Rodrigues, Michele F.; Nardi, Antonio E.; Levitan, Michelle

doi:10.1590/2237-6089-2016-0051

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Sumário

Review Article • Trends Psychiatry Psychother. 39 (3) • Jul-Sep 2017 • https://doi.org/10.1590/2237-6089-2016-0051 copiar

Mindfulness nos transtornos do humor e ansiedade: uma revisão da literatura

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

Introdução

O objetivo deste estudo foi fazer uma revisão da literatura abrangendo o uso das diferentes abordagens da terapia baseada em mindfulness no tratamento dos transtornos de humor e ansiedade, incluindo suas habilidades e sua relação com a regulação emocional e com o medo da avaliação negativa.

Métodos

Uma revisão de literatura foi realizada através de busca pelas bases científicas PubMed e PsycINFO, com as seguintes palavras-chave: mindfulness, transtornos do humor e transtornos de ansiedade. A pesquisa abrangeu os últimos 10 anos. A busca resultou em 532 artigos, sendo 24 selecionados e 16 incluídos nesta revisão.

Resultados

Foram revisados seis artigos sobre programa de redução de estresse baseado em mindfulness, quatro artigos sobre terapia cognitiva baseada em mindfulness, e três sobre medo da avaliação negativa e regulação emocional. Todos os artigos abordaram mindfulness com relação aos transtornos de humor e ansiedade

Conclusão

A literatura nessa área sugere que mindfulness é uma estratégia eficaz no tratamento dos transtornos de humor e ansiedade e é eficaz no protocolo de terapia em diferentes formatos, incluindo virtual. O uso de mindfulness continua a se expandir nos modelos científicos.

Mindfulness; transtornos do humor e transtornos ansiosos

Study authors	Intervention	Sample size	Psychopathology	Mean Age ± SD n (%)	Sex, male (%)
Desrosiers et al.³	NI	187	MD, AD	38 (14.2)	35.4
Smith B et al.⁵	MBSR	23	S, MD, AD	54.9 (12.0)	4.3
Wong et al.⁶	MBCT	18	GAD	NR	NR
Boettcher et al.⁷	MTG CG	91	SAD, GAD, PD, ADNOS	MTG = 37 (8.9) CG = 40 (11.5)	MTG = 24.4 CG = 28.6
Burton et al.⁸	CBT	65	SAD	40 (12.0)	39
Sundquist et al.⁹	MBSR MBCT CBT	215	S, MD, AD, AdjD	42	NR
Kraemer et al.¹⁰	NI	56	PD	19.5 (2.7)	30.4
Eyles et al.¹²	MBSR	19	MD, AD	37-65 years	0
Hoge et al.¹³	MBSR SME	89	GAD	MBSR = 41 (14.0) SME = 37 (12.0)	MBSR = 52 SME = 46
Lenze et al.¹⁴	MBSR	34	GAD, ADNOS, MDE, PD, OCD, DsyD, DD-NOS, PH, PHS	8 weeks= 70.9 (4.5) 12 weeks= 70.7 (4.9)	8 weeks= 31 12 weeks= 22
Serpa et al.¹⁶	MBSR	79	MD, AD	60 (7)	89
Arch et al.¹⁷	MBSR CBT	105	PD/A, GAD, SAD, SP, OCD, PTSD	45.91 (13.68)	83
Britton et al.¹⁸	MBCT	52	PRD	47.03 (1.9)	15.51
Kim et al.¹⁹	MBCT	65	PD	39.94 (9.13)	47.7
Eisendrath et al.²⁰	MBCT HEP	NI	MDD	NI	NI
Roemer et al.²¹	NI	411	GAD	32	33.5

