The effect of mindfulness therapy in acromegaly, a pilot study.

BACKGROUND: Patients with acromegaly have often several comorbidities, including decreased quality of life, mood alterations and chronic pain. Mindfulness is effective at improving mood, quality of life and pain management; however, there is no data available on its effect in patients with acromegaly. OBJECTIVE: We aimed at evaluating changes in quality of life, mood, pain, sleep, self-compassion, life satisfaction, blood pressure and heart rate after a mindfulness program. DESIGN AND PATIENTS: This was a randomized, multicentre, international clinical trial (Barcelona-BCN and Bergamo-BG) of 60 patients, 30 per centre. MEASUREMENTS: The intervention group participated in an 8-week face-to-face group program; the control group followed normal clinical routine. In BG, patients performed a classic Mindfulness Based Stress Reduction program; in BCN they performed an adapted program including elements of mindfulness and compassion with a greater focus on daily life. RESULTS: In the BCN intervention group there was an increase in night-time hours in bed (p = 0.05) after the program. In both centres there was a trend to a reduction of the time to start sleeping (p = 0.06 BCN, p = 0.07 BG). In BCN, the intervention group reduced the pain score compared to the control group (p = .02), and an improvement in self-compassion was found (p = .04). In both centres, heart rate decreased significantly in the intervention group during a single 2-hour session. This was evidenced at the first and the last program session (BCN p = .013 and p = .009; BG < 0.001 and p = .04). A training effect was found in BG, where heart rate fell more in the last session than in the first (p = 002). CONCLUSIONS: We have demonstrated for the first time the value of a mindfulness program in patients with acromegaly, analysing possible effects and advantages, and clarifying the usefulness of a specific protocol for the disease.

Advancing the treatment of long-lasting borderline personality disorder: a feasibility and acceptability study of an expanded DBT-based skills intervention.

BACKGROUND: Long-term follow-up studies in patients with borderline personality disorder (BPD) consistently show persistent impairment in psychosocial adjustment, although symptoms tend to decrease over time. Consequently, it might be better to deemphasize symptom-oriented interventions and instead promote interventions that incorporate patient perspectives on recovery. In this study we aimed to examine the feasibility and acceptability of a novel intervention (dialectical behavioral therapy combined with positive psychology and contextual-based skills) in the clinical treatment of long-lasting BPD difficulties. METHODS: This was a qualitative study. We developed an initial 8-week group intervention for long-lasting BPD. Upon completion of the 8-week program, the participants were asked to participate in a group discussion to provide feedback. Based on that feedback, the intervention protocol was modified and then offered to a second group of patients, who also provided feedback. The protocol was revised again and administered to a third group. A total of 32 patients participated in the group interventions; of these, 20 provided feedback in the qualitative study. The main outcome measure was acceptability. RESULTS: The following overarching themes emerged from the group interviews: helpful, unhelpful and neutral practices; internal/external barriers; facilitators; and effects. Participants reported difficulties in imagining an optimal future and self-compassion. By contrast, positive skills were associated with an increase in positive emotions. The main internal barrier was facing difficult emotions. The main external barriers were language-related issues. The group format was perceived as a facilitator to success. Dropout rates, which were assessed as an additional measure of acceptability, decreased substantially in each successive group, from 60 to 40% and finally 20%. CONCLUSIONS: The intervention was feasible to implement in the clinical setting and participants rated the final set of skills highly. Most of the skills were considered useful. Participant feedback was invaluable to improve the intervention, as evidenced by the large increase in the retention rate from 40 to 80%. Randomized clinical trials are needed to test the efficacy of this intervention in promoting well-being in participants with long-lasting BPD.

Ayahuasca may help to improve self-compassion and self-criticism capacities.

OBJECTIVE: Ayahuasca is a psychedelic brew that originated in the Amazon basin. The psychological effects of this drug are becoming better understood due to the growing research interest in identifying new potential therapeutic agents for the treatment of emotion dysregulation and other disorders. Previous studies suggest that ayahuasca enhances mindfulness-related capacities (decentering, non-judging, non-reacting and acceptance) and emotion regulation. The aim of the present exploratory study was to determine the effects of ayahuasca on self-compassion in a community sample. METHODS: We administered validated questionnaires (the Self-Compassion Scale-Short Form and Forms of Self-Criticism and Self-Reassurance) to evaluate pre-post changes in self-compassion and self-criticism/self-reassurance in 45 volunteers (27 women; 60%) before and after (≤24 h) an ayahuasca ceremony. Most participants (n = 29; 67.4%) had previously used ayahuasca. RESULTS: Ayahuasca resulted in significant improvements, with medium to large effect sizes (η2  = 0.184-0.276), in measures of self-compassion (p < 0.05), self-criticism (p < 0.01) and self-reassurance (p < 0.01). CONCLUSIONS: The findings of this study suggest that ayahuasca promotes well-being and self-compassion, which could have a therapeutic effect on individuals with negative affect and other psychopathological conditions. Large, controlled studies are needed to confirm these findings.

