Mindfulness-based cognitive therapy efficacy in reducing physiological response to emotional stimuli in patients with bipolar I disorder and the intermediate role of cognitive reactivity.

OBJECTIVES: This study aims to investigate the impact of Mindfulness-Based Cognitive Therapy (MBCT) for bipolar disorders on emotional responses by using skin conductance recording, and to investigate a mediating or predictive effect of cognitive reactivity. METHODS: Sixty-seven patients with bipolar disorder were assessed at baseline, pre-MBCT and post-MBCT. After answering inventories regarding depression and dysfunctional attitudes, they were instructed to focus on emotional pictures from the International Affective Pictures System while electrodermal recording. RESULTS: For a subgroup of patients having a significant change of the electrodermal response, MBCT reduced dysfunctional attitudes and the amplitude of the physiological response to negative stimuli. Findings also show that lower dysfunctional attitudes at baseline predicted a larger reduction of physiological reactivity. CONCLUSIONS: MBCT could decrease patient's reactivity to negative stimuli by decreasing its physiological component, which is coherent with its aim to facilitate disengaging from affective stimuli. Further studies are needed to better understand the mechanisms involved and how this could translate in reducing the risk of relapse.

Role of autobiographical memory in the impact of MBCT on dysfunctional attitudes, depressive symptoms and anxiety in bipolar I patients.

BACKGROUND: The literature suggests that cognitive reactivity in bipolar patients can increase relapse vulnerability, is enhanced by depressive mood and dysfunctional attitudes, and could be improved with MBCT. Autobiographical memory (AM) could be involved in cognitive reactivity, and improved with MBCT training. This study aims to investigate the effect of MBCT for bipolar patients on depressive and anxious symptoms, dysfunctional attitudes and AM, and the predictive versus mediating role of AM in the impact of MBCT on clinical symptoms. METHODS: Sixty-two outpatients diagnosed with bipolar I disorder were assigned to MBCT and were compared to 37 bipolar patients on a waiting list. Affective symptoms and dysfunctional attitudes were explored using self-report inventories (BDI, BAI, DAS) and AM was assessed using the Autobiographical Memory Test. RESULTS: Patients receiving MBCT demonstrated significantly decreased depressive symptoms, dysfunctional attitudes, overgeneral memories and omissions, and increased specific memories. General AM and omissions at baseline respectively predicted lower anxiety and dysfunctional attitudes improvement following therapy, but the improvement of AM did not explain the impact of MBCT on depression and dysfunctional attitudes improvement. LIMITS: Further studies should consider patients' therapeutic adherence and mechanisms involved in MBCT in order to better apprehend how MBCT may reduce dysfunctional attitudes and improve AM in bipolar patients. CONCLUSION: Results are consistent with the hypothesis that MBCT reduces cognitive reactivity and AM impairment in bipolar disorders. Findings suggest that AM training prior to MBCT may influence MBCT efficacy, but that MBCT efficacy on AM and clinical symptoms are non-related phenomena.

Time perspective differences between depressed patients and non-depressed participants, and their relationships with depressive and anxiety symptoms.

BACKGROUND: Time perspective (TP) can be described as an individual's attitude towards his personal past, present and future. Literature suggests that it plays a role in several areas of psychological functioning (self-efficacy, coping) and impacts actual thoughts and behaviors. However, TP has seldom been studied in mental health, despite previous studies suggesting that the temporal profile is altered in depressed patients. This study investigates the differences of TP between depressed patients and non-depressed participants, and its relationship with depressive and anxiety symptoms. METHODS: 45 patients diagnosed with major depressive disorder were compared to 43 non-depressed participants recruited in the general population. Participants were asked to answer time perspective (ZTPI), depression (BDI-13) and anxiety (STAI-Y) self-report inventories. Statistical analysis included comparisons of scores between depressed patients and non-depressed participants, correlation and regression analysis. RESULTS: Results indicate that TP is significantly altered in depressed patients. They display a more negative view of their past, a less hedonistic perspective towards their present, and a more fatalistic perspective when compared to non-depressed participants. Regression analysis shows that depressive and anxiety symptoms are associated with negative past and fatalistic present, and similar results are found with correlation analysis. LIMITATIONS: The size of the sample was small, and longitudinal studies are needed to understand the dynamics and causal relationship between TP and depression. CONCLUSIONS: These results underline the importance of considering TP in depressed patients, and encourage an in depth study of the relationship between TP and mood disorders. Therapeutic perspectives are discussed.

Self-Reported Long-Term Benefits of Mindfulness-Based Cognitive Therapy in Patients with Bipolar Disorder.

