Depression relapse prophylaxis with Mindfulness-Based Cognitive Therapy: replication and extension in the Swiss health care system

Guido Bondolfi, Françoise Jermann, Martial Van der Linden, Marianne Gex-Fabry, Lucio Bizzini, Béatrice Weber Rouget, Lusmila Myers-Arrazola, Christiane Gonzalez, Zindel Segal, Jean-Michel Aubry, Gilles Bertschy, Guido Bondolfi, Françoise Jermann, Martial Van der Linden, Marianne Gex-Fabry, Lucio Bizzini, Béatrice Weber Rouget, Lusmila Myers-Arrazola, Christiane Gonzalez, Zindel Segal, Jean-Michel Aubry, Gilles Bertschy

Abstract

Background: Mindfulness-Based Cognitive Therapy (MBCT) is a group intervention that integrates elements of Cognitive Behavioural Therapy (CBT) with components of mindfulness training to prevent depressive relapse. The efficacy of MBCT compared to Treatment As Usual (TAU), shown in two randomized controlled trials indicates a significant decrease in 1-year relapse rates for patients with at least three past depressive episodes. The present study is the first independent replication trial comparing MBCT+TAU to TAU alone across both language and culture (Swiss health care system).

Methods: Sixty unmedicated patients in remission from recurrent depression (>or=3 episodes) were randomly assigned to MBCT+TAU or TAU. Relapse rate and time to relapse were measured over a 60 week observation period. The frequency of mindfulness practices during the study was also evaluated.

Results: Over a 14-month prospective follow-up period, time to relapse was significantly longer with MBCT+TAU than TAU alone (median 204 and 69 days, respectively), although both groups relapsed at similar rates. Analyses of homework adherence revealed that following treatment termination, the frequency of brief and informal mindfulness practice remained unchanged over 14 months, whereas the use of longer formal meditation decreased over time.

Limitations: Relapse monitoring was 14months in duration and prospective reporting of mindfulness practice would have yielded more precise frequency estimates compared to the retrospective methods we utilized.

Conclusions: Further studies are required to determine which patient characteristics, beyond the number of past depressive episodes, may predict differential benefits from this therapeutic approach.

Copyright (c) 2009 Elsevier B.V. All rights reserved.

Figures

Fig. 1
Fig. 1
Patient flow through each stage of the study.
Fig. 2
Fig. 2
Survival (non-relapse/non-recurrence) curves comparing relapse/recurrence to major depression (Diagnostic and Statistical Manual of Mental Disorders 4th ed.; APA, 1994) for MBCT + TAU and TAU groups (per-protocol sample, n = 55).