Decentering, Acceptance, and Non-Attachment: Challenging the Question "Is It Me?"

Among mindfulness measures the three constructs acceptance, decentering, and non-attachment are psychometrically closely related, despite their apparent semantic differences. These three facets present robust psychometric features and can be considered core themes in most "third wave" clinical models. The aim of the present study was to explore the apparently different content domains (acceptance, decentering, and non-attachment) by administering various psychometric scales in a large sample of 608 volunteers. Resilience and depression were also assessed. Exploratory and confirmatory factor analyses performed in two randomly selected subsamples showed a bifactor approximation. The explained common variance suggested a unidimensional nature for the general factor, with good psychometric properties, which we named "Delusion of Me" (DoM). This construct is also strongly correlated with resilience and depression, and appears to be a solid latent general construct closely related to the concept of "ego." DoM emerges as a potentially transdiagnostic construct with influence on well-being and clinical indexes such as resilience and depression. Further studies should analyze the potential utility of this new construct at a therapeutic level.

Mindfulness in Borderline Personality Disorder: Decentering Mediates the Effectiveness.

BACKGROUND: Mindfulness skills training is a core component of dialectical behavior therapy (DBT) that has proven to be an effective stand-alone treatment for the general symptoms commonly present in patients with borderline personality disorder (BPD). The aim of the present study was to compare the effectiveness of mindfulness-based DBT skills training (DBT-M) to interpersonal effectiveness-based DBT skills training (DBT-IE) in reducing BPD symptoms. We also evaluated the specific mechanism of action of these therapies through two proposed mediators: decentering and emotion dysregulation. METHOD: A total of 102 participants diagnosed with BPD were included in the study. Multivariate repeated-measures ANOVAs were performed followed by a multiple mediation analysis. RESULTS: The analyses showed that DBT-M was more effective than DBT-IE in reducing BPD symptoms, although both interventions were effective in reducing emotion dysregulation. We identified a serial mediation model in which DBT-M reduced BPD symptoms by increasing decentering ability, which in turn reduced emotion dysregulation. This mediation effect showed that changes in decentering preceded improvements in emotion dysregulation. CONCLUSIONS: These findings underscore the key role of decentering as a primary mechanism of action in DBT-M, suggesting that this skill is a main component for BPD treatment.

Assessing self-criticism and self-reassurance: Examining psychometric properties and clinical usefulness of the Short-Form of the Forms of Self-Criticizing/Attacking & Self-Reassuring Scale (FSCRS-SF) in Spanish sample.

The Forms of Self-Criticizing/Attacking and Self-Reassuring Scale (FSCRS) was designed to measure self-criticism (SC) through Inadequate Self (IS) and Hated Self (HS) factors, as well as self-reassurance (RS). However, its long and short forms have yet to be validated in the Spanish Population. The present study examines the psychometric properties of the short form (FSCRS-SF) and its clinical usefulness in a sample of 576 adult individuals, 77 with psychiatric disorders and 499 without. Non-clinical participants were split according to their previous experience with meditation (active meditators, n = 133; non-active meditators, n = 41; and non-meditators, n = 325) and differences between these subgroups were explored. Additionally, a subsample of 20 non-clinical participants took part in a mindfulness- and compassion- based intervention (MCBI) to assess the usefulness of the scale as an outcome measure. Results confirmed the original three-factorial structure, good internal consistency, acceptable test-retest reliability, and a pattern of correlations consistent with previous literature. Regarding differences between groups, the clinical subsample showed significant higher SC and lower RS levels than non-clinical participants and active meditators had significant lower IS and higher RS levels than non-meditators. Participants who participated in the MCBI showed significant RS improvement and a decrease in IS and HS levels. Moreover, a hierarchical multiple regression showed that RS made a significant predictive contribution to distress at three months' time. In conclusion, results show that the Spanish version of the FSCRS-SF is a reliable and valid measure of SC and RS in non-clinical populations and an adequate instrument to detect changes after MCBIs.

Structural brain abnormalities in borderline personality disorder correlate with clinical severity and predict psychotherapy response.

