Criteria | Rationale |
---|---|
Inclusion criteria | |
1. >45 years of age; chronic pain (pain ≥3 months duration in any body region by self-report) | Older people with chronic pain are disproportionately affected by harms from prescribed opioids such as overdose and death [36] |
2. On LTOT (any opioid at any dose for ≥3 months by self-report) | Known contribution of LTOT to depression and secondary outcome of reducing opioid use/dose [13] |
3. Comorbid depressive symptoms of mild to moderate severity (PHQ-9 score 10–19) | People with subsyndromal depressive symptoms (PHQ-9 score 5–9) are less likely to show an effect from any intervention |
4. Understanding of English language; able to sit for 20–25 min without significant discomfort; be willing and able to attend all four training sessions of SSM/HEP, as well as 75% of follow-up sessions | Ensure ability to participate in interventions which will be delivered in English only and mostly in a seated position |
Exclusion criteria | |
1. Psychiatric conditions other than depression, including substance use disorder, psychosis and cognitive impairment as established by the MINI; severe depression (PHQ-9 ≥20) and risk of imminent suicide as per MINI and PHQ-9; noncorrectable, clinically significant sensory impairment; acutely unstable physical illnesses, including delirium or acute cerebrovascular or cardiovascular events within the last 6 months; a terminal medical diagnosis with prognosis of less than 12 months | People with these attributes are theoretically less likely to benefit from the group meditation intervention and/or HEP control condition. People with severe depression (i.e., PHQ-9 ≥20) may need a standard intervention (e.g., psychotherapy, antidepressant medications). In certain cases, a patient’s symptoms may worsen (e.g., patients with psychosis) or the patient may be too frail to complete the study (e.g., medically unstable patients) [37] |
2. Currently practicing any form of mind–body intervention | To limit confounding variables |
3. Inability to provide informed consent | As per ethical norms for research involving human subjects |