How Does MBCT for Depression Work? Studying Cognitive and Affective Mediation Pathways

Abstract

Mindfulness based cognitive therapy (MBCT) is a non-pharmacological intervention to reduce current symptoms and to prevent recurrence of major depressive disorder. At present, it is not well understood which underlying mechanisms during MBCT are associated with its efficacy. The current study (n = 130) was designed to examine the roles of mindfulness skills, rumination, worry and affect, and the interplay between those factors, in the mechanisms of change in MBCT for residual depressive symptoms. An exploratory but systematic approach was chosen using Sobel-Goodman mediation analyses to identify mediators on the pathway from MBCT to reduction in depressive symptoms. We replicated earlier findings that therapeutic effects of MBCT are mediated by changes in mindfulness skills and worry. Second, results showed that changes in momentary positive and negative affect significantly mediated the efficacy of MBCT, and also mediated the effect of worry on depressive symptoms. Third, within the group of patients with a prior history of ≤ 2 episodes of MDD, predominantly changes in cognitive and to a lesser extent affective processes mediated the effect of MBCT. However, within the group of patients with a prior history of ≥ 3 episodes of MDD, only changes in affect were significant mediators for the effect of MBCT.Trail Registration: Nederlands Trial Register NTR1084

Effects of mindfulness-based cognitive therapy on self-reported suicidal ideation: results from a randomised controlled trial in patients with residual depressive symptoms

“…Van Aalderen and colleagues [29] showed that the efficacy of MBCT, as compared with treatment as usual (TAU) in reducing levels of depression, was mediated by decreases in worry and rumination and increases in the mindfulness skill "accepting without judgement". Recently, Batink and coworkers [30] showed that changes in momentary positive and negative affect significantly mediated the efficacy of MBCT and the effect of changes in worry on depressive symptoms.…”

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

“…Batink et al (43) demonstrated improvement in rumination scores in a group with ≥3 depressive episodes (MBCT + TAU) and in a group with ≥2 depressive episodes (TAU). In the study of Van Vugt et al (2) practicing MBCT decreased the scores of depression and anxiety, however, both groups (MCBT and Control) increased their tendency to sustain trains of positive words.…”

Mindfulness-Based Cognitive Therapy for Treatment-Resistant Depression

“…In support of this theory, Geschwind and colleagues [ 66 ] found that MBCT compared to a waitlist control increased momentary positive emotions and reward from pleasant daily life activities for people with a history of MDD and current residual depressive symptoms. Batink and colleagues [ 64 ] found that changes in positive affect mediated 61 % of the effect of MBCT on residual depressive symptoms. And Garland and colleagues [ 65 ] found that MBCT enhanced momentary positive cognition, and appeared to strengthen the relationship between current positive affect and positive cognition the next day.…”

“…Another RCT with patients with three or more previous depressive episodes, with and without a current depressive episode, found that effect on depressive symp-toms were mediated by a decrease in worry and rumination, and an increase in the mindfulness skill "accept without judgment" [ 32 ]. Batink and colleagues [ 64 ] found that the effects of MBCT on residual symptoms of depression were mediated by changes in mindfulness skills and worry, but did not fi nd rumination to be a mediator.…”