The spontaneous oscillatory activity in the human brain shows long-range temporal correlations (LRTC) that extend over time scales of seconds to minutes. Previous research has demonstrated aberrant LRTC in depressed patients; however, it is unknown whether the neuronal dynamics normalize after psychological treatment. In this study, we recorded EEG during eyes-closed rest in depressed patients (N = 71) and healthy controls (N = 25), and investigated the temporal dynamics in depressed patients at baseline, and after attending either a brief mindfulness training or a stress reduction training. Compared to the healthy controls, depressed patients showed stronger LRTC in theta oscillations (4–7 Hz) at baseline. Following the psychological interventions both groups of patients demonstrated reduced LRTC in the theta band. The reduction of theta LRTC differed marginally between the groups, and explorative analyses of separate groups revealed noteworthy topographic differences. A positive relationship between the changes in LRTC, and changes in depressive symptoms was observed in the mindfulness group. In summary, our data show that aberrant temporal dynamics of ongoing oscillations in depressive patients are attenuated after treatment, and thus may help uncover the mechanisms with which psychotherapeutic interventions affect the brain.
The error-related negativity (ERN), an evoked-potential that arises in response to the commission of errors, is an important early indicator of self-regulatory capacities. In this study we investigated whether brief mindfulness training can reverse ERN deficits in chronically depressed patients. The ERN was assessed in a sustained attention task. Chronically depressed patients (n = 59) showed significantly blunted expression of the ERN in frontocentral and frontal regions, relative to healthy controls (n = 18). Following two weeks of training, the patients (n = 24) in the mindfulness condition showed a significantly increased ERN magnitude in the frontal region, but there were no significant changes in patients who had received a resting control (n = 22). The findings suggest that brief training in mindfulness may help normalize aberrations in the ERN in chronically depressed patients, providing preliminary evidence for the responsiveness of this parameter to mental training.
Conditional goal setting (CGS, the tendency to regard high order goals such as happiness, as conditional upon the achievement of lower order goals) is observed in individuals with depression and recent research has suggested a link between levels of dispositional mindfulness and conditional goal setting in depressed patients. Since interventions which aim to increase mindfulness through training in meditation are used with patients suffering from depression it is of interest to examine whether such interventions might alter CGS. Study 1 examined the correlation between changes in dispositional mindfulness and changes in CGS over a 3-4 month period in patients participating in a pilot randomised controlled trial of Mindfulness-Based Cognitive Therapy (MBCT). Results indicated that increases in dispositional mindfulness were significantly associated with decreases in CGS, although this effect could not be attributed specifically to the group who had received training in meditation. Study 2 explored the impact of brief periods of either breathing or loving kindness meditation on CGS in 55 healthy participants. Contrary to expectation, a brief period of meditation increased CGS. Further analyses indicated that this effect was restricted to participants low in goal re-engagement ability who were allocated to loving kindness meditation. Longer term changes in dispositional mindfulness are associated with reductions in CGS in patients with depressed mood. However initial reactions to meditation, and in particular loving kindness meditation, may be counterintuitive and further research is required in order to determine the relationship between initial reactions and longer-term benefits of meditation practice.
Conditional goal setting (CGS, the tendency to regard high order goals such as happiness, as conditional upon the achievement of lower order goals) is observed in individuals with depression and recent research has suggested a link between levels of dispositional mindfulness and conditional goal setting in depressed patients. Since interventions which aim to increase mindfulness through training in meditation are used with patients suffering from depression it is of interest to examine whether such interventions might alter CGS. Study 1 examined the correlation between changes in dispositional mindfulness and changes in CGS over a 3-4 month period in patients participating in a pilot randomised controlled trial of Mindfulness-Based Cognitive Therapy (MBCT). Results indicated that increases in dispositional mindfulness were significantly associated with decreases in CGS, although this effect could not be attributed specifically to the group who had received training in meditation. Study 2 explored the impact of brief periods of either breathing or loving kindness meditation on CGS in 55 healthy participants. Contrary to expectation, a brief period of meditation increased CGS. Further analyses indicated that this effect was restricted to participants low in goal re-engagement ability who were allocated to loving kindness meditation. Longer term changes in dispositional mindfulness are associated with reductions in CGS in patients with depressed mood. However initial reactions to meditation, and in particular loving kindness meditation, may be counterintuitive and further research is required in order to determine the relationship between initial reactions and longer-term benefits of meditation practice.
Negative emotional reactivity as measured by neuroticism has been shown to be an important risk factor for the development of depressive symptoms. This study investigated whether the ability to be mindful can protect against the negative effects of this temperamental vulnerability. An English community sample of N = 144 individuals who had completed a neuroticism questionnaire six years previously were assessed for current depressive symptoms and dispositional levels of mindfulness at points of assessment approximately one year apart. Dispositional mindfulness moderated the relation between neuroticism and current depressive symptoms: Neuroticism was significantly related to depression in those with low to medium levels of dispositional mindfulness but not in those with relatively high levels of mindfulness. Further analyzes focusing on particular mindfulness skills indicated that this effect was carried mostly by the ability to describe inner experience. The results suggest that dispositional mindfulness and particularly the ability to describe inner experience are helpful in dealing with negative emotional reactivity in a way that reduces the likelihood of depressive symptoms to develop.
