Photophobia, Trailing Phenomenon, Visual Aura, Visual Snow Syndrome
Conditions
Keywords
Mindfulness, Mindfulness Based Cognitive Therapy
Brief summary
This is a research study on Mindfulness-Based Cognitive Therapy for visual symptoms (MBCT-vision), to treat patients with debilitating symptoms of visual snow (VS) and is associated visual symptoms, severe light sensitivity (i.e. photophobia) and migrainous visual aura. Participants will receive an intervention of an 8-week MBCT course modified for visual symptoms, which will involve 8 weeks of once weekly group sessions and home practice between sessions.
Detailed description
This is a research study on Mindfulness-Based Cognitive Therapy for visual symptoms (MBCT-vision), to treat patients with debilitating symptoms of visual snow (VS) and its associated visual symptoms, severe light sensitivity (i.e. photophobia) and migrainous visual aura. VS is a condition of persistent flickering dots, like that of an out-of-focus analog television screen, affecting the whole visual field. There can be associated visual symptoms such as after-images, and trailing of images. No clinical trials for treatment have been done for VS. Instead, treatment data comes from patient case reports. Photophobia describes discomfort or pain to light stimulation. Causes include eye surface issues, migraine, or of an unknown trigger, and can be persistent despite optimum management of underlying causes. Patients with migrainous visual aura may have troublesome visual disturbances despite optimum migraine treatment. Previous studies have shown that dysfunction in brain pathways contribute to the above conditions. Mindfulness-Based Cognitive Therapy is a treatment that combines evidence-based approaches of Mindfulness-Based Stress Reduction and Cognitive Behavioural Therapy (CBT). MBCT is an established 8-week programme designed to develop skills of mindfulness and CBT strategies in individuals, through weekly small-group sessions and structured daily practice between sessions. Studies on MBCT and mindfulness-based interventions have shown improvements in psychological resilience; physical health including immune function; and neural changes associated with psychological wellbeing. The investigators propose that MBCT, modified to incorporate aspects relevant to persistent and distressing visual symptoms (MBCT-vision), can improve these debilitating symptoms by modifying dysfunctional neural pathways and equip patients with skills that promote psychological resilience and improve coping with residual symptoms. For this study, the investigators will assess the use of MBCT-vision in patients with visual snow or associated visual symptoms, migrainous visual aura or photophobia. This will be the first study of a mindfulness-based intervention in this population.
Interventions
BEHAVIORALMindfulness Based Cognitive Therapy
mindfulness and cognitive behavioural therapy techniques taught in group sessions meeting once weekly for 8 weeks, and home practice between sessions.
Sponsors
Guy's and St Thomas' NHS Foundation Trust
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
MBCT-vision intervention
Eligibility
Sex/Gender
ALL
Age
16 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients with visual snow or associated visual symptoms; photophobia for at least 3 months * Patients with migrainous visual aura occurring \>4 episodes a month for at least 3 months
Exclusion criteria
* Patient with a current severe depressive or psychotic episode * Patient with severe difficulties in emotional regulation * Patient unable to provide informed consent for participation * Patient with insufficient understanding of spoken English (due to need to participate in group discussions)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| change in severity of visual symptoms | week 9 and 20 | change in severity of visual symptoms pre- and post-intervention, comparing scores on Likert scale, ranging from 0/10 (no symptoms) to 10/10 (extremely severe symptoms) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| change in Clinical Outcomes in Routine Evaluation (CORE-10) scores | week 9 and 20 | change in CORE-10 scores, comparing pre- and post- intervention. CORE-10 scores range from 0-40 with higher scores indicating more distress. |
| change in Five-Facet Mindfulness Questionnaire (FFMQ) scores | week 9 and 20 | change in Five-Facet Mindfulness Questionnaire scores, comparing pre- and post- intervention. FFMQ scores range from 39-195 where higher scores represent more mindfulness |
| change in World Health Organisation (WHO) wellbeing index scores | week 9 and 20 | change in WHO wellbeing index, comparing pre- and post- intervention scores. WHO wellbeing index range from 0-25, with higher scores representing increased wellbeing. |
| qualitative assessment of MBCT-vision | week 9 | participant feedback on the design of MBCT-vision via structured qualitative interview |
| functional MRI | week 20 | changes to functional MRI comparing baseline to week 20 - this has been added for participants recruited in the second and third cohort |
| compliance (session attendance and completion of daily practice) | week 9 | participant compliance from attendance record for MBCT-vision weekly sessions and self-report compliance with daily home practice |
Countries
United Kingdom
Outcome results
None listed