Chelsea J. Siwik

Background: Migraine ranks among the leading causes of disability worldwide. Comorbid depressive symptoms are highly prevalent in patients with migraine and are associated with worsened pain severity, greater migraine-related disability, and poorer migraine prognosis. Despite this burdensome comorbidity, the treatment of these co-occurring disorders has rarely been studied. While mindfulness-based cognitive therapy (MBCT) shows promise for addressing both migraine-related disability and depressive symptoms, its traditional format—8 weekly 2-hour sessions in person—creates substantial access barriers, particularly for patients who experience frequent debilitating migraine and mood symptoms. Objective: The objective of the Treatment for Migraine and Mood (TEAM-M) trial is to evaluate the feasibility of an abbreviated MBCT intervention (MBCT-Brief) delivered via telephone or videoconferencing in adults with migraine and elevated depressive symptoms. Methods: TEAM-M is a 3-site trial with a goal sample size of 145 adults with episodic migraine and elevated depressive symptoms randomized to MBCT-Brief telephone, MBCT-Brief videoconferencing, or enhanced usual care (EUC). To be eligible, participants must meet the criteria for migraine as defined by the International Classification of Headache Disorders 3rd edition, have ≥1 year of migraine history, and have mild to moderate depressive symptoms (scores 5‐19 on the Patient Health Questionnaire-9). Results: Our primary outcomes include treatment feasibility, acceptability, and fidelity. Our secondary outcomes include headache disability, migraine-specific quality of life, and depressive symptoms. This trial was funded in May 2021. We began recruitment in November 2023 and completed enrollment in January 2026. As of May 2026, we have randomized 145 participants, of which 104 have completed the intervention and provided data for our primary outcomes. Data analysis is currently in progress, and primary outcome results are expected to be submitted for publication in spring 2027. Conclusions: The TEAM-M trial addresses a gap in clinical care by evaluating an abbreviated version of MBCT that has scalability and accessibility advantages over full-length MBCT and the potential to address both migraine and depressive symptoms. By reducing the time commitment while maintaining the core MBCT components, MBCT-Brief can potentially address significant access barriers that often prevent patients from receiving evidence-based health care for comorbid physical and mental health symptoms. The remote delivery model offers enhanced scalability. This trial will also yield information about potential differences in telephone versus videoconferencing delivery, which will inform optimal integration into existing primary care and mental health clinic workflows, allowing for improved access to specialized care for mental health and migraine across diverse health care settings.

BACKGROUND Migraine ranks among the leading causes of disability worldwide. Comorbid depressive symptoms are highly prevalent in patients with migraine and are associated with worsened pain severity, greater migraine-related disability, and poorer migraine prognosis. Despite this burdensome comorbidity, the treatment of these co-occurring disorders has rarely been studied. While Mindfulness-Based Cognitive Therapy (MBCT) shows promise for addressing both migraine-related disability and depressive symptoms, its traditional format—8 weekly, 2-hour in-person sessions—creates substantial access barriers, particularly for patients who experience frequent debilitating migraine and mood symptoms. OBJECTIVE The objective of the TEAM-M (Treatment for Migraine and Mood) trial is to evaluate the feasibility of an abbreviated MBCT intervention (MBCT-Brief) delivered via telephone or videoconferencing in adults with migraine and elevated depressive symptoms. METHODS TEAM-M is a three-site trial with a goal sample size of 145 adults with episodic migraine and elevated depressive symptoms randomized to MBCT-Brief telephone, MBCT-Brief videoconferencing, or enhanced usual care (EUC). To be eligible, participants must meet criteria for migraine as defined by the International Classification for Headache Disorders, 3rd Edition, have ≥1 year of migraine history, and have mild-moderate depressive symptoms (score 5–19 on the Patient Health Questionnaire). RESULTS Our primary outcomes include feasibility, acceptability, and fidelity of treatment. Our secondary outcomes include headache disability, migraine-specific quality of life, and depressive symptoms. We began recruitment in November 2023. To date, we have randomized 145 participants, and of these, 81 have completed the intervention. We completed enrollment in January 2026. CONCLUSIONS The TEAM-M trial addresses a gap in clinical care by evaluating an abbreviated version of MBCT that has scalability and accessibility advantages over full-length MBCT and the potential to address both migraine and depressive symptoms. By reducing time commitment and maintaining core MBCT components, MBCT-Brief has the potential to address significant access barriers that often prevent patients from receiving evidence-based healthcare for comorbid physical and mental health symptoms. The remote-delivery model offers enhanced scalability. This trial will also yield information about potential differences in telephone versus videoconferencing delivery that will inform optimal integration into existing primary care and mental health clinic workflows, allowing for improving access to specialized care for mental health and migraine across diverse healthcare settings. CLINICALTRIAL ClinicalTrials.gov NCT05576467. Registered on October 10, 2022.

