Mindfulness-Based Stress Reduction to Improve Neuropsychological Functioning in Acquired Brain Injury
Condition: Stroke
MeSH terms: Brain Injuries
Study type: Interventional

Summary: 
      Thousands of Veterans suffer a stroke every year, and these individuals often suffer
      emotional and cognitive changes that negatively affect their quality of life as well as their
      ability to recover. In addition to traditional rehabilitation such as physical and
      occupational therapy, a number of alternative treatments are now being studied for their
      ability to enhance patients' recovery following stroke. One of these treatments,
      Mindfulness-Based Stress Reduction or MBSR, involves an 8-week course that teaches
      individuals strategies such as breathing techniques, meditation, and movement therapy. The
      current study proposes to teach MBSR to a group of Veterans with a history of stroke to
      determine whether this type of intervention has beneficial effects on psychological and
      cognitive functioning. The investigators hope to find that MBSR is a useful, additional
      intervention that can improve Veterans' well-being and quality of life as they recover from
      stroke.
    

Detailed description: 
      Stroke affects approximately 800,000 Americans every year, including thousands of Veterans,
      and is a leading cause of disability in the US. While many stroke patients receive
      rehabilitation during the acute and post-acute phases of stroke, many individuals suffer
      chronic deficits and have few options for continued treatment. A number of low-cost,
      alternative treatments are now being tested for their usefulness in treating
      neuropsychological deficits in chronic stroke patients. One of the best studied of these
      treatments is Mindfulness-Based Stress Reduction (MBSR), which involves an 8-week course led
      by a trained instructor. MBSR teaches individuals strategies for coping with their injury,
      such as meditation, breathing techniques, and yoga. A handful of preliminary studies have
      shown that MBSR is effective in reducing symptoms of anxiety and depression in stroke
      patients, as well as enhancing performance on cognitive tasks. However, only a single
      randomized controlled trial of MBSR in stroke has been published to date, and that study
      suffered from a number of weaknesses such as the lack of an active control group. Moreover,
      no previous study has assessed the usefulness of MBSR for stroke in a Veteran population.
      Therefore, the current study proposes to undertake a rigorous, randomized controlled trial of
      MBSR in Veterans with a history of stroke, using an active control group, blinded examiners,
      and a 6-month follow-up session to determine whether the benefits of MBSR are long-lasting.
      For the study, 120 Veterans with a history of chronic stroke will be recruited: 60
      participants will be randomly assigned to the MBSR intervention, and 60 participants will be
      assigned to a Brain Health class that is matched to the MBSR intervention with respect to the
      instructor, number of hours of instruction, homework activities, and class size. A blinded
      examiner will complete a neuropsychological assessment of patients' emotional and cognitive
      status at three time points: 1) prior to the intervention, 2) following the intervention, and
      3) six months later. Evaluation of the MBSR intervention will test for improvements in
      anxiety and depressive symptomatology following the intervention, relative to the Brain
      Health group, as well as improvements on a cognitive test battery. It is predicted that
      improvements associated with the MBSR intervention will still be present at the 6-month
      follow-up assessment as well. The final objective of the current proposal is to determine
      whether the site of a patient's stroke plays a role in their ability to benefit from MBSR.
      Previous research has suggested that left prefrontal cortex plays a critical role underlying
      the effects of MBSR. Thus, it is predicted that involvement of this brain region will
      modulate the observed effects. Such information could be used to target those Veterans who
      can most benefit from the proposed intervention. If shown to be effective, MBSR could provide
      a low-cost, non-invasive rehabilitative treatment for Veterans with acquired brain injury
      that can improve their neuropsychological functioning and general sense of well-being.
    

Intervention name(s): Mindfulness-based Stress Reduction; Brain Health Education
Intervention type(s): Behavioral; Behavioral
Intervention description(s): 8-week Mindfulness-based Stress Reduction class that trains participants in mindfulness, meditation, and yoga.; 8-week Brain Health education class that teaches participants about brain-behavior relationships, nutrition, aging facts, sleep, and memory.
Other intervention name(s): MBSR
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Participants are assigned to either the MBSR or Brain Health education class, in parallel for the duration of the study.
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: stroke; MBSR; meditation; mindfulness; yoga