Relapse prevention in major depressive disorder: Mindfulness-based cognitive therapy versus an active control condition.

Abstract

Objective We evaluated the comparative effectiveness of Mindfulness-based cognitive therapy (MBCT) versus an active control condition (ACC) for depression relapse prevention, depressive symptom reduction, and improvement in life satisfaction. Method Ninety-two participants in remission from Major Depressive Disorder with residual depressive symptoms were randomized to either an 8-week MBCT or a validated ACC that is structurally equivalent to MBCT and controls for non-specific effects (e.g., interaction with a facilitator, perceived social support, treatment outcome expectations). Both interventions were delivered according to their published manuals. Results Intention-to-treat analyses indicated no differences between MBCT and ACC in depression relapse rates or time to relapse over a 60-week follow-up. Both groups experienced significant and equal reductions in depressive symptoms and improvements in life satisfaction. A significant quadratic interaction (group x time) indicated that the pattern of depressive symptom reduction differed between groups. The ACC experienced immediate symptom reduction post-intervention and then a gradual increase over the 60-week follow-up. The MBCT group experienced a gradual linear symptom reduction. The pattern for life satisfaction was identical but only marginally significant. Conclusions MBCT did not differ from an ACC on rates of depression relapse, symptom reduction, or life satisfaction, suggesting that MBCT is no more effective for preventing depression relapse and reducing depressive symptoms than the active components of the ACC. Differences in trajectory of depressive symptom improvement suggest that the intervention-specific skills acquired may be associated with differential rates of therapeutic benefit. This study demonstrates the importance of comparing psychotherapeutic interventions to active control conditions.

Mindfulness-Based Cognitive Therapy in Major depressive disorder - systematic review and metanalysis

“…The result of effect size (ES) for the studies were: large effect size for the study of Barnhofer et al (34) In analyzing the studies of Barnhofer et al (34) and Shallcross et al (13) (Figure 2) differences were observed that could generate bias (sample and publication) compared with the results of the other studies. Therefore an additional analysis of sensitivity was performed, replicating the meta-analysis after excluding these two studies.…”

“…The scores of the Pedro scale that measures the quality of the trials ranged from 5 to 10 points (total mean of all studies = 7.1 SD = 1.8). The nonrandomized studies presented a Pedro score of 5 points (32,33,37), the randomized studies with two groups from 5 to 10 points (2,13,34,35,39,41) and those with three groups from 6 to 9 points (36,38,40).…”

“…CPE educated them about these processes through interactive practical exercises and group discussions. Four studies presented continuous data (13,34,39,41) and were classified for the performance of the meta-analysis (Figures 2 and 3). The metaanalysis showed a result that revealed a moderate effect of MBCT on the depression outcome with a significant effect estimation of -0.52 (95% CI: -1.050 to -0.002; p = 0.04), revealing differences between the interventions.…”

“…Because of these limitations, some nonpharmacological alternatives have been implemented, including interventions in lifestyle, behavior modification, counseling and psychological therapies (13,14). One of these therapies is meditation, which is currently being integrated into the clinical practice for some medical conditions, such as hypertension, cancer, chronic pain, diabetes, etc.…”

“…Although psychological interventions are effective in the treatment of MDD, the prescription of antidepressant drugs is the mainstay of treatment to prevent relapse and recurrence (12), however, this may present some limitations, such as poor adherence and side effects (13).…”