The Benevolent Effects of Mindfulness and Self-Compassion

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RESEARCH UPDATE

Mindfulness-based cognitive therapy (MBCT), which combines mindfulness meditation techniques with cognitive behavioral therapy, has been shown to be effective in patients with remitted and acute depressive disorder-but how effective is it in chronically depressed patients? A Dutch study looked into this question and found patients who stuck with MBCT plus treatment-as-usual (TAU) benefited over patient who had TAU alone.¹

The research team from Radboud University Nijmegen (Netherlands), conducted an open-labeled, multicenter randomized controlled trial (RCT) that compared MBCT plus TAU (n= 49) with TAU alone (n=57) in patients with chronic depression who previously received at least 4 weeks of pharmacotherapy and at least 10 sessions of psychological counseling. Chronicity was defined as depressive symptoms persisting for 12 months or more.

The primary endpoint was reduction in depression symptoms. Secondary endpoints were remission rates, rumination, quality of life, mindfulness skills, and self-compassion. Variables that could possibly influence treatment effect also were analyzed, including gender, age, childhood trauma, number of previous episodes of depression, duration of the current depressive episode, and treatment resistance.

Participants randomized to MBCT were assigned to 8 weekly 2.5-hour sessions and 1 day of silent retreat in regular, naturalistic MBCT courses that included 8 to 12 participants of whom 2 to 3 were RCT subjects per individual course. TAU consisted of antidepressant therapy, psychological counseling, support of a psychiatric nurse, or day hospital treatment. Although current Dutch guidelines recommend pharmacotherapy plus psychological counseling for treatment of major depression,² 5 study participants refused antidepressant therapy.

This element and the high dropout rate in the MBCT-plus-TAU group (25%) affected outcomes data for the intention-to-treat (ITT) population. “Drop-out”/noncompleter was defined as attending fewer than 4 MBCT sessions. The most common reason for dropping out of a MBCT program was the “occurrence or deterioration of physical problems.”

The bottom line >

Those who dropped out generally had a shorter history of symptomatology than completers, leading the authors to believe that participants with longer lasting symptomatology had greater incentive than others to stick with the program. Completers attended an average of 7 of the total 8 sessions.

Based on ITT analysis, the primary endpoint was not reached. Although the participants in the MBCT plus TAU group did have lower levels of depressive symptoms, with small to medium effect sizes, the difference did not reach statistical significance. However, compared with TAU, the MBCT-plus-TAU group had significantly higher partial remission rates (39% vs 18%; P < .05), lower levels of rumination (P <.05), higher quality-of-life scores (P < .05), more mindfulness (P < .001), and more self-compassion (P = .001). When drop-outs were taken out of the dataset, analysis of this per-protocol population showed that MBCT plus TAU was associated with significantly (d = 0.45, P < .05) fewer depressive symptoms at posttreatment than was TAU.

The bottom line

Although the ITT analysis did not show MBCT plus TAU was superior to TAU in reducing depressive symptoms in patients with treatment-resistant depression, the regimen did significantly improve symptoms over TAU alone in those patients who completed the MBCT program. MBCT plus TAU also was superior to TAU alone in terms of the regimen’s effect on remission rates, rumination, quality of life, mindfulness skills, and self-compassion. The investigators noted that reasons for noncompletion of MBCT among chronically depressed patients needs further exploration to optimize use of this modality in therapeutic regimens for clinical depression among patients with chronicity.

References:

1. Cladder-Micus MB, Speckens AEM, Vrijsen JN, et al. Mindfulness-based cognitive therapy for patients with chronic, treatment-resistant depression: A pragmatic randomized controlled trial. Depress Anxiety. 2018 Aug 8. [Epub ahead of print]

2. Peeters FP, Ruhe HG, Wichers M, et al. The Dutch Measure for quantification of Treatment Resistance in Depression (DM-TRD): an extension of the Maudsley Staging Method. J Affect Disord. 2016;205:365-371.