Outcomes of Online Mindfulness-Based Cognitive Therapy for Patients With Residual Depressive Symptoms

Abstract

IMPORTANCEPatients with residual depressive symptoms face a gap in care because few resources, to date, are available to manage the lingering effects of their illness.OBJECTIVE To evaluate the effectiveness for treating residual depressive symptoms with Mindful Mood Balance (MMB), a web-based application that delivers mindfulness-based cognitive therapy, plus usual depression care compared with usual depression care only. DESIGN, SETTING, AND PARTICIPANTSThis randomized clinical trial was conducted in primary care and behavioral health clinics at Kaiser Permanente Colorado, Denver. Adults identified with residual depressive symptoms were recruited between March 2, 2015, and November 30, 2018. Outcomes were assessed for a 15-month period, comprising a 3-month intervention interval and a 12-month follow-up period.INTERVENTIONS Patients were randomized to receive usual depression care (UDC; n = 230) or MMB plus UDC (n = 230), which included 8 sessions delivered online for a 3-month interval plus minimal phone or email coaching support.MAIN OUTCOMES AND MEASURES Primary outcomes were reduction in residual depressive symptom severity, assessed using the Patient Health Questionaire-9 (PHQ-9); rates of depressive relapse (PHQ-9 scores Ն15); and rates of remission (PHQ-9 scores <5). Secondary outcomes included depression-free days, anxiety symptoms (General Anxiety Disorder-7 Item Scale), and functional status (12-Item Short Form Survey). RESULTS Among 460 randomized participants (mean [SD] age, 48.30 [14.89] years; 346 women [75.6%]), data were analyzed for the intent-to-treat sample, which included 362 participants (78.7%) at 3 months and 330 (71.7%) at 15 months. Participants who received MMB plus UDC had significantly greater reductions in residual depressive symptoms than did those receiving UDC only (mean [SE] PHQ-9 score, 0.95 [0.39], P < .02). A significantly greater proportion of patients achieved remission in the MMB plus UDC group compared with the UDC only group (PHQ-9 score, <5: β [SE], 0.38 [0.14], P = .008), and rates of depressive relapse were significantly lower in the MMB plus UDC group compared with the UDC only group (hazard ratio, 0.61; 95% CI, 0.39-0.95; P < .03). Compared with the UDC only group, the MMB plus UDC group had decreased depression-free days (mean [SD], 281.14 [164.99] days vs 247.54 [158.32] days; difference, days; t = −2.33; P = .02), decreased anxiety (mean [SE] General Anxiety Disorder-7 Item Scale score, 1.21 [0.42], P = .004), and improved mental functioning (mean [SE] 12-Item Short Form Survey score, −5.10 [1.37], P < .001), but there was no statistically significant difference in physical functioning.CONCLUSIONS AND RELEVANCE Use of MMB plus UDC resulted in significant improvement in depression and functional outcomes compared with UDC only. The MMB web-based treatment may offer a scalable approach for the management of residual depressive symptoms.

Evaluating the Effectiveness of Online Educational Modules and Interactive Workshops in Alleviating Symptoms of Mild to Moderate Depression: A Pilot Trial

“…A randomized clinical trial by Segal et al found significant improvements in depression symptomatology after participation in online structured CBT-based material. 12 Similar results are supported by 2 large meta-analyses. 13 , 14 Rollman et al included moderator-facilitated discussion groups with eight 50-minute computer-based CBT sessions.…”

“…The symptom improvement in our study is comparable to other online modalities with average PHQ-9 improvements ranging from 2.70 to 3.60. 12,16 While the data from pre and post PHQ-9 show trends of improvement within the intervention arm, a significant between-group difference was not found using the difference in difference analysis. This finding may be influenced by the small number of participants.…”

Brain health consequences of digital technology use

“…For example, Peter and colleagues 56 found that an online, 4-week intervention using cognitive behavioral therapy for insomnia reduced depression and insomnia ratings at levels comparable to traditional face-to-face interventions. Segal and associates 57 evaluated the effectiveness of treating residual depressive symptoms with a web-based program that delivers mindfulness-based cognitive therapy. They found that use of this program in addition to usual depression care significantly improved depression and functional outcomes compared with usual depression care alone.…”

Preventing Recurrent Depression with Mindfulness-Based Cognitive Therapy

“…Recently, one was published in JAMA Psychiatry. 1 Drawing on positive outcome data has been a very productive way for us to make the case to the larger psychiatric mental health community for the benefits of mindfulness strategies.…”