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

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)>14) 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 BDI>14 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, P<0.001) 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,P<0.001) 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.

Impact of acute-on-chronic liver failure and decompensated liver cirrhosis on psychosocial burden and quality of life of patients and their close relatives

“…Some complications of liver cirrhosis such as the occurrence of hepatic encephalopathy seem to cause particularly intense stress for caregiver [6]. In addition to optimal medical care, patients also benefit from intensive medical education and psychological therapy for their relatives [7]. Data on quality of life and psychosocial stress of patients with ACLF and their caregivers is scarce.…”

Approaches to Assessing Burden in Caregivers of Patients with Cirrhosis

“…This tool focuses on time schedule, physical health, mental and psychosocial burden. 1,11,12 Zarit burden scale: This 22-item self-reported instrument assesses caregiver's burden with each item on a 9point rating scale. A rating of 9 for each item indicates a higher level of burden.…”

Qigong Mind-Body Program for Caregivers of Cancer Patients: Design of a Pilot Three-Arm Randomized Clinical Trial

“…26,30,31 However, the evidence required to guide such an approach is still limited in multiple ways. First, while a growing body of research supports mind-body practices such as Tai Chi, Qigong, yoga and meditation for a range of symptoms in patients with chronic disease, [32][33][34][35][36] few large-scale studies have evaluated the effects of these practices in caregivers. Of the studies that have evaluated caregivers (mostly yoga or MBSR), many have utilized interventions tailored to patient-caregivers dyads.…”

“…Of the studies that have evaluated caregivers (mostly yoga or MBSR), many have utilized interventions tailored to patient-caregivers dyads. 35,[37][38][39][40] Although this approach has merit, it may limit speci cally addressing caregivers' psychological and physical needs. Additionally, while many MBSR and yoga studies show positive effects on mental health, most do not include physical function and disability measures.…”