Although previous imaging studies in borderline personality disorder (BPD) have found brain abnormalities, the results have been inconsistent. This study aimed to investigate structural brain abnormalities using voxel-based morphometry (VBM) and cortical thickness (Cth) analyses in a large sample of patients with BPD. Additionally, we aimed to determine the correlation between structural abnormalities and clinical severity and to assess its potential value at predicting psychotherapeutic response. Sixty-one individuals with BPD and 19 healthy controls underwent magnetic resonance imaging. Participants with BPD completed several self-report clinical scales, received dialectical-behavioral therapy skills training and post-therapy changes in clinical scores were also recorded. Gray matter volume (GMV) and Cth differences between groups were compared. Within the BPD group, we further characterized the structural brain correlates of clinical severity and investigated the relationship between pre-therapy structural abnormalities and therapeutic response. As potential confounders we included age, sex, educational level, and total intracranial volume (the latter only in VBM analyses). Compared to controls, the BPD group showed a reduced GMV/Cth in prefrontal areas but increased GMV in the limbic structures (amygdala and parahippocampal regions). Prefrontal abnormalities correlated with higher baseline scores on impulsivity and general BPD severity. Increased GMV in the parahippocampal area correlated with a greater emotion dysregulation. Importantly, several baseline structural abnormalities correlated with worse response to psychotherapy. Patients with BPD showed a reduced GMV in the prefrontal areas but a greater GMV in the limbic structures. Several structural abnormalities (i.e. middle and inferior prefrontal areas, anterior insula, or parahippocampal area) correlated with clinical severity and could potentially be used as imaging biological correlates biomarkers to predict psychotherapy response.

A genome-wide methylation study reveals X chromosome and childhood trauma methylation alterations associated with borderline personality disorder.

Borderline personality disorder (BPD) is a severe and highly prevalent psychiatric disorder, more common in females than in males and with notable differences in presentation between genders. Recent studies have shown that epigenetic modifications such as DNA methylation may modulate gene × environment interactions and impact on neurodevelopment. We conducted an epigenome wide study (Illumina Infinium HumanMethylation450k beadchip) in a group of BPD patients with (N = 49) and without (N = 47) childhood traumas and in a control group (N = 44). Results were confirmed in a replication cohort (N = 293 BPD patients and N = 114 controls) using EpiTYPER assays. Differentially methylated CpG sites were observed in several genes and intragenic regions in the X chromosome (PQBP1, ZNF41, RPL10, cg07810091 and cg24395855) and in chromosome 6 (TAP2). BPD patients showed significantly lower methylation levels in these CpG sites than healthy controls. These differences seemed to be increased by the existence of childhood trauma. Comparisons between BPD patients with childhood trauma and patients and controls without revealed significant differences in four genes (POU5F1, GGT6, TNFRSF13C and FAM113B), none of them in the X chromosome. Gene set enrichment analyses revealed that epigenetic alterations were more frequently found in genes controlling oestrogen regulation, neurogenesis and cell differentiation. These results suggest that epigenetic alterations in the X chromosome and oestrogen-regulation genes may contribute to the development of BPD and explain the differences in presentation between genders. Furthermore, childhood trauma events may modulate the magnitude of the epigenetic alterations contributing to BPD.

Effects of mindfulness training on the default mode network in borderline personality disorder.

Patients with borderline personality disorder (BPD) present dysfunctions of the default mode network (DMN). Mindfulness training has proven effective to improve the symptoms of BPD. The present study examines the effect of mindfulness training on BPD symptomatology and DMN activity during the performance of a working memory task in patients with BPD. Sixty-five individuals with BPD were randomized to receive psychotherapy with either the mindfulness module of dialectical behavioural therapy (DBT-M) or with interpersonal effectiveness module (DBT-IE). The impact of treatments was evaluated with clinical and mindfulness variables as well as with functional magnetic resonance imaging during performance of the task. Both groups showed improvement in BPD symptoms and other clinical variables after treatment. Unexpectedly, there were no between-group differences in DMN activation or deactivation. However, activation of the left anterior insula increased in both groups after the intervention. Compared with the control group, participants in the DBT-M group presented higher deactivation in a cluster extending bilaterally from the calcarine to the cuneus and superior occipital gyri.

Ayahuasca improves emotion dysregulation in a community sample and in individuals with borderline-like traits.

