Skip to main content
Search
Search
    Quick Search anywhere
    Quick search in Citations
Advanced Search
Skip main navigationClose Drawer MenuOpen Drawer Menu
Previous article
Next article
Originalarbeit

Loving Kindness Meditation zur Behandlung der chronischen Depression

Behandlungskonzept und Ergebnisse einer Pilot-Studie

Published Online:October 08, 2018https://doi.org/10.1026/1616-3443/a000486

Abstract

Zusammenfassung.Theoretischer Hintergrund: Chronische Depressionen gehen mit einer langwierigen Belastung einher und verursachen hohe Krankheitskosten. Ein möglicher Ansatz zur Behandlung könnte die Loving Kindness Meditation (LKM) sein. Methode: In dieser Pilot-Studie wurde ein LKM-Gruppenprogramm eingesetzt und bezüglich der Effektivität untersucht. N = 2207 Fälle aus Wartelistendaten wurden stufenweise zu der LKM-Gruppe (n = 12) zugeordnet. Zwei Kontrollgruppen (n = 134 und n = 12) wurden gebildet, indem zunächst die Ein-und Ausschlusskriterien angewandt wurden und dann die verbliebene Stichprobe basierend auf der Kovariatenverteilung mittels Propensity Score Matching (PSM) angepasst wurde. Die Gruppen wurden anhand des OQ-30 verglichen. Ergebnisse: Im Prä-Post-Vergleich zeigten sich im OQ-30 signifikante Verbesserungen. Allerdings zeigte sich das so nicht in den symptomspezifischen Instrumenten (BDI-II und HAM-D). Im Vergleich zu der gesamten Wartelistenstichprobe (n = 134) ergaben sich signifikante Verbesserungen im OQ-30. Verglichen mit der PSM-Wartelistenkontrollgruppe zeigten sich marginal signifikante Unterschiede im OQ-30, signifikante Unterschiede konnten bezüglich der Depressionsitems des OQ-30 nachgewiesen werden. In der Interventionsgruppe ergaben sich mehr reliable Verbesserungen im OQ-30 als in den Wartelistenkontrollgruppen. Schlussfolgerung: Die Pilotstudie zeigte eine geringere Abbruchquote als Vorgängerpilotstudien und eine gute Prä-Post Effektstärke im OQ-30, sowie im Vergleich zu den beiden Wartelistekontrollgruppen. Allerdings zeigten sich keine konsistenten Prä-Post Effekte in den Depressionsskalen. Eine weitere umfangreichere Studie mit aktiver Kontrollgruppe wäre nötig, um das Programm hinsichtlich seiner Effektivität, bezüglich des Abbruchs sowie der Heterogenität der Effekte in den Depressionsskalen weiter untersuchen zu können.


Loving Kindness Meditation for the Treatment of Chronic Depression: Treatment Concept and Results From a Pilot Study

Abstract.Background: Chronic depression is associated with much psychological distress and causes great financial burden. A treatment approach that might be effective is loving kindness meditation (LKM). Method: An LKM approach was employed and evaluated in this pilot study, in which 2,207 patients on a waiting list were matched stepwise to patients undergoing LKM (n = 12). Two control groups were generated by first applying the inclusion and exclusion criteria (n = 134) and then using propensity score matching (PSM) to adjust the remaining sample based on covariate distributions (n = 12). The groups were compared using the Outcome Questionnaire-30 (OQ-30). Results: In the pre–post comparison, significant improvements were found in the OQ-30. However, this was not the case for the symptom-specific instruments (Beck Depression Inventory-II [BDI-II] and the Hamilton Depression Rating Scale [HAM-D]). Compared with the full waiting list sample (n = 134), there were significant improvements in the OQ-30. Compared with the PSM sample, there were marginally significant differences in the OQ-30; significant differences were detected with regard to the depression-related items of the OQ-30. There were more reliable improvements in the OQ-30 in the intervention group than in the control groups. Conclusion: The pilot study showed a lower drop-out rate than previous pilot studies and good pre–post effect sizes in the OQ-30, as well as good effect sizes compared with the two control groups. However, there were no consistent pre–post effects in the depression scales. A more extensive study with an active control group is needed to further investigate the program in terms of its effectiveness, drop-out, and heterogeneity of effects in the depression scales.

