Mindfulness-based group therapy for systemic lupus erythematosus: A first exploration of a promising mind-body intervention

Abstract

Psychological effects related to systemic lupus erythematosus (SLE) are tremendous. While a variety of psychological treatments have been applied to assist SLE patients, the effects of mindfulness practice were never documented in SLE. Mindfulness-based psychotherapy includes several techniques, including body-scan, breathing exercises, and full awareness during daily activities. In this case report, we present a first attempt at conducting mindfulness-based group therapy among SLE patients. Six female SLE patients participated in an 8-week program. Improvement was observed in several areas: patients' increased ability to differentiate between themselves and the disease; increased ability to accept, rather than to actively fight the fact that one must live with the disease; and decreased behavioral avoidance. These observations speak to the significant therapeutic potential of mindfulness practice among SLE patients. With its emphasis on acceptance of negative physical and emotional states, mindfulness practice is a promising treatment option, which needs to be further studied.

Introduction

Systemic Lupus Erythematosus (SLE) is an inflammatory autoimmune disease, involving chronic fatigue, joint pain, stiffness and swelling. In addition, patients often display skin lesions that appear or worsen with sun exposure [1], [2]. It is a rare disease, with more frequent incidence in young women. The overall prevalence per 100,000 ranges around 5.5, with an increased incidence of ∼9.3 per 100,000 among females [3]. SLE causes significant morbidity and mortality due to inflammatory disease activity, infectious processes secondary to the disease-induced immunosuppression and its treatment, and cardiovascular complications [4]. SLE is considered a stress-related disease, and in many cases, symptoms are worsened under stressful conditions [5], [6]. Neurological and psychiatric manifestations affect nearly half of patients with SLE, and several of these manifestations define a disease criterion [7]. Throughout their lives, 65% of patients with lupus are diagnosed with a mood or anxiety disorder, including major depression (47%), specific phobia (24%), panic disorder (16%), obsessive-compulsive disorder (9%), and bipolar disorder (6%). Thus, psychological effects related to SLE are significant, and exert a considerable impact on patients' quality of life [8].

A recent meta-analysis showed that psychological interventions may reduce levels of anxiety, depression, stress, and disease activity among SLE patients [9]. Mindfulness-based psychotherapy encourages the patient to closely observe his/her emotional and physiological state with an invitation to accept, rather than to ward-off, painful feelings and physical sensations [10]. Most mindfulness programs include several core techniques, including body-scan (shifting attention between parts of the body with openness and curiosity), breathing exercises and practicing being fully aware during daily activities [11]. Mindfulness-based interventions have proved to be effective in treating various psychiatric and physical conditions, including conditions characterized by intrusive pain, such as fibromyalgia and arthritis [12]. Biological markers associated with mindfulness practice include reduced urine cortisol levels and increased number of white blood cell [13]. Surprisingly, mindfulness-based interventions were never explored in SLE.