Decentering and Relapse/Recurrence in MBCT for Depression in Adults

The Association Between Decentering and Reductions in Relapse/Recurrence in Mindfulness-Based Cognitive Therapy for Depression in Adults: A Randomized Controlled Trial

Objective: "Decentering" is defined as the ability to observe one's thoughts and feelings as temporary, objective events in the mind, and is increasingly regarded as a candidate mechanism in mindfulness-based interventions. The current study sought to examine the role of decentering, and other related variables, in the efficacy of Mindfulness-based cognitive therapy (MBCT) as compared to two active comparison conditions.

Method: Formerly depressed individuals (N = 227), randomly assigned to MBCT (n = 74), relaxation group therapy (RGT; n = 77) or treatment-as-usual (TAU; n = 76), completed self-report measures of decentering and symptoms of depression at pre-, mid-, and post-treatment, and relapse was assessed at 3, 6, 9, and 12 months, post-treatment.

Study Overview

• Status: Completed
• Conditions: Depression; Depressive Disorder, Major; Depression in Remission
• Intervention / Treatment: Behavioral: Mindfulness-based Cognitive Therapy (MBCT); Behavioral: Relaxation Group Therapy (RGT); Behavioral: Treatment as usual (TAU)

• Study Type: Interventional
• Enrollment (Actual): 227
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • British Columbia
    • Vancouver, British Columbia, Canada, V6J 5C6
      • Mark Lau

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: ADULT; OLDER_ADULT; CHILD
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• a Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM IV-TR; American Psychiatric Association (APA), diagnosis of major depressive disorder (MDD) without psychotic features, in Full Remission;
• three or more prior major depressive episodes;
• age between 18 and 65 years;
• cognitive reactivity (CR) or mood-activated dysfunctional beliefs score greater than or equal to eight (see assessment procedure below);
• a score of less than 10 on the Hamilton Rating Scale for Depression (HRSD);
• minimum of a 10 week period free of psychotropic medication other than stable dosage of antidepressant medication for a minimum of four weeks;
• fluency in English; An increased cognitive reactivity score of eight points or more and,
• ability to give informed consent and complete questionnaires unassisted.

Exclusion Criteria:

• a diagnosis of bipolar disorder (past or present), schizophreniform disorders, substance abuse or dependence (current or within the past six months), borderline or antisocial personality disorder, or neurocognitive disorders;
• current psychotherapy or counselling more frequently than twice per month;
• current practice of meditation more than once per week or yoga more than twice per week;
• electroconvulsive therapy within the past six months; or
• self-reported ingestion of alcohol or other psychoactive substances within the past 48 hrs.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: DOUBLE

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: Mindfulness-based Cognitive Therapy (MBCT); Remitted depressed participants received eight-weekly, two-hour MBCT sessions (Segal et al., 2013). This program combines MBSR meditation practices (e.g., body scan, mindful stretching, mindfulness of breath/body/sounds/thoughts) with traditional CT techniques (e.g., psychoeducation about depression symptoms and automatic thoughts, exercises designed to demonstrate how the nature of one's thoughts change with one's mood, questioning of automatic thoughts and creating a relapse prevention plan). Finally, participants engaged in a daily meditation practice and homework exercises directed at integrating the application of awareness skills into daily life. Each MBCT group was led by a masters-level clinician who was an active MBCT/Mindfulness-Based Stress Reduction (MBSR) instructor.	Behavioral: Mindfulness-based Cognitive Therapy (MBCT)
ACTIVE_COMPARATOR: Relaxation Group Therapy (RGT); The revised edition of the Changeways Relaxation Programme (Paterson, 1997) served as the active control condition to control for non-specific group factors including group participation, expectation of change or therapeutic contact and attention. The rationale was that relaxation can be used to better manage life stressors which precipitate depressive episodes. Participants received eight-weekly, two-hour relaxation training sessions. This group program combines psychoeducation regarding the effects of stress, diaphragmatic breathing, progressive muscle relaxation, passive relaxation and imagery. It also incorporates time for participants to discuss the events of the week to facilitate the supportive aspect of group participation. Finally, participants were asked to engage in daily exercises to practice the various relaxation strategies. Each RGT group was led by a doctoral-level therapist.	Behavioral: Relaxation Group Therapy (RGT)
PLACEBO_COMPARATOR: Treatment as usual (TAU); Participants randomized to the TAU group were instructed that participants would receive MBCT at the end of the follow-up period and to seek help from their family doctors or other sources as the normally would, should the participants encounter symptomatic deterioration or other difficulties over the course of the study. At the end of the follow-up phase, participants in the TAU and RGT group were offered the opportunity to receive MBCT.	Behavioral: Treatment as usual (TAU)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Major depressive disorder (MDD) relapse/recurrence - incidence of	Number of participants meeting criteria for relapse/recurrence of MDD during follow-up	12- month post-treatment follow-up
Change in major depressive disorder (MDD) relapse/recurrence - time to relapse/recurrence	Change in relapse/recurrence of MDD (i.e., survival) across follow-up	3-, 6-, 9-, and 12- month post-treatment follow-up

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Beck Depression Inventory - Second Edition total scores	Change in symptoms of depression across MBCT treatment	Pre-, mid- (i.e., at week 4 of MBCT), and post-treatment (i.e., after 8 weeks of MBCT)

Collaborators and Investigators

• Sponsor: University of British Columbia

Publications and helpful links

General Publications

• Moore MT, Lau MA, Haigh EAP, Willett BR, Bosma CM, Fresco DM. Association between decentering and reductions in relapse/recurrence in mindfulness-based cognitive therapy for depression in adults: A randomized controlled trial. J Consult Clin Psychol. 2022 Feb;90(2):137-147. doi: 10.1037/ccp0000718.

Study record dates

Study Major Dates

• Study Start (ACTUAL): February 14, 2008
• Primary Completion (ACTUAL): October 31, 2008
• Study Completion (ACTUAL): October 31, 2008

Study Registration Dates

• First Submitted: October 4, 2021
• First Submitted That Met QC Criteria: October 28, 2021
• First Posted (ACTUAL): November 8, 2021

Study Record Updates

• Last Update Posted (ACTUAL): November 8, 2021
• Last Update Submitted That Met QC Criteria: October 28, 2021
• Last Verified: October 1, 2021

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Behavioral Symptoms; Mental Disorders; Pathologic Processes; Mood Disorders; Disease Attributes; Depression; Depressive Disorder; Recurrence; Depressive Disorder, Major
• Other Study ID Numbers: H07-03046

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No