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:
Mindfulness-based cognitive therapy as a treatment for chronic depression: A preliminary study
Abstract 1:
This pilot study investigated the effectiveness of Mindfulness-Based Cognitive Therapy ( MBCT ) , a treatment combining mindfulness meditation and interventions taken from cognitive therapy , in patients suffering from chronic-recurrent depression . Currently symptomatic patients with at least three previous episodes of depression and a history of suicidal ideation were r and omly allocated to receive either MBCT delivered in addition to treatment-as-usual ( TAU ; N = 14 completers ) or TAU alone ( N = 14 completers ) . Depressive symptoms and diagnostic status were assessed before and after treatment phase . Self-reported symptoms of depression decreased from severe to mild levels in the MBCT group while there was no significant change in the TAU group . Similarly , numbers of patients meeting full criteria for depression decreased significantly more in the MBCT group than in the TAU group . Results are consistent with previous uncontrolled studies . Although based on a small sample and , therefore , limited in their generalizability , they provide further preliminary evidence that MBCT can be used to successfully reduce current symptoms in patients suffering from a protracted course of the disorder


Title 2:
Mindfulness-based stress reduction for chronic insomnia in adults older than 75 years: a randomized, controlled, single-blind clinical trial.
Abstract 2:
OBJECTIVE To assess the effectiveness of mindfulness-based stress reduction ( MBSR ) for chronic insomnia and combined depressive or anxiety symptoms of older adults aged 75 years and over . DESIGN A r and omized , controlled , single-blind clinical trial . PATIENTS AND METHODS Participants included 60 adults aged 75 years and over with chronic insomnia . Participants were r and omly assigned to the eight-week MBSR group or the wait-list control group . Assessment s using the Pittsburgh Sleep Quality Index ( PSQI ) , Self-rating Anxiety Sale ( SAS ) , and Geriatric Depression Scale ( GDS ) were taken at baseline and post-treatment . For each outcome measure , a repeated measures analysis of variance was used to detect changes across assessment s. RESULTS There was a significant time × group interaction for the PSQI global score ( P = .006 ) ; the MBSR group had a decrease in the PSQI global score ( Cohen׳s d = 1.12 ) , while the control group did not ( Cohen׳s d = -0.06 ) . Among the PSQI components , there was a significant time × group interaction for daytime dysfunction ( P = .048 ) ; Cohen׳s d of the MBSR group was 0.76 , while Cohen׳s d of control group was -0.04 . There was no significant time × group interaction for the SAS score ( P = .116 ) , while for the GDS there was a significant time × group interaction ( P = .039 ) ; the Cohen׳s d value for the MBSR group was 1.20 , and it was 0.12 for the control group . CONCLUSION This study demonstrated that the MBSR program could be a beneficial treatment for chronic insomnia in adults aged 75 years and older


Title 3:
Mindfulness-Based Stress Reduction for Older Adults With Stress Disorders and Neurocognitive Difficulties: A Randomized Controlled Trial.
Abstract 3:
OBJECTIVE To determine whether neurocognitive performance and clinical outcomes can be enhanced by a mindfulness intervention in older adults with stress disorders and cognitive complaints . To explore decreased hypothalamic-pituitary-adrenal ( HPA ) axis activity as a possible mechanism . METHODS 103 adults aged 65 years or older with an anxiety or depressive disorder ( diagnosed according to DSM-IV criteria ) and subjective neurocognitive difficulties were recruited in St. Louis , Missouri , or San Diego , California , from September 2012 through August 2013 and r and omly assigned in groups of 5 - 8 to  mindfulness-based stress reduction ( MBSR ) or a health education control condition matched for time , attention , and credibility . The primary outcomes were memory ( assessed by immediate and delayed paragraph and list recall ) and cognitive control ( Delis-Kaplan Executive Function System Verbal Fluency Test and Color Word Interference Test ) . Other outcomes included clinical symptoms ( worry , depression , anxiety , and global improvement ) . HPA axis activity was assessed using peak salivary cortisol . Outcomes were measured immediately post-intervention and ( for clinical outcomes only ) at 3- and 6-month follow up . RESULTS On the basis of intent-to-treat principles using data from all 103 participants , the mindfulness group experienced greater improvement on a memory composite score ( P = .046 ) . Groups did not differ on change in cognitive control . Participants receiving MBSR also improved more on measures of worry ( P = .042 ) and depression ( P = .049 ) at posttreatment and on worry ( P = .02 ) , depression ( P = .002 ) , and anxiety ( P = .002 ) at follow-up and were more likely to be rated as much or very much improved as rated by the Clinical Global Impressions-Improvement scale ( 47 % vs 27 % , χ² = 4.5 , P = .03 ) . Cortisol level decreased to a greater extent in the mindfulness group , but only among those participants with high baseline cortisol . CONCLUSIONS In this population of older adults with stress disorders and neurocognitive difficulties , a mindfulness intervention improves clinical outcomes such as excessive worry and depression and may include some forms of immediate memory performance . TRIAL REGISTRATION Clinical Trials.gov identifier : NCT01693874


