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Mindfulness-based stress reduction groups
Symposium abstracts / Journal of Psychosomatic Research 55 (2003) 111–129 Introduction: Cognitive behavioral therapy (CBT, individual or group) is effective for depression and some anxiety disorders. Depression and anxiety are frequently associated with somatic comorbidity. Objective: This aims to assess group CBT in addition to standard psychiatric care for general hospital patients with depression and/or anxiety. Methods: An ongoing ambulatory clinical 12 once-a-week program of group CBT was started in September 2002. Patients were offered to participate after individual assessment and treatment was prescribed. Between September 2002 and February 2003 the following scales were applied at baseline and postintervention: Beck Depression (BDI) and Anxiety (BAI) inventories, and Sheehan Disability. Results: Nineteen patients accepted the intervention. Twelve patients with treatment completed were included in this analysis — 63.2% were women, 52% were depressed, two thirds had additional medical comorbidity, 50% were taking two medications (psychiatric and/or medical). While at baseline, 10.4% had BDI or BAI scores between 0 – 10 (normal ups and downs), postintervention 58.5% and 66.7% were in this range on BDI and BAI, respectively ( P < .01). One of Sheehan subscales showed statistical difference pre/post (improved). Conclusions: As expected, somatic comorbidity was frequent in this population. Group CBT seems to be a good adjunct treatment to individual psychiatric care for depression and/or anxiety in this population.
Cognitive behavior support group for implantable defibrillator patients Gun-Usishkin M, Rosenfeld G Introduction: The implantable Cardio-Defibrillator (ICD) has been developed and extensively used for treatment in patients with life-threatening arrhythmias. The cardiac event that consequently required the implantation of the ICD is not without it’s difficult psychosocial effects like fear of death, depressive mood, anxiety, reduced coping ability and ineffective functioning in one’s daily responsibilities. The cognitive behavioral support group was proposed as successful treatment in helping this population cope with the psychosocial effects on both the patient and family. A team of a psychiatric nurse and a cardiac nurse specialist leads the group. Goals: (1) Engagement in the therapeutic process; (2) offering of health information; (3) problem solving and enhancement of coping skills; (4) teaching relaxation techniques; and (5) identification and change of dysfunctional thoughts. Conclusion: Each of the patients indicated that the support group helped them in dealing with their psychosocial issues. It was generally felt that their level of knowledge was broadened. The universality of their problems was recognized and they learned new coping strategies and problem solving. The group leaders felt particularly gratified with the outcomes of the group. The combination of the knowledge and expertise of both nursing professionals make them uniquely qualified to conduct the support group.
Groups for the seriously mentally ill address psychiatric hospitalization and medical care Gise LH Most psychiatric treatment of patients with serious and persistent mental illness in the United States is done individually. Attendance at self-help groups has been reported associated with better medication adherence and less hospitalization but no research has been done on psychiatrist-led medication groups for chronic mental illness. Objective: To see if attendance at weekly psychiatrist-led medication groups is associated with less psychiatric hospitalization. Method: Patients who attended weekly psychiatrist-led medication groups were compared to patients receiving usual care. Groups also addressed primary medical care. Results: Regression analysis showed a correlation between both (1) group attendance and (2) the amount of group attendance and (a) fewer psychiatric
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hospitalizations and (b) fewer days in the hospital. Patients who attended group did not differ from the comparison group with regard to age, sex, marital status, ethnicity, diagnosis, global assessment of functioning scale (Axis V) or the number of visits to the mental health center. Conclusion: Attendance at psychiatrist-led medication groups was associated with less psychiatric hospitalization. A controlled trial to test causal relationship is needed. The extent to which the effect is mediated by better medication adherence requires further study.
Mindfulness-based stress reduction groups Abbey SE Mindfulness-based stress reduction (MBSR) is a manualized group program developed by Kabat-Zinn and colleagues at the University of Massachusetts. It consists of 9 group sessions during which participants learn a variety of self-regulation techniques based on various forms of meditation and cognitive therapy principles as well as participating in psychoeducation on symptom management and coping with chronic illness and stress. This presentation will describe the intervention and report data from a cohort of 450 participants with heterogeneous medical and emotional symptoms. Analysis of quantitative data using validated, reliable self-report instruments documents improvements in multiple domains. Participants report reduced physical symptoms, bodily pain, and psychological distress in the form of depression and anxiety and improved health-related quality of life, sense of general well-being, heightened optimism, a greater sense of control over their lives and their ability to manage their symptoms, and improved sleep. Preliminary qualitative data also documents significant gains in terms of improved quality of life and more appropriate health care utilization. These clinically significant benefits are obtained for less than the cost of three individual sessions of psychotherapy.
Psychosomatic aspects in liver disease II (Chair) Withers NW, Madonado JR, Hilsabeck RC, Dishman B Selection of candidates for orthotopic liver transplantation (OLT) presents an ethical challenge. The current system gives priority to the most severely ill patients who have the poorest transplant survival and the highest costs. In the past, fewer patients with alcoholic liver disease received transplants due to concern that patients would relapse. There is clear consensus that patients with alcoholic cirrhosis be considered for OLT. Selection criteria proposed include, among others, a requirement of a minimum of 6 months sobriety, psychosocial and psychiatric stability, and commitment to treatment including random toxicology screening. Patients who are actively using drugs, or on methadone treatment or taking opioids, are often excluded from OLT consideration. Ethical considerations related to inclusion of methadone patients are reviewed. Before liver transplant, patients often demonstrate deficits in neurocognition and psychiatric symptoms. Studies indicate that, after transplant, neurocognitive functioning improves but the psychiatric symptoms persist or increase. Selected medications, including an antidepressant and an herbal supplement, have induced liver injury in reported cases. A mood stabilizer has been shown to be safe for hepatitis C patients. An understanding of the risks associated with each psychotropic agent is required before a rational treatment plan can be formulated for liver compromised patients.
