project uplift

Main Outcome Results

November 6, 2009Nancy J. Thompson, Ph.D., M.P.H.

Using Practice and Learning to Increase Favorable Thoughts

Project UPLIFTDelivery of MBCT by Web and Telephone Groups

To people with epilepsyRandomly assigned to groups of 7Computers and Internet access provided if neededGroups used for support surrounding Epilepsy

8 SessionsFacilitators

Peers and Graduate StudentsSupervised by a licensed psychologist

Funding: Centers for Disease Control and Prevention

Session # Topic

1 Monitoring Thoughts

2 Challenging and Changing Thoughts

3 Coping and Relaxing

4 Attention and Mindfulness

5 The Present as a Calm Place

6 Thoughts as Changeable and Impermanent

7 Pleasure and Reinforcement

8 Relapse Action Plans

The 8 Sessions

Each Session•Check-in•Teaching•Group Exercise•Discussion•Skill-building w/ discussion•Review & Homework

Design

Stratum 1: Pretest 2 gp 8 wk phone Interim Follow-up

Stratum 2: Pretest 2 gp 8 wk Web Interim Follow-up

Stratum 3: Pretest Interim 2 gp 8 wk phone Follow-up

Stratum 4: Pretest Interim 2 gp 8 wk Web Follow-up

Baseline Week 8 Week 16

Emphasis on Feasibility and Acceptability

Cross-over Design to Explore Effectiveness

Results

ParticipationScreened (n=98)

Excluded (n=34) Eligible (n=53)

Assessments Completed Baseline (n=48) Completed Interim Survey (n=40) Completed Third Survey (n=35)

Participated in at least one session Phone Intervention Group (n=12) Web Intervention Group (n=10) Phone Waitlist Group (n=10) Web Waitlist Group (n=10)

40 (75.5%) participated and completed the assessment following their participation

Data AnalysisBaseline Differences

Only mean Self Compassion was statistically significant (t = 3.00, df = 38, p = 0.005) Intervention group (mean = 19.7) Waitlist group (mean = 16.0)

Repeated Measures ANCOVAAssess the change in scores over time in the

intervention and the waitlist groupsControlled all analyses for Self Compassion

Depression Measures

Measure Time Intervention

(Mw/ outliers)

Treatment-

as-Usual

Waitlist

(Mw/ outliers)

Outliers Included Outliers Deleted

Finteraction

(df 1,37)

p-value Finteraction

(df 1,36)

p-value

BDI Pretest

Interim

15.2

5.5

12.4

10.6

11.99 0.001** 12.97 0.001**

mBDI Pretest

Interim

31.1

19.5

27.9

25.9

10.08 0.003** 10.67 0.002**

Depression: mBDITreatment vs. Waitlist

Foverall = 40.93, p=.0001

Finteraction = 10.14, p=.003*

Phone vs. Web vs. WaitlistFoverall = 40.11, p=.0001

Finteraction = 4.99, p=.012*

Depression: BDI

Treatment vs. WaitlistFoverall = 42.22,

p=.0001Finteraction = 11.99,

p=.001*

Depression: BDI By Intervention Type

• Phone vs. Web vs. WaitlistFoverall = 41.65,

p=.0001Finteraction = 5.93,

p=.006*

Effect by Presence of MDD

Measure Time

Intervention Waitlist

Finteractiondf p-valueno

MDDMDD

no

MDDMDD

BDIPretest

Interim

9.2

1.8

18.8

7.8

8.7

9.0

23.8

16.2

5.4731

1.2092

3,35

1,35

0.025*

0.279

mBDIPretest

Interim

23.4

14.3

35.9

23.0

24.0

24.0

40.7

32.6

4.8201

0.6512

3,35

1,35

0.035*

0.421

* < .051Time by Condition2Time by Condition by MDD

Maintenance of Effects

Measure Time InterventionTreatment

-as-Usual

Waitlist

F df p-value

BDI Pretest

Interim

Posttest

14.5

4.6

5.7

13.4

10.8

8.3

0.121

7.541

1.124

1,30

1,30

1,30

0.730

0.010*

0.297

mBDI Pretest

Interim

Posttest

30.0

18.2

18.2

29.5

26.0

21.0

0.018

6.026

0.406

1,30

1,30

1,30

0.895

0.020*

0.529

* < .05

Knowledge/Skills & Self-Efficacy

Measure Time Intervention TAU Waitlist

Finteraction

df 1,37

P-value

Knowledge/Skills

Pretest

Interim

122.5

136.3

123.5

126.04.75 0.036*

Depression Coping

Self-Efficacy

Pretest

Interim

67.7

75.5

72.4

72.93.59 0.066

Knowledge & SkillsTreatment vs. TAU

WaitlistFoverall = 8.97, p=.005

Finteraction = 4.75, p=.036*

Phone vs. Web vs. WaitlistFoverall = 9.67, p=.004

Finteraction = 3.67, p=.036*

Depression Coping Self-Efficacy

Treatment vs. WaitlistFoverall = 6.89,

p=.013Finteraction = 3.59,

p=.066

Quality of LifeMeasure Time Intervention

Tx As Usual Waitlist

Finteraction

df 1,37

P-value

Satisfaction with Life

Pretest

Interim

18.2

21.0

18.3

18.03.029 0.0901

Mental Health QOL

Pretest

Interim

59.3

80.9

65.4

83.60.123 0.727

Physical Health QOL

Pretest

Interim

68.9

78.9

76.2

80.80.496 0.486

1.05<p<.10

Satisfaction with Life

Treatment vs. WaitlistFoverall = 4.52,

p=.040Finteraction = 3.03,

p=.090

Mental Health QOLTreatment vs. Waitlist

Foverall = 16.07, p=.0001

Finteraction = 0.12, p=.727

Phone vs. Web vs. WaitlistFoverall = 15.10, p=.0001

Finteraction = 0.50, p=.609

Physical Health QOLTreatment vs. Waitlist

Foverall = 3.99, p=.053

Finteraction = 0.50 , p=.486

Phone vs. Web vs. WaitlistFoverall = 3.83, p=.058

Finteraction = 0.31, p=.737

SummaryEffective in:

Reducing depressive symptoms and teaching knowledge and skills associated with reducing depression Intervention group showed significant improvement

compared to the waitlist Equally effective for those with and without MDD Reduction in depressive symptoms maintained

Approaching significance for Satisfaction with Life and Depression Coping Self-Efficacy

DeliveryBoth phone and web were significantly more effective

in reducing depression than waitlist condition

SummaryQOL Findings consistent with the premises of

mindfulnessthat suffering is not something to turn away

from or something in need of fixing, that it is worthy of attention, that through attention we can see the ways in

which we attach thoughts to the suffering that exacerbate it, and

that letting go of these thoughts reduces suffering (Segal et al.)

Going Forward~$1 million Challenge GrantUPLIFT for PreventionParticipants in 4 states

GeorgiaMichiganTexasWashington