BACKGROUND: Research suggests that mindfulness-based interventions may improve mindfulness-related capacities (e.g., decentering, non-judging, and non-reacting) and emotion regulation. Previously, our group reported that ayahuasca could be a potential analogue of mindfulness practice. The main aim of the current study was to examine the effects of ayahuasca on emotional regulation and mindfulness-related capacities. Secondarily, we sought to explore the effects of ayahuasca on individuals with borderline personality disorder (BPD) traits. METHOD: This is an observational study of 45 volunteers who participated in an ayahuasca session. The volunteers completed various self-report instruments designed to measure emotional dysregulation (Difficulties in Emotion Regulation Scale (DERS)) and mindfulness traits (Five Facet Mindfulness Questionnaire (FFMQ)-Short Form and Experiences Questionnaire (EQ)) prior to and 24 h after the ayahuasca session. The volunteers were divided into two subgroups based on their score on the McLean Screening Instrument for BPD (MSI-BPD). Twelve participants were grouped into the BPD-like traits subgroup while the rest of them were included in the non-BPD-like subgroup. We performed within-subjects and between-group analyses. RESULTS: Overall, the participants showed significant improvements on the FFMQ subscales observing, acting with awareness, non-judging, and non-reacting and also significantly improved on decentering (EQ scale) and on the DERS subscales emotional non-acceptance, emotional interference, and lack of control. The BPD-like subgroup also showed significant improvements on the DERS subscales emotional interference and lack of control but not in mindfulness capacities. CONCLUSIONS: These findings suggest a potential therapeutic effect for ayahuasca in emotion regulation and mindfulness capacities (including decentering, acceptance, awareness, and sensitivity to meditation practice). Based on these results, we believe that ayahuasca therapy could be of value in clinical populations, such as individuals with BPD, affected by emotion dysregulation.

Assessing the Psychedelic "After-Glow" in Ayahuasca Users: Post-Acute Neurometabolic and Functional Connectivity Changes Are Associated with Enhanced Mindfulness Capacities.

Background: Ayahuasca is a plant tea containing the psychedelic 5-HT2A agonist N,N-dimethyltryptamine and harmala monoamine-oxidase inhibitors. Acute administration leads to neurophysiological modifications in brain regions of the default mode network, purportedly through a glutamatergic mechanism. Post-acutely, ayahuasca potentiates mindfulness capacities in volunteers and induces rapid and sustained antidepressant effects in treatment-resistant patients. However, the mechanisms underlying these fast and maintained effects are poorly understood. Here, we investigated in an open-label uncontrolled study in 16 healthy volunteers ayahuasca-induced post-acute neurometabolic and connectivity modifications and their association with mindfulness measures. Methods: Using 1H-magnetic resonance spectroscopy and functional connectivity, we compared baseline and post-acute neurometabolites and seed-to-voxel connectivity in the posterior and anterior cingulate cortex after a single ayahuasca dose. Results: Magnetic resonance spectroscopy showed post-acute reductions in glutamate+glutamine, creatine, and N-acetylaspartate+N-acetylaspartylglutamate in the posterior cingulate cortex. Connectivity was increased between the posterior cingulate cortex and the anterior cingulate cortex, and between the anterior cingulate cortex and limbic structures in the right medial temporal lobe. Glutamate+glutamine reductions correlated with increases in the "nonjudging" subscale of the Five Facets Mindfulness Questionnaire. Increased anterior cingulate cortex-medial temporal lobe connectivity correlated with increased scores on the self-compassion questionnaire. Post-acute neural changes predicted sustained elevations in nonjudging 2 months later. Conclusions: These results support the involvement of glutamate neurotransmission in the effects of psychedelics in humans. They further suggest that neurometabolic changes in the posterior cingulate cortex, a key region within the default mode network, and increased connectivity between the anterior cingulate cortex and medial temporal lobe structures involved in emotion and memory potentially underlie the post-acute psychological effects of ayahuasca.

Validación de la versión española del McLean Screening Instrument for Borderline Personality Disorder / Validation of the Spanish version of the McLean Screening Instrument for Borderline Personality Disorder

Introducción. El trastorno límite de la personalidad (TLP) es un trastorno mental frecuente y grave. Su detección precoz es importante y para ello se requieren instrumentos fiables de cribado. Sin embargo, no existen hasta la fecha instrumentos de screening específicos para el TLP validados en población castellanohablante. El McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) es un cuestionario autoinformado de 10 ítems que permite detectar la presencia de TLP de forma fiable y rápida. El objetivo de este estudio es la validación del MSI-BPD para su uso en población de habla española. Método. Se examinaron las propiedades psicométricas de la versión española del MSI-BPD en una muestra de 344 participantes (170 pacientes con orientación diagnóstica de TLP y 174 controles sanos). Resultados. El análisis factorial exploratorio mostró la existencia de una estructura bifactorial. La escala presentó una elevada consistencia interna (KR-20=0,873) y una óptima fiabilidad test-retest (CCI=0,87). Mediante un análisis de regresión logística y con la DIB-R como referencia se estableció un punto de corte óptimo de 7, obteniendo una adecuada sensibilidad (0,71) y especificidad (0,68). El área bajo la curva fue de 0,742 (IC 95% 0,660-0,824). El análisis discriminante permitió observar una capacidad clasificatoria de la escala del 72,8%. Conclusiones. La versión española del MSI-BPD presenta buenas propiedades psicométricas como instrumento de cribado del TLP. Su aplicación en la práctica clínica y en la investigación puede ser de gran utilidad para la detección del TLP por su rapidez y facilidad de uso (AU)

