What Works in Mindfulness Interventions for Medically Unexplained Symptoms? A Systematic Review (2020)Billones and Saligan

What Works in Mindfulness Interventions for Medically Unexplained Symptoms? A Systematic Review
Billones, Saligan

Note: Dr Saligan is involved in the NIH study with Dr Nath


Link to paper here



Abstract

Background/Purpose:

Mindfulness-based interventions (MBIs) have been used in medically unexplained symptoms (MUS). This systematic review describes the literature investigating the general effect of MBIs on MUS and identifies the effects of specific MBIs on specific MUS conditions.

Methods:

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis Guidelines (PRISMA) and the modified Oxford Quality Scoring System (Jadad score) were applied to the review, yielding an initial 1,556 articles. The search engines included PubMed, ScienceDirect, Web of Science, Scopus, EMBASE, and PsychINFO using the search terms: mindfulness, or mediations, or mindful or MBCT or MBSR and medically unexplained symptoms or MUS or Fibromyalgia or FMS. A total of 24 articles were included in the final systematic review.

Results/Conclusions:

MBIs showed large effects on: symptom severity (d = 0.82), pain intensity (d= 0.79), depression (d = 0.62), and anxiety (d = 0.67). A manualized MBI that applies the four fundamental elements present in all types of interventions were critical to efficacy. These elements were psycho-education sessions specific to better understand the medical symptoms, the practice of awareness, the nonjudgmental observance of the experience in the moment, and the compassion to ones' self. The effectiveness of different mindfulness interventions necessitates giving attention to improve the gaps that were identified related to home-based practice monitoring, competency training of mindfulness teachers, and sound psychometric properties to measure the mindfulness practice.

Keywords: cancer; chronic fatigue syndrome; fatigue; fibromyalgia; irritable bowel movement syndrome; mindfulness; pain. (Bolding mine: seriously?)

 

Beyond the abstract, here is the first 2 paragraphs:

Medically unexplained symptoms (MUS) are subjective symptoms that last for more than 3 months and cause a loss of function with little or absent pathology. Patients with MUS spend $256 billion a year on direct health care in the United States (Barsky, Orav, & Bates, 2005; Burton, McGorm, Richardson, Weller, & Sharpe, 2012) and visit both primary and secondary care centers nearly twice as often as patients without MUS (Barsky et al., 2005; Burton et al., 2012; Page & Wessely, 2003).

MUS have complex predisposing (e.g., genetics, experience, and personality trait), precipitating (e.g., life event, stressors, virus), and perpetuating (e.g., sensitization and the hypothalamus pituitary adrenal axis [HPA axis], cognitive and behavioral inhibitor, attention, belief, and response to illness) factors (Deary, Chalder, & Sharpe, 2007). Current management for MUS includes antidepressants and nonpharmacological interventions such as cognitive behavioral therapy (CBT) and mindfulness-based interventions (MBIs), which show small to moderate effectiveness (Bellato et al., 2013; Herwig, Kaffenberger, Jäncke, & Brühl, 2010; Hofmann, Sawyer, Witt & Oh, 2010).

Wessely, Sharpe and Chalder quoted front and center.

 

I initially misread the thread title as :

"What Works in Mindless Interventions for Medically Unexplained Symptoms?"

Having read the thread now I think my misreading was more accurate than the actual title.

 

I could draw a cartoon about an irritable bowel movement.

 

I believe they mean "irritable bowel syndrome", it's often described as functional.

 

Sure, buddy. Who needs self-consistency? Or consistency? Or substance? Woo, woo.

The involvement of quacks at the NIH study may explain its utter uselessness to this point. Why are quacks involved? For what purpose?

 

This is just a guess but I suspect there is little reliable evidence for mindfullness therapy for any of these disorders, probably mostly preliminary studies. If you combine al lot of disorders that have little in common except being poorly understood then you get quite few of these studies. It makes reviews of behavioral interventions look more impressive. No need for replications or large and and well conducted trials, you can just take a study from another poorly understood condition and add up the results in a review to justify the behavioral intervention of choice.

Another benefit might be that these MUS reviews are so broad in scope that few researchers know all the trials in it. That makes it harder to point out if the conclusion makes sense or not.

 

Well yes, the BPS movement is intensely irritating.

 

It is rather silly when BPS scientists try and sound knowledgeable about all the conditions science doesn't understand. More ego preening than science.

 

It looks like the last line was added in order to get it published in the "Asian/Pacific Island Nursing Journal"

A lot of Saligans papers are related to fatigue. I can see no reason he suddenly goes off and does this.......
https://pubmed.ncbi.nlm.nih.gov/?term=Saligan+L&cauthor_id=32704524

 

I was wondering why it appeared in this journal. I mean, it's not exactly at the top of the heap. How many rejections did they have?

 

Sigh.

I wonder how many types of CBT and/or different therapists one should try before deciding this isn't working.

 

Although I don't know the answer to your question, this seems a very valid observation. A pilot study surely is purely to identify whether a more meaningful, properly powered study should be done. Pilot studies are, almost by definition, under powered and not fit for purpose as anything other than piloting feasibility for a possible future study.

 

Doubtful that anyone outside the circle jerk reads the psychosomatic journals so probably one way to try to reach outside the mutual admiration society.

It must get tiring to always say the same things to the same crowds, no? I get that this is what defines belief systems but, still, how do they not tire of saying the exact same things with tiny style variations over and over again to the same people over and over again? At this point if it wasn't for tools to find plagiarism, I don't doubt that decades-old articles could be republished as is, the ideas and arguments are the exact same they've ever been.

 

I think ego preening is a bit of an addiction. The more you do it the more you need to do it.