Download - 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