You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
The effects of mindfulness-based cognitive therapy in patients with bipolar disorder: a controlled functional MRI investigation.
Abstract 1:
BACKGROUND Preliminary research findings have shown that mindfulness-based cognitive therapy improves anxiety and depressive symptoms in bipolar disorder . In this study , we further investigated the effects of MBCT in bipolar disorder , in a controlled fMRI study . METHOD Twenty three patients with bipolar disorder underwent neuropsychological testing and functional MRI .  Sixteen of these patients were tested before and after an eight-week MBCT intervention , and seven were wait listed for training and tested at the same intervals . The results were compared with 10 healthy controls . RESULTS Prior to MBCT , bipolar patients reported significantly higher levels of anxiety and symptoms of stress , scored significantly lower on a test of working memory , and showed significant BOLD signal decrease in the medial PFC during a mindfulness task , compared to healthy controls . Following MBCT , there were significant improvements in the bipolar treatment group , in measures of mindfulness , anxiety and emotion regulation , and in tests of working memory , spatial memory and verbal fluency compared to the bipolar wait list group . BOLD signal increases were noted in the medial PFC and posterior parietal lobe , in a repeat mindfulness task . A region of interest analysis revealed strong correlation between signal changes in medial PFC and increases in mindfulness . LIMITATIONS The small control group is a limitation in the study . CONCLUSION These data suggest that MBCT improves mindfulness and emotion regulation and reduces anxiety in bipolar disorder , corresponding to increased activations in the medial PFC , a region associated with cognitive flexibility and previously proposed as a key area of pathophysiology in the disorder


Title 2:
Mindfulness-based Cognitive Therapy (MBCT) in bipolar disorder: Preliminary evaluation of immediate effects on between-episode functioning
Abstract 2:
Background Bipolar disorder is highly recurrent and rates of comorbidity are high . Studies have pointed to anxiety comorbidity as one factor associated with risk of suicide attempts and poor overall outcome . This study aim ed to explore the feasibility and potential benefits of a new psychological treatment ( Mindfulness-based Cognitive Therapy : MBCT ) for people with bipolar disorder focusing on between-episode anxiety and depressive symptoms . Methods The study used data from a pilot r and omized trial of MBCT for people with bipolar disorder in remission , focusing on between-episode anxiety and depressive symptoms . Immediate effects of MBCT versus waitlist on levels of anxiety and depression were compared between unipolar and bipolar participants . Results The results suggest that MBCT led to improved immediate outcomes in terms of anxiety which were specific to the bipolar group . Both bipolar and unipolar participants allocated to MBCT showed reductions in residual depressive symptoms relative to those allocated to the waitlist condition . Limitations Analyses were based on a small sample , limiting power . Additionally the study recruited participants with suicidal ideation or behaviour so the findings can not immediately be generalized to individuals without these symptoms . Conclusions The study , although preliminary , suggests an immediate effect of MBCT on anxiety and depressive symptoms among bipolar participants with suicidal ideation or behaviour , and indicates that further research into the use of MBCT with bipolar patients may be warranted


Title 3:
Long-term symptomatic status of bipolar I vs. bipolar II disorders.
Abstract 3:
Weekly affective symptom severity and polarity were compared in 135 bipolar I ( BP I ) and 71 bipolar II ( BP II ) patients during up to 20 yr of prospect i ve symptomatic follow-up . The course of BP I and BP II was chronic ; patients were symptomatic approximately half of all follow-up weeks ( BP I 46.6 % and BP II 55.8 % of weeks ) . Most bipolar disorder research has concentrated on episodes of MDD and mania and yet minor and subsyndromal symptoms are three times more common during the long-term course . Weeks with depressive symptoms predominated over manichypomanic symptoms in both disorders ( 31 ) in BP I and BP II at 371 in a largely depressive course ( depressive symptoms=59.1 % of weeks vs. hypomanic=1.9 % of weeks ) . BP I patients had more weeks of cyclingmixed polarity , hypomanic and subsyndromal hypomanic symptoms . Weekly symptom severity and polarity fluctuated frequently within the same bipolar patient , in which the longitudinal symptomatic expression of BP I and BP II is dimensional in nature involving all levels of affective symptom severity of mania and depression . Although BP I is more severe , BP II with its intensely chronic depressive features is not simply the lesser of the bipolar disorders ; it is also a serious illness , more so than previously thought ( for instance , as described in DSM-IV and ICP-10 ) . It is likely that this conventional view is the reason why BP II patients were prescribed pharmacological treatments significantly less often when acutely symptomatic and during intervals between episodes . Taken together with previous research by us on the long-term structure of unipolar depression , we su bmi t that the thrust of our work during the past decade supports classic notions of a broader affective disorder spectrum , bringing bipolarity and recurrent unipolarity closer together . However the genetic variation underlying such a putative spectrum remains to be clarified


