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JMIR Research Protocols Jun 2024Depression poses a major threat to public health with an increasing prevalence in the United States. Mindfulness-based interventions, such as mindfulness-based cognitive...
BACKGROUND
Depression poses a major threat to public health with an increasing prevalence in the United States. Mindfulness-based interventions, such as mindfulness-based cognitive therapy (MBCT), are effective methods for managing depression symptoms and may help fortify existing efforts to address the current disease burden. The in-person group format of MBCT, however, incurs barriers to care such as expenses, childcare needs, and transportation issues. Alternate delivery modalities such as MBCT delivered via the web can be investigated for their capacity to overcome these barriers and still reduce symptoms of depression with adequate feasibility and efficacy.
OBJECTIVE
This study protocol aims to examine the feasibility and efficacy of MBCT delivered via the web for the treatment of depression.
METHODS
To attain study aims, 2 phases will be implemented using a waitlist control design. A total of 128 eligible participants will be randomized into either an 8-week MBCT intervention group plus treatment as usual (MBCT + TAU; group 1) or an 8-week waitlist control group (group 2). In phase I (8 weeks), group 1 will complete the intervention and group 2 will proceed with TAU. In phase II (8 weeks), group 2 will complete the intervention and group 1 will continue with TAU until reaching an 8-week follow-up. TAU may consist of receiving psychotherapy, pharmacotherapy, or combined treatment. Data collection will be completed at baseline, 8 weeks (postintervention for group 1 and preintervention for group 2), and 16 weeks (follow-up for group 1, postintervention for group 2). The primary outcomes will include (1) current, residual, or chronic depression symptoms and (2) psychiatric distress. Secondary outcomes will include perceived stress and facets of mindfulness. The feasibility will be measured by assessing protocol adherence, retention, attendance, and engagement. Finally, the extent of mindfulness self-practice and executive functioning skills will be assessed as mediators of intervention outcomes.
RESULTS
This study began screening and recruitment in December 2022. Data collection from the first cohort occurred in January 2023. By November 2023, a total of 30 participants were enrolled out of 224 who received screening. Data analysis began in February 2024, with an approximate publication of results by August 2024. Institutional review board approval took place on September 11, 2019.
CONCLUSIONS
This trial will contribute to examining mindfulness-based interventions, delivered via the web, for improving current, residual, or chronic depression symptoms. It will (1) address the feasibility of MBCT delivered via the web; (2) contribute evidence regarding MBCT's efficacy in reducing depression symptoms and psychiatric distress; and (3) assess the impact of MBCT on several important secondary outcomes. Findings from this study will develop the understanding of the causal pathways between MBCT delivered via the web and depression symptoms further, elucidating the potential for future larger-scale designs.
TRIAL REGISTRATION
ClinicalTrials.gov NCT05347719; https://www.clinicaltrials.gov/ct2/show/NCT05347719.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)
DERR1-10.2196/53966.
Topics: Adult; Female; Humans; Male; Middle Aged; Cognitive Behavioral Therapy; Depression; Internet; Internet-Based Intervention; Mindfulness; Treatment Outcome; Randomized Controlled Trials as Topic
PubMed: 38888958
DOI: 10.2196/53966 -
JAMA Network Open Jun 2024The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), recently identified internet gaming disorder (IGD) as a condition... (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), recently identified internet gaming disorder (IGD) as a condition warranting more research, and few empirically validated treatments exist. Mindfulness meditation (MM) has multiple health benefits; however, its efficacy in treating IGD and potential neural mechanisms underlying MM treatment of the disorder remain largely unknown.
OBJECTIVE
To explore the efficacy of MM used to treat adults with IGD and to identify neural mechanisms underlying MM.
DESIGN, SETTING, AND PARTICIPANTS
This randomized clinical trial was performed from October 1 to November 30, 2023, at Hangzhou Normal University in Hangzhou, China. Adults (aged ≥18 years) who met at least 6 of the 9 DSM-5-TR proposed criteria for IGD were recruited to receive either MM or progressive muscle relaxation (PMR). Data analysis was performed on December 1, 2023.
INTERVENTION
Participants underwent MM training (an 8-session meditation program that focuses on attention and acceptance) and PMR training (an 8-time program for body relaxation) delivered in groups that met 2 times each week for 4 weeks.
MAIN OUTCOMES AND MEASURES
This per-protocol analysis included only participants who finished the pretest assessment, 8 training sessions, and posttest assessment. The main outcomes were addiction severity (measured with the DSM-5-TR proposed criteria for IGD and with Internet Addiction Test scores), gaming craving (measured with Questionnaire for Gaming Urges scores), and blood oxygen level-dependent signals assessed with cue-craving tasks on fMRI. Behavioral and brain measurements were compared using analysis of variance. Functional connectivity (FC) among identified brain regions was measured to test connectivity changes associated with MM.
