Audio-Guided Mindfulness Meditation During Transcranial Magnetic Stimulation Sessions for the Treatment of Major Depressive Disorder: A Pilot Feasibility Study

Combining mindfulness-based cognitive therapy (MBCT) guided audio exercises with daily transcranial magnetic stimulation (TMS) sessions for major depressive disorder proved largely unfeasible. Of 29 depressed patients who started, 17 completed the 5-week protocol and 12 dropped out. Reasons for discontinuation included inability to meditate in the treatment setting and induction of negative mood states. TMS percussive sensations and clicking sounds hindered concentration on the audio narrator. Some patients felt overwhelmed, increased pressure, anxiety, or aggravation trying to meditate during TMS. The findings highlight numerous feasibility issues with delivering MBCT via guided audiotapes concurrently with TMS.

Study at a glance

Abstract

Background: Mindfulness-Based Cognitive Therapy (MBCT) has been shown to enhance the long-term treatment outcomes for major depressive disorder (MDD), and engagement of specific brain activities during brain stimulation may produce synergistic effects. Audio-guided meditation exercises are a component of MBCT that might be combined with standard transcranial magnetic stimulation (TMS) therapy sessions. We developed and pilot-tested a modified MBCT protocol for patients undergoing a standard course of TMS for MDD.Methods: Four MBCT audiotracks with differing durations and types of mental focus were selected. Patients listened to the audiotapes through headphones during daily TMS sessions for 5 consecutive weeks. The primary goal was to evaluate the feasibility and acceptability of the meditation intervention with TMS. Changes in self-rated measures of symptom severity, stress, life satisfaction, and mindfulness were also assessed.Results: Seventeen depressed subjects completed the study and 12 terminated early. Reasons for discontinuation included an inability to meditate in the treatment setting and induction of negative mood states. TMS percussive sensations and clicking sounds hindered the ability of patients to fully concentrate on or hear the voice of the audiotape narrator. Some became overwhelmed or felt increased pressure, anxiety, or aggravation trying to do meditation exercises while receiving TMS.Conclusion: There is a growing interest in combining TMS with other concurrent psychotherapeutic interventions to optimize treatment outcomes. The results highlight numerous feasibility issues with MBCT via guided audiotapes during TMS treatment. Future work should draw on these shortcomings to evaluate the appropriateness of MBCT for depressed patients undergoing neuromodulation.