Title 4:
Randomized controlled trial of mindfulness-based therapy for dyspnea in chronic obstructive lung disease.
Abstract 4:
OBJECTIVES Patients with chronic obstructive lung disease ( COPD ) suffer from significant dyspnea and may benefit from complementary and alternative medicine ( CAM ) therapies aim ed at mitigating symptoms . The objective of this study was to test the efficacy of a mindfulness-based breathing therapy ( MBBT ) on improving symptoms and health-related quality of life in those with COPD . DESIGN We conducted a r and omized controlled trial of 8-week mindfulness-based breathing therapy ( MBBT ) compared to support groups to test efficacy on improving symptoms and health-related quality of life in those with COPD . SETTING The setting for this study was an academic-affiliated veterans healthcare system . SUBJECTS The subjects consisted of 86 patients with COPD . INTERVENTIONS MBBT included weekly meetings practicing mindfulness mediation and relaxation response . OUTCOME MEASURES The main outcome measure was a post 6-minute-walk test ( 6MWT ) Borg dyspnea assessment . Other outcome measures included health-related quality of life measures , 6MWT distance , symptom scores , exacerbation rates , and measures of stress and mindfulness . Analysis of covariance compared differences in outcomes between groups ; paired t test evaluated changes within groups . RESULTS Participants were predominantly elderly men with moderate to severe COPD . We found no improvements in dyspnea ( post 6MWT Borg difference between the MBBT and support group was 0.3 ( 95 % confidence interval [ CI ] : -1.1 , 1.7 ) . We found no differences between groups in almost all other outcome measures by either intention-to-treat analysis or within the subset that completed assigned group sessions . For the physical summary scale of the generic Short Form-36 for Veterans , the difference between outcomes favored the support group ( 4.3 , 95 % CI : 0.4 , 8.1 ) . Participant retention was low compared to mind-body trials that r and omize from CAM wait lists . CONCLUSIONS This trial found no measurable improvements in patients with COPD receiving a mindfulness-based breathing CAM therapy compared to a support group , suggesting that this intervention is unlikely to be an important therapeutic option for those with moderate-to-severe COPD


Title 5:
The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials
Abstract 5:
Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more


Title 6:
Emotional benefits of mindfulness-based stress reduction in older adults: the moderating roles of age and depressive symptom severity
Abstract 6:
Objectives : To examine the effects of age and depressive symptom severity on changes in positive affect among older adults r and omly assigned to a Mindfulness-Based Stress Reduction ( MBSR ) program or a Waitlist Control group . Drawing from the Motivational Theory of Life-Span Development , we hypothesized that lower levels of depressive symptom severity and older age would be associated with greater positive affect in response to the MBSR intervention . Methods : Data were collected from a sample of community-dwelling English-speaking adults ( n = 200 ) aged ≥ 65 , r and omly assigned to an eight-week MBSR program or a Waitlist Control group . Our main outcome variable was a five-item measure of positive affect , which was measured at study entry as well as eight weeks and six months later . Results : At the six-month follow-up , we observed group by baseline depressive symptom severity ( β = −.17 , p = .02 ) and group by baseline depressive symptom severity by age ( β = −.14 , p = .05 ) interactions . Among MBSR participants , greater baseline depressive symptom severity was also associated with less improvement in positive affect at the six-month follow-up ( β = −.30 , p = .003 ) . Findings were qualified by a significant depressive symptom severity by age interaction ( β = −.25 , p = .01 ) , such that MBSR participants who were 70 and over with lower baseline depressive symptom severity having the greatest improvement in positive affect at the six-month follow-up . Conclusion : MBSR  improves positive affect for older adults with lower depressive symptom severity , perhaps because it capitalizes on naturalistic changes in control strategies


