The contributions of focused attention and open monitoring in mindfulness-based cognitive therapy for affective disturbances: A 3-armed randomized dismantling trial

Abstract

Objective Mindfulness-based cognitive therapy (MBCT) includes a combination of focused attention (FA) and open monitoring (OM) meditation practices. The aim of this study was to assess both short- and long-term between- and within-group differences in affective disturbance among FA, OM and their combination (MBCT) in the context of a randomized controlled trial. Method One hundred and four participants with mild to severe depression and anxiety were randomized into one of three 8-week interventions: MBCT (n = 32), FA (n = 36) and OM (n = 36). Outcome measures included the Inventory of Depressive Symptomatology (IDS), and the Depression Anxiety Stress Scales (DASS). Mixed effects regression models were used to assess differential treatment effects during treatment, post-treatment (8 weeks) and long-term (20 weeks). The Reliable Change Index (RCI) was used to translate statistical findings into clinically meaningful improvements or deteriorations. Results All treatments demonstrated medium to large improvements (ds = 0.42–1.65) for almost all outcomes. While all treatments were largely comparable in their effects at post-treatment (week 8), the treatments showed meaningful differences in rapidity of response and pattern of deteriorations. FA showed the fastest rate of improvement and the fewest deteriorations on stress, anxiety and depression during treatment, but a loss of treatment-related gains and lasting deteriorations in depression at week 20. OM showed the slowest rate of improvement and lost treatment-related gains for anxiety, resulting in higher anxiety in OM at week 20 than MBCT (d = 0.40) and FA (d = 0.36), though these differences did not reach statistical significance after correcting for multiple comparisons (p’s = .06). MBCT and OM showed deteriorations in stress, anxiety and depression at multiple timepoints during treatment, with lasting deteriorations in stress and depression. MBCT showed the most favorable pattern for long-term treatment of depression. Conclusions FA, OM and MBCT show different patterns of response for different dimensions of affective disturbance. Trial registration This trial is registered at (v NCT01831362); www.clinicaltrials.gov.

Defining and Measuring Meditation-Related Adverse Effects in Mindfulness-Based Programs

“…Because "the same treatment can have both beneficial and harmful effects" (Dimidjian & Hollon, 2010, p. 22), it is important to consider the balance between benefits and harms in clinical decision-making. For example, in the current study, clinically relevant events associated with impaired functioning occurred within a context of overall efficacy on multiple outcomes (Cullen et al, 2021), high practice compliance, and low attrition, which suggests that participants found the difficulties worth tolerating in light of expected or concurrent benefits or in comparison with not receiving treatment.…”

“…In terms of overall treatment efficacy, all three forms of mindfulness training produced large effect size improvements in IDS-C scores from baseline to posttreatment (ds = 1.48-1.65) and Week 20 follow-up (ds = 1.34-1.57) with no differences between groups (Cullen et al, 2021).…”

“…The design and analysis plans for the experiments were preregistered clinicaltrials.gov and are available at https:// clinicaltrials.gov/ct2/show/study/NCT01831362. The trial protocol was published with the primary outcomes (Cullen et al, 2021). The Medex-I interview, the main measure in the current article, was described in the published protocol but was not a primary or secondary outcome and was not accompanied by a statistical analysis plan.…”

From Self-Esteem to Selflessness: An Evidence (Gap) Map of Self-Related Processes as Mechanisms of Mindfulness-Based Interventions

“…The current review may not be exhaustive, as SRPs are often measured as secondary outcomes and thus some important studies may not have been identified in this map. In addition, this review investigated the effects of meditation practice on SRPs without differentiating the types of meditation practices, which may impact target engagement and target validation ( Cullen et al, 2021 ). Additionally, our review depended on the measurement tools used in extant research, which have some limitations.…”

Measuring Psychological Mechanisms in Meditation Practice: Using a Phenomenologically Grounded Classification System to Develop Theory-Based Composite Scores

“…Second, the field is witnessing the introduction of a quickly growing number of new self-report measures purported to more adequately capture already established constructs or to capture new constructs for meditation research (see Van Dam et al, 2018). Third, new and modified meditation-based programmes are increasingly complex, combining multiple practice modalities each targeting specific psychological capacities (e.g., Cullen et al, 2021;Goldberg et al, 2020). Importantly, the evaluation of the efficacy of these programmes will be affected by methodological decisions regarding the measurement of meditation-related mechanisms (e.g., data-driven vs. theory-based approaches, established scales vs. new scales).…”