References

    1. American Psychiatric Association . American Psychiatric Association; Washington, DC: 1994. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV.
    1. Aubry J.M., Gervasoni N., Osiek C., Perret G., Rossier M.F., Bertschy G., Bondolfi G. The DEX/CRH neuroendocrine test and the prediction of depressive relapse in remitted depressed outpatients. J. Psychiatr. Res. 2007;41:290–294.
    1. Beck A.T., Rush A.J., Shaw B.F., Emery G. Guilford Press; New York: 1979. Cognitive Therapy of Depression.
    1. Beck A.T., Steer R.A., Brown G.K. The Psychological Corporation; San Antonio, TX: 1996. Beck Depression Inventory-II.
    1. Bockting C.L., Schene A.H., Spinhoven P., Koeter M.W., Wouters L.F., Huyser J., Kamphuis J.H. Preventing relapse/recurrence in recurrent depression with cognitive therapy: a randomized controlled trial. J. Consult. Clin. Psychol. 2005;73:647–657.
    1. Carmody J., Baer R.A. Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program. J. Behav. Med. 2008;31:23–33.
    1. Chambless D.L., Hollon S.D. Defining empirically supported therapies. J. Consult. Clin. Psychol. 1998;66:7–18.
    1. Davidson R.J., Kabat-Zinn J., Schumacher J., Rosenkranz M., Muller D., Santorelli S.F., Urbanowski F., Harrington A., Bonus K., Sheridan J.F. Alterations in brain and immune function produced by mindfulness meditation. Psychosom. Med. 2003;65:564–570.
    1. Dobson K.S., Hollon S.D., Dimidjian S., Schmaling K.B., Kohlenberg R.J., Gallop R.J., Rizvi S.L., Gollan J.K., Dunner D.L., Jacobson N.S. Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression. J. Consult. Clin. Psychol. 2008;76:468–477.
    1. Editions du Centre de Psychologie Appliquée . Editions du Centre de Psychologie Appliquée; Paris: 1998. Inventaire de Dépression de Beck, BDI-II.
    1. Eisendrath S.J., Delucchi K., Bitner R., Fenimore P., Smit M., McLane M. Mindfulness-based cognitive therapy for treatment-resistant depression: a pilot study. Psychother. Psychosom. 2008;77:319–320.
    1. First M.B., Spitzer R.L., Gibbon M., Williams J.B.W. New York State Psychiatric Institute, Biometrics Research Department; New York: 1996. Structured Clinical Interview for DSM-IV Axis I Disorders – Patient Edition (SCID-I/P, Version 2.0.
    1. Hamilton M. A rating scale for depression. J. Neurol. Neurosurg. Psychiatry. 1960;23:56–62.
    1. Howell C.A., Turnbull D.A., Beilby J.J., Marshall C.A., Briggs N., Newbury W.L. Preventing relapse of depression in primary care: a pilot study of the “Keeping the Blues Away” program. Med. J. Aust. 2008;188:S138–141.
    1. Judd L.L., Akiskal H.S., Zeller P.J., Paulus M., Leon A.C., Maser J.D., Endicott J., Coryell W., Kunovac J.L., Mueller T.I., Rice J.P., Keller M.B. Psychosocial disability during the long-term course of unipolar major depressive disorder. Arch. Gen. Psychiatry. 2000;57:375–380.
    1. Kabat-Zinn J. Delta; New York: 1990. Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness.
    1. Kenny M.A., Williams J.M. Treatment-resistant depressed patients show a good response to mindfulness-based cognitive therapy. Behav. Res. Ther. 2007;45:617–625.
    1. Kingston T., Dooley B., Bates A., Lawlor E., Malone K. Mindfulness-based cognitive therapy for residual depressive symptoms. Psychol. Psychother. 2007;80:193–203.
    1. Kuyken W., Byford S., Taylor R.S., Watkins E., Holden E., White K., Barrett B., Byng R., Evans A., Mullan E., Teasdale J.D. Mindfulness-based cognitive therapy to prevent relapse in recurrent depression. J. Consult. Clin. Psychol. 2008;76:966–978.
    1. Luborsky L., Luborsky E. Jason Aronson; Lanham, MD: 2006. Research and Psychotherapy: The Vital Link.
    1. Ma S., Teasdale J.D. Mindfulness-based cognitive therapy for depression: replication and exploration of differential relapse prevention effects. J. Consult. Clin. Psychol. 2004;72:31–40.
    1. Mason O., Hargreaves I. A qualitative study of mindfulness-based cognitive therapy for depression. Br. J. Med. Psychol. 2001;74(Part 2):197–212.
    1. Montgomery S.A., Asberg M. A new depression scale designed to be sensitive to change. Br. J. Psychiatry. 1979;134:382–389.
    1. Office of Population Censuses and Surveys . Her Majesty's Stationery Office; London: 1991. Standard Occupational Classification (Vol. 3)
    1. Paykel E.S., Brugha T., Fryers T. Size and burden of depressive disorders in Europe. Eur. Neuropsychopharmacol. 2005;15:411–423.
    1. Ramel W., Goldin P.R., Carmona P.E., McQuaid J.R. The effects of mindfulness meditation on cognitive processes and affect in patients with past depression. Cogn. Ther. Res. 2004;28:433–455.
    1. Reibel D.K., Greeson J.M., Brainard G.C., Rosenzweig S. Mindfulness-based stress reduction and health-related quality of life in a heterogeneous patient population. Gen. Hosp. Psych. 2001;23:183–192.
    1. Segal Z.V., Teasdale J.D., Williams J.M., Gemar M.C. The mindfulness-based cognitive therapy adherence scale: inter-rater reliability, adherence to protocol and treatment distinctiveness. Clin. Psychol. Psychother. 2002;9:131–138.
    1. Segal Z.V., Williams J.M.G., Teasdale J.D. Guilford Press; New York: 2002. Mindfulness-based cognitive therapy for depression: a new approach to preventing relapse.
    1. Segal Z.V., Williams J.M.G., Teasdale J.D. Bruxelles; De Boeck: 2006. La thérapie cognitive basée sur la pleine conscience pour la dépression: Une nouvelle approche pour prévenir la rechute.
    1. Simons A.D., Murphy G.E., Levine J.L., Wetzel R.D. Cognitive therapy and pharmacotherapy for depression: sustained improvement over one year. Arch. Gen. Psychiatry. 1986;43:43–48.
    1. Speca M., Carlson L.E., Goodey E., Angen M. A randomized, wait-list controlled clinical trial: the effect of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients. Psychosom. Med. 2000;62:613–622.
    1. Teasdale J.D. Cognitive vulnerability to persistent depression. Cogn. Emot. 1988;2:247–274.
    1. Teasdale J.D., Segal Z., Williams J.M. How does cognitive therapy prevent depressive relapse and why should attentional control (mindfulness) training help? Behav. Res. Ther. 1995;33:25–39.
    1. Teasdale J.D., Segal Z.V., Williams J.M.G., Ridgeway V.A., Soulsby J.M., Lau M.A. Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. J. Consult. Clin. Psychol. 2000;68:615–623.
    1. Williams J.M., Russell I., Russell D. Mindfulness-based cognitive therapy: further issues in current evidence and future research. J. Consult. Clin. Psychol. 2008;76:524–529.
    1. World Health Organization . World Health Organization; Geneva: 2005. Mental Health Atlas – 2005.
    1. Zimmerman M., Posternak M.A., Chelminski I. Derivation of a definition of remission on the Montgomery–Asberg depression rating scale corresponding to the definition of remission on the Hamilton rating scale for depression. J. Psychiatr. Res. 2004;38:577–582.

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