The Effects of Mindfulness-Based Cognitive Therapy and Cognitive Behavioral Analysis System of Psychotherapy added to Treatment as Usual on suicidal ideation in chronic depression: Results of a randomized-clinical trial

Abstract

Background: Suicidal ideation (SI) is common in chronic depression, but only limited evidence exists for the assumption that psychological treatments for depression are effective for reducing SI.

Methods: In the present study, the effects of Mindfulness-based Cognitive Therapy (MBCT; group version) plus treatment-as-usual (TAU: individual treatment by either a psychiatrist or a licensed psychotherapist, including medication when indicated) and Cognitive Behavioral Analysis System of Psychotherapy (CBASP; group version) plus TAU on SI was compared to TAU alone in a prospective, bi-center, randomized controlled trial. The sample consisted of 106 outpatients with chronic depression.

Results: Multivariate regression analyses revealed different results, depending on whether SI was assessed via self-report (Beck Depression Inventory suicide item) or via clinician rating (Hamilton Depression Rating Scale suicide item). Whereas significant reduction of SI emerged when assessed via clinician rating in the MBCT and CBASP group, but not in the TAU group while controlling for changes in depression, there was no significant effect of treatment on SI when assessed via self-report.

Limitations: SI was measured with only two single items.

Conclusions: Because all effects were of small to medium size and were independent of effects from other depression symptoms, the present results warrant the application of such psychotherapeutical treatment strategies like MBCT and CBASP for SI in patients with chronic depression.

Trial registration: ClinicalTrials.gov NCT01065311.

Keywords: Chronic depression; Cognitive Behavioral Analysis System of Psychotherapy; Mindfulness-based Cognitive Therapy; Persistent depression; RCT; Suicidal ideation.