Mindfulness-based cognitive therapy for preventing relapse in recurrent depression: A randomized dismantling trial.

TLDR

The study compared mindfulness‑based cognitive therapy (MBCT) with cognitive psychological education (CPE) and treatment as usual (TAU) to prevent relapse of major depressive disorder in patients in remission after at least three episodes. MBCT was delivered per its manual with added focus on suicidal cognitions, while CPE mirrored MBCT without meditation training, and both interventions consisted of eight weekly group classes. Across the full sample, neither MBCT nor CPE significantly reduced relapse risk versus TAU, but among participants with high childhood trauma severity, MBCT markedly lowered relapse risk compared to CPE and TAU, whereas no differences were seen in those with lower trauma severity.

Abstract

We compared mindfulness-based cognitive therapy (MBCT) with both cognitive psychological education (CPE) and treatment as usual (TAU) in preventing relapse to major depressive disorder (MDD) in people currently in remission following at least 3 previous episodes.A randomized controlled trial in which 274 participants were allocated in the ratio 2:2:1 to MBCT plus TAU, CPE plus TAU, and TAU alone, and data were analyzed for the 255 (93%; MBCT = 99, CPE = 103, TAU = 53) retained to follow-up. MBCT was delivered in accordance with its published manual, modified to address suicidal cognitions; CPE was modeled on MBCT, but without training in meditation. Both treatments were delivered through 8 weekly classes.Allocated treatment had no significant effect on risk of relapse to MDD over 12 months follow-up, hazard ratio for MBCT vs. CPE = 0.88, 95% CI [0.58, 1.35]; for MBCT vs. TAU = 0.69, 95% CI [0.42, 1.12]. However, severity of childhood trauma affected relapse, hazard ratio for increase of 1 standard deviation = 1.26 (95% CI [1.05, 1.50]), and significantly interacted with allocated treatment. Among participants above median severity, the hazard ratio was 0.61, 95% CI [0.34, 1.09], for MBCT vs. CPE, and 0.43, 95% CI [0.22, 0.87], for MBCT vs. TAU. For those below median severity, there were no such differences between treatment groups.MBCT provided significant protection against relapse for participants with increased vulnerability due to history of childhood trauma, but showed no significant advantage in comparison to an active control treatment and usual care over the whole group of patients with recurrent depression.