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Mindfulness-Based Stress Reduction Therapy Improves Patient and Caregiver-Reported Outcomes in Cirrhosis.

Jasmohan S Bajaj, Michael Ellwood, Timothy Ainger, Thomas Burroughs, Andrew Fagan, Edith A Gavis, Douglas M Heuman, Michael Fuchs, Binu John, James B Wade

Clinical and translational gastroenterology July 27, 2017 DOI: 10.1038/ctg.2017.38 (opens in new tab)

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Study at a glance

AI-extracted from the abstract
Characteristics Uncontrolled before-after intervention study Peer reviewed
Sample size 20
Population Cirrhotic outpatients with mild depression (BDI > 14) and their adult caregivers; all patients were men (mean age 60 years, MELD 12.9, 14 with prior hepatic encephalopathy), most caregivers were women (n=15)
Duration Four weekly one-hour group sessions with home practice; follow-up immediately after the last session
Measures Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Beck Anxiety Inventory, Sickness Impact Profile (SIP), Zarit Burden Interview Short-form (ZBI-SF), perceived caregiver burden (PCB)
Topics Meditation
Key points A four-week mindfulness-based stress reduction plus supportive group therapy program was associated with significant improvements in patient depression (BDI 19.0 to 15.6), sleep quality (PSQI 7.2 to 5.5), and overall health-related quality of life (SIP 25.0 to 17.7), but not anxiety or covert hepatic encephalopathy. Caregivers showed reduced burden (ZBI-SF 13.0 to 9.8) and depression (BDI 9.1 to 5.9) and improved sleep quality (7.2 to 5.5).

Abstract

Patient-reported outcomes such as health-related quality of life (HRQOL) are impaired in cirrhosis due to under-treated mood and sleep disorders, which can adversely impact their caregivers. Mindfulness-based stress reduction (MBSR) can improve patient-reported outcomes (PRO) in non-cirrhotic patients but their impact in cirrhosis is unclear. To evaluate the effect of MBSR and supportive group therapy on mood, sleep and HRQOL in cirrhotic patients and their caregivers. Cirrhotic outpatients with mild depression (Beck Depression Inventory (BDI)>14) on screening with an adult caregiver were enrolled. At baseline, BDI, sleep (Pittsburgh sleep quality index PSQI, Epworth Sleepiness Scale, ESS), anxiety (Beck Anxiety inventory) and HRQOL (Sickness Impact Profile, SIP) for both patients/caregivers and caregiver burden (Zarit Burden Interview Short-form, ZBI-SF and perceived caregiver burden, PCB) and patient covert HE(CHE) status were measured. Patients who had BDI>14 at baseline, along with their caregivers then underwent a structured MBSR program with four weekly hour-long group sessions interspersed with home practice using CDs. After the last group, all questionnaires were repeated. 20 patient/caregiver dyads were included. All patients were men (60±8 years MELD 12.9±5.7, 14 prior hepatic encephalopathy (HE)) while most caregivers (n=15) were women (55±12 years, 23±14 years of relationship, 65% spouses). There was no change in patient BDI between screening and baseline (20.1±11.2 vs. 19.0±10.6, P=0.81). All dyads were able to complete the four MBSR+supportive group therapy sessions. There was a significant improvement in BDI (19.0±10.6 vs.15.6±8.2 P=0.01), PSQI (7.2±3.7 vs. 5.5±3.7, P<0.001) and overall HRQOL (25.0±13.2 vs. 17.7±14.0,P=0.01) but not in anxiety or CHE rates in patients. Similarly caregiver burden (ZBI-SF13.0±9.0 vs. 9.8±6.9,P=0.04, Perceived burden 72.1±29.9 vs. 63.0±14.5,P=0.05) and depression reduced (BDI 9.1±7.8 vs. 5.9±6.0,P=0.03) while caregiver sleep quality (7.2±3.7 vs. 5.5±3.7,P<0.001) improved. Prior HE did not affect PRO change after MBSR+supportive groups but the ZBI-SF of caregivers taking care of HE patients improved to a greater extent (delta -1.1±6.5 vs. 7.4±5.3 HE, P=0.04). A short program of mindfulness and supportive group therapy significantly improves PRO and caregiver burden in cirrhotic patients with depression. This non-pharmacological method could be a promising approach to alleviate psychosocial stress in patients with end-stage liver disease and their caregivers.

Comparable studies

Other non-randomized and open-label trials on meditation, most cited first.

Study Year Design Participants
Mindfulness-Based Stress Reduction in Relation to Quality of Life, Mood, Symptoms of Stress, and Immune Parameters in Breast and Prostate Cancer Outpatients Early-stage breast and prostate cancer patients 2003 Pre-post intervention study n = 59
Exploring self‐compassion and empathy in the context of mindfulness‐based stress reduction (MBSR) Community sample 2010 Pre-post intervention study
Mindfulness-Based Stress Reduction Lowers Psychological Distress In Medical Students Second-year medical students 2003 Prospective nonrandomized cohort-controlled study n = 302
Intensive meditation training, immune cell telomerase activity, and psychological mediators. Retreat participants and matched controls 2011 Controlled trial with wait-list control group n = 60
The Effectiveness of Mindfulness Training for Children with ADHD and Mindful Parenting for their Parents Children aged 8-12 with ADHD and their parents 2011 Within-group waitlist controlled trial n = 22

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