Mindfulness-based cognitive therapy for depression in people with dementia: A qualitative study on participant, carer and facilitator experiences

  1. Douglas, Sarah 1
  2. Payne, Jacob 1
  3. Stott, Josh 1
  4. Hanratty, Éanna 2
  5. Aguirre, Elisa 1
  6. Brede, Janina 1
  7. Charlesworth, Georgina 1
  8. Spector, Aimee 1
  9. Noone, Deirdre 1
  10. Patel, Mina 3
  1. 1 University College London
    info

    University College London

    Londres, Reino Unido

    ROR https://ror.org/02jx3x895

  2. 2 Waltham Forest Child and Family Consultation Service, North East London NHS Foundation Trust, UK
  3. 3 North East London NHS Foundation Trust, UK
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Revista:
Dementia

ISSN: 1471-3012,  1741-2684

Año de publicación: 2021

Volumen: 21

Número: 2

Páginas: 457-476

Tipo: Artículo

DOI: 10.1177/14713012211046150 GOOGLE SCHOLAR lock_openAcceso abierto editor

Otras publicaciones en: Dementia

Resumen

BackgroundDepression in dementia is common and associated with negative health outcomes. Mindfulness-based cognitive therapy is a recommended treatment of choice for recurrent depression, but its use for depression in dementia is yet to be assessed.ObjectiveThis study aimed to investigate the experiences of people with depression and dementia who participated in the mindfulness-based cognitive therapy intervention and those of their carers and facilitators.MethodsThis qualitative study was nested within a randomised controlled feasibility study. Semi-structured interviews were conducted with 18 people (eight people with dementia and depression, six carers and four course facilitators). Thematic analysis was used to analyse the data.FindingsSeveral beneficial effects of mindfulness-based cognitive therapy were described. These were a sense of shared suffering among the group, greater present moment focus and awareness, various positive emotional changes, including greater self-compassion, and benefits for carers, such as the reduction of anxiety. Specific aspects of the programme were identified as particularly useful, including facilitator characteristics and certain mindfulness practices. Carer involvement, cognitive difficulties and barriers to home practice influenced engagement with the course. Facilitators described adaptations made to mindfulness-based cognitive therapy and suggested additional modifications for future groups.ConclusionResults of this process evaluation suggest that mindfulness-based cognitive therapy is a potentially useful intervention for people with depression in dementia, but that further adaptation of the intervention is required to make the programme suitable for this clinical population.

