Friday, November 6, 2009

mediTation or mediCation: Well-Established Mindfulness Meditation Training Helps Kids in Psych Treatment Get Off Meds, Build Esteem

RCT study in JCCP: Well-established Mindfulness Meditation Treatment Helps Kids in Psych Treatment Get Off Meds.

THe study is: Biegel, Brown, Warren, Schubert, authors: Mindfulness-Based Stress Reduction for the treatment of adolescent psychiatric outpatients: A randomized clinical trial. Journal of Consulting and Clinical Psychology, 77, 5, October 2009, pages 855-866.

In short, the researchers took a group of adolescents who were refered to psychiatry specialty care in a large health care provider organization - Kaiser Permanente. The diagnostic problems were, bascailly, whatever came through the door - predominantly cases of depression, some cases of anxiety, some various other complaints.

The kids were randomized to the well-recognized Jon Kabat-Zinn developed MBSR (mindfulness-based stress reduction) or to usual care. This would typically end up being a mix of talk therapy, maybe family talk therapy, and some medication therapy. A hundred kids altogether, about fifity in each group. MBSR is explained and referenced well in the article. I have read the book and done MBSR-based treatment - their intervention is great from what I can tell.

So, the test ends up being: for a group of adolescents that is typical of cases seen in a mental health / psychiatric practice in a large health care organization, can mindfulness-based stress reduction lead to better outcomes than the usual?

The results? In brief, MBSR wins compared to care as usual. In other words, MBSR is a suitable treatment strategy for a general case load in a psychiatric practice. Depression scores improved more for MBSR than the usual care group. Also, MBSR was superior for anxiety, anger, and somatic symptoms. Across the board.

Is this a big deal? Maybe, maybe not. It does serve to expand the robustness of yet another psychosocial intervention. so, it helps me and other proclaim more strongly: you have plenty of options! You don't need to take psych drugs just because a DSM diagnosis fits!!

Here is the biggest deal, in my opinion:

**The MBSR got kids OFF of psych drugs.**

Without even trying. That was not a specific outcome of the study.

Not only did MBSR result in superior benfit across a whole set of outcomes, metioned above, but the kids in that group migrated away from psych drugs AND got even better than the other group. Double Play!

At baseline, about half in each group were taking psych drugs. At the beginning, 25 of those randomized to MBSR were on psych meds, while 20 in the usual-care group were on psych meds.

At completion, eight weeks later, the number of MBSR kids on psych drugs had gone down to 18. A 20% reduction. By the later follow-up assessment, the number of MBSR kids on psych drugs had gone lower, to 15. A 40% drop. From 25 to 15.

In the usual care group? No change. 20 to 22, reflecting increased psych drug use typically happens when you get referred, then to 19 at the follow-up assessment. I guess if you get out your calculator, you will see that there was, technically, a 5% reduction in meds, since one person fewer, out of 20, was on psych meds at the follow-up point.

Five percent or forty percent: you be the judge. Meds vs. therapy. Therapy wins this one.


**Also, another cool outcome**

While symptom change, what changes IN the kids? Sure we measure change, but what is going on?

Well, you think about it: you go for help for depression or anxiety, or whatever. You get given meds, or someone trains you in stress management. Either way, your symptoms get better.

What is your view of your problem and solution? If you get cured with meds, you figure: I have a biologically based brain disorder; without meds I am at risk of not being able to cope with whatever life brings me. For the rest of my life. I used to believe I was half-way OK, but now I know I am diseased, and need meds to be normal.

OR:

You learn skills, and you figure: I was lacking some skills to cope with life, and now I have been trained; I am better able to cope with whatever life brings me. For the rest of my life. I did it, and I can do it. There was not something wrong with me, I just lacked a skill set I needed, just like going through Driver's Ed.

Myself, I believe it is preferrerd for a kid to have good outcomes AND believe they are prepared for the future, versus believing, FALSELY, that they are diseased and are dependent on meds for the rest of their life. Hey, call me crazy. I am sure some people are comforted to know they can take a pill and get relief. Me, not so much.

I don't know what the kids are thinking. But I believe this interpretation of the nature of the problem is one dimension that shows us we should generally favor talk therapy if it seems indicated whatsoever, before meds.

In this study, evidence supporting my belief: self-esteem IMPROVED for the MBSR group, where med use dropped 40%, but got slightly worse for the usual care group, where med use was the same.

---It would be interesting to see an after-the-fact analysis: noting the influence of med use upon self-esteem, across the two groups, along with the main finding of MBSR being superior to usual care, which holds status quo with meds.

Thanks for listening. This analysis of the results will probably be found nowhere else, but is probably the result that has the most potential to really suport a change in every day practice for these kids.

1 comment:

Mindfulness111 said...

Happy to see that the scientific community is paying attention to the benefits of mindfulness with children