RESULTS
This study included 64 adults with IGD. A total of 32 participants received MM (mean [SD] age, 20.3 [1.9] years; 17 women [53%]) and 32 received PMR (mean [SD] age, 20.2 [1.5] years; 16 women [50%]). The severity of IGD decreased in the MM group (pretest vs posttest: mean [SD], 7.0 [1.1] vs 3.6 [0.8]; P < .001) and in the PMR group (mean [SD], 7.1 [0.9] vs 6.0 [0.9]; P = .04). The MM group had a greater decrease in IGD severity than the PMR group (mean [SD] score change for the MM group vs the PMR group, -3.6 [0.3] vs -1.1 [0.2]; P < .001). Mindfulness meditation was associated with decreased brain activation in the bilateral lentiform nuclei (r = 0.40; 95% CI, 0.19 to 0.60; P = .02), insula (r = 0.35; 95% CI, 0.09 to 0.60; P = .047), and medial frontal gyrus (MFG; r = 0.43; 95% CI, 0.16 to 0.70; P = .01). Increased MFG-lentiform FC and decreased craving (pretest vs posttest: mean [SD], 58.8 [15.7] vs 33.6 [12.0]; t = -8.66; ƞ2 = 0.30; P < .001) was observed after MM, and changes in MFG-lentiform FC mediated the relationship between increased mindfulness and decreased craving (mediate effect, -0.17; 95% CI, -0.32 to -0.08; P = .03).
CONCLUSIONS AND RELEVANCE
In this study, MM was more effective in decreasing addiction severity and gaming cravings compared with PMR. These findings indicate that MM may be an effective treatment for IGD and may exert its effects by altering frontopallidal pathways.
TRIAL REGISTRATION
Chinese Clinical Trial Registry Identifier: ChiCTR2300075869.
Topics: Humans; Mindfulness; Male; Female; Internet Addiction Disorder; Adult; Meditation; Young Adult; Treatment Outcome; Magnetic Resonance Imaging; China; Video Games
PubMed: 38888924
DOI: 10.1001/jamanetworkopen.2024.16684 -
JAMA Network Open Jun 2024Older adults are particularly vulnerable to loneliness and its physical and psychosocial sequelae, but scalable interventions are lacking, especially during disasters... (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Older adults are particularly vulnerable to loneliness and its physical and psychosocial sequelae, but scalable interventions are lacking, especially during disasters such as pandemics.
OBJECTIVE
To compare the effects of layperson-delivered, telephone-based behavioral activation and mindfulness interventions vs telephone-based befriending on loneliness among at-risk older adults.
DESIGN, SETTING, AND PARTICIPANTS
This assessor-blinded, 3-arm randomized clinical trial screened Chinese older adults through household visits and community referrals from April 1, 2021, to April 30, 2023, in Hong Kong. Eligible participants (≥65 years of age) who were lonely, digitally excluded, living alone, and living below the poverty line and provided consent to participate were randomized into behavioral activation, mindfulness, and befriending groups. Assessments were conducted at baseline, 1 month, and 3 months.
INTERVENTION
As part of the Helping Alleviate Loneliness in Hong Kong Older Adults (HEAL-HOA) dual randomized clinical trial, 148 older laypersons were trained to deliver a twice-weekly 30-minute intervention via telephone for 4 weeks.
MAIN OUTCOMES AND MEASURES
The primary outcome was loneliness measured by the UCLA Loneliness Scale (range, 20-80) and the De Jong Gierveld Loneliness Scale (range, 0-6), with higher scores on both scales indicating greater loneliness. Secondary outcomes were depression, perceived stress, life satisfaction, psychological well-being, sleep quality, perceived social support, and social network.
RESULTS
A total of 1151 participants (mean [SD] age, 76.6 [7.8] years; 843 [73.2%] female) were randomized to the behavioral activation (n = 335), mindfulness (n = 460) or befriending (n = 356) group. Most were widowed or divorced (932 [81.0%]), had primary education or below (782 [67.9%]), and had 3 or more chronic diseases (505 [43.9%]). Following intention-to-treat principles, linear mixed-effects regression model analyses showed that loneliness measured by the UCLA Loneliness Scale was significantly reduced in the behavioral activation group (mean difference [MD], -1.96 [95% CI, -3.16 to -0.77] points; P < .001]) and in the mindfulness group (MD, -1.49 [95% CI, -2.60 to -0.37] points; P = .004) at 3 months compared with befriending. Loneliness measured by the De Jong Gierveld Loneliness Scale was not significantly reduced at 3 months in the behavioral activation group (MD, -0.06 [95% CI, -0.26 to 0.13] points; P > .99]) but was in the mindfulness group (MD, 0.22 [95% CI, 0.03 to 0.40] points; P = .01) at 3 months compared with befriending. In the behavioral activation and mindfulness groups, sleep quality improved compared with befriending, but perceived stress increased. Psychological well-being and perceived social support improved in the behavioral activation group. No statistically significant between-group differences were observed in depression, life satisfaction, or social network.
