Adding mindfulness-based cognitive therapy to maintenance antidepressant medication for prevention of relapse/recurrence in major depressive disorder: Randomised controlled trial

Huijbers, Marloes J.; Spinhoven, Philip; Spijker, Jan; Ruhé, Henricus G.; Oppen, Patricia van; Nolen, Willem A.; Ormel, Johan; Kuyken, Willem; Wilt, Gert Jan van der; Blom, Marc; Schene, Aart H.; Donders, A. Rogier T.; Speckens, Anne

doi:10.1016/j.jad.2015.08.023

Cited by 37 publications

(43 citation statements)

References 36 publications

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“…This study was based on two parallel randomized controlled trials: the first one comparing the combination of MBCT and antidepressant medication with medication alone (Huijbers et al 2015) and the second one comparing the combination of MBCT and antidepressant medication with MBCT alone, i.e. with discontinuation of medication (Huijbers et al 2016).…”

Section: Methodsmentioning

confidence: 99%

“…number of sessions), possible mechanisms of change (rumination, cognitive reactivity, mindfulness, and self-compassion), and key outcome variables (depressive symptoms at post treatment and depressive relapse/recurrence during the 15-month follow-up). The study was part of two multi-centre randomized controlled trials (RCTs) including MBCT as a relapse prevention strategy for patients with recurrent depression (Huijbers et al 2016, 2015). Both RCTs involved relatively large numbers of MBCT teachers, which allowed us to investigate the possible effect of teacher competence on patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Teacher Competence in Mindfulness-Based Cognitive Therapy for Depression and Its Relation to Treatment Outcome

et al. 2017

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As mindfulness-based cognitive therapy (MBCT) becomes an increasingly mainstream approach for recurrent depression, there is a growing need for practitioners who are able to teach MBCT. The requirements for being competent as a mindfulness-based teacher include personal meditation practice and at least a year of additional professional training. This study is the first to investigate the relationship between MBCT teacher competence and several key dimensions of MBCT treatment outcomes. Patients with recurrent depression in remission (N = 241) participated in a multi-centre trial of MBCT, provided by 15 teachers. Teacher competence was assessed using the Mindfulness-Based Interventions: Teaching Assessment Criteria (MBI:TAC) based on two to four randomly selected video-recorded sessions of each of the 15 teachers, evaluated by 16 trained assessors. Results showed that teacher competence was not significantly associated with adherence (number of MBCT sessions attended), possible mechanisms of change (rumination, cognitive reactivity, mindfulness, and self-compassion), or key outcomes (depressive symptoms at post treatment and depressive relapse/recurrence during the 15-month follow-up). Thus, findings from the current study indicate no robust effects of teacher competence, as measured by the MBI:TAC, on possible mediators and outcome variables in MBCT for recurrent depression. Possible explanations are the standardized delivery of MBCT, the strong emphasis on self-reliance within the MBCT learning process, the importance of participant-related factors, the difficulties in assessing teacher competence, the absence of main treatment effects in terms of reducing depressive symptoms, and the relatively small selection of videotapes. Further work is required to systematically investigate these explanations.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Teacher Competence in Mindfulness-Based Cognitive Therapy for Depression and Its Relation to Treatment Outcome

et al. 2017

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“…MBCT+mADM for patients wanting MBCT (current trial), and an RCT comparing MBCT+mADM v . mADM alone for patients wanting to hold on to their medication 19 (parallel trial). Thereby we acknowledged patients' preferences while maintaining the experimental rigor of randomisation.…”

Section: Methodsmentioning

confidence: 99%

Discontinuation of antidepressant medication after mindfulness-based cognitive therapy for recurrent depression: Randomised controlled non-inferiority trial

et al. 2016

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BackgroundMindfulness-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.AimsTo investigate whether MBCT with discontinuation of mADM is non-inferior to MBCT+mADM.MethodA multicentre randomised controlled non-inferiority trial (: NCT00928980). Adults with recurrent depression in remission, using mADM for 6 months or longer (n = 249), were randomly allocated to either discontinue (n = 128) or continue (n = 121) mADM after MBCT. The primary outcome was depressive relapse/recurrence within 15 months. A confidence interval approach with a margin of 25% was used to test non-inferiority. Key secondary outcomes were time to relapse/recurrence and depression severity.ResultsThe difference in relapse/recurrence rates exceeded the non-inferiority margin and time to relapse/recurrence was significantly shorter after discontinuation of mADM. There were only minor differences in depression severity.ConclusionsOur findings suggest an increased risk of relapse/recurrence in patients withdrawing from mADM after MBCT.

