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

M

Milo

Senior Member (Voting Rights)
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?)
 
Last edited:
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.
 
Milo said:
Note: Dr Saligan is involved in the NIH study with Dr Nath
Click to expand...
How much exposure has Dr Saligan had to people with ME/CFS on the trial? What involvement will they have in the analysis and presentation of the trial data?

It's incredible that this sort of lazy drivel is still being presented as scientific fact. I'm sure we can pull it all apart, and we probably should. It's very frustrating to see this sort of stuff still coming from people with influence.
 
The authors clearly see CFS as a somatisation disorder:
this study said:
A systematic review on the effectiveness of MBI in improving symptoms of FMS, CFS, IBS, and non-specified/mixed somatization disorder reported an overall small to moderate effect size of MBIs on reducing pain, symptoms severity, depression and anxiety, and improving overall quality of life among patients with these somatization disorders compared to controls
Click to expand...

None of the studies reviewed were specifically on people with ME/CFS or even CFS. But presumably, because it's a somatisation disorder, it's fine to assume what works for other MUS will work for CFS.
this study said:
Of the studies reviewed, eight enrolled fibromyalgia patients, eight enrolled irritable and inflammatory bowel syndrome subjects, and five studies enrolled participants with chronic back pain (n  = 342), one Gulf War illness (n  = 55), one PTSD (n  = 35), and one unclassified MUS (n  = 87).
Click to expand...

I'm a bit surprised to see 'inflammatory bowel syndrome' included in a MUS study. If they mean inflammatory bowel disease, then conditions in this category aren't functional. I don't think inflammatory bowel syndrome is really a thing.
CDC said:
Inflammatory Bowel Disease (IBD) Inflammatory Bowel Disease (IBD) is a broad term that describes conditions characterized by chronic inflammation of the gastrointestinal tract. The two most common inflammatory bowel diseases are ulcerative colitis and Crohn's disease.
Click to expand...
 
Hutan said:
The authors clearly see CFS as a somatisation disorder:


None of the studies reviewed were specifically on people with ME/CFS or even CFS. But presumably, because it's a somatisation disorder, it's fine to assume what works for other MUS will work for CFS.


I'm a bit surprised to see 'inflammatory bowel syndrome' included in a MUS study. If they mean inflammatory bowel disease, then conditions in this category aren't functional. I don't think inflammatory bowel syndrome is really a thing.
Click to expand...
I believe they mean "irritable bowel syndrome", it's often described as functional.
 
Hutan said:
I'm sure we can pull it all apart, and we probably should
Click to expand...
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.
 
It looks like the last line was added in order to get it published in the "Asian/Pacific Island Nursing Journal"
The findings of this review are particularly informative for the Asian/Pacific Islander population who have historically been linked to increase use of complementary and alternative therapies such as MBIs (Nadin et al., 2007).
Click to expand...

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
 
Midnattsol said:
I believe they mean "irritable bowel syndrome", it's often described as functional.
Click to expand...
One of the 24 papers is Berrill et al. 'Mindfulness-based therapy for inflammatory bowel disease patients with functional abdominal symptoms or high perceived stress levels'. So, those people actually did have inflammatory bowel disease, but were judged to be complaining about things more than was appropriate.

Seven of the 24 papers were about IBS. It's notable that Ljotsson et al had three papers included, one in 2010 titled 'open pilot study'; another one in 2010 titled 'a randomised controlled trial'; and another one in 2011 titled 'long term followup'. so, it looks extremely likely that a single study contributed three data sets, in a sample of 24 trials.

Despite the bit I quoted before
Of the studies reviewed, eight enrolled fibromyalgia patients, eight enrolled irritable and inflammatory bowel syndrome subjects, and five studies enrolled participants with chronic back pain (n  = 342), one Gulf War illness (n  = 55), one PTSD (n  = 35), and one unclassified MUS (n  = 87).
Click to expand...
which seemed to suggest that no CFS studies were included, Table 2, which lists the studies but is almost impossible to read, includes a CFS study. This is, I think, Rimes and Wingrove 2011, 'Mindfulness-based cognitive therapy for people with chronic fatigue syndrome still experiencing excessive fatigue after CBT, a pilot randomised study'.
 
Hutan said:
One of the 24 papers is Berrill et al. 'Mindfulness-based therapy for inflammatory bowel disease patients with functional abdominal symptoms or high perceived stress levels'. So, those people actually did have inflammatory bowel disease, but were judged to be complaining about things more than was appropriate.

Seven of the 24 papers were about IBS. It's notable that Ljotsson et al had three papers included, one in 2010 titled 'open pilot study'; another one in 2010 titled 'a randomised controlled trial'; and another one in 2011 titled 'long term followup'. so, it looks extremely likely that a single study contributed three data sets, in a sample of 24 trials.
Click to expand...
Sigh.

Hutan said:
Despite the bit I quoted before

which seemed to suggest that no CFS studies were included, Table 2, which lists the studies but is almost impossible to read, includes a CFS study. This is, I think, Rimes and Wingrove 2011, 'Mindfulness-based cognitive therapy for people with chronic fatigue syndrome still experiencing excessive fatigue after CBT, a pilot randomised study'.
Click to expand...
I wonder how many types of CBT and/or different therapists one should try before deciding this isn't working.
 
Hutan said:
Table 2, which lists the studies but is almost impossible to read, includes a CFS study. This is, I think, Rimes and Wingrove 2011, 'Mindfulness-based cognitive therapy for people with chronic fatigue syndrome still experiencing excessive fatigue after CBT, a pilot randomised study'.
Click to expand...

A question: Is it normal to include pilot studies in systematic reviews? I thought pilot studies were done with very small patient samples in order to see whether there is any point doing a fully powered study, not to provide data that can be combined with other underpowered studies to make conclusions.
 
Trish said:
A question: Is it normal to include pilot studies in systematic reviews? I thought pilot studies were done with very small patient samples in order to see whether there is any point doing a fully powered study, not to provide data that can be combined with other underpowered studies to make conclusions.
Click to expand...
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.
 
dave30th said:
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?
Click to expand...
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.
 
rvallee said:
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?
Click to expand...
I think ego preening is a bit of an addiction. The more you do it the more you need to do it.
 
You must log in or register to reply here.
Back
Top Bottom