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mindfulness based cognitive therapy for generalized anxiety disorder

Mindfulness-based cognitive therapy for generalized anxiety disorder

Susan Evansa, , , Stephen Ferrandoa, Marianne Findlera, Charles Stowella, Colette Smartb and Dean HaglinaaDepartment of Psychiatry, Weill Cornell Medical College, United StatesbJFK Johnson Rehabilitation Institute, New Jersey Neuroscience Institute, United States

experimental hypothesis
Experimental Hypothesis
  • Mindfulness will reduce anxiety in patients with GAD
purpose
Purpose
  • The purpose of the study was to investigate whether an 8-week group mindfulness-based cognitive therapy program that focused on intensive training in mindfulness meditation and would be an acceptable and effective treatment for patients suffering from GAD.
independent variable
Independent Variable
  • Theoretical definition
    • Mindfulness
      • non-judgemental moment-to-moment awareness.
  • Operational definition
    • Score on MAAS
      • Mindfulness attention awareness scale
      • Higher scores indicate greater awareness.
      • 15-item, 7 point self-report scale
dependent variable
Dependent Variable
  • Theoretical definition
    • Anxiety in GAD patients
  • Operational definition
    • Beck Anxiety Inventory (BAI)
    • Beck Depression Inventory-II (BDI-II)
    • Penn State Worry Questionnaire (PSWQ)
    • Profile of Mood States (POMS)
who they measured and how they got them
Who they measured and how they got them
  • Posted notices around hospital and sent letters to faculty
  • Inclusion criteria
    • (a) 18–80 years of age, (b) English speaking, (c) medically stable, (d) met criteria for GAD
  • patients with co-morbid current major depression, substance abuse and/or dependence and psychosis were excluded from the study because to the likelihood of a compromised ability to sustain concentration.
  • Eleven subjects (six female and five male) with a mean age of 49 (range = 36–72)
treatment independent variable mbct
Treatment/Independent VariableMBCT
  • The Mindfulness-Based Stress Reduction Program
    • Helps individuals develop mindfulness through intensive training in mindfulness meditation
    • Met eight weeks for 2 hours
    • intensive, structured, client-centered approach that has been used successfully in a range of clinical settings, hospitals and schools.
dependent variable measures
Dependent Variable Measures
  • Beck Anxiety Inventory (BAI)
    • discriminate anxiety from depression
    • Each item on the scale describes a symptom of anxiety. The respondent is asked to rate how much he or she has been bothered by each symptom over the past week
  • Beck Depression Inventory-II (BDI-II)
    • one of the most widely used self-report measures of depression.
  • Penn State Worry Questionnaire (PSWQ)
    • measure most frequently used to assess pathological worry in both clinical and non-clinical populations.
    • designed to capture the generality, excessiveness and uncontrollability of pathological worry.
  • Profile of Mood States (POMS)
    • screens six mood factors including “tension-anxiety.”
statistical methods
Statistical Methods
  • non-parametric statistics
  • Wilcoxon Signed Ranks Test
    • paired comparisons baseline to end of treatment
results
Results

Measure Baseline Post-intervention Z-score

Mean S.D. Mean S.D.

BAI 19.00 13.7 8.91 7.8 −2.5**

PSWQ 60.82 11.0 48.82 6.95 −2.98**

POMS tension–anxiety 16.9 8.2 9.7 6.7 −2.3*

BDI 13.80 7.9 8.82 8.5 −1.4*

MAAS 3.68 .66 4.2 .58 −1.8

Note: BAI, Beck Anxiety Inventory; PSWQ, Penn State Worry Questionnaire; POMS,

Profile of Mood States; BDI, Beck Depression Inventory; MAAS, Mindfulness Attention

Awareness Scale. Higher scores on the BAI, PSWQ, POM and BDI indicate greater

psychological distress. Higher scores on the MAAS indicate increased mindful awareness.*p < .05.**p < .01.

results1
Results
  • 5 subjects dropped from a clinically significant score (moderate–severe) on the BAI to the non-clinical range (minimal).
  • 3/5 subjects who exhibited clinical levels of depressive symptomatology on the BDI dropped to the non-clinical range
  • 5 patients with clinically significant scores indicative of pathological worry on the PSWQ dropped below the cutoff range for pathological worry.
  • 3 subjects with clinically meaningful tension–anxiety scores dropped to the non-clinical.
discussion
Discussion
  • Increase in mindfulness not statistically significant
    • Scale may not have measured what had an affect
    • Small sample size
    • Baseline group was below normative sample, after course became just a mindful as normative sample
  • Sample of highly educated
    • Non-randomized
  • Findings may not generalized to GAD patients with depression