Mindfulness Based Cognitive Therapy for Depression and Cognitive Inhibition in Suicide
Condition: Depression, Anxiety
MeSH terms: Depression; Depressive Disorder; Suicide
Study type: Interventional
Phase: Early Phase 1

Summary: 
      Background: According to the World Health Organization, one million people die by suicide
      each year worldwide and the rate of attempted suicide is ten times greater. A less known fact
      is that suicide is 3 times more frequent in elderly adults compared to younger counterpart.
      Unfortunately, predicting and preventing suicidal behaviours (SB) in general, and in elderly
      in particular, remain difficult. Clinical, biological and genetic data suggests that SB may
      be best understood according to a stress-vulnerability model where, more vulnerable
      individuals are at increased risk of committing a suicidal act when experiencing (mostly
      social) stress. Vulnerability to SB has also been associated with specific (i.e. distinct
      from comorbid psychiatric disorders like depression) neurocognitive alterations. However, the
      neurocognitive basis of suicidal behavior in elderly has been more rarely investigated.

      Aim: Mindfulness based cognitive therapy (MBCT) has been successfully used to treat many
      psychiatric symptoms in many different populations, given that this therapy reduces cognitive
      creativity. Thus, this pilot study aims at addressing the SB in older adults with a Modified
      Mindfulness Based Cognitive Therapy (MMBCT).

      Hypotheses: We hypothesise that MMBCT is not only a feasible intervention in older people
      with SB, but also, effective to treat depressive symptoms and suicidal ideation.
      Additionally, we will explore the changes in cognitive testing.

      Methods: This is a pilot randomized controlled trial of a MMBCT tailored to older adults with
      depression and suicidal behaviors at the Douglas Mental Health University Institute. Patients
      with depression Hamilton Depression Rating Scale (HAM-D) >10 and suicidal ideation (Scale for
      Suicide Ideation [SSI] score ≥1) will be randomized to MMBCT or usual care. The meditation
      intervention will involve doing seated 90minute/week meditation exercises for 8 weeks. The
      primary outcomes will examine feasibility and acceptability of the treatment. The secondary
      outcome measures will scores in HAM-D and we will control for any important covariates
      differing between groups, (e.g. age, sex, # medical illnesses).

      Perspectives: Implementation of these interventions could potentially prevent many
      consultations to psychiatry/mental health professionals. Increase quality of life, decrease
      medical comorbidity, illness and mortality. [2] Taken together, in our rapidly aging
      population, this could translate to substantial savings in health costs.
    


Intervention name(s): Mindfulness Based Cognitive Therapy
Intervention type(s): Behavioral
Intervention description(s): The 8-week MMBCT protocol combines the practice of specific meditation techniques with cognitive therapy principles applicable to anxiety and depression. Each session will cover a meditation practice, as well as a relevant topic for discussion. The initial sessions will introduce general concepts of mindfulness (non-judgemental awareness, being in the moment, fostering curiosity, etc.), which will be expanded to more elaborate notions that are particularly relevant to anxiety, depression and suicidal ideations (recognizing thoughts are not facts, cultivating loving kindness for oneself, improving communication with others, etc.) Participants will be encouraged to practice the mindfulness techniques between sessions, a process that will be reviewed during groups in an ongoing fashion.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment