness factors. This study aimed at developing a short version of the German adaptation of the KIMS (KIMS-Short). Confirmatory factor analyses were carried out with two samples (N = 469 and N = 602) to develop subscales with fewer items and to confirm the factor structure of the KIMS-Short. Furthermore, the relations between the KIMS-Short subscales and other scales were evaluated. The KIMS-Short with its 20 items enable researchers to replicate the basic factor structure of four separate mindfulness skills. However, the analyses for the "observing" subscale revealed two different but strongly correlated factors depending on whether the observed stimuli were internal or external phenomena.

Rumination as a predictor of relapse in mindfulness-based cognitive therapy for depression.

OBJECTIVES: In mindfulness-based cognitive therapy (MBCT), it is proposed that training in mindfulness should reduce the tendency of formerly depressed patients to enter into ruminative thinking, thus reducing their risk of depressive relapse. However, data showing that rumination is associated with depressive relapse are lacking. METHOD: In an uncontrolled study with 24 formerly depressed patients, rumination was assessed with the Ruminative Response Scale. To assess the occurrence of relapse or recurrence, the Structured Clinical Interview for DSM-IV was administered 12 months after the end of the MBCT. RESULTS: Rumination significantly decreased during the MBCT course. Post-treatment levels of rumination predicted the risk of relapse of major depressive disorder in the 12-month follow-up period even after controlling for numbers of previous episodes and residual depressive symptoms. CONCLUSIONS: The results provide preliminary evidence that rumination is important in the process of depressive relapse.

The psychometric properties of the Kentucky Inventory of Mindfulness Skills in clinical populations.

The Kentucky Inventory of Mindfulness Skills (KIMS) is a well-validated multidimensional questionnaire measuring dimensions of mindfulness on four scales: Observing, Describing, Act With Awareness, and Accept Without Judgment. Even though the KIMS has been used in several clinical studies no information is available about the psychometric properties in different clinical samples. The present study includes two clinical samples: a German sample of people diagnosed with borderline personality disorder, posttraumatic stress disorder, or major depression and an English sample of people diagnosed with recurrent depression. Results of confirmatory factor analysis offer good support for the hypothesized model of four correlated factors, whereas the model of one general underlying mindfulness factor as a second order construct was not confirmed. Furthermore, our analyses revealed that the KIMS scales show high internal consistency and that all KIMS scales are sensitive to change in a subsample of participants taking part in Mindfulness-Based Cognitive Therapy.