Posted 01.24.2018 | by AMRA

One of the biggest difficulties in treating recurrent major depressive disorder (MDD) is that most people with recurrent MDD experience a relapse within two years following recovery from symptoms. Three treatments appear to have some success at limiting the two-year relapse rate to 30-40%: Antidepressant Medication Maintenance Therapy, Cognitive Therapy (CT), and Mindfulness-Based Cognitive Therapy (MBCT).

MBCT and CT attempt to reduce the risk of relapse by promoting different skill sets. CT promotes challenging dysfunctional thinking and increasing physical activity level. MBCT promotes nonjudgmental monitoring of moment-by-moment experience, and decentering from thoughts or seeing thoughts as transient mental phenomena and not necessarily valid.

Farb et al. [Journal of Consulting and Clinical Psychology] conducted the first randomized controlled head-to-head comparison of CT and MBCT for relapse prevention in MDD.

The researchers randomly assigned 166 people with MDD (average age = 40 years, 2/3 female; average of 4 past MDD episodes) currently in remission to either a MBCT or CT group.

Assessments of diagnosis and symptoms were done through a combined structured clinical interview and a self-report questionnaire. MDD symptoms were assessed bimonthly through an initial brief questionnaire. If the initial questionnaire suggested relapse, it was followed-up with another questionnaire and a structured clinical phone interview. A research psychiatrist confirmed all relapse diagnoses. In addition, participants completed questionnaires measuring decentering and dysfunctional beliefs every three months.

CT was delivered in 8 weekly 2-hour sessions that stressed goal setting, self-monitoring, maintaining thought records, and cognitive restructuring during its initial sessions, and lifestyle modification, environmental mastery, life purpose, self-acceptance, and optimizing interpersonal relationships in later sessions.

MBCT was delivered in 8 weekly 2-hour sessions with an additional retreat day. It emphasized mindfulness meditation, disengaging from habitual ruminative processes, awareness of everyday activities, and regulating negative emotions through approach and curiosity rather than avoidance.

Two-year participant retention rates were 60% for MBCT and 56% for CT. Treatment fidelity ratings were good for both CT and MBCT. Two-year relapse rates were not significantly different for the MBCT (22%) and CT (21%) groups, nor was there any difference in the time elapsed until relapse between groups.

Participants showed a significant linear increase in decentering over time, regardless of therapy group. Those who relapsed had significantly lower decentering levels than those who remained in remission. Dysfunctional beliefs declined significantly for the CT group only, but there was no relationship between the change in dysfunctional beliefs and the risk of relapse.

The results show that MBCT and CT are equally effective in reducing the risk of relapse in people with MDD. Despite differences in curriculum, both therapies seem to achieve their effect by strengthening the metacognitive skill of decentering.

The fact that both treatments appear to be equally beneficial is good news. People with MDD can opt for the treatment that is most consistent with their personal beliefs without needing to worry about receiving an inferior treatment. It is important to note, however, that the patients in this study tended to be White and highly educated. It is unclear how well these results might generalize to other populations.

Reference:

Farb, N., Anderson, A., Ravindran, A., Hawley, L., Irving, J., Mancuso, E., . . . Segal, Z. V. (2017). Prevention of relapse/recurrence in major depressive disorder with either mindfulness-based cognitive therapy or cognitive therapy. Journal of Consulting and Clinical Psychology.

[Link to abstract]