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

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Project UPLIFT. Main Outcome Results November 6, 2009 Nancy J. Thompson, Ph.D., M.P.H. U sing P ractice and L earning to I ncrease F avorable T houghts. Project UPLIFT. Delivery of MBCT by Web and Telephone Groups To people with epilepsy Randomly assigned to groups of 7 - PowerPoint PPT Presentation

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Page 1: Project UPLIFT

Main Outcome Results

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

Page 2: Project UPLIFT

Using Practice and Learning to Increase Favorable Thoughts

Page 3: Project UPLIFT

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

Page 4: Project UPLIFT

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

Page 5: Project UPLIFT

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

Page 6: Project UPLIFT

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

Page 7: Project UPLIFT

Results

Page 8: Project UPLIFT

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

Page 9: Project UPLIFT

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

Page 10: Project UPLIFT

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**

Page 11: Project UPLIFT

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*

Page 12: Project UPLIFT

Depression: BDI

Treatment vs. WaitlistFoverall = 42.22,

p=.0001Finteraction = 11.99,

p=.001*

Page 13: Project UPLIFT

Depression: BDI By Intervention Type

• Phone vs. Web vs. WaitlistFoverall = 41.65,

p=.0001Finteraction = 5.93,

p=.006*

Page 14: Project UPLIFT

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

Page 15: Project UPLIFT

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

Page 16: Project UPLIFT

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

Page 17: Project UPLIFT

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*

Page 18: Project UPLIFT

Depression Coping Self-Efficacy

Treatment vs. WaitlistFoverall = 6.89,

p=.013Finteraction = 3.59,

p=.066

Page 19: Project UPLIFT

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

Page 20: Project UPLIFT

Satisfaction with Life

Treatment vs. WaitlistFoverall = 4.52,

p=.040Finteraction = 3.03,

p=.090

Page 21: Project UPLIFT

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

Page 22: Project UPLIFT

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

Page 23: Project UPLIFT

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

Page 24: Project UPLIFT

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.)

Page 25: Project UPLIFT

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

GeorgiaMichiganTexasWashington