Moderators of the effectiveness of a mindfulness-based stress reduction intervention compared to an active control for solid organ transplant patients.

Abstract

Psychological distress and sleep disturbance are common among post-operative transplant patients. Mindfulness-Based Stress Reduction (MBSR) may be helpful in providing relief for these symptoms without interfering with a demanding medication regimen. This study is based on the Wellness Intervention After Transplant Study (Gross, Kreitzer, Thomas, Reilly-Spong, Cramer-Bornemann, Nyman, Frazier, & Ibrahim, in press) and evaluated moderators of the effectiveness of MBSR compared to an active control group for reducing depression, anxiety, and sleep dysfunction. The active control group was referred to as Health Education (HE) and was based on Stanford University's Chronic Disease Self-Management Program (Lorig et. al, 2000). It was hypothesized that individuals with greater levels of depression, anxiety, and sleep disturbance, and fewer psychosocial resources (mindfulness and self-efficacy) would benefit from either intervention more than individuals with less distress and more psychosocial resources. Additionally, individuals would do better in the intervention that targeted the domain in which they were lacking (e.g. those with lower baseline mindfulness would do better in MBSR than HE; those with lower baseline self-efficacy would do better in HE than MBSR). Participants consisted of 127 solid organ transplant recipients who were at least six months post-surgery, randomized to either the MBSR or HE groups, and completed baseline and post-intervention (8-week) assessments. Results indicated that participants with fewer psychosocial resources and greater distress did better in the HE group in regards to reducing symptoms. This pattern did not hold for those in the MBSR group where individuals with greater psychosocial resources reduced symptoms; whereas those with more distress and fewer resources increased in symptoms.