Introduction. Borderline personality disorder (BPD) is a common and severe mental illness. Early detection is important and reliable screening instruments are required. To date, however, there has been no evidence of any specific BPD screening tool validated for the Spanish-speaking population. The McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) is a 10-item self-report questionnaire that can detect the presence of BPD in a reliable and quick manner. The aim of the present study is the validation of the MSI-BPD for its use in the Spanish-speaking population. Method. Psychometric properties of the MSI-BPD Spanish version were examined in a sample of 344 participants (170 outpatients with the possible diagnosis of BPD and 174 healthy controls). Results. Exploratory factor analysis revealed the existence of a bi-factorial structure. The scale showed a high internal consistency (KR-20=0.873) and an optimal test-retest reliability (ICC=0.87). Using logistic regression analyses and taking the DIB-R as reference, a best cut-off of 7 was determined, obtaining a good sensitivity (0.71) and specificity (0.68). The area under the curve, was 0.742 (95% CI 0.660-0.824). The discriminant analysis showed a classification ability of 72.8%. Conclusions. The Spanish version of the MSI-BPD has good psychometric properties as a measure for the screening of BPD. Its ease and quickness of use make it valuable to detect the presence of BPD in clinical and research settings (AU)

Validation of the Spanish version of the McLean Screening Instrument for Borderline Personality Disorder. / Validación de la versión española del McLean Screening Instrument for Borderline Personality Disorder.

INTRODUCTION: Borderline personality disorder (BPD) is a common and severe mental illness. Early detection is important and reliable screening instruments are required. To date, however, there has been no evidence of any specific BPD screening tool validated for the Spanish-speaking population. The McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) is a 10-item self-report questionnaire that can detect the presence of BPD in a reliable and quick manner. The aim of the present study is the validation of the MSI-BPD for its use in the Spanish-speaking population. METHOD: Psychometric properties of the MSI-BPD Spanish version were examined in a sample of 344 participants (170 outpatients with the possible diagnosis of BPD and 174 healthy controls). RESULTS: Exploratory factor analysis revealed the existence of a bi-factorial structure. The scale showed a high internal consistency (KR-20=0.873) and an optimal test-retest reliability (ICC=0.87). Using logistic regression analyses and taking the DIB-R as reference, a best cut-off of 7 was determined, obtaining a good sensitivity (0.71) and specificity (0.68). The area under the curve, was 0.742 (95% CI 0.660-0.824). The discriminant analysis showed a classification ability of 72.8%. CONCLUSIONS: The Spanish version of the MSI-BPD has good psychometric properties as a measure for the screening of BPD. Its ease and quickness of use make it valuable to detect the presence of BPD in clinical and research settings.

Ayahuasca: Pharmacology, neuroscience and therapeutic potential.

Ayahuasca is the Quechua name for a tea obtained from the vine Banisteriopsis caapi, and used for ritual purposes by the indigenous populations of the Amazon. The use of a variation of the tea that combines B. caapi with the leaves of the shrub Psychotria viridis has experienced unprecedented expansion worldwide for its psychotropic properties. This preparation contains the psychedelic 5-HT2A receptor agonist N,N-dimethyltryptamine (DMT) from P. viridis, plus ß-carboline alkaloids with monoamine-oxidase-inhibiting properties from B. caapi. Acute administration induces a transient modified state of consciousness characterized by introspection, visions, enhanced emotions and recollection of personal memories. A growing body of evidence suggests that ayahuasca may be useful to treat substance use disorders, anxiety and depression. Here we review the pharmacology and neuroscience of ayahuasca, and the potential psychological mechanisms underlying its therapeutic potential. We discuss recent findings indicating that ayahuasca intake increases certain mindfulness facets related to acceptance and to the ability to take a detached view of one's own thoughts and emotions. Based on the available evidence, we conclude that ayahuasca shows promise as a therapeutic tool by enhancing self-acceptance and allowing safe exposure to emotional events. We postulate that ayahuasca could be of use in the treatment of impulse-related, personality and substance use disorders and also in the handling of trauma. More research is needed to assess the full potential of ayahuasca in the treatment of these disorders.