A New Direction of Treatment for Dysthymic Persons: A Randomized Controlled Trial Examining the Affliction-Equanimity Framework in the Psychosocial Group Intervention
People with dysthymia experience less severe but longer-lasting symptoms of depression. They often seek help due to increasing levels of stress or personal difficulties that may be situation-related. Integrative Body-mind-spirit (I-BMS) intervention model has gained abundant evidence in building people’s capacity and resilience as well as coping with physical and psychological pain to achieve equilibrium between body, mind and spirit and inner balance between affliction and equanimity. This study aimed to investigate the effectiveness of the I-BMS intervention group in enhancing the psychosocial well being of Chinese people with dysthymia in terms of alleviation of affliction and improvement of equanimity.
Methods:
Participants were recruited in a community mental health online survey between September and October in 2013. The survey was comprised of measures including Center for Epidemiologic Studies Depression Scale (CES-D) which was a screening test for depression and depressive disorder. Those who had mild grade depression (i.e. scoring 10-35 in CES-D) without bipolar or other psychotic morbidity were invited to attend the randomized controlled clinical trial. In the RCT, 144 people agreed to participate (experimental I-BMS group, n = 68; control group, n = 76) an 8 three-hour weekly intervention sessions. Beside, CES-D, outcome measures include Somatic Symptom Index (SSI) , Pittsburgh Sleep Quality Index (PSQI) , Holistic Well-being Scale (HWS) with subscales of Affliction and Equanimity. Repeated measures ANOVA was used to examine the interaction effect of treatment and time. The changes of all outcomes (T1-T0) between two groups were also compared by independent T-test.
Results:
Independent T-test showed that participants from both groups was comparable on CES-D score (95% confidence, CI: -0.08-4.31 , P>0.05). Results of ANOVA analysis showed that the intervention group has demonstrated a significant improvement on level of depression, somatic symptoms, sleep quality and holistic well-being. The CES-D score of more than half of the participants in the intervention group has dropped below the cutoff point of 16 after attending the group treatment. Independent T-test of pre-post changes(T1-T0) between two groups also showed a significant differences on CES-D (95% confidence, CI: -9.89- -4.95, P< 0.001), PSQI (95% confidence, CI: -3.63- -1.36, P < 0.001), SSI (95% confidence, CI: -12.72- -3.13 , P < 0.01), HWS-affliction (95% confidence, CI: -15.60- -5.01, P < 0.001) and HWS-equanimity (95% confidence, CI: 5.32-16.82, P < 0.001).
Conclusion and Implications:
Affliction was defined as a consequence of an maladaptive attachment, while equanimity was a state of psychological stability and composure which is undisturbed by experience of or exposure to pain and suffering, in which both were believed to be the core elements of human existence according to Chinese culture. These findings implies that I-BMS intervention group was in enhancing the well being of people with dysthymia by means of establishing the internal balance between affliction and equanimity. This has provided a new clinical direction in helping people with depressive symptoms which should be denoted in future studies. .