The Effect Of Mindfulness Based Cognitive Therapy On Depression And Brain Electrophysiological Mechanism

Objective: To explore the emotion expressive characteristics among depressive people and therapeutic effect of Mindfulness Based Cognitive Therapy in the treatment of patients with depression,and to search the possible emotional and electrophysiological mechanism of the therapeutic effects.Methods: 1.Patients are recruited by doctors who belong to the psychological counseling Outpatient Department in Shanghai Mental Mealth Center,and meet the diagnostic criteria of depression in DSM-IV,we determine to enlist 64 patients with depression in the end,48 patients considered and finally signed the informed consent,6people eventually fall off,there are 16 patients who apply mindfulness therapy solely and not taking antidepressants,and 26 patients who apply mindfulness as well as antidepressants,at the same time we recruitted a groups of gender,age and education level matched 38 healthy controls.2.All of the subjects were assessed by baseline clinical tests: Hamilton Depression Scale-24(HAMD24),Hamilton Anxiety Scale-14(HAMA14),Toronto Alexithymia Scale-20(TAS20),Five Facet Mindfulness Questionaire(FFMQ),Beck Depression Inventory-II(BDI-II),Self-rating Anxiety Scale(SAS)and computer test(emotional stroop test and emotion regulation test),EEG test,in order to assess the level of depression,anxiety,emotional regulation characteristics,behavioral charateristics,EEG and other indicators.We use independent sample t test to find the difference between baseline depression patients and normal subjects;and use paired samples t test to explore the difference in various indicator before and after MBCT within depressive patients;3.We use the independent sample t test to find out the subtraction between patients with MBCT and patients with both antidepressants and MBCT before and after eight weeks of MBCT.Results: 1.The scale results between depressive group and health control group at baseline are as follows:(1)Scale results are : There are obvious differences in the total score of Toronto Alexithymia Scale-20(TAS20)(t=-6.743,P=0.000),and in f1(difficulties identifying feelings)(t=-6.768,P=0.000),in f2(difficulties describing feelings)(t=-5.418,P=0.000)and in f3(external thinking)(t=--4.315,P=0.000).Pearson scores between TAS20,its factors and HAMD24 and HAMA14 are as follows: there is a positive correlation between the total score of TAS20 and HAMD24(r = 0.654,P=0.000),there is a positive correlation between the scores of TAS20 and HAMA14(r = 0.564,P=0.000);f1 is positively correlates with HAMD24(r = 0.659,P=0.000),f1 has a positive correlation with HAMA14(r = 0.627,P=0.000),f2 is positively correlates with HAMD24(r = 0.469,P=0.000),f2 has a positive correlation with HAMA14(r = 0.103,P=0.000),f3 is positively correlates with HAMD24(r = 0.439,P=0.000),f3 has a positive correlation with HAMA14(r = 0.303,P=0.002);(2)Results in the emotional stroop are as follow,time is longer when depressive patients watch the neutral expression of male faces(t=-2.144,P=0.045)and watching neutral expressions of female faces(t=-2.194,P=0.028)and watching frightening expressions of female faces(t=-1.967,P=0.049);(3)Differences in EEG data show: under the negative pictures emotion tests,when subjects receive extraneous stimulus,depressive patients and healthy subjects have P300 differences,mainly reflects in the decrease of amplitude in left parietal lobe(t=-2.306,P=0.021),as well as the incubation period of central region of overhead(t=2.081,P=0.041);under the negative pictures emotion tests,when subjects receive target stimulus,depressive patients and healthy subjects have P300 differences,mainly reflects in decrease of amplitude in left central region(t=-2.367,P=0.018)and decrease of amplitude in central area of overhead(=2.068,P=0.046).2.After eight weeks’ MBCT treatment in patients with depression,we use paired sample t test to analyze the statistical indexes,the results are:(1)There were significantdifferences before and after treatment in HAMD-24 score(t=5.907,P=0.000)and in HAMA-14(t=2.994,P=0.006);score of act with awareness has significant stastical difference(t=-2.148,P=0.046),so is non-judgment(t=-2.651,P=0.017),the rest of Five Facet Mindfulness Questionaire(FFMQ)have no difference;The Pearson relationships within scales are as follows: TAS20 and FFMQ score correlates each other(r=-0.526,P=0.025),TAS20 and SAS score correlates too(r=0.582,P=0.037).(2)As for the emotional stroop results,the reaction time of watching the neutral expression of male faces reduces significantly(t=2.648,P=0.013)and in neutral expressions of female faces(t=2.545,P=0.017),and then there is significant difference in the increasing accuracy rate for male neutral face(t=2.242,P=0.033),there is significant statistical differences;in emotional regulation,the scores in two groups of free watching neutral pictures(t=2.139,P=0.041)and watching negative pictures(t=2.162,P=0.039)or negative pictures under expressive suppression decrease significantly after treatment(t=2.109,P=0.044);(3)Differences in EEG data show: under the positive pictures,when subjects receive target stimulus,mainly reflects in the increase of P300 latency period inf left parietal lobe,(t=2.303,P=0.030);and under the negative pictures,when subjects receive target stimulus,mainly reflects in decrease of p300 latency period in right parietal lobe(t=-2.206,P=0.036).3.After eight weeks of treatment,we use independent sample t test to analyze the subtraction scores of different index in MBCT group’s patients with or without antidepressants.