Referencias bibliográficas

  • Aguirre, E., Stott, J., Charlesworth, G., Noone, D., Payne, J., Patel, M., Spector, A. (2017). Mindfulness-based cognitive therapy (MBCT) programme for depression in people with early stages of dementia: Study protocol for a randomised controlled feasibility study. Pilot and Feasibility Studies, 3(1), 28. https://dx.doi.org/10.1186/s40814-017-0143-x.
  • American Psychiatric Association . (2013). Diagnostic and statistical manual of mental disorders : DSM-5.
  • Bhattacharjee, S., Lee, J. K., Patanwala, A. E., Vadiei, N., Malone, D. C., Knapp, S. M., Lo-Ciganic, W.-H., Burke, W. J. (2019). Extent and predictors of potentially inappropriate antidepressant use among older adults with dementia and major depressive disorder. The American Journal of Geriatric Psychiatry, 27(8), 794-805. https://doi.org/10.1016/j.jagp.2019.02.002.
  • Bihari, J. L. N., Mullan, E. G. (2014). Relating mindfully: A qualitative exploration of changes in relationships through mindfulness-based cognitive therapy. Mindfulness, 5(1), 46-59. https://dx.doi.org/10.1007/s12671-012-0146-x.
  • Braun, V., Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101. https://dx.doi.org/10.1191/1478088706qp063oa.
  • Cairns, V., Murray, C. (2015). How do the features of mindfulness-based cognitive therapy contribute to positive therapeutic change? A meta-synthesis of qualitative studies. Behavioural and Cognitive Psychotherapy, 43(3), 342-359. https://dx.doi.org/10.1017/s1352465813000945.
  • Castilla-Puentes, R. C., Habeych, M. E. (2010). Subtypes of depression among patients with Alzheimer’s disease and other dementias. Alzheimer’s & Dementia, 6(1), 63-69. https://dx.doi.org/10.1016/j.jalz.2009.04.1232.
  • Churcher Clarke, A., Chan, J. M. Y., Stott, J., Royan, L., Spector, A. (2017). An adapted mindfulness intervention for people with dementia in care homes: Feasibility pilot study. International Journal of Geriatric Psychiatry, 32(12), e123-e131. https://dx.doi.org/10.1002/gps.4669.
  • Dudas, R., Malouf, R., McCleery, J., Dening, T. (2018). Antidepressants for treating depression in dementia. Cochrane Database of Systematic Reviews, 8(8), CD003944. https://dx.doi.org/10.1002/14651858.CD003944.pub2.
  • Folstein, M. F., Folstein, S. E., McHugh, P. R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189-198. https://dx.doi.org/10.1016/0022-3956(75)90026-6.
  • González-Salvador, M. T., Arango, C., Lyketsos, C. G., Barba, A. C. (1999). The stress and psychological morbidity of the Alzheimer patient caregiver. International Journal of Geriatric Psychiatry, 14(9), 701-710. https://dx.doi.org/10.1002/(sici)1099-1166(199909)14:9<701::aid-gps5>3.0.co;2-#.
  • Guest, G., Bunce, A., Johnson, L. (2006). How many interviews are enough? An experiment with data saturation and variability. Field Methods, 18(1), 59-82. https://dx.doi.org/10.1177/1525822X05279903.
  • Kales, H. C., Chen, P., Blow, F. C., Welsh, D. E., Mellow, A. M. (2005). Rates of clinical depression diagnosis, functional impairment, and nursing home placement in coexisting dementia and depression. The American Journal of Geriatric Psychiatry, 13(6), 441-449. https://dx.doi.org/10.1176/appi.ajgp.13.6.441.
  • Karttunen, K., Karppi, P., Hiltunen, A., Vanhanen, M., Välimäki, T., Martikainen, J., Valtonen, H., Sivenius, J., Soininen, H., Hartikainen, S., Suhonen, J., Pirttilä, T. (2011). Neuropsychiatric symptoms and quality of life in patients with very mild and mild Alzheimer’s disease. International Journal of Geriatric Psychiatry, 26(5), 473-482. https://dx.doi.org/10.1002/gps.2550.
  • Kroenke, K., Spitzer, R. L., Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606-613. https://dx.doi.org/10.1046/j.1525-1497.2001.016009606.x.
  • Kunik, M. E., Snow, A. L., Molinari, V. A., Menke, T. J., Souchek, J., Sullivan, G., Ashton, C. M. (2003). Health care utilization in dementia patients with psychiatric comorbidity. The Gerontologist, 43(1), 86-91. https://dx.doi.org/10.1093/geront/43.1.86.
  • Lyketsos, C. G., Lopez, O., Jones, B., Fitzpatrick, A. L., Breitner, J., DeKosky, S. (2002). Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: Results from the cardiovascular health study. JAMA, 288(12), 1475-1483. https://dx.doi.org/10.1001/jama.288.12.1475.
  • Malpass, A., Kessler, D., Sharp, D., Shaw, A. (2015). MBCT for patients with respiratory conditions who experience anxiety and depression: A qualitative study. Mindfulness, 6(5), 1181-1191. https://dx.doi.org/10.1007/s12671-014-0370-7.
  • McBee, L. (2009). Mindfulness-based elder care: Communicating mindfulness to frail elders and their caregivers. In Kabat-Zinn, J. (Ed.), Clinical handbook of mindfulness (pp. 431-445). Springer.
  • Medical Research Council . (2006). Developing and evaluating complex interventions: New guidance. MRC Health Services and Public Health Research Board.
  • Moore, K. M., Martin, M. E. (2015). Using MBCT in a chronic pain setting: A qualitative analysis of participants’ experiences. Mindfulness, 6(5), 1129-1136. https://dx.doi.org/10.1007/s12671-014-0363-6.
  • Moyle, W., Kellett, U., Ballantyne, A., Gracia, N. (2011). Dementia and loneliness: An Australian perspective. Journal of Clinical Nursing, 20(9–10), 1445-1453. https://dx.doi.org/10.1111/j.1365-2702.2010.03549.x.
