Mindfulness-Based Stress Reduction Therapy Improves Patient and Caregiver-Reported Outcomes in Cirrhosis

Jasmohan S. Bajaj, Michael Ellwood, Timothy Ainger, Thomas Burroughs, Andrew Fagan, Edith A. Gavis, Douglas M. Heuman, Michael Fuchs, Binu John, James B. Wade

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32 Scopus citations

Abstract

OBJECTIVES: Patient-reported outcomes such as health-related quality of life (HRQOL) are impaired in cirrhosis due to under-treated mood and sleep disorders, which can adversely impact their caregivers. Mindfulness-based stress reduction (MBSR) can improve patient-reported outcomes (PRO) in non-cirrhotic patients but their impact in cirrhosis is unclear. To evaluate the effect of MBSR and supportive group therapy on mood, sleep and HRQOL in cirrhotic patients and their caregivers. METHODS: Cirrhotic outpatients with mild depression (Beck Depression Inventory (BDI)414) on screening with an adult caregiver were enrolled. At baseline, BDI, sleep (Pittsburgh sleep quality index PSQI, Epworth Sleepiness Scale, ESS), anxiety (Beck Anxiety inventory) and HRQOL (Sickness Impact Profile, SIP) for both patients/caregivers and caregiver burden (Zarit Burden Interview Short-form, ZBI-SF and perceived caregiver burden, PCB) and patient covert HE(CHE) status were measured. Patients who had BDI414 at baseline, along with their caregivers then underwent a structured MBSR program with four weekly hour-long group sessions interspersed with home practice using CDs. After the last group, all questionnaires were repeated. RESULTS: 20 patient/caregiver dyads were included. All patients were men (60 ± 8 years MELD 12.9 ± 5.7, 14 prior hepatic encephalopathy (HE)) while most caregivers (n = 15) were women (55 ± 12 years, 23 ± 14 years of relationship, 65% spouses). There was no change in patient BDI between screening and baseline (20.1 ± 11.2 vs. 19.0 ± 10.6, P = 0.81). All dyads were able to complete the four MBSR+supportive group therapy sessions. There was a significant improvement in BDI (19.0 ± 10.6 vs.15.6 ± 8.2 P = 0.01), PSQI (7.2 ± 3.7 vs. 5.5 ± 3.7, Po0.001) and overall HRQOL (25.0 ± 13.2 vs. 17.7 ± 14.0,P = 0.01) but not in anxiety or CHE rates in patients. Similarly caregiver burden (ZBI-SF13.0 ± 9.0 vs. 9.8 ± 6.9,P = 0.04, Perceived burden 72.1 ± 29.9 vs. 63.0 ± 14.5,P = 0.05) and depression reduced (BDI 9.1 ± 7.8 vs. 5.9 ± 6.0,P = 0.03) while caregiver sleep quality (7.2 ± 3.7 vs. 5.5 ± 3.7,Po0.001) improved. Prior HE did not affect PRO change after MBSR+supportive groups but the ZBI-SF of caregivers taking care of HE patients improved to a greater extent (delta − 1.1 ± 6.5 vs. 7.4 ± 5.3 HE, P = 0.04). CONCLUSION: A short program of mindfulness and supportive group therapy significantly improves PRO and caregiver burden in cirrhotic patients with depression. This non-pharmacological method could be a promising approach to alleviate psychosocial stress in patients with end-stage liver disease and their caregivers.

Original languageEnglish
Article numbere108
JournalClinical and Translational Gastroenterology
Volume8
Issue number7
DOIs
StatePublished - Jul 1 2017

Bibliographical note

Funding Information:
Guarantor of the article: Jasmohan S. Bajaj, MD. Specific Author contributions: JSB, ME and JBW conceptualized and designed the study, ME, JBW, TA and TB were responsible for conducting and designing the groups, AF and EAG were responsible for study coordination, and DMH, BJ and MF helped with recruitment. Financial Support: This was partly supported by VA Merit Review I0CX001076, NIH RO1DK089713 and McGuire Research Institute funds to JSB. Potential Competing Interests: None.

Publisher Copyright:
© 2017 Lippincott Williams and Wilkins. All rights reserved.

ASJC Scopus subject areas

  • Gastroenterology

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