(1)The comparison in scale subtraction showed that: the subtraction in total score of TAS20 shows significant differences(t=2.514,P=0.025),as well as in f1(t=2.325,P=0.031)and in f2(t=2.204,P=0.039),but because the baseline score between the two groups of depressive patients is different,so it’s unclear which group receive more effects after MBCT,the subtraction in total score of FFMQ has significant difference(t=-3.018,P=0.008)as well as the observing factor(t=-2.195,P=0.043)and describing factor(t=-2.832,P=0.012);(2)As for the results found in the emotional stroop,subtraction of watching six kinds of male and female faces all don’t have the statistical difference,and in the emotional regulation(p>0.05),two groups in free watching,cognitive reappraisal and expressive suppression don’t show much statistical difference(p>0.05).4.(1)patients with MBCT and without drugs before and after treatment have significant statistical difference in the total scores of TAS20(t=3.457,P=0.009)as well as in f1 factor(t=3.773,P=0.005)and in f2(t=3.468,P=0.008),there were significant statistical differences in the total score of FFMQ(t=-4.204,P=0.008),and in describing factor(t=-3.515,P=0.017).Differences in EEG data show: under the positive pictures,when subjects receive extraneous stimulus,mainly reflects in the increase of P300 amplitude in left parietal lobe(t=2.353,P=0.046),and under the negative pictures,when subjects receive target stimulus,mainly reflects in increase of P300 amplitude in right parietal lobe(t=2.326,P=0.045)and in central egion of overhead(t=2.752,P=0.025);(2)Indexes with stastical difference within patients using MBCT and combined with drugs aer as follows: There were significant statistical differences in HAMD-24(t=9.255,P=0.000),and in HAMA-14(t=3.144,P=0.007),the responding time of male neutral expression is significantly shortened(t=2.401,P=0.027),and the reacting time of neutral facial expression is significantly shortened(t=2.271,P=0.036),while the accuracy rate of neutral male faces is significantly increased(t=-2.567,P=0.018);under the positive pictures,when subjects receive target stimulus,significant difference mainly reflects in decrease of the P300 amplitude in left parietal lobe(t=-2.444,P=0.026)and in right parietal area(t=-2.198,P=0.042),and under the negative pictures,when subjects receive extraneous stimulus,increase of the P300 latency period in parietal brain shows significant difference(t=-2.338,P=0.034).Conclusions: 1.Compared with healthy people,patients with major depressive disorder are more likely to have alexithymia,and the level of alexithymia has a positive correlationship with depression and anxiety;and more difficult to identify neutral faces and frightening female looks,and costing a longer time,the difference of P300 mainly concentrated on the decrease of P300 amplitude in left parietal lobe,decrease of the P300 latency period in central area under negative picyures receiving extraneous stimulus,decrease of P300 amplitude in left central lobe and decrease of P300 amplitude in central area of overhead when subjects are under negative pictures receiving target stimulus.2.After MBCT,depressive and anxious symptoms are significantly released,alexithymia also decrease to a certain extent,mindfulness level has improved significantly,in recognition of male or female neutral faces,the accuracy rate and responding time were significantly improved,the emotion change decrease when subjects are free watching neutral and negative pictures and using expression supression of negative pictures after MBCT,increase of P300 latency period in the left frontal lobe when subjects are watching positive pictures when receiving target stimulus,decrease of P300 latency period in right parietal lobe when subjects are watching negative pictures when receiving target stimulus.The level of mindfulness improves better in patients without antidepressant while accepting MBCT compared with patients with both MBCT and drugs.Under the positive pictures,when MBCT group without drugs receive extraneous stimulus,mainly reflects in the increase of P300 amplitude in left parietal lobe,and under the negative pictures,when subjects receive target stimulus,mainly reflects in increase of P300 amplitude in right parietal lobe and in central region of overhead.And under the positive pictures,when patients combined with drugs and MBCT receive target stimulus,significant difference mainly reflects in decrease of the P300 amplitude in left parietal lobe and in right parietal are,and under the negative pictures,when subjects receive extraneous stimulus,increase of the P300 latency period.