Depression relapse prophylaxis with Mindfulness-Based Cognitive Therapy: Replication and extension in the Swiss health care system

Department of Psychiatry, Geneva University Hospital, Switzerland.
Journal of Affective Disorders (Impact Factor: 3.38). 09/2009; 122(3):224-31. DOI: 10.1016/j.jad.2009.07.007
Source: PubMed


Mindfulness-Based Cognitive Therapy (MBCT) is a group intervention that integrates elements of Cognitive Behavioural Therapy (CBT) with components of mindfulness training to prevent depressive relapse. The efficacy of MBCT compared to Treatment As Usual (TAU), shown in two randomized controlled trials indicates a significant decrease in 1-year relapse rates for patients with at least three past depressive episodes. The present study is the first independent replication trial comparing MBCT+TAU to TAU alone across both language and culture (Swiss health care system).
Sixty unmedicated patients in remission from recurrent depression (>or=3 episodes) were randomly assigned to MBCT+TAU or TAU. Relapse rate and time to relapse were measured over a 60 week observation period. The frequency of mindfulness practices during the study was also evaluated.
Over a 14-month prospective follow-up period, time to relapse was significantly longer with MBCT+TAU than TAU alone (median 204 and 69 days, respectively), although both groups relapsed at similar rates. Analyses of homework adherence revealed that following treatment termination, the frequency of brief and informal mindfulness practice remained unchanged over 14 months, whereas the use of longer formal meditation decreased over time.
Relapse monitoring was 14months in duration and prospective reporting of mindfulness practice would have yielded more precise frequency estimates compared to the retrospective methods we utilized.
Further studies are required to determine which patient characteristics, beyond the number of past depressive episodes, may predict differential benefits from this therapeutic approach.