Literatur

  • Amann, G. (1991). Die Relevanz der Dauer einer Depression für das soziale Netzwerk und die soziale Unterstützung. Nervenarzt, 62, 557 – 564. First citation in articleGoogle Scholar

  • American Psychiatric Association (APA). (2000). Diagnostic and statistical manual of mental disorders (DSM-IV-TR). Washington, DC: American Psychiatric Association. First citation in articleGoogle Scholar

  • American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). Arlington, VA: American Psychiatric Association. First citation in articleCrossref, Google Scholar

  • Austin, P. C. (2009). Using the standardized difference to compare the prevalence of a binary variable between two groups in observational research. Communications in Statistics-Simulation and Computation, 38, 1228 – 1234. First citation in articleCrossref, Google Scholar

  • Bagby, R. M. & Parker, J. D. A. (2001). Relation of rumination and distraction with neuroticism and extraversion in a sample of patients with major depression. Cognitive Therapy and Research, 25, 91 – 102. First citation in articleCrossref, Google Scholar

  • Barnhofer, T., Brennan, K., Crane, C., Duggan, D. & Williams, J. M. G. (2014). A comparison of vulnerability factors in patients with persistent and remitting lifetime symptom course of depression. Journal of Affective Disorders, 152, 155 – 161. First citation in articleCrossref, Google Scholar

  • Barnhofer, T., Crane, C., Hargus, E., Amarasinghe, M., Winder, R. & Williams, J. M. G. (2009). Mindfulness-based cognitive therapy as a treatment for chronic depression. A preliminary study. Behaviour Research and Therapy, 47, 366 – 373. First citation in articleCrossref, Google Scholar

  • Beblo, T., Fernando, S., Klocke, S., Griepenstroh, J., Aschenbrenner, S. & Driessen, M. (2012). Increased suppression of negative and positive emotions in major depression. Journal of Affective Disorders, 141, 474 – 479. First citation in articleCrossref, Google Scholar

  • Beck, A. T., Steer, R. A. & Brown, G. K. (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation. First citation in articleGoogle Scholar

  • Bickman, L., Lyon, A. R. & Wolpert, M. (2016). Achieving precision mental health through effective assessment, monitoring, and feedback processes. Administration and Policy in Mental Health and Mental Health Services Research, 43, 271 – 276. First citation in articleGoogle Scholar

  • Bürger, C. & Kühner, C. (2007). Copingstile im Umgang mit depressiver Stimmung. Zeitschrift für Klinische Psychologie und Psychotherapie, 36, 36 – 45. First citation in articleLink, Google Scholar

  • Carlson, K. D. & Schmidt, F. L. (1999). Impact of experimental design on effect size. Findings from the research literature on training. Journal of Applied Psychology, 84, 851 – 862. First citation in articleCrossref, Google Scholar

  • Carson, J. W., Keefe, F. J., Lynch, T. R., Carson, K. M., Goli, V., Fras, A. M. et al. (2005). Loving-kindness meditation for chronic low back pain. Results from a pilot trial. Journal of Holistic Nursing: Official Journal of the American Holistic Nurses’ Association, 23, 287 – 304. First citation in articleCrossref, Google Scholar

  • Constantino, M. J., Laws, H. B., Arnow, B. A., Klein, D. N., Rothbaum, B. O. & Manber, R. (2012). The relation between changes in patients’ interpersonal impact messages and outcome in treatment for chronic depression. Journal of Consulting and Clinical Psychology, 80, 354 – 364. First citation in articleCrossref, Google Scholar

  • Constantino, M. J., Manber, R., Degeorge, J., McBride, C., Ravitz, P., Zuroff, D. C. et al. (2008). Interpersonal styles of chronically depressed outpatients. Profiles and therapeutic change. Psychotherapy (Chicago, Ill.), 45, 491 – 506. First citation in articleCrossref, Google Scholar