Title 7:
The Importance of Cultivating Mindfulness for Cognitive and Emotional Well-Being in Late Life
Abstract 7:
The cultivation of mindfulness has received increasing attention over the past 2 decades because of its association with increased psychological well-being and reduced stress-related health disorders . Given the robust positive association between perceived stress and cognitive impairment in late life , the current study evaluated the association between trait mindfulness , psychological well-being , and cognitive function in 73 healthy community-dwelling older adults . Controlling for a priori covariates , multivariate regression analyses showed a significant association between trait mindfulness and measures of psychological well-being , including self-reported depressive symptoms , quality of life , and stress profile . Analyses further showed a significant association between trait mindfulness and executive function , namely set shifting . No association was found for declarative memory . Mediation analyses showed that the association between mindfulness and cognitive function is mediated by perceived stress . This research supports the importance of cultivating mindfulness in late life to ensure cognitive and emotional well-being


Title 8:
An Adapted Mindfulness-Based Stress Reduction Program for Elders in a Continuing Care Retirement Community
Abstract 8:
The purpose of this study was to test the feasibility and effectiveness of an adapted 8-week Mindfulness-Based Stress Reduction ( MBSR ) program for elders in a continuing care community . This mixed- methods study used both quantitative and qualitative measures . A r and omized waitlist control design was used for the quantitative aspect of the study . Thirty-nine elderly were r and omized to MBSR ( n = 20 ) or a waitlist control group ( n = 19 ) , mean age was 82 years . Both groups completed pre – post measures of health-related quality of life , acceptance and psychological flexibility , facets of mindfulness , self-compassion , and psychological distress . A subset of MBSR participants completed qualitative interviews . MBSR participants showed significantly greater improvement in acceptance and psychological flexibility and in role limitations due to physical health . In the qualitative interviews , MBSR participants reported increased awareness , less judgment , and greater self-compassion . Study results demonstrate the feasibility and potential effectiveness of an adapted MBSR program in promoting mind – body health for elders


Title 9:
Effects of Karate Training Versus Mindfulness Training on Emotional Well-Being and Cognitive Performance in Later Life
Abstract 9:
In a r and omized controlled trial , we investigated the effects of karate versus a mindfulness-based stress reduction ( MBSR ) intervention on well-being and cognitive functioning in older adults . Fifty-five adults ( 52–81 years old ) participated in twice-weekly karate versus MBSR sessions or no training for 8 weeks . In pre- and post assessment s , subjective well-being , health , cognitive functioning , and chronic stress were measured . Pre assessment hair cortisol served as physiological stress marker . The results showed an improvement for the karate group , but not the MBSR and control group , in subjective mental health and anxiety as well as cognitive processing speed . The MBSR group showed by trend as a decrease in stress . No significant correlation between pre assessment hair cortisol and post assessment outcomes could be established . But the higher the level of baseline self-reported perceived stress , the higher the increase in depression , anxiety , and chronic stress . Generally , it can be assumed that karate and MBSR showed only small training effects concerning the assessed emotional and cognitive parameters
The results of this review provide evidence that the MBSR is more effective than wait-list-control group to reduce depression in older adults with clinical ly significant symptoms immediately following the intervention .
However , there is no clear evidence that the intervention reduced the perception of stress and anxiety , or that positive effects are maintained over the longer term .