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The efficacy of mindfulness-based cognitive therapy in recurrent depressed patients with and without a current depressive episode: a randomized controlled trial

Published online by Cambridge University Press:  03 October 2011

J. R. van Aalderen ,
A. R. T. Donders ,
F. Giommi ,
P. Spinhoven ,
H. P. Barendregt  and
A. E. M. Speckens
J. R. van Aalderen*
Affiliation:
Department of Psychiatry, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
A. R. T. Donders
Affiliation:
Department of Psychiatry, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
F. Giommi
Affiliation:
Department of Psychiatry, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
P. Spinhoven
Affiliation:
Department of Psychiatry, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
H. P. Barendregt
Affiliation:
Department of Psychiatry, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
A. E. M. Speckens
Affiliation:
Department of Psychiatry, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
*
*Address for correspondence: J. R. van Aalderen, Department of Psychiatry, Radboud University Nijmegen Medical Centre, Reinier Postlaan 10, 6500 HB Nijmegen, The Netherlands. (Email: [email protected])
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Abstract

Background

The aim of this study is to examine the efficacy of mindfulness-based cognitive therapy (MBCT) in addition to treatment as usual (TAU) for recurrent depressive patients with and without a current depressive episode.

Method

A randomized, controlled trial comparing MBCT+TAU (n=102) with TAU alone (n=103). The study population consisted of patients with three or more previous depressive episodes. Primary outcome measure was post-treatment depressive symptoms according to the Hamilton Rating Scale for Depression. Secondary outcome measures included the Beck Depression Inventory, rumination, worry and mindfulness skills. Group comparisons were carried out with linear mixed modelling, controlling for intra-group correlations. Additional mediation analyses were performed. Comparisons were made between patients with and without a current depressive episode.

Results

Patients in the MBCT+TAU group reported less depressive symptoms, worry and rumination and increased levels of mindfulness skills compared with patients receiving TAU alone. MBCT resulted in a comparable reduction of depressive symptoms for patients with and without a current depressive episode. Additional analyses suggest that the reduction of depressive symptoms was mediated by decreased levels of rumination and worry.

Conclusions

The study findings suggest that MBCT is as effective for patients with recurrent depression who are currently depressed as for patients who are in remission. Directions towards a better understanding of the mechanisms of action of MBCT are given, although future research is needed to support these hypotheses.

Keywords

DepressionMBCTmindfulnessrecurrence
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 5 , May 2012 , pp. 989 - 1001
Copyright
Copyright © Cambridge University Press 2011

