The long-term effects of psychotherapy added to pharmacotherapy on morning to evening diurnal cortisol patterns in outpatients with major depression.

BACKGROUND: Psychotherapy added to pharmacotherapy results in greater improvement in clinical outcomes than does pharmacotherapy alone. However, few studies examined how psychotherapy coupled with pharmacotherapy could produce a long-term protective effect by improving the psychobiological stress response. METHODS: The researchers recruited 63 subjects with major depressive disorder (MDD) in an outpatient department of psychiatry at a general hospital. The randomly assigned subjects formed 2 groups: 29 in combined therapy (COMB) and 34 in monotherapy (MT). The COMB included 8 weekly body-mind-spirit group psychotherapy sessions added to pharmacotherapy. MT consisted of pharmacotherapy only. The outcome measures, collected at the subjects' homes, included the Beck Depression Inventory II (BDI-II), the State Trait Anxiety Inventory (STAI) and salivary cortisol on awakening, 45 min after awakening, and at 12.00, 17.00 and 21.00 h. Evaluation of outcome measures was at baseline condition, and at months 2 (end of additional psychotherapy), 5 and 8. RESULTS: While the decreases in symptoms of depression were similar between COMB and MT (p > 0.05), the reductions in anxiety state were greater in COMB than in MT during the 8-month follow-up (p < 0.05). A steeper diurnal cortisol pattern more likely occurred in COMB than in MT in the 3 follow-up periods (p < 0.05, p <0.001 and p < 0.01). CONCLUSIONS: The superior outcomes of group psychotherapy added to pharmacotherapy for MDD outpatients could relate to decreasing the anxiety state and to producing long-term impacts on positive stress endocrine outcomes seen as a steeper diurnal cortisol pattern.

The self-perceived symptom distress and health-related conditions associated with morning to evening diurnal cortisol patterns in outpatients with major depressive disorder.

OBJECTIVE: This study was an examination of 126 major depressive disorder (MDD) outpatients' morning to evening diurnal cortisol patterns to determine their association with family histories of mental illness, self-perceived depressive and anxiety distress, self-perceived health-related conditions, and healthy behaviors. METHODS: 126 MDD outpatients and 106 healthy subjects were recruited. Self-reports of symptom distress, health-related conditions, and healthy behaviors and objective measures of salivary cortisol upon awakening, 45min after awakening, and at 1200, 1700, and 2100h were collected at subjects' homes. The individual growth curve model was used to manage data and to analyze repeated observations of self-report data associated with diurnal cortisol patterns. RESULTS: For MDD outpatients, flatter diurnal cortisol patterns were more likely found in subjects with family histories of mental illness than in those without. Patient-reported shorter total sleep hours, more severe levels of depression and higher suffering levels were positively associated with flatter diurnal cortisol patterns. Less than 5 sleep hours was more likely associated with flatter diurnal cortisol patterns than above 7 sleep hours. Severe levels of depression were more likely related to flatter diurnal cortisol patterns than moderate and mild levels of depression. Higher anxiety levels, better sleep quality and higher levels of physical activity reported by patients were positively associated with steeper diurnal cortisol patterns. Unlike the MDD outpatients, the only trait associated with diurnal cortisol patterns in healthy subjects was total sleep hours. CONCLUSIONS: These results suggested that self-perceived good sleep quality, total hours slept of 7 or greater, and self-perceived higher levels of physical activity in the home environment could be positively related to positive stress endocrine outcomes seen as steep diurnal cortisol patterns in outpatients with major depressive disorder.

The effect of psychotherapy added to pharmacotherapy on cortisol responses in outpatients with major depressive disorder.

The present study examined the changes of depressive symptoms and salivary cortisol responses in 36 outpatients with major depression. These patients were randomly assigned to receive combination therapy (CT), consisting of antidepressants and body-mind-spirit group psychotherapy, or monotherapy (MT), consisting of antidepressants only. The results indicated that CT and MT had similar effects on reducing depressive symptoms. Nevertheless, the results revealed that cortisol levels at night appeared to have a greater reduction in CT than in MT, indicating a downward trend in CT but an upward trend in MT. Moreover, a steeper diurnal pattern of cortisol-a larger deviation in cortisol levels between 30 and 45 minutes postwaking and evening-was more likely associated with CT than MT. The findings suggest that CT produced a protective effect on outpatients with major depression, preventing the increased night salivary cortisol levels and the flatter diurnal cortisol pattern that tended to occur in MT.