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“…Just three of these studies were included in the only other metaanalysis of compassion-based interventions (Kirby et al 2017). One study (Huijbers et al 2015), despite not reporting self-compassion outcomes, was included because a second study by the same authors (Huijbers et al 2017) indicated that the SCS was administered in the RCT. We were able to obtain a breakdown of the SCS results from the authors to be included in this meta-analysis.…”

Section: Study Selectionmentioning

confidence: 99%

“…Results for Egger's test were as follows: self-compassion, p = 0.136; anxiety, p = 0.737; depression, p = 0.851. Given that p = 0.1 is taken as the threshold for significance in Egger's Falsafi (2016) Mindfulness-based intervention One active control; one waitlist/TAU control Clinical Hoffart et al (2015) CFT-CFT equivalent Active Clinical Hou et al (2013) Mindfulness-based intervention Active Subclinical Huijbers et al (2015) Mindfulness-based intervention Waitlist/TAU Subclinical Jazaieri et al (2012) Mindfulness-based intervention One active control; one waitlist/TAU control Clinical Kelly and Carter (2015) CFT/CFT equivalent One active control; one waitlist/TAU control Clinical Kelly et al (2017) CFT/CFT equivalent Waitlist/TAU Clinical Key et al (2017) Mindfulness-based intervention Waitlist/TAU Clinical Kingston et al (2015) Mindfulness-based intervention Waitlist/TAU Subclinical Koszycki et al (2016) Mindfulness-based intervention Waitlist/TAU Clinical Kuyken et al (2010) Mindfulness-based intervention Waitlist/TAU Subclinical Mann et al (2016) Mindfulness-based intervention Waitlist/TAU Subclinical Shahar et al (2015) CFT/CFT equivalent Waitlist/TAU Subclinical Van Dam et al (2014) Mindfulness-based intervention Waitlist/TAU Subclinical Yadavaia et al (2014) ACT Waitlist/TAU Subclinical test, we took the borderline result for self-compassion as reason for investigating the sensitivity of the self-compassion effects to publication bias by running the trim-and-fill procedure on the residuals for the moderated model for self-compassion. This indicated that 3 studies were 'missing' from the left of the plot and that adding these would adjust the summary effect slightly, β = 0.08.…”

Section: Publication Biasmentioning

confidence: 99%

Effectiveness of Self-Compassion Related Therapies: a Systematic Review and Meta-analysis

et al. 2018

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This systematic review and meta-analysis investigated whether self-compassion-related therapies, including compassionfocussed therapy, mindfulness-based cognitive therapy and acceptance and commitment therapy, are effective in promoting self-compassion and reducing psychopathology in clinical and subclinical populations. A total of 22 randomised controlled trials met inclusion criteria, with data from up to 1172 individuals included in each quantitative analysis. Effect sizes were the standardised difference in change scores between intervention and control groups. Results indicated that self-compassionrelated therapies produced greater improvements in all three outcomes examined: self-compassion (g = 0.52, 95% CIs [0.32, 0.71]), anxiety (g = 0.46, 95% CIs [0.25, 0.66]) and depressive symptoms (g = 0.40, 95% CIs [0.23, 0.57]). However, when analysis was restricted to studies that compared self-compassion-related therapies to active control conditions, change scores were not significantly different between the intervention and control groups for any of the outcomes. Patient status (clinical vs. subclinical) and type of therapy (explicitly compassion-based vs. other compassion-related therapies, e.g. mindfulness) were not moderators of outcome. There was some evidence that self-compassion-related therapies brought about greater improvements in the negative than the positive subscales of the Self-Compassion Scale, although a statistical comparison was not possible. The methodological quality of studies was generally good, although risk of performance bias due to a lack of blinding of participants and therapists was a concern. A narrative synthesis found that changes in self-compassion and psychopathology were correlated in several studies, but this relationship was observed in both intervention and control groups. Overall, this review presents evidence that third-wave therapies bring about improvements in self-compassion and psychopathology, although not over and beyond other interventions.

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Adding mindfulness-based cognitive therapy to maintenance antidepressant medication for prevention of relapse/recurrence in major depressive disorder: Randomised controlled trial

Cited by 37 publications

References 36 publications

Teacher Competence in Mindfulness-Based Cognitive Therapy for Depression and Its Relation to Treatment Outcome

Teacher Competence in Mindfulness-Based Cognitive Therapy for Depression and Its Relation to Treatment Outcome

Discontinuation of antidepressant medication after mindfulness-based cognitive therapy for recurrent depression: Randomised controlled non-inferiority trial

Effectiveness of Self-Compassion Related Therapies: a Systematic Review and Meta-analysis

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