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Exploring mechanisms of change in a pilot randomised trial of a distant delivery mindfulness intervention for people with Parkinson’s disease

Coxon, A. (2018). Exploring mechanisms of change in a pilot randomised trial of a distant delivery mindfulness intervention for people with Parkinson’s disease. (Unpublished Doctoral thesis, City, University of London)


People with Parkinson’s disease report high levels of non-motor symptoms, including anxiety and depression, that are difficult to treat pharmacologically. Mindfulness-based interventions have been shown to be effective in other long-term conditions. This pilot study explored how a mindfulness-based intervention may have had an effect and for whom, with a view to informing future studies. Volunteers were randomised to a remote delivery, eight-week mindfulness cognitive behavioural group therapy intervention (n=40) or wait-list (n=38), and measures for psychological outcomes and putative mediators were taken at baseline, 4 weeks, 8 weeks and 20-week follow-up. The study showed that all the outcome measures changed in a positive health direction in the intervention group. The intervention had a small effect on decentering (d=.36) and acceptance (d=.27) by mid-point, before depression at 8 weeks (d=-.28) and anxiety at follow-up (d=-.29), indicating an indirect effect between trial arm and levels of distress. Mediation and moderation analysis were conducted using PROCESS, time-lagging the mediators to the outcome variables, but no combined or individual indirect effects had confidence intervals entirely above or below zero, thus mediation cannot be confirmed. When the end of intervention mediators were analysed with the follow-up levels of anxiety and depression, there is evidence of inconsistent mediation, or possible suppression effects. Moderation analysis revealed that the effect on anxiety levels was moderated by gender, with women benefitting more from the mindfulness intervention. Moderated mediation analysis also indicated that the effect of the trial arm on levels of acceptance was conditional by age and time since diagnosis, and the effect of trial arm on levels of mindfulness skills by age, meaning that younger, newly-diagnosed patients were more able to increase mindfulness skills and acceptance.

Publication Type: Thesis (Doctoral)
Subjects: R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
Departments: Doctoral Theses
Doctoral Theses > School of Health Sciences Doctoral Theses
School of Health Sciences
Date Deposited: 13 Feb 2019 10:34
Text - Accepted Version
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