Posted: 01.20. 2014 | by AMRA

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Mindfulness-Based Cognitive Therapy (MBCT) is a well-established prophylactic treatment against relapse in major depressive disorder (MDD), but issues persist over which depressive patients benefit most.

Previous research suggests that MBCT may only prevent depressive relapse in a vulnerable subgroup of people with MDD. This group includes people with the most frequent episodes, earliest onsets, greatest levels of childhood adversity, and most persistent residual symptoms. In addition, prior research has not dismantled MBCT to discover whether its mindfulness training component is absolutely necessary for its effectiveness. Williams et al. [Journal of Consulting and Clinical Psychology] addressed these issues by comparing MBCT with Cognitive Psychological Education (CPE), an 8-week group treatment which included MBCT’s cognitive educational component while excluding mindfulness training embedded in meditation practice.

The authors randomly assigned 274 currently remitted patients with a history of three or more episodes of MDD to either MBCT, CPE, or treatment-as-usual (TAU). At 12-month follow-up, roughly half of each group had suffered a relapse (as defined by meeting the full diagnostic criteria for MDD for at least a two week time period), and there were no significant differences in the relapse rates between the two treatment groups. Participants with higher residual symptoms at baseline and/or stronger histories of childhood trauma were significantly more likely to relapse.

When the study compared participants with higher levels of childhood trauma to those with lower levels, the participants with higher levels benefited significantly more from MBCT than from TAU, with relapse rates of 41 (MBCT), 54 (CPE) and 65 (TAU) respectively. No significant differences between treatment groups emerged for participants with low levels of childhood trauma. These results further clarify those who benefit most from MBCT, and support the value of mindfulness training in the MBCT treatment package.

Reference:

Williams, J. M., Crane, C., Barnhofer, T., Brennan, K., Duggan, D. S., Fennell, M. J., . . . Russell, I. T. (2014). Mindfulness-Based cognitive therapy for preventing relapse in recurrent depression: A randomized dismantling trial. Journal of Consulting and Clinical Psychology, 82(2):275-86. [PMID: 24294837]

[Link to abstract]