Study authors	Dose (session length)	Frequency (sessions per week)	Length of intervention	Modality	Follow up	Outcomes	Main findings
Desrosiers et al.³	NI	NI	NI	NI	NI	MASQ-AD, ERQ, MASQ-AA, RRS, FFMQ, PSWQ, DERS	Some treatments for anxiety and mood disorders incorporate aspects of the practice of mindfulness and show beneficial effects on treatment outcomes.
Smith et al.⁵	120 min to 180 min	1x/week	8 weeks	Group-based session plus home based exercise and 6-hour retreat	Immediately after the intervention	GAD-7 PSS-4 SF-36	The MBSR approach includes daily mindfulness activities related to awareness of mind and body, using techniques focused on the present moment and nonjudgment.
Wong et al.⁶	120 min	1x/week	8 weeks	Group-based session plus home based exercise	3 months 6 months 9 months	PSWQ, BAI CES-D SF-12	The MBCT approach is based on an integration of CBT and MBSR and is designed to reduce the rates of relapse and recurrence of major depression.
Boettcher et al.⁷	120 min	1x/week	8 weeks	Internet based treatment plus home based exercise	6 months	BAI BDI ISI QOLI	Internet-based mindfulness treatments that are delivered remotely were studied, showing positive outcomes of treatment of anxiety disorders.
Burton et al.⁸	NR	1x/week	8 weeks	Virtual reality exposure or exposure group therapy	3 months	BFNE MAAS	Fear of negative appraisal decreased with successive treatments and was negatively associated with mindfulness throughout treatment and follow-up.
Sundquist et al.⁹	120 min	1x/week	8 weeks	Group-based session plus home based exercise	Immediately after the intervention	HADS PHQ-9 MADRS-S	The variations between the mindfulness and control groups were irrelevant, therefore their protocols was non-inferior to treatment as usual for patients.
Kraemer et al.¹⁰	NI	NI	NI	NI	NI	PANAS FFMQ ASI-3 IDAS	The study’s ﬁndings suggested that targeting use of the skill of acting with awareness may be a new approach to eliminating panic symptomatology among individuals with asthma.
Eyles et al.¹²	120 min	1x/week	8 weeks	Group-based session plus retreat day and home based exercise	4 months 6 months	HADS BFI TMS	The study implemented an MBSR-based treatment in women with MBC who were experiencing enhanced anxiety and effects on their QoL. The MBSR-based treatment was accepted by MBC patients who reported its benefits on their anxiety and QoL.
Hoge et al.¹³	120 min	1x/week	8 weeks	Group-based session plus 4 hour retreat and home based exercise	Immediately after the intervention	HAM-A BAI	In the majority of studies, the MBSR program consisted of 8 weekly group classes with a single weekend “retreat” day and daily home practice guided by audio recordings.
Lenze et al.¹⁴	150 min	1x/week	8 weeks 12 weeks	Group-based session plus one day-long retreat or 2.5 hour retreat	3 months 6 moths	MAAS CAMS-R	The study showed that MBSR was effective in anxious older adults; the patients experienced positive developments such as decreased worry severity and improved memory.
Serpa et al.¹⁶	120min	1x/week	9 weeks	Group-based session plus home based exercise	Immediately after the intervention	SF-12 FFMQ PHQ-9	The data did not show a significant difference in cognitive or clinical performance due to MBSR techniques in the 12-week MBSR program compared to the 8-week MBSR program.
Arch et al.¹⁷	90 min	1x/week	10 weeks	Group-based session plus a single 3 hour retreat and home based exercise	3 months	BDI MASQ-AA PSWQ	They noted that the effects of MBSR on veterans included improved symptoms of anxiety and depression and a reduction in suicidal ideation.
Britton et al.¹⁸	NR	1x/week	8 weeks	Group-based session plus home based exercise		TSST, BDI, HRST STAI-Y1	The CBT and adapted MBSR interventions were mutually effective at reducing the primary diagnoses and fairly effective at reducing self-reported anxiety symptoms within the trial.
Kim et al.¹⁹	90 min	1x/week	8 weeks	Group-based session plus home based exercise	1 year	PDSS, HAM-D ASI-R, HAM-A	This study supported the empirical basis for the relevance of mindfulness-based approaches in depressed patients.
Eisendrath et al.²⁰	135 min	1x/week	8 weeks	Group-based session plus home based exercise	6 months 9 months 13 months	HAM-D, SF-12 QIDS, WSAS Q-LES-SQ AAQ, RRS, SCS	The presence of comorbid personality disorders predicted non-completion of MBCT for panic disorders. Likewise, treatment response and remission after MBCT could be predicted by enhanced anxiety sensitivity.
Roemer et al.²¹	NI	NI	NI	NI	NI	DERS PSWQ MAAS SCS DASS-21	Lack of emotion regulation and aspects of mindfulness was noticed in GAD patients in both studies.

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[1] Correspondence: Michele F. Rodrigues. Laboratório de Pânico e Respiração, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro. Av. Venceslau Bras, 71, fundos 21941-901 - Rio de Janeiro, RJ - Brazil. Tel.: +55 (21) 3938.5506 / +55 (21) 3938.5507. E-mail: michelefrodrigues@gmail.com