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References

Baer, RA, Smith, GT, Allen, KB (2004). Assessment of mindfulness by self-report: The Kentucky Inventory of Mindfulness Skills. Assessment 11, 191–206.Google Scholar
Baer, RA, Smith, GT, Hopkins, J, Krietemeyer, J, Toney, L (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment 1, 27–45.Google Scholar
Barnhofer, T, Crane, C, Hargus, E, Amarasinghe, M, Winder, R, Williams, JMG (2009). Mindfulness-based cognitive therapy as a treatment for chronic depression: a preliminary study. Behaviour Research and Therapy 47, 366–373.Google Scholar
Baum, C, Kuyken, W, Bohus, M, Heidenreich, T, Michalak, J, Steil, R (2010). The psychometric properties of the Kentucky Inventory of Mindfulness Skills in clinical populations. Assessment 17, 220–229.Google Scholar
Bech, P, Kastrup, M, Rafaelson, OJ (1989). Mini-compendium of Rating Scales for States of Anxiety, Depression, Mania and Schizophrenia with Corresponding DSM-III Syndromes (authorized Dutch translation by H. A. H. D'Haenen and W. M. A. Verhoeven). VUB-Press: Brussels.Google Scholar
Beck, A, Steer, R, Garbin, M (1988). Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clinical Psychology Review 8, 77–100.CrossRefGoogle Scholar
Beck, A, Ward, C, Mendelson, M, Mock, J, Erbaugh, J (1961). An inventory for measuring depression. Archives of General Psychiatry 4, 561–571.CrossRefGoogle ScholarPubMed
Bockting, CLH, Schene, AH, Spinhoven, P, Koeter, MWJ, Wouters, LF, Huyser, J, Kamphuis, JH (2005). Preventing relapse/recurrence in recurrent depression with cognitive therapy: a randomized controlled trial. Journal of Consulting and Clinical Psychology 73, 647–657.Google Scholar
Bondolfi, G, Jermann, F, van der Linden, M, Gex-Fabry, M, Bizzini, L, Rouget, B, Myers-Arrazola, L, Gonzalez, C, Segal, Z, Aubry, J (2010). Depression relapse prophylaxis with Mindfulness-Based Cognitive Therapy: replication and extension in the Swiss health care system. Journal of Affective Disorders 122, 224–231.Google Scholar
Bouman, T, Luteijn, F, Albersnagel, F, van der Ploeg, F (1985). Enige ervaringen met de Beck Depression Inventory (BDI). Gedrag, Tijdschrift voor Psychologie 13, 13–24.Google Scholar
de Vries, J, van Heck, GL (1996). De Nederlandse versie van de WHOQOL-Bref. [The Dutch version of the WHOQOL-Bref]. Tilburg University: Tilburg.Google Scholar
Eaton, WW, Shao, H, Nestadt, G, Lee, HB, Bienvenu, OJ, Zandi, P (2008). Population-based study of first onset and chronicity in major depressive disorder. Archives of General Psychiatry 65, 513–520.CrossRefGoogle ScholarPubMed
Eisendrath, SJ, Delucchi, K, Bitner, R, Fenimore, P, Smit, M, McLane, M (2008). Mindfulness-based cognitive therapy for treatment-resistant depression: a pilot study. Psychotherapy and Psychosomatics 77, 319–320.Google Scholar
Evans, C, Margison, F, Barkham, M (1998). The contribution of reliable and clinically significant change methods to evidence-based mental health. Evidence Based Mental Health 1, 70–72.Google Scholar
Finucane, A, Mercer, SW (2006). An exploratory mixed methods study of the acceptability and effectiveness of mindfulness-based cognitive therapy for patients with active depression and anxiety in primary care. BMC Psychiatry 6, 14.CrossRefGoogle ScholarPubMed
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (1995). Structured Clinical Interview for DSM-IV Axis I Disorders-Patient Edition (SCID-I/P, Version 2.0). American Psychiatric Press: Washington, DC.Google Scholar
Groenestijn, MAC, Akkerhuis, GW, Kupka, RW, Schneider, N, Nolen, WA (1999). Structured Clinical Interview for DSM-IV Axis I Disorders. Swets: Lisse, the Netherlands.Google Scholar
Hamilton, M (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry 23, 56–62.Google Scholar
Hardeveld, F, Spijker, J, de Graaf, R, Nolen, WA, Beekman, ATF (2010). Prevalence and predictors of recurrence of major depressive disorder in the adult population. Acta Psychiatrica Scandinavica 122, 184–191.CrossRefGoogle ScholarPubMed
Hofmann, SG, Sawyer, AT, Witt, AA, Oh, D (2010). The effect of Mindfulness-Based Therapy on anxiety and depression: a meta-analytic review. Journal of Consulting and Clinical Psychology 78, 169–183.Google Scholar
Hollon, SD, DeRubeis, RJ, Shelton, RC, Amsterdam, JD, Salomon, RM, O'Reardon, JP, Lovett, ML, Young, PR, Haman, KL, Freeman, BB (2005). Prevention of relapse following cognitive therapy vs. medications in moderate to severe depression. Archives of General Psychiatry 62, 417–422.Google Scholar
Hollon, SD, Muñoz, RF, Barlow, DH, Beardslee, WR, Bell, CC, Bernal, G, Clarke, GN, Franciosi, LP, Kazdin, AE, Kohn, L (2002). Psychosocial intervention development for the prevention and treatment of depression: promoting innovation and increasing access. Biological Psychiatry 52, 610–630.Google Scholar
Jacobson, NS, Truax, P (1991). Clinical significance: a statistical approach to denning meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychologv 59, 12–19.Google Scholar
Kabat-Zinn, J, Massion, AO, Kristeller, J, Peterson, LG, Fletcher, KE, Pbert, L, Lenderking, WR, Santorelli, SF (1992). Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. American Journal of Psychiatry 149, 936–943.Google Scholar
