1 Unit for Psychooncology and Health Psychology, Aarhus University and Aarhus University Hospital, Denmark.
2 Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Denmark.
J Telemed Telecare. 2019 Sep;25(8):468-475. doi: 10.1177/1357633X18780563. Epub 2018 Jun 25.
Mindfulness-based cognitive therapy has been shown to reduce psychological distress in chronic obstructive pulmonary disease, but uptake and attendance rates of hospital-based, face-to-face mindfulness-based cognitive therapy are low. The present mixed-methods study evaluates the clinical feasibility of home-based, tele-delivered mindfulness-based cognitive therapy in chronic obstructive pulmonary disease.
Eight patients with chronic obstructive pulmonary disease (mean age: 72.6 years; 50% female) received a standardised eight-week mindfulness-based cognitive therapy programme delivered via home-based video-conferences in groups of four. Feasibility in relation to (a) clinical change, (b) attendance and (c) instructor-patient working alliance were evaluated with questionnaires and semi-structured interviews.
Statistically non-significant reductions in psychological distress (Cohen's = 0.504; = 0.399) and physical health status impairment ( = 0.743; = 0.156) were observed from pre- to post-intervention. Participant narratives about clinical outcomes focused on changes in how to relate to unpleasant sensations, i.e. through attentional flexibility, taking a pause and acceptance. The average attendance rate was 7.5 (standard deviation = 0.8) out of eight sessions and no participants dropped out. The tele-based format appeared to accommodate participants' planning difficulties and promoted their ability and wish to participate. Although participant narratives suggested the tele-based format to be a barrier to developing a trusting and safe therapeutic environment, working alliance questionnaire scores were comparable to those found for face-to-face mindfulness-based cognitive therapy.
The preliminary results indicate that tele-delivered mindfulness-based cognitive therapy is a clinically feasible intervention in chronic obstructive pulmonary disease. Future large-scale, randomised controlled trials testing its efficacy on the outcomes of psychological distress and physical health status should include analyses of potential mediators and moderators of the effect as well as and careful monitoring of attendance and adverse events.
正念认知疗法已被证明可以减轻慢性阻塞性肺疾病患者的心理困扰，但基于医院的面对面正念认知疗法的参与率和出勤率都很低。本混合方法研究评估了基于家庭的远程正念认知疗法在慢性阻塞性肺疾病中的临床可行性。
8 名慢性阻塞性肺疾病患者（平均年龄：72.6 岁；50%为女性）接受了标准化的八周正念认知疗法方案，通过家庭视频会议以四人小组的形式进行。通过问卷和半结构化访谈评估了与（a）临床变化、（b）出勤率和（c）治疗师与患者的工作联盟相关的可行性。
从干预前到干预后，心理困扰（Cohen's = 0.504； = 0.399）和身体健康状况受损（ = 0.743； = 0.156）均呈统计学上无显著降低。参与者关于临床结果的叙述重点是改变与不愉快感觉的关系，即通过注意力的灵活性、暂停和接受。平均出勤率为 8 次中的 7.5 次（标准差 = 0.8），没有参与者退出。远程格式似乎适应了参与者的计划困难，并促进了他们参与的能力和意愿。尽管参与者的叙述表明远程格式是建立信任和安全治疗环境的障碍，但工作联盟问卷得分与面对面正念认知疗法相当。
初步结果表明，远程正念认知疗法是慢性阻塞性肺疾病的一种临床可行的干预措施。未来的大规模、随机对照试验应包括对心理困扰和身体健康状况结果的疗效进行分析，以及对出勤率和不良事件进行仔细监测，同时分析潜在的中介因素和调节因素。
