Background Mindfulness-based cognitive therapy (MBCT) is effective for relapse prevention in major depressive disorder (MDD). It reduces cognitive reactivity (CR) and rumination, and enhances self... Show moreBackground Mindfulness-based cognitive therapy (MBCT) is effective for relapse prevention in major depressive disorder (MDD). It reduces cognitive reactivity (CR) and rumination, and enhances self-compassion and mindfulness. Although rumination and mindfulness after MBCT are associated with relapse, the association of CR, rumination, self-compassion, and mindfulness with relapse before initiation of MBCT has never been investigated. Methods Data were drawn from two randomized controlled trials, including a total of 282 remitted MDD participants (>= 3 depressive episodes) who had been using maintenance antidepressant medication (mADM) for at least 6 months before baseline. All participants were offered MBCT while either their mADM was maintained or discontinued after MBCT. CR, rumination, self-compassion, and mindfulness were assessed at baseline by self-rated questionnaires and were used in Cox proportional hazards regression models to investigate their association with relapse. Results CR and mindfulness were associated with relapse, independent of residual symptoms, previous depressive episodes, and mADM-use. Higher CR and lower mindfulness increased the risk of relapse. Self-compassion was not associated with relapse. For rumination, a significant interaction with mADM-use was found. Rumination was associated with relapse in patients who discontinued their mADM, while this effect was absent if patients continued mADM. Conclusions These results show that CR, rumination, and mindfulness are associated with relapse in remitted MDD-patients before initiation of MBCT, independent of residual symptoms and previous depressive episodes. This information could improve decisions in treatment planning in remitted individuals with a history of depression. Show less
Background: The current study aimed to investigate the possible interplay between self-compassion and affect during Mindfulness-Based Compassionate Living (MBCL) in recurrently depressed... Show moreBackground: The current study aimed to investigate the possible interplay between self-compassion and affect during Mindfulness-Based Compassionate Living (MBCL) in recurrently depressed individuals.Methods: Data was used from a subsample of a parallel-group randomized controlled trial investigating the efficacy of MBCL in recurrently depressed adults (n = 104). Self-reports of self-compassion and positive/negative affect were obtained at the start of each of the eight MBCL sessions.Results: Bivariate Autoregressive Latent Trajectory (ALT) modeling showed that, when looking at the interplay between self-compassion and positive/negative affect on a session-to-session basis, no significant reciprocal cross-lagged effects between self-compassion and positive affect were found. Although there were no cross-lagged effects from negative affect to self-compassion, higher levels of self-compassion at each session did predict lower levels of negative affect at the subsequent session (b(SC(t-1),NA(t)) = -0.182, s.e. = 0.076, p =.017).Conclusions: The current study shows that increases in self-compassion are followed by decreases in negative affect in MBCL for depression. Show less
Background: The current study aimed to investigate the possible interplay between self-compassion and affect during Mindfulness-Based Compassionate Living (MBCL) in recurrently depressed... Show moreBackground: The current study aimed to investigate the possible interplay between self-compassion and affect during Mindfulness-Based Compassionate Living (MBCL) in recurrently depressed individuals.Methods: Data was used from a subsample of a parallel-group randomized controlled trial investigating the efficacy of MBCL in recurrently depressed adults (n = 104). Self-reports of self-compassion and positive/negative affect were obtained at the start of each of the eight MBCL sessions.Results: Bivariate Autoregressive Latent Trajectory (ALT) modeling showed that, when looking at the interplay between self-compassion and positive/negative affect on a session-to-session basis, no significant reciprocal cross-lagged effects between self-compassion and positive affect were found. Although there were no cross-lagged effects from negative affect to self-compassion, higher levels of self-compassion at each session did predict lower levels of negative affect at the subsequent session (b(SC(t-1),NA(t)) = -0.182, s.e. = 0.076, p =.017).Conclusions: The current study shows that increases in self-compassion are followed by decreases in negative affect in MBCL for depression. Show less