Title 4:
Online mindfulness-based intervention for late-stage bipolar disorder: pilot evidence for feasibility and effectiveness.
Abstract 4:
OBJECTIVES People in the late stage of bipolar disorder ( BD ) experience elevated relapse rates and poorer quality of life ( QoL ) compared with those in the early stages . Existing psychological interventions also appear less effective in this group . To address this need , we developed a new online mindfulness-based intervention targeting quality of life ( QoL ) in late stage BD . Here , we report on an open pilot trial of ORBIT ( online , recovery-focused , bipolar individual therapy ) . METHODS Inclusion criteria were : self-reported primary diagnosis of BD , six or more episodes of BD , under the care of a medical practitioner , access to the internet , proficient in English , 18 - 65 years of age . Primary outcome was change ( baseline - post-treatment ) on the Brief QoL.BD  ( Michalak and Murray , 2010 ) . Secondary outcomes were depression , anxiety , and stress measured on the DASS scales ( Lovibond and Lovibond , 1993 ) . RESULTS Twenty-six people consented to participate ( Age M=46.6 years , SD=12.9 , and 75 % female ) . Ten participants were lost to follow-up ( 38.5 % attrition ) . Statistically significant improvement in QoL was found for the completers , t(15)=2.88 , 95 % CI:.89 - 5.98 , p=.011 , ( Cohen׳s dz=.72 , partial η(2)=.36 ) , and the intent-to-treat sample t(25)=2.65 , 95 % CI:.47 - 3.76 , ( Cohen׳s dz=.52 ; partial η(2)=.22 ) . A non-significant trend towards improvement was found on the DASS anxiety scale ( p=.06 ) in both completer and intent-to-treat sample s , but change on depression and stress did not approach significance . LIMITATIONS This was an open trial with no comparison group , so measured improvements may not be due to specific elements of the intervention . Structured diagnostic assessment s were not conducted , and interpretation of effectiveness was limited by substantial attrition . CONCLUSION Online delivery of mindfulness-based psychological therapy for late stage BD appears feasible and effective , and ORBIT warrants full development . Modifications suggested by the pilot study include increasing the 3 weeks duration of the intervention , adding caution s about the impact of extended meditations , and addition of coaching support/monitoring to optimise engagement


Title 5:
Mindfulness-Oriented Recovery Enhancement versus CBT for co-occurring substance dependence, traumatic stress, and psychiatric disorders: Proximal outcomes from a pragmatic randomized trial.
Abstract 5:
In many clinical setting s , there is a high comorbidity between substance use disorders , psychiatric disorders , and traumatic stress . Novel therapies are needed to address these co-occurring issues efficiently . The aim of the present study was to conduct a pragmatic r and omized controlled trial comparing Mindfulness-Oriented Recovery Enhancement ( MORE ) to group Cognitive-Behavioral Therapy ( CBT ) and treatment-as-usual ( TAU ) for previously homeless men residing in a therapeutic community . Men with co-occurring substance use and psychiatric disorders , as well as extensive trauma histories , were r and omly assigned to 10 weeks of group treatment with MORE ( n = 64 ) , CBT ( n = 64 ) , or TAU ( n = 52 ) . Study findings indicated that from pre-to post-treatment MORE was associated with modest yet significantly greater improvements in substance craving , post-traumatic stress , and negative affect than CBT , and greater improvements in post-traumatic stress and positive affect than TAU . A significant indirect effect of MORE on decreasing craving and post-traumatic stress by increasing dispositional mindfulness was observed , suggesting that MORE may target these issues via enhancing mindful awareness in everyday life . This pragmatic trial represents the first head-to-head comparison of MORE against an empirically-supported treatment for co-occurring disorders . Results suggest that MORE , as an integrative therapy design ed to bolster self-regulatory capacity , may hold promise as a treatment for intersecting clinical conditions


