A mindfulness-based therapy for depression has the added benefit of reducing health-care visits among patients who often see their family doctors, according to a new study by the Centre for Addiction and Mental Health (CAMH) and the Institute for Clinical Evaluative Sciences (ICES)

The research showed that frequent health service users who received mindfulness-based cognitive therapy showed a significant reduction in non-mental health care visits over a one-year period, compared with those who received other types of group therapy. "We speculate that mindfulness-based cognitive therapy has elements that could help people who are high health-care utilizers manage their distress without needing to go to a doctor," says Dr. Paul Kurdyak, lead author and Director of Health Systems Research at CAMH and Lead of the Mental Health and Addictions Research Program at ICES. Mindfulness-based cognitive therapy is a structured form of psychotherapy that combines elements of cognitive-behaviour therapy with mindfulness meditation. It is delivered in a group setting for eight weekly sessions. The therapy was originally developed to prevent relapse of symptoms among people with recurring depression, as an alternative to ongoing medication treatment. It has been proven effective in multiple studies, and has been applied to other conditions such as anxiety and chronic pain. "Primary care physicians play a large role in managing patients with distress, and they often report feeling overwhelmed and unable to effectively deal with cases of medically unexplained symptoms," says Dr. Kurdyak. "This study shows the potential of mindfulness-based cognitive therapy to help both patients and their doctors."

The happiness of over 18,000 people worldwide has been predicted by a mathematical equation developed by researchers at UCL, with results showing that moment-to-moment happiness reflects not just how well things are going, but whether things are going better than expected

The new equation accurately predicts exactly how happy people will say they are from moment to moment based on recent events, such as the rewards they receive and the expectations they have during a decision-making task. Scientists found that overall wealth accumulated during the experiment was not a good predictor of happiness. Instead, moment-to-moment happiness depended on the recent history of rewards and expectations. These expectations depended, for example, on whether the available options could lead to good or bad outcomes. The study investigated the relationship between happiness and reward, and the neural processes that lead to feelings that are central to our conscious experience, such as happiness. Before now, it was known that life events affect an individual's happiness but not exactly how happy people will be from moment to moment as they make decisions and receive outcomes resulting from those decisions, something the new equation can predict. Scientists believe that quantifying subjective states mathematically could help doctors better understand mood disorders, by seeing how self-reported feelings fluctuate in response to events like small wins and losses in a smartphone game. A better understanding of how mood is determined by life events and circumstances, and how that differs in people suffering from mood disorders, will hopefully lead to more effective treatments. For the study, 26 subjects completed a decision-making task in which their choices led to monetary gains and losses, and they were repeatedly asked to answer the question 'how happy are you right now?'. The participant's neural activity was also measured during the task using functional MRI and from these data, scientists built a computational model in which self-reported happiness was related to recent rewards and expectations. The model was then tested on 18,420 participants in the game 'What makes me happy?' in a smartphone app developed at UCL called 'The Great Brain Experiment'. Scientists were surprised to find that the same equation could be used to predict how happy subjects would be while they played the smartphone game, even though subjects could win only points and not money. Lead author of the study, Dr Robb Rutledge (UCL Wellcome Trust Centre for Neuroimaging and the new Max Planck UCL Centre for Computational Psychiatry and Ageing), said: "It is often said that you will be happier if your expectations are lower. We find that there is some truth to this: lower expectations make it more likely that an outcome will exceed those expectations and have a positive impact on happiness. However, expectations also affect happiness even before we learn the outcome of a decision. If you have plans to meet a friend at your favorite restaurant, those positive expectations may increase your happiness as soon as you make the plan." The team used functional MRI to demonstrate that neural signals during decisions and outcomes in the task in an area of the brain called the striatum can be used to predict changes in moment-to-moment happiness. The striatum has a lot of connections with dopamine neurons, and signals in this brain area are thought to depend at least partially on dopamine. These results raise the possibility that dopamine may play a role in determining happiness.

Weight loss significantly improves physical health but effects on mental health are less straightforward, finds new research

In a study of 1,979 overweight and obese adults in Britain, people who lost 5% or more of their initial body weight over four years showed significant changes in markers of physical health, but were more likely to report depressed mood than those who stayed within 5% of their original weight. The research highlights the need to consider mental health alongside physical health when losing weight. Clinical trials of weight loss have been shown to improve participants' mood, but this could be a result of the supportive environment rather than the weight loss itself, as the effects are seen very early on in treatment and are not related to the extent of weight loss. It's important to note this new result does not mean that weight loss necessarily causes depression directly, as depression and weight loss may share a common cause. However, it shows that weight loss outside the clinical trial setting cannot be assumed to improve mood and raises questions about the psychological impact of weight loss. The data came from the English Longitudinal Study of Ageing, a British study of adults aged 50 or older, and excluded participants with a diagnosis of clinical depression or a debilitating illness. Depressed mood and overall well-being were assessed using standard questionnaires and weight was measured by trained nurses. Of the 1,979 overweight and obese participants, 278 (14%) lost at least 5% of their initial body weight with a mean weight loss of 6.8kg per person. Before adjusting for serious health issues and major life events such as bereavement, which can cause both weight loss and depressed mood, the people who lost weight were 78% more likely to report depressed mood. After controlling for these, the increased odds of depressed mood remained significant at 52%.