CONCLUSION AND RELEVANCE
In this randomized clinical trial, scalable psychosocial interventions delivered remotely by older laypersons appeared promising in reducing later life loneliness and addressing the pressing mental health challenges faced by aging populations and professional geriatric mental health workforce shortages. Further research should explore ways to maximize the clinical relevance and cost-effectiveness of these interventions.
TRIAL REGISTRATION
Chinese Clinical Trial Registry Identifier: ChiCTR2300072909.
Topics: Humans; COVID-19; Female; Aged; Male; Loneliness; Hong Kong; Telephone; Poverty; Mindfulness; SARS-CoV-2; Pandemics; Aged, 80 and over
PubMed: 38888923
DOI: 10.1001/jamanetworkopen.2024.16767 -
Frontiers in Public Health 2024The purpose of this study is to summarize the health system response to COVID-19 in four East Asian countries, analyze the effectiveness of their health system response,...
OBJECTIVE
The purpose of this study is to summarize the health system response to COVID-19 in four East Asian countries, analyze the effectiveness of their health system response, and provide lessons for other countries to control the epidemic and optimize their health system response.
METHODS
This study investigated and summarized COVID-19 data and health system response in four East Asian countries, China, Japan, Mongolia, and South Korea from national governments and ministries of health, WHO country offices, and official websites of international organizations, to assess the effectiveness of health system measures.
RESULT
As of June 30, 2022, all four countries are in a declining portion of COVID-19. China has two waves, and new cases increased slowly, with the total cases per million remaining within 4, indicating a low level. Japan has experienced six waves, with case growth at an all-time high, total cases per million of 250.994. Mongolia started the epidemic later, but also experienced four waves, with total cases per million of 632.658, the highest of the four countries. South Korea has seen an increasing number of new cases per wave, with a total case per million of 473.759.
CONCLUSION
In containment strategies adopted by China and Mongolia, and mitigation strategies adopted by Japan and South Korea, health systems have played important roles in COVID-19 prevention and control. While promoting vaccination, countries should pay attention to non-pharmaceutical health system measures, as evidenced by: focusing on public information campaigns to lead public minds; strengthening detection capabilities for early detection and identification; using technical ways to participate in contact tracing, and promoting precise judging isolation.
Topics: Humans; Asia, Eastern; China; Communicable Disease Control; COVID-19; Delivery of Health Care; Japan; Mongolia; Republic of Korea
PubMed: 38887248
DOI: 10.3389/fpubh.2024.1385291 -
Biomarker Research Jun 2024Inhibitors of Bruton's tyrosine kinase (BTKi) and chimeric antigen receptor T-cell (CAR-T) therapy targeting CD19 are paradigm-shifting advances in treating patients...
Inhibitors of Bruton's tyrosine kinase (BTKi) and chimeric antigen receptor T-cell (CAR-T) therapy targeting CD19 are paradigm-shifting advances in treating patients with aggressive mantle cell lymphoma (MCL). However, clinical relapses following BTKi and CD19-directed CAR-T treatments are a fast-growing medical challenge. Development of novel therapies to overcome BTKi resistance (BTKi-R) and BTKi-CAR-T dual resistance (Dual-R) are urgently needed. Our single-cell RNA sequencing data revealed major transcriptomic reprogramming, with great enrichment of MYC-targets evolving as resistance to these therapies developed. Interestingly, cyclin-dependent kinase 9 (CDK9), a critical component of the positive transcription elongation factor-b complex, was among the top upregulated genes in Dual-R vs. BTKi-R samples. We therefore hypothesized that targeting CDK9 may turn off MYC-driven tumor survival and drug resistance. Enitociclib (formerly VIP152) is a selective CDK9 inhibitor whose potency against MCL has not been assessed. In this study, we found that enitociclib was highly potent in targeting lymphoma cells, with the half-maximal inhibitory concentration (IC) ranging from 32 to 172 nM in MCL and diffuse large B-cell lymphoma cell lines. It inhibited CDK9 phosphorylation and downstream events including de novo synthesis of the short-lived proteins c-MYC, MCL-1, and cyclin D1, and induced apoptosis in a caspase-3-dependent manner. Enitociclib potently inhibited in vivo tumor growth of cell line-derived and patient-derived xenografts having therapeutic resistance. Our data demonstrate the potency of enitociclib in overcoming therapeutic resistance in MCL models and provide evidence in favor of its clinical investigation.