Liver transplantation in alcoholic liver disease: selection and outcome Maldonado JR Alcohol is one of the most commonly used psychoactive drugs. Alcoholic cirrhosis is a leading cause of death in the United States. Several factors
Cognitive behavior support group for implantable defibrillator patients Gun-Usishkin M, Rosenfeld G Introduction: The implantable Cardio-Defibrillator (ICD) has been developed and extensively used for treatment in patients with life-threatening arrhythmias. The cardiac event that consequently required the implantation of the ICD is not without it’s difficult psychosocial effects like fear of death, depressive mood, anxiety, reduced coping ability and ineffective functioning in one’s daily responsibilities. The cognitive behavioral support group was proposed as successful treatment in helping this population cope with the psychosocial effects on both the patient and family. A team of a psychiatric nurse and a cardiac nurse specialist leads the group. Goals: (1) Engagement in the therapeutic process; (2) offering of health information; (3) problem solving and enhancement of coping skills; (4) teaching relaxation techniques; and (5) identification and change of dysfunctional thoughts. Conclusion: Each of the patients indicated that the support group helped them in dealing with their psychosocial issues. It was generally felt that their level of knowledge was broadened. The universality of their problems was recognized and they learned new coping strategies and problem solving. The group leaders felt particularly gratified with the outcomes of the group. The combination of the knowledge and expertise of both nursing professionals make them uniquely qualified to conduct the support group.
Groups for the seriously mentally ill address psychiatric hospitalization and medical care Gise LH Most psychiatric treatment of patients with serious and persistent mental illness in the United States is done individually. Attendance at self-help groups has been reported associated with better medication adherence and less hospitalization but no research has been done on psychiatrist-led medication groups for chronic mental illness. Objective: To see if attendance at weekly psychiatrist-led medication groups is associated with less psychiatric hospitalization. Method: Patients who attended weekly psychiatrist-led medication groups were compared to patients receiving usual care. Groups also addressed primary medical care. Results: Regression analysis showed a correlation between both (1) group attendance and (2) the amount of group attendance and (a) fewer psychiatric
115
hospitalizations and (b) fewer days in the hospital. Patients who attended group did not differ from the comparison group with regard to age, sex, marital status, ethnicity, diagnosis, global assessment of functioning scale (Axis V) or the number of visits to the mental health center. Conclusion: Attendance at psychiatrist-led medication groups was associated with less psychiatric hospitalization. A controlled trial to test causal relationship is needed. The extent to which the effect is mediated by better medication adherence requires further study.
Mindfulness-based stress reduction groups Abbey SE Mindfulness-based stress reduction (MBSR) is a manualized group program developed by Kabat-Zinn and colleagues at the University of Massachusetts. It consists of 9 group sessions during which participants learn a variety of self-regulation techniques based on various forms of meditation and cognitive therapy principles as well as participating in psychoeducation on symptom management and coping with chronic illness and stress. This presentation will describe the intervention and report data from a cohort of 450 participants with heterogeneous medical and emotional symptoms. Analysis of quantitative data using validated, reliable self-report instruments documents improvements in multiple domains. Participants report reduced physical symptoms, bodily pain, and psychological distress in the form of depression and anxiety and improved health-related quality of life, sense of general well-being, heightened optimism, a greater sense of control over their lives and their ability to manage their symptoms, and improved sleep. Preliminary qualitative data also documents significant gains in terms of improved quality of life and more appropriate health care utilization. These clinically significant benefits are obtained for less than the cost of three individual sessions of psychotherapy.
Psychosomatic aspects in liver disease II (Chair) Withers NW, Madonado JR, Hilsabeck RC, Dishman B Selection of candidates for orthotopic liver transplantation (OLT) presents an ethical challenge. The current system gives priority to the most severely ill patients who have the poorest transplant survival and the highest costs. In the past, fewer patients with alcoholic liver disease received transplants due to concern that patients would relapse. There is clear consensus that patients with alcoholic cirrhosis be considered for OLT. Selection criteria proposed include, among others, a requirement of a minimum of 6 months sobriety, psychosocial and psychiatric stability, and commitment to treatment including random toxicology screening. Patients who are actively using drugs, or on methadone treatment or taking opioids, are often excluded from OLT consideration. Ethical considerations related to inclusion of methadone patients are reviewed. Before liver transplant, patients often demonstrate deficits in neurocognition and psychiatric symptoms. Studies indicate that, after transplant, neurocognitive functioning improves but the psychiatric symptoms persist or increase. Selected medications, including an antidepressant and an herbal supplement, have induced liver injury in reported cases. A mood stabilizer has been shown to be safe for hepatitis C patients. An understanding of the risks associated with each psychotropic agent is required before a rational treatment plan can be formulated for liver compromised patients.
Liver transplantation in alcoholic liver disease: selection and outcome Maldonado JR Alcohol is one of the most commonly used psychoactive drugs. Alcoholic cirrhosis is a leading cause of death in the United States. Several factors