Cavallero Fiamma, Gold Michael C, Tirrell Eric, Kokdere Fatih, Donachie Nancy, Steinfink Dan, Kriske Joseph, Carpenter Linda L
Butler Hospital TMS Clinic and Neuromodulation Research Facility, Providence, RI, United States.
Brown Department of Psychiatry and Human Behavior, Warren Alpert Medical School at Brown University, Providence, RI, United States.
Front Psychol. 2021 Aug 17;12:678911. doi: 10.3389/fpsyg.2021.678911. eCollection 2021.
Mindfulness-Based Cognitive Therapy (MBCT) has been shown to enhance the long-term treatment outcomes for major depressive disorder (MDD), and engagement of specific brain activities during brain stimulation may produce synergistic effects. Audio-guided meditation exercises are a component of MBCT that might be combined with standard transcranial magnetic stimulation (TMS) therapy sessions. We developed and pilot-tested a modified MBCT protocol for patients undergoing a standard course of TMS for MDD. Four MBCT audiotracks with differing durations and types of mental focus were selected. Patients listened to the audiotapes through headphones during daily TMS sessions for 5 consecutive weeks. The primary goal was to evaluate the feasibility and acceptability of the meditation intervention with TMS. Changes in self-rated measures of symptom severity, stress, life satisfaction, and mindfulness were also assessed. Seventeen depressed subjects completed the study and 12 terminated early. Reasons for discontinuation included an inability to meditate in the treatment setting and induction of negative mood states. TMS percussive sensations and clicking sounds hindered the ability of patients to fully concentrate on or hear the voice of the audiotape narrator. Some became overwhelmed or felt increased pressure, anxiety, or aggravation trying to do meditation exercises while receiving TMS. There is a growing interest in combining TMS with other concurrent psychotherapeutic interventions to optimize treatment outcomes. The results highlight numerous feasibility issues with MBCT guided audiotapes during TMS treatment. Future work should draw on these shortcomings to evaluate the appropriateness of MBCT for depressed patients undergoing neuromodulation.
基于正念的认知疗法（MBCT）已被证明可提高重度抑郁症（MDD）的长期治疗效果，并且在脑刺激过程中特定脑活动的参与可能会产生协同效应。音频引导的冥想练习是MBCT的一个组成部分，可以与标准经颅磁刺激（TMS）治疗疗程相结合。我们为接受MDD标准TMS疗程的患者开发并进行了一项改良MBCT方案的试点测试。选择了四个持续时间和心理专注类型不同的MBCT音轨。患者在每日TMS疗程中通过耳机连续5周收听这些录音带。主要目标是评估冥想干预与TMS结合的可行性和可接受性。还评估了症状严重程度、压力、生活满意度和正念的自评测量指标的变化。17名抑郁症患者完成了研究，12名提前终止。停药原因包括无法在治疗环境中进行冥想以及诱发负面情绪状态。TMS的敲击感和咔嗒声阻碍了患者完全集中注意力或听到录音带叙述者声音的能力。一些人在接受TMS时进行冥想练习时变得不堪重负或感到压力、焦虑或加重。将TMS与其他同时进行的心理治疗干预相结合以优化治疗效果的兴趣日益浓厚。结果突出了TMS治疗期间MBCT引导录音带存在的众多可行性问题。未来的工作应借鉴这些缺点来评估MBCT对接受神经调节的抑郁症患者的适用性。
