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Randomized Controlled Trial
. 2015 Oct;83(5):964-75.
doi: 10.1037/ccp0000050. Epub 2015 Aug 10.

Relapse prevention in major depressive disorder: Mindfulness-based cognitive therapy versus an active control condition

Amanda J Shallcross  1 , James J Gross  2 , Pallavi D Visvanathan  3 , Niketa Kumar  4 , Amy Palfrey  4 , Brett Q Ford  5 , Sona Dimidjian  6 , Stephen Shirk  7 , Jill Holm-Denoma  7 , Kari M Goode  7 , Erica Cox  7 , William Chaplin  4 , Iris B Mauss  5
Affiliations
Randomized Controlled Trial

Relapse prevention in major depressive disorder: Mindfulness-based cognitive therapy versus an active control condition

Amanda J Shallcross et al. J Consult Clin Psychol. 2015 Oct.

Abstract

Objective: We evaluated the comparative effectiveness of mindfulness-based cognitive therapy (MBCT) versus an active control condition (ACC) for depression relapse prevention, depressive symptom reduction, and improvement in life satisfaction.

Method: Ninety-two participants in remission from major depressive disorder with residual depressive symptoms were randomized to either an 8-week MBCT or a validated ACC that is structurally equivalent to MBCT and controls for nonspecific effects (e.g., interaction with a facilitator, perceived social support, treatment outcome expectations). Both interventions were delivered according to their published manuals.

Results: Intention-to-treat analyses indicated no differences between MBCT and ACC in depression relapse rates or time to relapse over a 60-week follow-up. Both groups experienced significant and equal reductions in depressive symptoms and improvements in life satisfaction. A significant quadratic interaction (Group × Time) indicated that the pattern of depressive symptom reduction differed between groups. The ACC experienced immediate symptom reduction postintervention and then a gradual increase over the 60-week follow-up. The MBCT group experienced a gradual linear symptom reduction. The pattern for life satisfaction was identical but only marginally significant.

Conclusions: MBCT did not differ from an ACC on rates of depression relapse, symptom reduction, or life satisfaction, suggesting that MBCT is no more effective for preventing depression relapse and reducing depressive symptoms than the active components of the ACC. Differences in trajectory of depressive symptom improvement suggest that the intervention-specific skills acquired may be associated with differential rates of therapeutic benefit. This study demonstrates the importance of comparing psychotherapeutic interventions to active control conditions.

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Figures

Figure 1
Figure 1
CONSORT flow diagram. MBCT=mindfulness based cognitive therapy; ACC=active control condition; SCID=Structured Clinical Interview for DSM-IV.
Figure 2
Figure 2
Survival (non-relapse/recurrence) curves comparing relapse/recurrence of major depression for Mindfulness Based Cognitive Therapy (MBCT) and Active Comparison Condition (ACC) over a 60-week follow up period (intention-to-treat sample). Zero weeks=baseline.
Figure 3
Figure 3
Differential pattern of quadratic change in depressive symptoms (BDI-Panel A) and life satisfaction (SWL-Panel B) between groups. Zero weeks=baseline. BDI-II scale range: 0–63; SWL scale range: 1–7.
See this image and copyright information in PMC

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