Title 6:
Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy.
Abstract 6:
This study evaluated mindfulness-based cognitive therapy ( MBCT ) , a group intervention design ed to train recovered recurrently depressed patients to disengage from dysphoria-activated depressogenic thinking that may mediate relapse/recurrence . Recovered recurrently depressed patients ( n = 145 ) were r and omized to continue with treatment as usual or , in addition , to receive MBCT .  Relapse/recurrence to major depression was assessed over a 60-week study period . For patients with 3 or more previous episodes of depression ( 77 % of the sample ) , MBCT significantly reduced risk of relapse/recurrence . For patients with only 2 previous episodes , MBCT did not reduce relapse/recurrence .  MBCT offers a promising cost-efficient psychological approach to preventing relapse/recurrence in recovered recurrently depressed patients


Title 7:
A randomized, controlled, pilot study of dialectical behavior therapy skills in a psychoeducational group for individuals with bipolar disorder.
Abstract 7:
BACKGROUND Bipolar disorder ( BD ) is a chronic and disabling psychiatric disorder characterized by recurrent episodes of mania/hypomania and depression . Dialectical behavior therapy ( DBT ) techniques have been shown to effectively treat borderline personality disorder , a condition also marked by prominent affective disturbances . The utility of DBT techniques in treating BD has been largely unexplored . The purpose of this research was to conduct a pilot study of a DBT-based psychoeducational group ( BDG ) in treating euthymic , depressed , or hypomanic Bipolar I or II patients . METHODS In this experiment , 26 adults with bipolar I or II were r and omized to intervention or  wait-list control groups and completed the Beck depression inventory II , mindfulness-based self-efficacy scale , and affective control scale at baseline and 12 weeks . The BDG intervention consisted of 12 weekly 90-min sessions which taught DBT skills , mindfulness techniques , and general BD psychoeducation . RESULTS Using RM-ANOVA , subjects in BDG demonstrated a trend toward reduced depressive symptoms , and significant improvement in several MSES subscales indicating greater mindful awareness , and less fear toward and more control of emotional states ( ACS ) . These findings were supported with a larger sample of patients who completed the BDG . Furthermore , group attendees had reduced emergency room visits and mental health related admissions in the six months following BDG . LIMITATIONS The small sample size in RCT affects power to detect between group differences . How well improvements after the12-week BDG were maintained is unknown . CONCLUSIONS There is preliminary evidence that DBT skills reduce depressive symptoms , improve affective control , and improve mindfulness self-efficacy in BD . Its application warrants further evaluation in larger studies


Title 8:
Mindfulness‐Based Cognitive Therapy for Nonremitted Patients with Bipolar Disorder
Abstract 8:
Introduction : Bipolar disorder is characterized by recurrent episodes of depression and /or mania along with interepisodic mood symptoms that interfere with psychosocial functioning . Despite periods of symptomatic recovery , many individuals with bipolar disorder continue to experience substantial residual mood symptoms that often lead to the recurrence of mood episodes


Title 9:
Mindfulness-based cognitive therapy for bipolar disorder: a feasibility trial.
Abstract 9:
BACKGROUND The present open study investigates the feasibility of  Mindfulness-based cognitive therapy ( MBCT ) in groups solely composed of bipolar patients of various subtypes .  MBCT has been mostly evaluated with remitted unipolar depressed patients and little is known about this treatment in bipolar disorder . METHODS Bipolar out patients ( type I , II and NOS ) were included and evaluated for depressive and hypomanic symptoms , as well as mindfulness skills before and after MBCT . Patients ' expectations before the program , perceived benefit after completion and frequency of mindfulness practice were also recorded . RESULTS Of 23 included patients , 15 attended at least four MBCT sessions  . Most participants reported having durably , moderately to very much benefited from the program , although mindfulness practice decreased over time . Whereas no significant increase of mindfulness skills was detected during the trial , change of mindfulness skills was significantly associated with change of depressive symptoms between pre- and post-MBCT assessment s. CONCLUSIONS MBCT is feasible and well perceived among bipolar patients . Larger and r and omized controlled studies are required to further evaluate its efficacy , in particular regarding depressive and (hypo)manic relapse prevention . The mediating role of mindfulness on clinical outcome needs further examination and efforts should be provided to enhance the persistence of meditation practice with time
Our meta- analysis showed significantly beneficial effects on depressive and anxiety symptoms of BD patients in within-group analysis .
However , this significance was not observed in comparison with the control groups .