  • Cuijpers, P., Straten, A. van, Schuurmans, J., Oppen, P. van, Hollon, S. D. & Andersson, G. (2010). Psychotherapy for chronic major depression and dysthymia. A meta-analysis. Clinical Psychology Review, 30, 51 – 62. First citation in articleCrossref, Google Scholar

  • Elkin, I., Gibbons, R. D., Shea, M. T., Sotsky, S. M., Watkins, J. T., Pilkonis, P. A. et al. (1995). Initial severity and differential treatment outcome in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Journal of Consulting and Clinical Psychology, 63, 841 – 847. First citation in articleCrossref, Google Scholar

  • Ellsworth, J. R., Lambert, M. J. & Johnson, J. (2006). A comparison of the Outcome Questionnaire‐45 and Outcome Questionnaire‐30 in classification and prediction of treatment outcome. Clinical Psychology & Psychotherapy, 13, 380 – 391. First citation in articleCrossref, Google Scholar

  • Fernandez, E., Salem, D., Swift, J. K. & Ramtahal, N. (2015). Meta-analysis of dropout from cognitive behavioral therapy. Magnitude, timing, and moderators. Journal of Consulting and Clinical Psychology, 83, 1108 – 1122. First citation in articleCrossref, Google Scholar

  • Fjorback, L. O., Arendt, M., Ornbøl, E., Fink, P. & Walach, H. (2011). Mindfulness-based stress reduction and mindfulness-based cognitive therapy. A systematic review of randomized controlled trials. Acta Psychiatrica Scandinavica, 124, 102 – 119. First citation in articleCrossref, Google Scholar

  • Garyfallos, G., Adarnopoulou, A., Karastergiou, A., Voikli, M., Sotiropoulou, A., Donias, S. et al. (1999). Personality disorders in dysthymia and major depression. Acta Psychiatrica Scandinavica, 99, 332 – 340. First citation in articleCrossref, Google Scholar

  • George, L. K., Blazer, D. G., Hughes, D. C. & Fowler, N. (1989). Social support and the outcome of major depression. The British Journal of Psychiatry, 154, 478 – 485. First citation in articleCrossref, Google Scholar

  • Geue, K., Strauß, B. & Brähler, E. (Hrsg.). (2016). Diagnostische Verfahren in der Psychotherapie. Göttingen: Hogrefe. First citation in articleCrossref, Google Scholar

  • Gilmer, W. S., Trivedi, M. H., Rush, A. J., Wisniewski, S. R., Luther, J., Howland, R. H. et al. (2005). Factors associated with chronic depressive episodes. A preliminary report from the STAR-D project. Acta Psychiatrica Scandinavica, 112, 425 – 433. First citation in articleCrossref, Google Scholar

  • Graser, J., Bohn, C., Kelava, A., Schreiber, F., Hofmann, S. G. & Stangier, U. (2012). Der „Affective Style Questionnaire (ASQ)“. Deutsche Adaption und Validitäten. Diagnostica, 58, 100 – 111. First citation in articleLink, Google Scholar

  • Graser, J., Höfling, V., Weßlau, C., Mendes, A. & Stangier, U. (2016). Effects of a 12-week mindfulness, compassion, and loving kindness program on chronic depression. A pilot within-subjects wait-list controlled trial. Journal of Cognitive Psychotherapy, 30, 35 – 49. First citation in articleCrossref, Google Scholar

  • Greenberg, P. E. & Birnbaum, H. G. (2005). The economic burden of depression in the US. Societal and patient perspectives. Expert Opinion on Pharmacotherapy, 6, 369 – 376. First citation in articleCrossref, Google Scholar

  • Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry, 23, 56 – 62. First citation in articleCrossref, Google Scholar

  • Hofmann, S. G., Grossman, P. & Hinton, D. E. (2011). Loving-kindness and compassion meditation. Potential for psychological interventions. Clinical Psychology Review, 31, 1126 – 1132. First citation in articleCrossref, Google Scholar

