Chesin Megan S, Benjamin-Phillips Christopher A, Keilp John, Fertuck Eric A, Brodsky Beth S, Stanley Barbara
1 Department of Psychology, William Paterson University , Wayne, NJ.
2 Molecular Imagining and Neuropathology Division, New York State Psychiatric Institute , New York, NY.
J Altern Complement Med. 2016 Aug;22(8):642-9. doi: 10.1089/acm.2015.0351. Epub 2016 Jun 15.
To test changes to cognitive functioning among high-suicide risk outpatients participating in an adjunct mindfulness-based intervention combining mindfulness-based cognitive therapy and safety planning (MBCT-S).
Ten outpatients with a 6-month history of suicide attempt or active suicidal ideation plus suicidal ideation at study entry received 9 weeks of adjunct group-based MBCT-S. Executive attention, sustained attention, visual memory, and semantic memory encoding were measured by neuropsychological assessment. Rumination, mindfulness, cognitive reactivity (defined as the tendency towards depressogenic information processing and thought content in response to mild mood deterioration), and self-compassion were assessed using self-report measures. Changes in pre- to post-treatment functioning on these constructs were analyzed by using dependent t-tests. Where significant improvements were found, correlations between changes to cognitive functioning and depression and suicidal ideation during treatment were calculated.
Executive attention improved with MBCT-S in high-suicide risk outpatients (Stroop interference effect = 0.39 [standard deviation (SD), 27] at baseline and 0.27 (SD, 0.15) at post-treatment, t[9] = 2.35, p = 0.04, d = 0.75). One mindfulness skill, acting with awareness, increased with MBCT-S (average change in Five Facet Mindfulness Questionnaire-acting with awareness subscale score with treatment, 3.3 [SD, 3.0], t[9] = 3.46, p < 0.01, d = 1.1). Self-reported rumination and cognitive reactivity to suicidality and hopelessness decreased among participants (Ruminative Responses Brooding subscale score change, -3.4 [SD, 1.1], t[9] = 10, p < 0.001, d = 3.2; Leiden Index of Depression Sensitivity-Revised-Hopelessness/Suicidality subscale score change, -3 [SD, 2.7], t[9] = 3.56, p < 0.01, d = 1.1). None of these changes were related to improvements in depression or reductions in suicidal ideation during treatment.
Findings from the present pilot study suggest that treatment with MBCT-S may improve cognitive deficits specific to suicide ideators and attempters among depressed patients. Future controlled trials using follow-up assessments are needed to determine the specificity of these improvements in cognitive functioning to MBCT-S and their durability and to formally test whether the observed improvements in cognitive functioning explain MBCT-S treatment gains.
测试参与一项基于正念的辅助干预（该干预结合了基于正念的认知疗法和安全计划，即MBCT-S）的高自杀风险门诊患者的认知功能变化。
10名有6个月自杀未遂史或有积极自杀意念且在研究开始时仍有自杀意念的门诊患者接受了为期9周的基于小组的MBCT-S辅助治疗。通过神经心理学评估来测量执行注意力、持续注意力、视觉记忆和语义记忆编码。使用自我报告量表评估沉思、正念、认知反应性（定义为在轻度情绪恶化时对致抑郁信息处理和思维内容的倾向）和自我同情。使用相关样本t检验分析这些指标在治疗前到治疗后的功能变化。在发现有显著改善的情况下，计算治疗期间认知功能变化与抑郁及自杀意念变化之间的相关性。
在高自杀风险门诊患者中，MBCT-S改善了执行注意力（基线时斯特鲁普干扰效应 = 0.39 [标准差（SD），27]，治疗后为0.27 [SD，0.15]，t[9] = 2.35，p = 0.04，d = 0.75）。一种正念技能，即有意识地行动，随着MBCT-S而增加（五因素正念问卷 - 有意识地行动子量表得分随治疗的平均变化为3.3 [SD，3.0]，t[9] = 3.46，p < 0.01，d = 1.1）。参与者的自我报告的沉思以及对自杀和绝望的认知反应性降低（沉思反应 - 沉思子量表得分变化，-3.4 [SD，1.1]，t[9] = 10，p < 0.001，d = 3.2；莱顿抑郁敏感性指数 - 修订版 - 绝望/自杀子量表得分变化，-3 [SD，2.7]，t[9] = 3.56，p < 0.01，d = 1.1）。这些变化均与治疗期间抑郁的改善或自杀意念的减少无关。
本初步研究的结果表明，MBCT-S治疗可能改善抑郁症患者中自杀意念者和自杀未遂者特有的认知缺陷。未来需要使用随访评估的对照试验来确定这些认知功能改善对MBCT-S的特异性及其持久性，并正式测试观察到的认知功能改善是否能解释MBCT-S的治疗效果。