A study on the efficacy of body-mind-spirit group therapy for patients with breast cancer.

AIMS AND OBJECTIVES: This study aims to understand the effects of culturally enriched body-mind-spirit group therapy on anxiety, depression and holistic well-being among women with breast cancer and to examine patients' views on what aspects of group therapy worked to enhance their health. DESIGN: The study was designed using multiple methods, which consisted of a randomised controlled trial and a focus group interview. METHODS: A total of 16 subjects in the control group received the standard care of a physician's treatment at the outpatient department. In addition to standard care, 12 subjects in the experimental group received 10 sessions of weekly body-mind-spirit group therapy for 180 minutes each. This therapy integrates concepts and practices of traditional Chinese medicine and Western medicine (e.g. positive psychology and forgiveness therapy). The subjects in the experimental group were invited to participate in a focus group interview regarding their perceptions of the change mechanisms that occurred in group therapy. RESULTS: The results of analysis of covariance indicated that after a two-month trial, there was a similarity between the experimental and control groups in reducing the scores of Beck depression inventory and increasing the scores of body-mind-spirit well-being. However, subjects in the experimental group had a better reduction of the scores of state anxiety inventory than subjects in the control group. The qualitative analysis yielded eight domains: (i) imparting of information, (ii) interpersonal learning, (iii) catharsis, (iv) universality, (v) group cohesiveness, (vi) altruism, (vii) instillation of hope and (viii) existential factors. These domains illustrate how the therapeutic effects of group therapy worked to reduce patients' anxiety. CONCLUSION: The culturally sensitive body-mind-spirit group therapy reduced anxiety among outpatients with breast cancer. RELEVANCE TO CLINICAL PRACTICE: The involvement of mental health nurses in providing group therapy for cancer patients could enhance the quality of care in psycho-ontological nursing.

The comparison of effectiveness of two modalities of mental health nurse follow-up programmes for female outpatients with depression in Taipei, Taiwan.

AIMS AND OBJECTIVES: This study compares the effectiveness of two modalities of mental health nurse three-month follow-up programmes: telephone counselling programme and group therapy programme for female outpatients with depression. BACKGROUND: The lifetime prevalence of major depression is 15% and is about twice as common in women as in men. Outpatients with depression often discontinue their treatment after the initial visits to their physicians. METHODS: This study used a quasi-experimental, pre-post-test comparison group design. Twenty-six female outpatients with depression were assigned to one of follow-up programmes: telephone counselling programme or group therapy programme. To qualify for group therapy programme, potential participants were required to come to group sessions weekly. To be accepted into telephone counselling programme, potential participants had to be able to be contacted by phone regularly. Mental health nurse three-month follow-up programmes included care management and structured psychotherapy. Patients in telephone counselling programme received 10 regular telephone calls of 30-60 minutes each. Patients in group therapy programme received 12 sessions of weekly group meetings of 90-120 minutes each. RESULTS: Wilcoxon signed ranks tests provided evidence that the group therapy programme (S = -52.5, p < 0.001; S = 31.5, p = 0.046) and telephone counselling programme (S = -36, p = 0.002; S = 25, p = 0.050) follow-up programmes were effective in terms of relieving depressed symptoms and improving quality of life. According to Quade's analysis of covariance, telephone counselling programme and group therapy programme appeared to have similar effects of relieving depressed symptoms (F(1,24) = 0.06, p = 0.813) and increasing quality of life (F(1,24) = 0.07, p = 0.792). While there was no significant difference in using emergency services ( chi(2)(1)= 0.89, p = 0.539) between telephone counselling programme and group therapy programme, the rate of adherence to scheduled outpatient appointments with psychiatrists was higher among patients in group therapy programme than patients in telephone counselling programme (chi(2)(3) = 8.67, p = 0.034). CONCLUSIONS: Establishing two modalities of mental health nurse follow-up programmes in Taiwan could benefit patients with different needs. RELEVANCE TO CLINICAL PRACTICE: Mental health nurses specialized in management of depression could provide not only care management but also structured psychotherapy.