PubMed: 38886769
DOI: 10.1186/s40364-024-00589-7 -
Cannabis (Albuquerque, N.M.) 2024Problematic cannabis use is highly prevalent among postsecondary students. Consequently, there is a need to examine risk factors associated with problematic cannabis use...
Problematic cannabis use is highly prevalent among postsecondary students. Consequently, there is a need to examine risk factors associated with problematic cannabis use in this population. The present study investigated whether emotion dysregulation mediates the relationship between adverse childhood experiences (ACEs) and problematic cannabis use, and whether affective impulsivity (negative and positive urgency) uniquely moderates this relationship. Participants consisted of current cannabis users ( 586) recruited from five universities across Canada. Participants completed an online survey containing self-report measures of ACEs, emotion dysregulation, negative and positive urgency, and problematic cannabis use. Among the sample of postsecondary students, 36% ( = 213) met the threshold for problematic cannabis use. Moderated-mediation analyses revealed that ACEs were positively associated with emotion dysregulation and problematic cannabis use. There was also a significant indirect effect of emotion dysregulation on the association between ACEs and problematic cannabis use at moderate and high (but not low) levels of negative urgency, and at moderate and high (but not low) levels of positive urgency. The moderated-mediation models remained significant when controlling for other facets of impulsivity. Results suggest that elevated levels of emotion dysregulation and urgency are important proximal risk factors for problematic cannabis use among postsecondary students with a history of ACEs. While ACEs cannot be modified given their occurrence in the past, interventions that aim to build mindfulness and adaptive emotion regulation skills may be beneficial for reducing the likelihood that these students will engage in impulsive behaviors, such as cannabis use, when experiencing emotional distress.
PubMed: 38883277
DOI: 10.26828/cannabis/2023/000190 -
Appetite Jun 2024While moral concern for animals has become increasingly important for both consumer food choice and food policy makers, previous research demonstrated that meat eaters...
While moral concern for animals has become increasingly important for both consumer food choice and food policy makers, previous research demonstrated that meat eaters attribute lower moral status and mental capacities to animals raised for meat compared to non-food animals. The current research investigated whether this strategic flexibility in moral concern and mind perceptions also occurs when considering aquatic food animals and animals used for dairy and egg products, and the degree to which these concerns and perceptions are evident in pescatarians and vegetarians. We compared perceptions (mind attributions and moral concern) of land food animals versus aquatic food animals, and of animals in the meat versus dairy and egg industry between omnivores (n = 122), pescatarians (n = 118), vegetarians (n = 138), vegans (n = 120), and flexitarians (n = 60). Pescatarians scored lower than other dietary groups on moral concern and mind attribution for aquatic animals relative to farmed land animals. Unlike the other dietary groups, pescatarians and vegetarians scored lower on moral concern and mind attribution for dairy than beef cows and for layer chickens than broiler chickens. These findings demonstrate that pescatarians and vegetarians were flexible in their moral thinking about different types of food animals in ways that suited their consumption habits, even when the same animal was evaluated (e.g., dairy vs beef cows). This research highlights the psychological barriers that might prevent people from reducing animal product consumption and may need to be addressed in interventions to encourage transitioning towards more plant-based diets.
PubMed: 38880280
DOI: 10.1016/j.appet.2024.107559 -
Scientific Reports Jun 2024The current study aimed to assess the impact of combined interventions including mindfulness and self-regulation on self-neglect and self-regulation among Iranian older... (Randomized Controlled Trial)
Randomized Controlled Trial
The current study aimed to assess the impact of combined interventions including mindfulness and self-regulation on self-neglect and self-regulation among Iranian older adults with type 2 diabetes. This was a three-arm cluster randomized controlled trial study conducted among 135 older diabetic patients in Shiraz, Iran. Three urban healthcare centers (clusters) were randomly assigned to three study groups. The intervention groups received either a Self-Regulation-based Intervention Program (SRIP) or a Combined Mindfulness and Self-Regulation Intervention Program (CMSRIP), while the control group received routine care and COVID-19 prevention training. These training programs, which consisted of text and video-based content, were conducted over 24 weeks using WhatsApp as a mobile-based communication platform. Outcomes were measured using the Elder Self-Neglect Scale and Short-Form Self-Regulation Questionnaire at baseline, week 4, and week 16 post-intervention, with data analysis conducted using SPSS software. The CMSRIP led to significantly greater improvement in the score of self-regulation (χ = 73.23, P-Value = < .001) and a reduction in the score of self-neglect (χ = 62.97, P-Value = < .001) at both 4 weeks and 16 weeks after education compared to SRIP. In the control group, there was also a slight improvement. Improvement of self-regulation and reduction of self-neglect in all three groups were less in week 16 than in week 4. Nevertheless, the changes in the intervention groups were significantly better than the control group. This study confirmed a combination of mindfulness-based intervention and self-regulation intervention can effectively improve self-neglect and self-regulation behavior in older patients with type 2 diabetes.Trial registration: This trial (ISRCTN77260130) was retrospectively registered on 28/09/2021.
Topics: Humans; Mindfulness; Aged; Male; Female; Self-Control; Diabetes Mellitus, Type 2; Iran; Middle Aged; COVID-19; Aged, 80 and over; Surveys and Questionnaires
PubMed: 38879620
DOI: 10.1038/s41598-024-64314-y -
La Revue de Medecine Interne Jun 2024Functional somatic disorders (FSD) are common conditions that result in a significant deterioration of the quality of life. Their origin is multifactorial and poorly... (Review)
Review
Functional somatic disorders (FSD) are common conditions that result in a significant deterioration of the quality of life. Their origin is multifactorial and poorly understood, and their management is often inadequately defined. Medications typically show limited effectiveness, while mind-body approaches play a central role, guided by three key principles: establishing an empathetic, respectful, and sincere doctor-patient relationship; promoting regular and gradual physical activity; and implementing cognitive behavioral therapy (CBT). Special attention must be devoted to establishing a trustworthy relationship between the physician and the patient. Recognizing the reality and severity of symptoms and providing a positive diagnosis as well as an explanatory model to account for them rationally are fundamental aspects of patient management. Cognitive and behavioral maintenance factors should be investigated and constitute therapeutic targets. Cognitive factors include focused attention on body functioning and catastrophizing. Patients frequently display avoidance behaviors, particularly in relation to physical exertion, and it is crucial to motivate them to reintroduce gradual physical activity customized to their abilities. This approach has demonstrated efficacy in improving fatigue, pain, and the physical and mental quality of life for patients with FSD. Among psychotherapeutic approaches, the benefit of CBT is well-established. The combination of gradual physical activity and CBT appears to be complementary. Other mind-body approaches such as mindfulness meditation might help although their level of evidence is weaker. Given the prevalence of FSD in the general population, it seems necessary for all physicians to be trained in managing this condition.
PubMed: 38876948
DOI: 10.1016/j.revmed.2024.05.025 -
Appetite Jun 2024The aim of this study was to investigate the impact of a mindfulness intervention (IG) compared to an inactive control group (CG) on explicit and implicit attitudes...
OBJECTIVES
The aim of this study was to investigate the impact of a mindfulness intervention (IG) compared to an inactive control group (CG) on explicit and implicit attitudes toward vegetarian and meat-based foods, nutrition behavior measures, trait mindfulness and wellbeing.
METHODS
In the IG (N = 66), we implemented a mindfulness-based intervention consisting of eight weekly group sessions online, along with an additional half-day session held on campus. The CG (N = 71) received no intervention or training. We employed a pre-/post-intervention design involving questionnaires (trait mindfulness, wellbeing, sustainable nutrition behavior scale), an online supermarket scenario, as well as an explicit rating task and an implicit association task using pictures of vegetarian and meat-based foods. Additionally, a voluntary follow-up testing was conducted two months after the final group session.
RESULTS
No intervention effects were observed on explicit and implicit attitudes, wellbeing, or nutrition behavior measures. However, there was an increase in trait mindfulness within the IG. Exploratory cross-sectional findings indicated that trait mindfulness facets such as "Acting with Awareness" and "Outer Awareness", along with explicit attitudes, were significant predictors of self-reported sustainable consumption behavior. Additionally, sex and explicit attitudes were identified as significant predictors of vegetarian consumption behavior in the online supermarket task.
CONCLUSION
Our findings could not substantiate previous claims regarding the potential causal effects of mindfulness practice on sustainable consumption behavior, specifically in the realm of sustainable and vegetarian nutrition, as well as subjective wellbeing. Future studies may benefit from implementing longer-term mindfulness-based interventions and considering other potential decisive factors, such as connectedness to nature and others. Integrating training elements focusing on these specific variables into the intervention could be valuable.
PubMed: 38876151
DOI: 10.1016/j.appet.2024.107554