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Stress-reduction therapy improves depression in patients with cirrhosis

Mindfulness-based stress reduction tactics and supportive group therapy decreased rates of depression and improved sleep quality among patients with cirrhosis and their caregivers, according to a recently published study.

“Cirrhosis is associated with impaired patient-reported outcomes such as depression, and sleep disorders. These disorders of mood and sleep are often inadequately treated in cirrhosis because of the role of the liver in clearing psychotropic medications and the fact that the therapeutic-toxic threshold of these medications is very narrow in cirrhosis,” Jasmohan S. Bajaj, MD, from the Virginia Commonwealth University, and colleagues wrote. “Therefore, strategies that do not depend on psychotropic medications are needed to relieve this immense burden on the patients and their families.”

The researchers enrolled 20 men with confirmed cirrhosis who had a live-in family member or caregiver. Patients and caregivers responded to questionnaires for mood, sleep quality, anxiety and health-related quality of life, including the Beck Depression Inventory and Sickness Impact Profile (SIP); attended clinical psychologist-led group therapy sessions once a week for 4 weeks; and received with CDs with guided mindfulness exercises to listen to daily.

Mindfulness training is a practice that, “involves sustained attention to internal and external sensory stimuli,” Bajaj and colleagues wrote. “Formal practice often involves a meditative body scan which involves moving a spotlight of attention from one body part to another.”

Additionally, the group therapy involved identifying barriers and strategies, “Qigong” or gentle movements, progressive relaxation and “loving kindness” meditation.

Compared with baseline questionnaire results, patients had decreased scores on the Beck Depression Inventory (19 vs. 15.6; P = .012), total SIP (25 vs. 17.7; P = .005), Psychological SIP (25.1 vs. 17.3; P = .01), Physical SIP (18.5 vs. 13.1; P = .001), and Pittsburgh Sleep Quality Index (7.2 vs. 5.5; P < .001). At the end of the sessions, the researchers considered nine patients to still have depression (P = .0001).

Similarly, caregivers had decreased scores from baseline on the Zarit Burden Interview Short-Version (13 vs. 9.8; P = .04), Perceived Caregiver Burden (72.1 vs. 63; P = .05), Beck Depression Inventory (9.1 vs. 5.9; P =. 03), and Pittsburgh Sleep Quality Index (7.2 vs. 5.5; P < .001).

“While our groups were in-person and led by psychologists with a home-based CD, mindfulness can also be practiced using smartphone apps as well as internet-based delivery systems for care,” the researchers concluded. “These options may be more attractive for younger patients and family members as well as in clinical practices where psychology specialists are not available for extended periods of time.” – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.