Background: This study aimed: (a) to examine the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) for patients with a treatment-refractory anxiety disorders compared to Relapse... Show moreBackground: This study aimed: (a) to examine the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) for patients with a treatment-refractory anxiety disorders compared to Relapse Prevention-Cognitive Behavioral Therapy (CBT-RP); and (b) to explore candidate mediating variables. Methods: We conducted a pragmatic randomized controlled trial comparing MBCT with CBT-RP in a group format for 136 outpatients with treatment-refractory DSM-IV defined anxiety disorder, who insufficiently responded to first-line psychological treatment. Results: At post-treatment, the MBCT group showed a significantly larger decrease in self-reported anxiety (Beck Anxiety Inventory), avoidance (Fear Questionnaire), difficulties in emotion regulation (Difficulties in Emotion Regulation Strategies), and worry (Penn State Worry Questionnaire), as well as a significantly larger increase in mindfulness skills (Five Facet Mindfulness Questionnaire). After a 6-month follow-up treatment gains were somewhat diminished. Effects of MBCT on anxiety at post-treatment did not prove to be mediated by mindfulness skills, difficulties in emotion regulation strategies, worry, or rumination (Rumination on Sadness Scales) at midtreatment. Conclusions: MBCT seems to be a promising intervention in routine clinical care for persons with an anxiety disorder who insufficiently responded to first-line psychological treatment. Future research in larger samples assessing long-term effects and using intensive longitudinal designs to identify possible working mechanisms is called for. 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
Ter Avest, M.J.; Dusseldorp, E.; Huijbers, M.J.; Van Aalderen, J.R.; Cladder-Micus, M.B.; Spinhoven, P.; ... ; Speckens, A.E.M. 2019
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
We investigated the effects of two novel treatments for posttraumatic stress disorder (PTSD). The first treatment is Attentional Bias Modification (ABM). This treatment for anxiety disorders has... Show moreWe investigated the effects of two novel treatments for posttraumatic stress disorder (PTSD). The first treatment is Attentional Bias Modification (ABM). This treatment for anxiety disorders has become quite popular in a relatively short time and was featured in recent articles in the New York Times and The Economist. ABM is a brief, computerized treatment in which patients are trained to keep their attention away from the threatening stimuli from which they automatically attend. Since attentional bias (AB) is considered an important feature of PTSD, we tested ABM in a randomized controlled trial. ABM did not effect PTSD, nor did it change AB. We also investigated an individualized version of ABM in a case series and saw no therapeutic effects. Since the current popularity of ABM is based on smaller studies than our RCT, dissemination efforts may have to be reconsidered. Next, we explored the usefulness of a 8-week course of mindfulness-based cognitive therapy (MBCT) in a pilot study with patients with chronic PTSD. No adverse effects were observed and patients evaluated the course positively. About half of the patients who finished MBCT demonstrated positive clinical effects. However, considering the early dropout rate, different formats may have to be developed to increase its acceptability in this group. Show less