Objectives Gaining knowledge of dynamic processes of mechanisms underlying mindfulness-based cognitive therapy (MBCT) for recurrent depression could help to improve treatment efficacy. The current... Show moreObjectives Gaining knowledge of dynamic processes of mechanisms underlying mindfulness-based cognitive therapy (MBCT) for recurrent depression could help to improve treatment efficacy. The current study examined the overall course and week-to-week associations of mindfulness and positive/negative affect during MBCT for recurrent depression. Methods Using data from the MOMENT study, 235 patients with recurrent depression in (partial) remission allocated to MBCT were included. Prior to each MBCT session, self-reports were obtained on mindfulness, positive affect, and negative affect. Results Autoregressive latent trajectory (ALT) modeling revealed that, across the MBCT course, larger increases in mindfulness were associated with larger increases in positive affect (r = .80,p < .050). Higher general levels of negative affect were associated with smaller increases in mindfulness over time (r = -.26,p < .001). Week-to-week effects showed no reciprocal cross-lagged effects between mindfulness and positive affect or negative affect, except for positive affect at session 2 which was positively associated with mindfulness at session 3 (r = .11,p < .050). Conclusions The current study supports a positive association in strength of increase between mindfulness and positive affect, while higher general levels of negative affect might be associated with smaller increases of mindfulness during MBCT for recurrent depression. For future research, experience sampling methods (ESMs) are recommended to capture dynamics on a smaller time scale. ALT modeling techniques are advised to be better able to interpret the processes of stability and change during MBCT for recurrent depression. Show less
Background Home practice is considered a key element in increasing treatment effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) for depression. However, long-term longitudinal research... Show moreBackground Home practice is considered a key element in increasing treatment effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) for depression. However, long-term longitudinal research into the associations between home practice and depression outcomes is scarce. The current study examined the prospective associations between the extent of formal home practice and subsequent depression severity during 15 months of follow-up. Methods Data from two randomized-controlled trials on MBCT for recurrent depression were used (n = 200). Depressive symptoms were assessed at 3-month intervals: 0 (baseline), 3 (posttreatment), 6, 9, 12, and 15 months. Formal home practice frequency was calculated for each 3-month period. Autoregressive latent trajectory (ALT) modelling was applied. Results Participants practiced formal exercises on 57% (SD = 0.22, range 0-1) of the days during MBCT, equivalent to an average of 4 days per week, which showed a rapid decline after MBCT. The level of depressive symptoms did not change over the full study period. A small positive association was found between formal home practice frequency during each three-month period on subsequent depressive symptoms, but sensitivity analyses did not confirm this. More robust, a small negative association was found between levels of depressive symptoms at each measurement point and formal home practice frequency during the subsequent three-month periods. Conclusions The hypothesis that more frequent home practice would lead to reductions in depressive symptoms was not confirmed in the current study. Rather, it seems that patients with higher levels of depression may subsequently practice less frequently at home. The interplay between home practice and outcome might not be as straightforward as expected. However, these results are preliminary and should be replicated first before recommendations for clinical practice can be formulated. Show less
Aim: To identify moderators of treatment effect for Mindfulness-Based Cognitive Therapy (MBCT) versus Treatment As Usual (TAU) in depressed patients.Methods: An individual patient data-analysis was... Show moreAim: To identify moderators of treatment effect for Mindfulness-Based Cognitive Therapy (MBCT) versus Treatment As Usual (TAU) in depressed patients.Methods: An individual patient data-analysis was performed on three randomized-controlled trials, investigating the effect of MBCT + TAU versus TAU alone (N = 292). Patients were either in (partial) remission, currently depressed or had chronic, treatment-resistant depression. Outcomes were depressive symptoms and quality of life. The Qualitative INteraction Trees (QUINT) method was used to identify subgroups that benefited more from either condition.Results: MBCT + TAU outperformed TAU in reducing depressive symptoms. For both conditions, the effect of baseline depressive symptoms on post-treatment depressive symptoms was curvilinear. QUINT analyses revealed that MBCT + TAU was more beneficial than TAU for patients with an earlier onset and higher rumination levels in terms of depressive symptom reduction and for patients with a lower quality of life in terms of improving quality of life.Conclusions: The results suggest that MBCT might be more beneficial for those with earlier onset and higher levels of rumination and for patients with a lower quality of life. Sophisticated analytical techniques such as QUINT can be used in future research to improve personalized assignment of MBCT to patients. Long-term outcome could also be integrated in this. Show less
