A randomized, controlled trial of mindfulness-based stress reduction in HIV infection.
Frederick M Hecht, Judith T. Moskowitz, Patricia J Moran, Elissa S Epel, Peter Bacchetti, Michael Acree, Margaret E Kemeny, Wendy Berry Mendes, Larissa G Duncan, Helen Y. Weng, Jay A Levy, Steven G Deeks, Susan Folkman
Brain, Behavior, and Immunity October 2018 DOI: 10.1016/j.bbi.2018.05.017 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 177 |
| Population | Adults with HIV-1 infection and CD4 T-cell counts above 350 cells/μl who were not on antiretroviral therapy, recruited at the University of California at San Francisco |
| Interventions | Mindfulness-based stress reduction (MBSR) HIV disease self-management skills group |
| Duration | 12-month follow-up, with assessments at 3, 6, and 12 months after intervention initiation |
| Measures | CD4 T-cell count, c-reactive protein, IL-6, d-dimer, HIV-1 viral load, Beck Depression Inventory, modified Differential Emotions Scale, Perceived Stress Scale, mindfulness |
| Topics | Depression Meditation |
| Keywords | Cd4 lymphocyte count Emotions Hiv-1 Mind-body therapies Psychoimmunology Psychological stress Viral load |
| Key findings | MBSR improved positive affect more than an active control group at 3 months (per-item difference 0.25, 95% CI 0.049-0.44), but this difference was not maintained over 12 months. Immunological outcomes did not differ significantly: mean CD4+ T-cell decrease was 49.6 cells/μl with MBSR versus 54.2 cells/μl in controls (difference 4.6 cells, 95% CI -44.6 to 53.7), and c-reactive protein, IL-6, viral load, and d-dimer showed no significant between-group differences at any time point. |
Abstract
Evidence links depression and stress to more rapid progression of HIV-1 disease. We conducted a randomized controlled trial to test whether an intervention aimed at improving stress management and emotion regulation, mindfulness-based stress reduction (MBSR), would improve immunological (i.e. CD4+ T-cell counts) and psychological outcomes in persons with HIV-1 infection. We randomly assigned participants with HIV-1 infection and CD4 T-cell counts >350 cells/μl who were not on antiretroviral therapy in a 1:1 ratio to either an MBSR group (n = 89) or an HIV disease self-management skills group (n = 88). The study was conducted at the University of California at San Francisco. We assessed immunologic (CD4, c-reactive protein, IL-6, and d-dimer) and psychological measures (Beck Depression Inventory for depression, modified Differential Emotions Scale for positive and negative affect, Perceived stress-scale, and mindfulness) at 3, 6 and 12 months after initiation of the intervention; we used multiple imputation to address missing values. We observed statistically significant improvements from baseline to 3-months within the MBSR group in depression, positive and negative affect, perceived stress, and mindfulness; between group differences in change were significantly greater in the MBSR group only for positive affect (per item difference on DES-positive 0.25, 95% CI 0.049, 0.44, p = .015). By 12 months the between group difference in positive affect was not statistically significant, although both groups had trends toward improvements compared to baseline in several psychological outcomes that were maintained at 12-months; these improvements were only statistically significant for depression and negative affect in the MBSR group and perceived stress for the control group. The groups did not differ significantly on rates of antiretroviral therapy initiation (MBSR = 39%, control = 29%, p = .22). After 12 months, the mean decrease in CD4+ T-cell count was 49.6 cells/μl in participants in the MBSR arm, compared to 54.2 cells/μl in the control group, a difference of 4.6 cells favoring the MBSR group (95% CI, -44.6, 53.7, p = .85). The between group differences in other immunologic-related outcomes (c-reactive protein, IL-6, HIV-1 viral load, and d-dimer) were not statistically significant at any time point. MBSR improved positive affect more than an active control arm in the 3 months following the start of the intervention. However, this difference was not maintained over the 12-month follow-up and there were no significant differences in immunologic outcomes between intervention groups. These results emphasize the need for further carefully designed research if we are to translate evidence linking psychological states to immunological outcomes into evidence-based clinical practices.
Comparable studies
Other randomized controlled trials on meditation, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Alterations in Brain and Immune Function Produced by Mindfulness Meditation Healthy employees in a work environment | 2003 | Randomized controlled trial | n = 41 |
| Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Recovered recurrently depressed patients | 2000 | Randomized controlled trial | n = 145 |
| Open hearts build lives: Positive emotions, induced through loving-kindness meditation, build consequential personal resources. Working adults | 2008 | Randomized controlled trial | n = 139 |
| Short-term meditation training improves attention and self-regulation Undergraduate Chinese students | 2007 | Randomized controlled trial | n = 40 |
| Mindfulness-Based Cognitive Therapy for Depression: Replication and Exploration of Differential Relapse Prevention Effects. Recovered recurrently depressed patients | 2004 | Randomized controlled trial | n = 73 |
Citations in the library
Cited by 11
- A Framework for the Empirical Investigation of Mindfulness Meditative Development Mindfulness April 13, 2023
- Mindfulness-Based Stress Reduction for Symptom Management in Older Individuals with HIV-Associated Neurocognitive Disorder. AIDS and behavior June 1, 2024
- Psychology, Meditation, and the Brain Across Contemplative Traditions The Oxford Handbook of Psychology and Spirituality January 23, 2024
- Quadrato motor training (QMT) influences IL-1β expression and creativity: Implications for inflammatory state reduction and cognitive enhancement. Progress in Brain Research 2023
- Yoga, Meditation, Breathing Exercises, and Inflammatory Biomarkers with Possible Implications in COVID-19: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Evidence-based Complementary and Alternative Medicine October 7, 2022
and 6 more in the library
Cites 11
- Using Self-Report Assessment Methods to Explore Facets of Mindfulness Assessment January 27, 2006
- Meditation Programs for Psychological Stress and Well-being JAMA Internal Medicine January 6, 2014
- Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders American Journal of Psychiatry July 1, 1992
- What Do We Really Know About Mindfulness-Based Stress Reduction? Psychosomatic Medicine 2002
- Effects of Mindfulness-Based Stress Reduction Intervention on Psychological Well-being and Quality of Life: Is Increased Mindfulness Indeed the Mechanism? Annals of Behavioral Medicine June 1, 2008
and 6 more in the library