How does mindfulness-based cognitive therapy work?

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Abstract

Mindfulness-based cognitive therapy (MBCT) is an efficacious psychosocial intervention for recurrent depression (Kuyken et al., 2008, Ma and Teasdale, 2004, Teasdale et al., 2000). To date, no compelling research addresses MBCT’s mechanisms of change. This study determines whether MBCT’s treatment effects are mediated by enhancement of mindfulness and self-compassion across treatment, and/or by alterations in post-treatment cognitive reactivity. The study was embedded in a randomized controlled trial comparing MBCT with maintenance antidepressants (mADM) with 15-month follow-up (Kuyken et al., 2008). Mindfulness and self-compassion were assessed before and after MBCT treatment (or at equivalent time points in the mADM group). Post-treatment reactivity was assessed one month after the MBCT group sessions or at the equivalent time point in the mADM group. One hundred and twenty-three patients with ≥3 prior depressive episodes, and successfully treated with antidepressants, were randomized either to mADM or MBCT. The MBCT arm involved participation in MBCT, a group-based psychosocial intervention that teaches mindfulness skills, and discontinuation of ADM. The mADM arm involved maintenance on a therapeutic ADM dose for the duration of follow-up. Interviewer-administered outcome measures assessed depressive symptoms and relapse/recurrence across 15-month follow-up. Mindfulness and self-compassion were measured using self-report questionnaire. Cognitive reactivity was operationalized as change in depressive thinking during a laboratory mood induction.

MBCT’s effects were mediated by enhancement of mindfulness and self-compassion across treatment. MBCT also changed the nature of the relationship between post-treatment cognitive reactivity and outcome. Greater reactivity predicted worse outcome for mADM participants but this relationship was not evident in the MBCT group.

MBCT’s treatment effects are mediated by augmented self-compassion and mindfulness, along with a decoupling of the relationship between reactivity of depressive thinking and poor outcome. This decoupling is associated with the cultivation of self-compassion across treatment.

Section snippets

Design

This mechanisms study was embedded in an RCT comparing MBCT (with discontinuation of ADM) to mADM (Kuyken et al., 2008). MBCT was delivered as a manualized, group-based training program designed to enable patients to learn mindfulness and other skills that prevent depression recurrence (Segal et al., 2002). The MBCT program involved a one-to-one orientation session with the therapist followed by eight weekly two hour sessions over approximately two months and four follow-up sessions spread out

Results

For the treatment-adherent sample (N = 114) and cognitive reactivity sub-sample (n = 80), descriptive information at baseline is in Table 1, and outcomes at post-treatment and 15-month follow-up are in Table 2. These outcome profiles were comparable to the ITT sample (Kuyken et al., 2008).

Discussion

This study provides the first evidence of what mediates MBCT’s treatment effects. Consistent with MBCT’s theoretical premise, increases in mindfulness and self-compassion across treatment mediated the effect of MBCT on depressive symptoms at 15-month follow-up. Furthermore, MBCT changed the relationship between post-treatment cognitive reactivity and depression outcome. In patients receiving mADM, greater reactivity predicted poorer outcome, replicating previous findings (Segal et al., 2006).

Acknowledgements

We are grateful to the patients who participated in the trial, the physicians and other health care staff who enabled the trial, Anna Rabinovich and Helene Kraemer who advised on and assisted with the analyses, Becca Crane and Trish Bartley at the Bangor Centre for Mindfulness Research and Practice for their input to the MBCT therapist training, the independent members of the Trial Steering Committee (comprising John Campbell [Chair], Emer O’Neill, Richard Moore, Paul Lanham, and Andy

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  • Cited by (0)

    This paper was written by Willem Kuyken and Tim Dalgleish on behalf of the Exeter MBCT Trial team. Sarah Byford, Rod Taylor & Ed Watkins were co-investigators, Emily Holden and Kat White were research staff, Alison Evans was a trial therapist, Sholto Radford completed his MSc on archival data and John Teasdale advised on the design, conduct and analysis of this study.

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