OBJECTIVES: This study focused on patients with bipolar disorder (BD), several years after their participation in mindfulness-based cognitive therapy (MBCT). It aimed at documenting sustained mindfulness practice, perceived long-term benefit from the program, and changes regarded as direct consequences of the intervention. DESIGN: This cross-sectional survey took place at least 2 years after MBCT for 70.4% of participants. LOCATION: It was conducted in two specialized outpatient units for BDs that are part of the Geneva University Hospitals (Switzerland) and the Sainte-Anne Hospital in Paris (France). SUBJECTS: Eligibility criteria were a diagnosis of BD according to DSM-IV and participation in at least four MBCT sessions. Response rate was 66.4%. The final sample included 71 outpatients (71.8% bipolar I, 28.2% bipolar II). OUTCOME MEASURES: A questionnaire retrospectively assessed patient-perceived change, benefit from MBCT, and current mindfulness practice. RESULTS: Proportions of respondents who practiced mindfulness at least once a week were 54.9% for formal practice (body scan, sitting meditation, mindful walking, or movements) and 57.7% for informal practice (mindful daily activities). Perceived benefit for the prevention of relapse was moderate, but patients acknowledged long-lasting effects and persistent changes in their way of life. Formal mindfulness practice at least once a week tended to be associated with increased long-lasting effects (p = 0.052), whereas regular informal practice and mindful breathing were significantly associated with persistent changes in daily life (p = 0.038) and better prevention of depressive relapse (p = 0.035), respectively. The most frequently reported positive change was increased awareness of being able to improve one's health. CONCLUSIONS: Despite methodological limitations, this survey allowed documenting mindfulness practice and perceived sustained benefit from MBCT in patients with BD. Participants particularly valued increased awareness that they can influence their own health. Both informal and formal practices, when sustained in the long term, might promote long-lasting changes.

The role of CBT in explicit memory bias in bipolar I patients.

BACKGROUND AND OBJECTIVES: Cognitive and Behavioural Therapy (CBT) is widely used in bipolar disorder, but recent meta-analyses showed that its impact is either of limited effect or not significant for important aspects such as recurrence rate. A possible benefit of CBT could concern cognitive functions, known to be frequently impaired in patients with bipolar disorder. We analysed if the positive impact of 6 months group-CBT was associated with the improvement of a specific cognitive function, namely explicit memory, trying to disentangle if memory bias (i.e. different capacity according to the emotional valence of words to be recalled) was more improved than memory performance (i.e., total number of recalled words). METHODS: Depressive, manic, anxiety symptoms and explicit memory for emotional words were initially assessed in 68 remitted bipolar I patients. Six months later, with an attrition rate of 16.2%, patients were re-assessed after CBT (N = 42) or as control condition (waiting list, N = 15). The expected impact of CBT was assessed through the improvement in the Dysfunctional Attitudes Scale. RESULTS: After CBT, an increase was observed for the number of neutral, positive and total words recalled, whereas the number of negative words recalled decreased. This increase was still significant when the improvement of dysfunctional attitudes and mood symptoms are taken into account. LIMITATIONS: The small sample of control patients. CONCLUSIONS: CBT was effective, as it improved dysfunctional attitudes and reduced remaining symptoms, but also, and independently, it improved explicit memory performance while reducing memory bias in favour of negative words.

[Non pharmacological treatment for bipolar disorder]. / Les thérapies non-médicamenteuses dans les troubles bipolaires.

Bipolar disorder is a chronic and recurring disorder associated with significant psychosocial impairment. A number of psychosocial interventions have been developed to address impairment. The consensus makes mood stabilizer the treatment of bipolar disorder. However, numerous patients are not in complete remission despite a controlled observance. Every patient can follow a psycho educational program. What this paper adds. The review identifies that a range of interventions have demonstrated efficacy in extended periods of euthymia, improved social and occupational functioning and alleviation of subsyndromal symptoms. Adjunctive, short-term psychotherapies have been shown to offer fairly consistent benefits to bipolar disorder patients. Cognitive-behavioural therapy, family-focused therapy, and psychoeducation offer the most robust efficacy in regard to relapse prevention. The most complex situations including comorbidities can be helped by behavioral and cognitive therapy for bipolar disorder. Evaluations emphasize positive impact. The psychosocial interventions reviewed provide mental health nurses with evidence-based approaches to improving mental health care for patients with bipolar disorder. There is a need for mental health nurses to conduct high quality trials of the clinical effectiveness of these interventions.

[Evaluation of behavioral and cognitive therapy in depression]. / Les critères d'evaluation des thérapeutiques comportementales et cognitives dans la dépression.

Many psychotherapeutic approaches have been developed for depression, among which behavioral and cognitive therapies have shown their effectiveness. These short-term therapies quickly improve symptoms and reduce the relapse rate by around 30%. This article reviews the main studies of behavioral and cognitive therapy in depressed patients. The results are discussed in terms of acceptability, feasibility, and efficacy. The study protocols, psychiatric symptoms, and endpoints are described. There is now a need to identify which patients are most likely to respond to these treatments.

[Social anxiety]. / Anxiété sociale.

Social anxiety disorders are various, frequent and invalidant. Social phobia is characterized by marked and persistent fear of social or performance situations in which embarrassment may occur including, for example, fear of public speaking. In clinical setting, the majority of social phobics report fears of more than one type of social situation. Social phobia tends to develop early in life, with a life time prevalence of 2-4%. Pharmacotherapy and behavioural and cognitive therapy are communly used.

[Behavioural and cognitive therapies in depression]. / Thérapies comportementales et cognitives de la dépression.

A large number of psychotherapies were proposed to depressed patients. The behavioural and cognitive therapies (TCC) showed their efficacy. This short term therapy improves quickly the symptoms and prevents around 30% of relapse. The TCC works on the depressed symptoms (engaging the patients in a large number of pleasant activities), on hopelessness cognitions and on the own psychological vulnerability (named cognitive schemata). The activation of depressed schemata is correlated with relapse). The indication of TCC in depressed patient is discussed after two or three sessions performed by a cognitive and behaviour therapist. This professional has preliminary learnt the theory and practice during a specific training.