Posted 09.20.2018 | by AMRA

About one-in-five major depressive episodes are not responsive to either medication or psychotherapy and go on to become chronic illnesses. Mindfulness-Based Cognitive Therapy (MBCT) has been shown to be useful as an adjunctive treatment in acute depressions and the prevention of depressive relapse in patents with a history of multiple depressive episodes. Its effectiveness in chronic treatment-resistant depressions has not yet been established.

Cladder-Micus et al. [Depression and Anxiety] compared the effectiveness of MBCT as an adjunctive treatment to treatment-as-usual in patients with treatment-resistant chronic depression.

The researchers randomly assigned 106 patients with treatment-resistant chronic depression (female = 62%; mean age = 47 years; mean length of depressive episode = 70 months; mean number of previous episodes = 2.7) to either treatment-as-usual (TAU) or TAU combined with adjunctive MBCT. MBCT was offered in the standard 8-week group format. TAU consisted of medication, psychological treatment, psychiatric nursing support, and day hospitalization as needed. There was no difference between conditions as to the type and amount of TAU received.

Participants were assessed at baseline and post-treatment on symptom severity, remission of illness (no symptoms for two weeks), quality of life, rumination, self-compassion, and mindfulness (using the Five Facet Mindfulness Questionnaire).

The MBCT attrition rate was 24.5%, with participants dropping out due to physical complaints, trouble awakening in the morning, and practical considerations (e.g., moving away from the area). Completers did not differ from non-completers in terms of baseline depressive symptoms.

The main analyses were performed using an intention-to-treat (ITT) protocol using data from all participants available for post-testing, whether or not they successfully completed the MBCT program. Secondary analyses were conducted using only those MBCT participants who completed 4 or more group sessions.

Results showed that there were no significant immediate post-treatment between-group differences in severity of depressive symptoms when the entire ITT sample was analyzed. When data from completers was analyzed, MBCT completers had significantly fewer depressive symptoms than TAU participants (d = 0.45).

Using the entire ITT sample, significantly more MBCT participants (42%) achieved partial or complete symptom remission than TAU participants (22%). MBCT participants also reported significantly less rumination (d = .39), significantly better quality of life (d= .42), significantly more self-compassion (d = .64), and significantly greater degrees of mindfulness (d = .73) than TAU participants.

MBCT participants with higher baseline levels of rumination benefited more from MBCT than those with lower baseline levels (d=1.64).

This study shows that adjunctive MBCT increases mindfulness, self-compassion, and quality of life while reducing rumination in patients with treatment-resistant chronic depression when compared to patients in treatment-as-usual alone.

MBCT reduces symptom severity for those patients who complete the MBCT protocol, and increases the odds of achieving a partial remission of symptoms. MBCT is more effective for depressed patients who experience high levels of rumination. The study is limited by the absence of an active control adjunctive intervention and by its relatively high attrition rate.


Cladder-Micus, M. B., Speckens, A. E., Vrijsen, J. N., A, R. R., Becker, E. S., & Spijker, J. (2018). Mindfulness-based cognitive therapy for patients with chronic, treatment-resistant depression: A pragmatic randomized controlled trial. Depression and Anxiety.

[Link to abstract]