  • Hofmann, S. G. & Kashdan, T. B. (2010). The Affective Style Questionnaire. Development and psychometric properties. Journal of Psychopathology and Behavioral Assessment, 32, 255 – 263. First citation in articleCrossref, Google Scholar

  • Hofmann, S. G., Petrocchi, N., Steinberg, J., Lin, M., Arimitsu, K., Kind, S. et al. (2015). Loving-kindness meditation to target affect in mood disorders. A proof-of-concept study. Evidence-based Complementary and Alternative Medicine: eCAM, 2015, 269126. First citation in articleGoogle Scholar

  • Hofmann, S. G., Sawyer, A. T., Witt, A. A. & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression. A meta-analytic review. Journal of Consulting and Clinical Psychology, 78, 169 – 183. First citation in articleCrossref, Google Scholar

  • Hölzel, L., Härter, M., Reese, C. & Kriston, L. (2011). Risk factors for chronic depression–a systematic review. Journal of Affective Disorders, 129, 1 – 13. First citation in articleCrossref, Google Scholar

  • Hutcherson, C. A., Seppala, E. M. & Gross, J. J. (2008). Loving-kindness meditation increases social connectedness. Emotion, 8, 720 – 724. First citation in articleCrossref, Google Scholar

  • Jacobson, N. S. & Truax, P. (1991). Clinical significance. A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12 – 19. First citation in articleCrossref, Google Scholar

  • Johnson, D. P., Penn, D. L., Fredrickson, B. L., Kring, A. M., Meyer, P. S., Catalino, L. I. et al. (2011). A pilot study of loving-kindness meditation for the negative symptoms of schizophrenia. Schizophrenia Research, 129, 137 – 140. First citation in articleCrossref, Google Scholar

  • Kearney, D. J., McManus, C., Malte, C. A., Martinez, M. E., Felleman, B. & Simpson, T. L. (2014). Loving-kindness meditation and the broaden-and-build theory of positive emotions among veterans with posttraumatic stress disorder. Medical Care, 52, 32 – 38. First citation in articleCrossref, Google Scholar

  • Keller, M. B., Gelenberg, A. J., Hirschfeld, R., Rush, A. J., Thase, M. E., Kocsis, J. H. et al. (1998). The treatment of chronic depression, part 2. A double-blind, randomized trial of sertraline and imipramine. The Journal of Clinical Psychiatry, 59, 598 – 607. First citation in articleCrossref, Google Scholar

  • Klein, D. N., Schwartz, J. E., Rose, S. & Leader, J. B. (2000). Five-year course and outcome of dysthymic disorder. A prospective, naturalistic follow-up study. American Journal of Psychiatry, 157, 931 – 939. First citation in articleCrossref, Google Scholar

  • Kühner, C., Huffziger, S. & Nolen-Hoeksema, S. (2007). Response styles questionnaire (RSQ-D). Göttingen: Hogrefe. First citation in articleGoogle Scholar

  • Kuss, O., Blettner, M. & Börgermann, J. (2016). Propensity score. An alternative method of analyzing treatment effects. Deutsches Ärzteblatt International, 113, 597 – 603. First citation in articleGoogle Scholar

  • Lambert, M. J., Burlingame, G. M., Umphress, V., Hansen, N. B., Vermeersch, D. A., Clouse, G. C. et al. (1996). The reliability and validity of the Outcome Questionnaire. Clinical Psychology & Psychotherapy, 3, 249 – 258. First citation in articleCrossref, Google Scholar

  • Lambert, M. J., Finch, A. M., Okiishi, J. & Burlingame, G. M. (2005). Administration and scoring manual for the OQ-30.2®. Adult outcome questionnaire for screening individuals and population monitoring. Salt Lake City, UT: OQ Measures LLC. First citation in articleGoogle Scholar

  • Lutz, W., Hofmann, S. G., Rubel, J., Boswell, J. F., Shear, M. K., Gorman, J. M. et al. (2014). Patterns of early change and their relationship to outcome and early treatment termination in patients with panic disorder. Journal of Consulting and Clinical Psychology, 82, 287 – 297. First citation in articleCrossref, Google Scholar