  • National Institute for Clinical Excellence . (2009). Depression in adults: Recognition and management (CG90).
  • Orgeta, V, Qazi, A, Spector, AE, Orrell, M (2014). Psychological treatments for depression and anxiety in dementia and mild cognitive impairment. The Cochrane Database of Systematic Reviews, 2014(1), CD009125.
  • Paller, K. A., Creery, J. D., Florczak, S. M., Weintraub, S., Mesulam, M.-M., Reber, P. J., Kiragu, J., Rooks, J., Safron, A., Morhardt, D., O’Hara, M., Gigler, K. L., Molony, J. M., Maslar, M. (2015). Benefits of mindfulness training for patients with progressive cognitive decline and their caregivers. American Journal of Alzheimer’s Disease & Other Dementiasr, 30(3), 257-267. https://dx.doi.org/10.1177/1533317514545377.
  • Piet, J., Hougaard, E. (2011). The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: A systematic review and meta-analysis. Clinical Psychology Review, 31(6), 1032-1040. https://dx.doi.org/10.1016/j.cpr.2011.05.002.
  • Pinquart, M., Duberstein, P. R., Lyness, J. M. (2007). Effects of psychotherapy and other behavioral interventions on clinically depressed older adults: A meta-analysis. Aging & Mental Health, 11(6), 645-657. https://dx.doi.org/10.1080/13607860701529635.
  • Pope, C., Ziebland, S., Mays, N. (2000). Qualitative research in health care: Analysing qualitative data. BMJ, 320(7227), 114-116. https://dx.doi.org/10.1136/bmj.320.7227.114.
  • Quintana-Hernández, D. J., Miró-Barrachina, M. T., Ibáñez-Fernández, I. J., Pino, A. S.-d., Quintana-Montesdeoca, M. P., Rodríguez-de Vera, B., Morales-Casanova, D., Pérez-Vieitez, M. d. C., Rodríguez-García, J., Bravo-Caraduje, N. (2015). Mindfulness in the maintenance of cognitive capacities in Alzheimer’s disease: A randomized clinical trial. Journal of Alzheimer’s Disease, 50(1), 217-232. https://dx.doi.org/10.3233/jad-143009.
  • Rapp, M. A., Schnaider-Beeri, M., Wysocki, M., Guerrero-Berroa, E., Grossman, H. T., Heinz, A., Haroutunian, V. (2011). Cognitive decline in patients with dementia as a function of depression. The American Journal of Geriatric Psychiatry, 19(4), 357-363. https://dx.doi.org/10.1097/JGP.0b013e3181e898d0.
  • Schoultz, M., Macaden, L., Hubbard, G. (2016). Participants’ perspectives on mindfulness-based cognitive therapy for inflammatory bowel disease: A qualitative study nested within a pilot randomised controlled trial. Pilot and Feasibility Studies, 2(1), 3. https://dx.doi.org/10.1186/s40814-015-0041-z.
  • Segal, Z. V., Teasdale, J. D., Williams, J. M. G. (2004). Mindfulness-based cognitive therapy: Theoretical rationale and empirical status. In Hayes, S. C., Follette, V. M., Linehan, M. (Eds.), Mindfulness and acceptance: Expanding the cognitive-behavioural tradition (pp. 45-65).
  • Segal, Z. V., Williams, J. M. G., Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. Guilford Press.
  • Segal, Z. V., Williams, J. M. G., Teasdale, J. D., Kabat-Zinn, J. (2007). The mindful way through depression: Freeing yourself from chronic unhappiness. The Guildford Press.
  • Shin, I.-S., Carter, M., Masterman, D., Fairbanks, L., Cummings, J. L. (2005). Neuropsychiatric symptoms and quality of life in Alzheimer disease. The American Journal of Geriatric Psychiatry, 13(6), 469-474. https://dx.doi.org/10.1176/appi.ajgp.13.6.469.
  • Smith, A. (2004). Clinical uses of mindfulness training for older people. Behavioural and Cognitive Psychotherapy, 32, 423-430. https://dx.doi.org/10.1017/S1352465804001602.
  • Smith, A., Graham, L., Senthinathan, S. (2007). Mindfulness-based cognitive therapy for recurring depression in older people: A qualitative study. Aging & Mental Health, 11(3), 346-357. https://dx.doi.org/10.1080/13607860601086256.
  • Smith, E. L., Jones, F. W., Holttum, S., Griffiths, K. (2015). The process of engaging in mindfulness-based cognitive therapy as a partnership: A grounded theory study. Mindfulness, 6(3), 455-466. https://dx.doi.org/10.1007/s12671-014-0278-2.
  • Suh, G. H., Kil Yeon, B., Shah, A., Lee, J. Y. (2005). Mortality in Alzheimer’s disease: A comparative prospective Korean study in the community and nursing homes. International Journal of Geriatric Psychiatry, 20(1), 26-34. https://dx.doi.org/10.1002/gps.1256.
  • Teasdale, J. D., Segal, Z. A., Williams, J. M. G. (2003). Mindfulness training and problem formulation. Clinical Psychology: Science and Practice, 10(2), 157-160. https://doi.org/10.1093/clipsy.bpg017.
  • Winblad, B., Palmer, K., Kivipelto, M., Jelic, V., Fratiglioni, L., Wahlund, L.-O., Nordberg, A., Backman, L., Albert, M., Almkvist, O., Arai, H., Basun, H., Blennow, K., de Leon, M., DeCarli, C., Erkinjuntti, T., Giacobini, E., Graff, C., Hardy, J., Petersen, R. C. (2004). Mild cognitive impairment–Beyond controversies, towards a consensus: Report of the international working group on mild cognitive impairment. Journal of Internal Medicine, 256(3), 240-246. https://dx.doi.org/10.1111/j.1365-2796.2004.01380.x.
  • Williams, C. M., Meeten, F., Whiting, S. (2018). ‘I had a sort of epiphany!’ An exploratory study of group mindfulness-based cognitive therapy for older people with depression. Aging & Mental Health, 22(2), 208-217. https://dx.doi.org/10.1080/13607863.2016.1247415.
  • World Health Organization . (2006). Neurological disorders: A public health approach (dementia, epilepsy, headache disorders, multiple sclerosis, neuroinfections).