Download full-text


Available from: Martial Van der Linden
    • "Previous studies comparing MBCT and treatment as usual (TAU) in patients with recurrent depression concluded that MBCT was an effective intervention to reduce relapse/recurrence (Piet and Hougaard, 2011). However, some of these trials included in this meta-analysis have been criticised for only including patients who were free of ADM (Teasdale et al., 2000;Ma and Teasdale, 2004;Bondolfi et al., 2010). This might have led to a higher relapse/recurrence rate in the TAU condition, thus inadvertently contributing to the the superiority of MBCT. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Mindfulness-based cognitive therapy (MBCT) and maintenance antidepressant medication (mADM) both reduce the risk of relapse in recurrent depression, but their combination has not been studied. Our aim was to investigate whether the addition of MBCT to mADM is a more effective prevention strategy than mADM alone. This study is one of two multicenter randomised trials comparing the combination of MBCT and mADM to either intervention on its own. In the current trial, recurrently depressed patients in remission who had been using mADM for 6 months or longer (n=68), were randomly allocated to either MBCT+mADM (n=33) or mADM alone (n=35). Primary outcome was depressive relapse/recurrence within 15 months. Key secondary outcomes were time to relapse/recurrence and depression severity. Analyses were based on intention-to-treat. There were no significant differences between the groups on any of the outcome measures. The current study included patients who had recovered from depression with mADM and who preferred the certainty of continuing medication to the possibility of participating in MBCT. Lower expectations of mindfulness in the current trial, compared with the parallel trial, may have caused selection bias. In addition, recruitment was hampered by the increasing availability of MBCT in the Netherlands, and even about a quarter of participants included in the trial who were allocated to the control group chose to get MBCT elsewhere. For this selection of recurrently depressed patients in remission and using mADM for 6 months or longer, MBCT did not further reduce their risk for relapse/recurrence or their (residual) depressive symptoms. Copyright © 2015 Elsevier B.V. All rights reserved.
    No preview · Article · Aug 2015 · Journal of Affective Disorders
  • Source
    • "Nevertheless, considering that longer and more structured programs can potentially offer medical students a greater variety of strategies to cope with stress, a 5-week mindfulness-based stress management (MBSM/Mindful-Gym) program was developed. The program was developed based on the principles of Mindfulness-based Stress Reduction Program—MBSR (Chiesa and Serretti 2009; Grossman et al. 2004; Kabat-Zinn 2003) and Mindfulness-based Cognitive Therapy—MBCT (Bondolfi et al. 2010; Ree and Craigie 2007; Teasdale et al. 2000; Williams et al. 2008). In the recent comprehensive meta-analysis of 209 studies (Khoury et al. 2013), it was concluded that mindfulness-based interventions (MBI) are effective for reducing stress, anxiety, and depression. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Pursuing undergraduate medical training can be very stressful and academically challenging experience. A 5-week mindfulness-based stress management (MBSM/Mindful-Gym) program was developed to help medical students cope with stress. The aim of this study was to evaluate the effectiveness of the intervention in reducing stress among students in a medical school in Malaysia. Seventy-five medical students participated in the program. They were stratified according to years of studies and randomly allocated to intervention (N = 37) and control groups (N = 38). The following outcome variables were measured at pre- and post-intervention: mindfulness (with Mindful Awareness Attention Scale); perceived stress (with Perceived Stress Scale); mental distress (with General Health Questionnaire), and self-efficacy (with General Self-efficacy Scale). Hierarchical multiple regressions were used to analyse the effect of group (intervention vs. control) on changes in the outcome variables. There were significant improvements at one week post-intervention in all outcome variables: mindfulness (β = 0.19, ΔR2 = 0.04, p = .040, f 2 = 0.05), perceived stress (β = −0.26, ΔR2 = 0.07, p = .009, f 2 = 0.10); mental distress (β = −0.28, ΔR2 = 0.10, p = .003, f 2 = 0.15); and self-efficacy (β = 0.30, ΔR2 = 0.09, p < .001, f 2 = 0.21). Six months after the intervention, those who had joined the program reported higher self-efficacy compared to those in the control group (β = 0.24, ΔR2 = 0.06, p = .020, f 2 = 0.08); but there was no difference in other outcome measures. More than 90 % of the participants found the program applicable in helping patients and all reported that they would recommend it to others. This study indicates that the program is potentially an effective stress management program for medical students in Malaysia.
    Full-text · Article · Feb 2015 · Advances in Health Sciences Education
  • Source
    • "Women in this study reported more frequent use of informal practice. Although this pattern is consistent with reports from other studies of MBCT that indicate higher and more consistent use of informal practices over time (e.g., Bondolfi et al. 2010), it also may be the case that pregnant women require greater emphasis on brief and accessible forms of practice given the competing demands on energy and time during pregnancy and the postpartum. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Pregnant women with histories of depression are at high risk of depressive relapse/recurrence during the perinatal period, and options for relapse/recurrence prevention are limited. Mindfulness-based cognitive therapy (MBCT) has strong evidence among general populations but has not been studied among at-risk pregnant women to prevent depression. We examined the feasibility, acceptability, and clinical outcomes of depression symptom severity and relapse/recurrence associated with MBCT adapted for perinatal women (MBCT-PD). Pregnant women with depression histories were recruited from obstetrics clinics in a large health maintenance organization at two sites and enrolled in MBCT-PD (N = 49). Self-reported depressive symptoms and interview-based assessments of depression relapse/recurrence status were measured at baseline, during MBCT-PD, and through 6-months postpartum. Pregnant women reported interest, engagement, and satisfaction with the program. Retention rates were high, as were rates of completion of daily homework practices. Intent to treat analyses indicated a significant improvement in depression symptom levels and an 18 % rate of relapse/recurrence through 6 months postpartum. MBCT-PD shows promise as an acceptable, feasible, and clinically beneficial brief psychosocial prevention option for pregnant women with histories of depression. Randomized controlled trials are needed to examine the efficacy of MBCT-PD for the prevention of depressive relapse/recurrence during pregnancy and postpartum.
    Full-text · Article · Oct 2014 · Archives of Women s Mental Health
Show more