Review of: Wetherell JL et al, J Clin Psychiatry;78(7):e734–e743

Mindfulness-based stress reduction (MBSR) is a formalized combination of mindfulness meditation, body awareness, and yoga. The technique has been shown to help with symptoms of depression and anxiety, and some preliminary small studies have hinted that it might improve both memory and anxiety/depressive symptoms in older patients. Here, researchers conducted a larger study to better see if MBSR might be helpful for older patients.

This study recruited 103 adults age 65 or older, all with anxiety or depressive disorders and with subjective age-related neurocognitive difficulties. Subjects with any dementia or serious medical illness were excluded, as were those with a lifetime history of bipolar disorder or psychosis, or with a history of alcohol or substance abuse within the last 6 months. The study participants were assigned randomly to an intervention: either 8 weeks of MBSR (n = 47) or 8 weeks of a similar manualized health education control group (n = 56), with follow-ups at 3 and 6 months. In both study arms, patients received treatment in small-group formats (5–8 people per class), and the outcome ratings were single-blinded, with the study raters unaware of which participants had which interventions.

At the end of the study period, MBSR participants improved significantly more on the measure of memory than controls, though the two groups did not differ in their subjective perception of cognitive performance. In addition, the MBSR group improved more on measures of worry and depression, and 47% of MBSR participants were rated on the Clinical Global Impressions Scale as much improved or very much improved versus just 27% of health education participants. These improvements continued at 3 and 6 months post-intervention.

TCPR’s Take
Mood disorders, anxiety disorders, and mild cognitive impairment are common in older adults, and the inclusion criteria for this study realistically reflect many of the older patients we might see in our offices. The study results support the use of MBSR for the treatment of mood and anxiety symptoms in older adults, and perhaps for assistance with age-related memory issues as well. The memory improvement noted after MBSR is an interesting finding. One wonders, however, if this was just a consequence of the improvement in the patients’ comorbid anxious or depressive symptoms.

In any case, whenever available, we should recommend MBSR groups to our older patients with anxious or depressive symptoms and with subjective cognitive decline in memory. Also, as mindfulness-based psychotherapy techniques are relatively easy to learn, they represent promising additions to our psychotherapy toolkits.