Mindfulness-based cognitive therapy for preventing relapse in recurrent depression: a randomized dismantling trial

J Mark G Williams, Catherine Crane, Thorsten Barnhofer, Kate Brennan, Danielle S Duggan, Melanie J V Fennell, Ann Hackmann, Adele Krusche, Kate Muse, Isabelle Rudolf Von Rohr, Dhruvi Shah, Rebecca S Crane, Catrin Eames, Mariel Jones, Sholto Radford, Sarah Silverton, Yongzhong Sun, Elaine Weatherley-Jones, Christopher J Whitaker, Daphne Russell, Ian T Russell, J Mark G Williams, Catherine Crane, Thorsten Barnhofer, Kate Brennan, Danielle S Duggan, Melanie J V Fennell, Ann Hackmann, Adele Krusche, Kate Muse, Isabelle Rudolf Von Rohr, Dhruvi Shah, Rebecca S Crane, Catrin Eames, Mariel Jones, Sholto Radford, Sarah Silverton, Yongzhong Sun, Elaine Weatherley-Jones, Christopher J Whitaker, Daphne Russell, Ian T Russell

Abstract

Objective: We compared mindfulness-based cognitive therapy (MBCT) with both cognitive psychological education (CPE) and treatment as usual (TAU) in preventing relapse to major depressive disorder (MDD) in people currently in remission following at least 3 previous episodes.

Method: A randomized controlled trial in which 274 participants were allocated in the ratio 2:2:1 to MBCT plus TAU, CPE plus TAU, and TAU alone, and data were analyzed for the 255 (93%; MBCT = 99, CPE = 103, TAU = 53) retained to follow-up. MBCT was delivered in accordance with its published manual, modified to address suicidal cognitions; CPE was modeled on MBCT, but without training in meditation. Both treatments were delivered through 8 weekly classes.

Results: Allocated treatment had no significant effect on risk of relapse to MDD over 12 months follow-up, hazard ratio for MBCT vs. CPE = 0.88, 95% CI [0.58, 1.35]; for MBCT vs. TAU = 0.69, 95% CI [0.42, 1.12]. However, severity of childhood trauma affected relapse, hazard ratio for increase of 1 standard deviation = 1.26 (95% CI [1.05, 1.50]), and significantly interacted with allocated treatment. Among participants above median severity, the hazard ratio was 0.61, 95% CI [0.34, 1.09], for MBCT vs. CPE, and 0.43, 95% CI [0.22, 0.87], for MBCT vs. TAU. For those below median severity, there were no such differences between treatment groups.

Conclusion: MBCT provided significant protection against relapse for participants with increased vulnerability due to history of childhood trauma, but showed no significant advantage in comparison to an active control treatment and usual care over the whole group of patients with recurrent depression.

Figures

Figure 1
Figure 1
Flow of participants through the study. Numbers in parentheses denote participants at Oxford, first, and Bangor, second. MBCT = mindfulness-based cognitive therapy; CPE = cognitive psychological education; TAU = treatment as usual.
Figure 2
Figure 2
Proportions of patients who survived without relapse during follow-up in those with high (a: n = 126) and low (b: n = 129) Childhood Trauma Questionnaire (CTQ) scores. MBCT = mindfulness-based cognitive therapy plus TAU; CPE = cognitive psychological education plus TAU; TAU = treatment as usual.

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