  • Lutz, W., Schiefele, A.-K., Wucherpfennig, F., Rubel, J. & Stulz, N. (2016). Clinical effectiveness of cognitive behavioral therapy for depression in routine care. A propensity score based comparison between randomized controlled trials and clinical practice. Journal of Affective Disorders, 189, 150 – 158. First citation in articleCrossref, Google Scholar

  • Mondimore, F. M., Zandi, P. P., MacKinnon, D. F., McInnis, M. G., Miller, E. B., Crowe, R. P. et al. (2006). Familial aggregation of illness chronicity in recurrent, early-onset major depression pedigrees. American Journal of Psychiatry, 163, 1554 – 1560. First citation in articleCrossref, Google Scholar

  • Morris, S. B. (2008). Estimating Effect Sizes From Pretest-Posttest-Control Group Designs. Organizational Research Methods, 11, 364 – 386. First citation in articleCrossref, Google Scholar

  • Morris, S. B. & DeShon, R. P. (2002). Combining effect size estimates in meta-analysis with repeated measures and independent-groups designs. Psychological Methods, 7, 105 – 125. First citation in articleCrossref, Google Scholar

  • Murphy, J. A. & Byrne, G. J. (2012). Prevalence and correlates of the proposed DSM-5 diagnosis of Chronic Depressive Disorder. Journal of Affective Disorders, 139, 172 – 180. First citation in articleCrossref, Google Scholar

  • Nolen-Hoeksema, S., Wisco, B. E. & Lyubomirsky, S. (2008). Rethinking rumination. Perspectives on Psychological Science, 3, 400 – 424. First citation in articleCrossref, Google Scholar

  • Rosenbaum, P. R. & Rubin, D. B. (1985). Constructing a control group using multivariate matched sampling methods that incorporate the propensity score. The American Statistician, 39, 33 – 38. First citation in articleGoogle Scholar

  • Rubin, D. B. (2001). Using propensity scores to help design observational studies. Application to the tobacco litigation. Health Services and Outcomes Research Methodology, 2, 169 – 188. First citation in articleCrossref, Google Scholar

  • Smit, F., Cuijpers, P., Oostenbrink, J., Batelaan, N., Graaf, R. de & Beekman, A. (2006). Excess costs of common mental disorders. Population-based cohort study. The Journal of Mental Health Policy and Economics, 9, 193 – 200. First citation in articleGoogle Scholar

  • Stangier, U. (2013). The psychiatric status rating for chronic depression. Unpublished Manuscript, Department of Clinical Psychology and Psychotherapy, University of Frankfurt. First citation in articleGoogle Scholar

  • Stangier, U. & Pawelkiewicz, M. A. (2015). Achtsamkeitsbasierte Loving Kindness Meditation. Unveröffentlichtes Manuskript, Goethe-Universität Frankfurt, Abteilung für Klinische Psychologie und Psychotherapie. First citation in articleGoogle Scholar

  • Storch, E. A., Roberti, J. W. & Roth, D. A. (2004). Factor structure, concurrent validity, and internal consistency of the beck depression inventory—second edition in a sample of college students. Depression and Anxiety, 19, 187 – 189. First citation in articleCrossref, Google Scholar

  • Stuart, E. A. (2010). Matching methods for causal inference. A review and a look forward. Statistical Science, 25, 1 – 21. First citation in articleCrossref, Google Scholar

  • Trajković, G., Starčević, V., Latas, M., Leštarević, M., Ille, T., Bukumirić, Z. et al. (2011). Reliability of the Hamilton Rating Scale for Depression. A meta-analysis over a period of 49 years. Psychiatry Research, 189, 1 – 9. First citation in articleCrossref, Google Scholar

  • Wittchen, H.-U., Wunderlich, U., Gruschwitz, S. & Zaudig, M. (1997). SKID I. Strukturiertes Klinisches Interview für DSM-IV. Achse I: Psychische Störungen (Interviewheft und Beurteilungsheft, deutschsprachige, erw. Bearb. d. amerikanischen Originalversion des SKID I). Göttingen: Hogrefe. First citation in articleGoogle Scholar