Background: Mindfulness-Based Cognitive Therapy (MBCT) reduces depression relapse, yet graduates have expressed a need for structured guidance post-program to maintain mindfulness practice and sustain benefits. To address this, we created MBCT for Depression-Taking it Further (MBCT-D-TiF). Objective: To refine and pilot test feasibility and acceptability of MBCT-D-TiF. Methods: We collected qualitative focus group data to inform refinements and quantitative data to pilot test feasibility and acceptability of MBCT-D-TiF. In round one, participants received MBCT-D-TiF (n = 14), consisting of 4 weekly and then monthly sessions delivered via group videoconferencing. In round two (n = 20), participants were randomized 1:1 to MBCT-D-TiF or waitlist control. Surveys were completed at baseline, 1 and 4 months by all participants. We explored participants’ experiences with MBCT-D-TiF in two focus groups (n = 7 in each) conducted via videoconferencing. We used descriptive statistics and mixed linear models to analyze quantitative data and thematic content analysis to analyze qualitative data. Results: MBCT-D-TiF participants (n = 25) attended all weekly sessions (100%) and at least 75% of the monthly sessions (76%); found the weekly sessions very or extremely helpful (77.1%), and the monthly sessions very or extremely helpful (66.7%). The following themes emerged: (1) the importance of the group for participants’ social connection, support, and practice community that enhanced their meditative experience, helped improve their mental health, and facilitated accountability; (2) MBCT-D-TiF provided mental health benefits, including tools to lessen the negative impact of depression and anxiety, increase connections to the world, and enhance positive experiences; (3) participants’ home practices were reinvigorated during the weekly MBCT-D-TiF sessions, but fell short of their goals thereafter. Conclusion: MBCT-D-TiF was well attended and rated very or extremely helpful by most participants, supporting its feasibility and acceptability. Qualitative data showed that additional steps to help participants sustain home practice are needed, offering a target for refinement and further testing.

Objective: To assess the acceptability of a randomized single-blind trial of cognitive behavioral therapy (CBT) and whole-body hyperthermia (WBH) treatment for major depressive disorder (MDD). Methods: All participants (N = 30) with MDD received CBT for depression and were randomized to also receive either: (1) WBH that raised core body temperature using an infrared sauna device, or (2) sham WBH of a similar duration that did not significantly raise core body temperature. Results: Study acceptability was the primary outcome: of participants who completed the final assessment (n = 29; 96.7%), 22 (75.9%) reported that they would recommend participation to a friend or family member with MDD. Twenty-five (86.2%) participants reported that they would be likely or extremely likely to enroll in this study, given the experience they had in the study. All participants randomized to WBH correctly believed they received WBH, and 6 (43%) of participants randomized to sham WBH correctly believed they received sham WBH. Both arms achieved clinically meaningful and statistically significant reductions in depression symptoms. The average decreases in the Beck Depression Inventory-II (BDI-II) were −19.07 (SE = 2.69, P < 0.0001) in the WBH arm (80.0% no longer meeting DSM-5 criteria, 60.0% achieving 50% or greater reduction in BDI-II) and −21.10 (SE = 2.41, P <0.0001) in the sham WBH arm (92.9% no longer meeting DSM-5 criteria, 78.6% achieving 50% or greater reduction in BDI-II). Conclusions: Study procedures were acceptable. Participants in the WBH and sham WBH groups had substantial reductions in depressive symptoms that were greater than typically seen with CBT alone. The sham WBH arm was not fully credible and may have exerted antidepressant effects, thus raising concerns about its use in future trials. Further research to test whether adding WBH to CBT results in additional antidepressant effects is warranted.

PURPOSE: To provide evidence-based recommendations to health care providers on integrative approaches to managing anxiety and depression symptoms in adults living with cancer. METHODS: The Society for Integrative Oncology and ASCO convened an expert panel of integrative oncology, medical oncology, radiation oncology, surgical oncology, palliative oncology, social sciences, mind-body medicine, nursing, methodology, and patient advocacy representatives. The literature search included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2023. Outcomes of interest included anxiety or depression symptoms as measured by validated psychometric tools, and adverse events. Expert panel members used this evidence and informal consensus with the Guidelines into Decision Support methodology to develop evidence-based guideline recommendations. RESULTS: The literature search identified 110 relevant studies (30 systematic reviews and 80 randomized controlled trials) to inform the evidence base for this guideline. RECOMMENDATIONS: Recommendations were made for mindfulness-based interventions (MBIs), yoga, relaxation, music therapy, reflexology, and aromatherapy (using inhalation) for treating symptoms of anxiety during active treatment; and MBIs, yoga, acupuncture, tai chi and/or qigong, and reflexology for treating anxiety symptoms after cancer treatment. For depression symptoms, MBIs, yoga, music therapy, relaxation, and reflexology were recommended during treatment, and MBIs, yoga, and tai chi and/or qigong were recommended post-treatment. DISCUSSION: Issues of patient-health care provider communication, health disparities, comorbid medical conditions, cost implications, guideline implementation, provider training and credentialing, and quality assurance of natural health products are discussed. While several approaches such as MBIs and yoga appear effective, limitations of the evidence base including assessment of risk of bias, nonstandardization of therapies, lack of diversity in study samples, and lack of active control conditions as well as future research directions are discussed. Additional information is available at www.asco.org/survivorship-guidelines .

To examine the association between depressive symptoms, leukocyte telomere length–a marker of cellular ageing, and survival amongst lung cancer patients.Patients with non-small cell lung cancer wer...

The link between smoking and lung cancer predisposes patients to feeling shame and guilt, which increases risk for depression. To test the hypothesis shame would have a stronger association with depressive symptoms than guilt, a hierarchical regression was conducted. Three regressions were run to examine the associations of self-compassion with shame, guilt, and depressive symptoms. The best model to explain depressive symptoms included shame, but not guilt. Greater self-compassion was associated with less shame and fewer depressive symptoms, but not guilt. Results point to interventions targeting shame via enhancing self-compassion among patients with lung cancer and histories of smoking.

We explored associations between problem-focused, emotional processing, and emotional expression coping strategies and markers of stress including perceived stress, depressive symptoms, and diurnal cortisol profiles among women with gynecologic cancer. Problem-focused coping was associated with less perceived stress, fewer depressive symptoms, and more rhythmic diurnal salivary cortisol profiles. Emotional processing was associated with lower perceived stress and fewer depressive symptoms. Emotional expression was associated with fewer depressive symptoms and elevated diurnal mean and evening cortisol levels. Results point to key differences in coping strategies. In this sample, only problem-focused coping was linked with adaptive differences in both psychological and physiological stress measures.