By Russell H. Greenfield, MD,
Medical Director, Integrative Oncology Services, Carolinas Medical Center, Charlotte; Clinical Assistant Professor, School of Medicine, University of North Carolina, Chapel Hill; Visiting Assistant Professor, University of Arizona College of Medicine, Tucson, Arizona.
Dr. Greenfield reports no financial relationships relevant to this field of study.
Synopsis: A study shows mindfulness-based stress reduction may improve mild-to-moderate depressive symptoms in elderly patients.
Source: Gallegos AM, et al. Emotional benefits of mindfulness-based stress reduction in older adults: The moderating roles of age and depressive symptom severity. Aging Ment Health 2013; May 22 [Epub ahead of print].
Routine practice of mindfulness-based stress reduction has been shown to benefit numerous patients with a variety of conditions. One group in which the effects of MBSR practice has yet to be adequately understood is the elderly. Aging is often marked by the unpleasant decline in physical ability and even frequently mental acumen—realities that can weigh heavily as stressors. Though many of course are able to endure such challenges, keeping positive in the face of what seems to many like inevitable can be difficult for even the staunchest optimist. A serious factor of the stressors affecting many elderly is a loss of control that coincides with such decline. Such a loss of control, both perceived and real, can be debilitating to an elderly person’s, any person’s, psyche. MBSR practice is designed to help people cope with issues like a lack of control.
This is not the authors’ first exploration of MBSR and stress-management techniques; rather, they had previously devised what they called the Motivational Theory of Life-Span Development. Gallegos AM, et al used their theory as the framework for the study at hand, in which they examine the effects age and depressive symptom severity have on changing positive affect among elderly (65 and older) people. Over the course of eight weeks, 200 community dwelling older people were examined after being randomized to either an MBSR program or a control group.
The authors’ theory implies strongly that most people, and especially elderly people, best adapt to circumstances and maintain levels of control by setting attainable goals and replacing unattainable ones. Perhaps the most important form of control for many people is primary control, which is perhaps best described as controlling circumstances to fit your will. Aging often deteriorates people’s capacity for primary control, which can be worsened by and even contribute to depressive symptoms. Older people, however, can employ secondary control mechanisms to compensate for such a loss of primary control. Secondary control differs significantly from primary control and is defined as changing oneself to fit environmental forces, or in other words changing one’s will to fit circumstances. Augmentation of secondary control techniques allow for a coming-to-terms with often uncontrollable circumstances that provides long-term and short-term emotional benefits. By aiming to teach participants the importance of nonjudgmental self-awareness, MBSR teaches patients to control what they can and accept what they cannot. MBSR can supplement proper emotional aging and ideally mitigate certain symptoms of depression.
The study’s subjects were recruited through newspaper advertisements and flyers targeted at primary care patients. Criteria for exclusion from the study included potential cognitive or serious, uncorrected, sensory impairment, major depression and/or psychosis, bipolar disorder, and substance abuse within the past year. After enrollment, subjects were randomly assigned to either active (MBSR) or control (waitlisted) groups. The 8-week MBSR program consisted of 9 group sessions of varying length, though typically each session lasted two hours. The meetings emphasized several practices as a part of MBSR, including yoga (deemed mindful movement), sitting meditation (mindful experiential awareness while sitting), informal meditation (mindful awareness while performing simple activities), and a “body scan” (serial focus on various body areas). Activities were adapted individually to accommodate participant disabilities, including adjustments for wheelchair-bound patients.
Each participant took the Center for Epidemiological Studies Depression Scale, Revised (CESD-R), the Positive Affect (PA) scale, the Positive and Negative Affect Schedule (PANAS) at baseline, treatment end, and 6-month follow-up. Gallegos AM, et al controlled for potential confounders like gender, level of education and comorbidity, while patients below 70 years of age were compared with older subjects. The authors also used regression to determine potential associations age and/or depression severity had on changes in the positive affect.
At baseline, the two groups were very similar; however, the MBSR group did have a slightly greater symptom severity on average. After eight weeks of MBSR practice, 54% of the test group experienced positive improvements. Forty-six percent of the wait-listed control group reported improvements. After analysis of 6-month follow-up positive affect outcomes, significant group by baseline depressive symptom severity and group by baseline depressive symptom severity by age interactions; as such, the authors separately analyzed the roles age and baseline symptom severity played in changing positive affect, both for the MBSR group and the waitlisted group.
The analysis’s revealed findings are important. Older MBSR members with the most severe baseline symptoms experienced less symptom improvement both at the completion of treatment and at the 6-month follow-up than their age-matched subjects with milder symptoms. The effects related to age and the association between depression severity and age were not found to be significant in either group. Older (70 or older) patients with low baseline symptom severity demonstrated the greatest change in positive affect at follow-up, while older patients with severe symptoms had the least improvements. Gallegos AM, et al, concluded their study by asserting that the findings reveal MBSR significantly improves positive affect among older adults without severe depressive symptoms.