Kazdin, AE (2007). Mediators and mechanisms of change in psychotherapy research. Annual Review of Clinical Psychology 3, 1–27.CrossRefGoogle ScholarPubMed
Kennedy, N, Abbott, R, Paykel, ES (2004). Longitudinal syndromal and sub-syndromal symptoms after severe depression: 10-year follow-up study. The British Journal of Psychiatry 184, 330–336.Google Scholar
Kenny, MA, Williams, JMG (2007). Treatment-resistant depressed patients show a good response to mindfulness-based cognitive therapy. Behaviour Research and Therapy 45, 617–625.Google Scholar
Kessler, RC, Berglund, P, Demler, O, Jin, R, Koretz, D, Merikangas, KR, Rush, AJ, Walters, EE, Wang, PS (2003). The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). Journal of the American Medical Association 289, 3095–3105.Google Scholar
Kingston, T, Dooley, B, Bates, A, Lawlor, E, Malone, K (2007). Mindfulness-based cognitive therapy for residual depressive symptoms. Psychology and Psychotherapy: Theory, Research and Practice 80, 193–203.CrossRefGoogle ScholarPubMed
Kraemer, HC, Wilson, GT, Fairburn, CG, Agras, WS (2002). Mediators and moderators of treatment effects in randomized clinical trials. Archives of General Psychiatry 59, 877–884.Google Scholar
Kuyken, W, Byford, S, Taylor, RS, Watkins, E, Holden, E, White, K, Barrett, B, Byng, R, Evans, A, Mullan, E, Teasdale, JD (2008). Mindfulness-based cognitive therapy to prevent relapse in recurrent depression. Journal of Consulting and Clinical Psychology 76, 966–978.CrossRefGoogle ScholarPubMed
Kuyken, W, Watkins, E, Holden, E, White, K, Taylor, RS, Evans, A, Byford, S, Radford, S, Teasdale, JD, Dalgleish, T (2010). How does Mindfulness-based Cognitive Therapy work? Behaviour Research and Therapy 48, 1105–1112.Google Scholar
Ma, SH, Teasdale, JD (2004). Mindfulness-based cognitive therapy for depression: replication and exploration of differential relapse prevention effects. Journal of Consulting and Clinical Psychology 72, 31–40.Google Scholar
MacKinnon, DP (2008). Introduction to Statistical Mediation Analysis. Erlbaum Psych Press: London.Google Scholar
Meyer, TJ, Miller, ML, Metzger, RL, Borkovec, TD (1990). Development and validation of the Penn State worry questionnaire. Behaviour Research and Therapy 28, 487–495.CrossRefGoogle ScholarPubMed
Morriss, R, Leese, M, Chatwin, J, Baldwin, D (2008). Inter-rater reliability of the Hamilton Depression Rating Scale as a diagnostic and outcome measure of depression in primary care. Journal of Affective Disorders 111, 204–213.CrossRefGoogle ScholarPubMed
Paykel, ES, Ramana, R, Cooper, Z, Hayhurst, H, Kerr, J, Barocka, A (1995). Residual symptoms after partial remission: an important outcome in depression. Psychological Medicine 25, 1171–1180.Google Scholar
Preacher, KJ, Hayes, AF (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods 40, 879–891.Google Scholar
R Development Core Team (2009). R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing: Vienna, Austria.Google Scholar
Raes, F, Hermans, D, Eelen, P (2003). The Dutch version of the Ruminative Response Scale (RRS-NL) and the Rumination on Sadness Scale (RSS-NL). Gedragstherapie 36, 97–104.Google Scholar
Rush, AJ, Trivedi, MH, Wisniewski, SR, Nierenberg, AA, Stewart, JW, Warden, D, Niederehe, G, Thase, ME, Lavori, PW, Lebowitz, BD (2006). Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR* D report. American Journal of Psychiatry 163, 1905–1917.Google Scholar
Segal, ZV, Bieling, P, Young, T, MacQueen, G, Cooke, R, Martin, L, Bloch, R, Levitan, RD (2010). Antidepressant monotherapy vs sequential pharmacotherapy and Mindfulness-Based Cognitive Therapy, or placebo, for relapse prophylaxis in recurrent depression. Archives of General Psychiatry 67, 1256–1264.Google Scholar
Segal, ZV, Williams, JMG, Teasdale, JD (2002). Mindfulness-based Cognitive Therapy for Depression: A New Approach to Preventing Relapse. The Guilford Press: New York.Google Scholar
Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, Hergueta, T, Baker, R, Dunbar, GC (1998). The Mini-International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry 59, 22–33.Google ScholarPubMed
Teasdale, JD, Segal, Z, Williams, JMG (1995). How does cognitive therapy prevent depressive relapse and why should attentional control (mindfulness) training help? Behaviour Research and Therapy 33, 25–39.Google Scholar
Teasdale, JD, Segal, ZV, Williams, JM, Ridgeway, VA, Soulsby, JM, Lau, MA (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology 68, 615–623.CrossRefGoogle ScholarPubMed
van Rijsoort, S, Emmelkamp, P, Vervaeke, G (1999). The Penn state worry questionnaire and the worry domains questionnaire: Structure, reliability and validity. Clinical Psychology & Psychotherapy 6, 297–307.Google Scholar
van Vliet, IM, Leroy, H, van Megen, H (2000). MINI Plus: MINI Internationaal Neuropsychiatrisch Interview: Dutch Version 5.0.0. Leiden: LUMC.Google Scholar
Williams, JMG, Russell, I, Crane, C, Russell, D, Whitaker, C, Duggan, D, Barnhofer, T, Fennell, M, Crane, R, Silverton, S (2010). Staying well after depression: trial design and protocol. BMC Psychiatry 10, 23.CrossRefGoogle ScholarPubMed