Few empirical studies have explored the associations between formal and informal mindfulness home practice and outcome in Mindfulness-based Cognitive Therapy (MBCT). In this study ninety-nine participants randomised to MBCT in a multi-centre randomised controlled trial completed self-reported ratings of home practice over 7 treatment weeks. Recurrence of Major Depression was assessed immediately after treatment, and at 3, 6, 9, and 12-months post-treatment. Results identified a significant association between mean daily duration of formal home practice and outcome and additionally indicated that participants who reported that they engaged in formal home practice on at least 3 days a week during the treatment phase were almost half as likely to relapse as those who reported fewer days of formal practice. These associations were independent of the potentially confounding variable of participant-rated treatment plausibility. The current study identified no significant association between informal home practice and outcome, although this may relate to the inherent difficulties in quantifying informal home mindfulness practice. These findings have important implications for clinicians discussing mindfulness-based interventions with their participants, in particular in relation to MBCT, where the amount of participant engagement in home practice appears to have a significant positive impact on outcome.
Few empirical studies have explored the associations between formal and informal mindfulness home practice and outcome in Mindfulness-based Cognitive Therapy (MBCT). In this study ninety-nine participants randomised to MBCT in a multi-centre randomised controlled trial completed self-reported ratings of home practice over 7 treatment weeks. Recurrence of Major Depression was assessed immediately after treatment, and at 3, 6, 9, and 12-months post-treatment. Results identified a significant association between mean daily duration of formal home practice and outcome and additionally indicated that participants who reported that they engaged in formal home practice on at least 3 days a week during the treatment phase were almost half as likely to relapse as those who reported fewer days of formal practice. These associations were independent of the potentially confounding variable of participant-rated treatment plausibility. The current study identified no significant association between informal home practice and outcome, although this may relate to the inherent difficulties in quantifying informal home mindfulness practice. These findings have important implications for clinicians discussing mindfulness-based interventions with their participants, in particular in relation to MBCT, where the amount of participant engagement in home practice appears to have a significant positive impact on outcome.
Few empirical studies have explored the associations between formal and informal mindfulness home practice and outcome in Mindfulness-based Cognitive Therapy (MBCT). In this study ninety-nine participants randomised to MBCT in a multi-centre randomised controlled trial completed self-reported ratings of home practice over 7 treatment weeks. Recurrence of Major Depression was assessed immediately after treatment, and at 3, 6, 9, and 12-months post-treatment. Results identified a significant association between mean daily duration of formal home practice and outcome and additionally indicated that participants who reported that they engaged in formal home practice on at least 3 days a week during the treatment phase were almost half as likely to relapse as those who reported fewer days of formal practice. These associations were independent of the potentially confounding variable of participant-rated treatment plausibility. The current study identified no significant association between informal home practice and outcome, although this may relate to the inherent difficulties in quantifying informal home mindfulness practice. These findings have important implications for clinicians discussing mindfulness-based interventions with their participants, in particular in relation to MBCT, where the amount of participant engagement in home practice appears to have a significant positive impact on outcome.
This study explored the immediate effects of a course of Mindfulness-Based Cognitive Therapy (MBCT) for chronically depressed participants with a history of suicidality on the specificity of important goals for the future. Participants were randomly allocated to immediate treatment with MBCT or to a waitlist condition and life goals were assessed both before and after the treatment or waiting period. Results showed that participants receiving MBCT reported significantly more specific goals post-treatment whereas those allocated to the waitlist condition showed no significant change. Similarly, participants allocated to MBCT regarded themselves as significantly more likely to achieve their important goals post-treatment, whilst again there was no significant change in the waitlist group. Increases in goal specificity were associated with parallel increases in autobiographical memory specificity whereas increases in goal likelihood were associated with reductions in depressed mood. These results suggest that MBCT may enable participants to clarify their important goals and in doing so increase their confidence in their capacity to move in valued life directions.
This study explored the immediate effects of a course of Mindfulness-Based Cognitive Therapy (MBCT) for chronically depressed participants with a history of suicidality on the specificity of important goals for the future. Participants were randomly allocated to immediate treatment with MBCT or to a waitlist condition and life goals were assessed both before and after the treatment or waiting period. Results showed that participants receiving MBCT reported significantly more specific goals post-treatment whereas those allocated to the waitlist condition showed no significant change. Similarly, participants allocated to MBCT regarded themselves as significantly more likely to achieve their important goals post-treatment, whilst again there was no significant change in the waitlist group. Increases in goal specificity were associated with parallel increases in autobiographical memory specificity whereas increases in goal likelihood were associated with reductions in depressed mood. These results suggest that MBCT may enable participants to clarify their important goals and in doing so increase their confidence in their capacity to move in valued life directions.
This study explored the immediate effects of a course of Mindfulness-Based Cognitive Therapy (MBCT) for chronically depressed participants with a history of suicidality on the specificity of important goals for the future. Participants were randomly allocated to immediate treatment with MBCT or to a waitlist condition and life goals were assessed both before and after the treatment or waiting period. Results showed that participants receiving MBCT reported significantly more specific goals post-treatment whereas those allocated to the waitlist condition showed no significant change. Similarly, participants allocated to MBCT regarded themselves as significantly more likely to achieve their important goals post-treatment, whilst again there was no significant change in the waitlist group. Increases in goal specificity were associated with parallel increases in autobiographical memory specificity whereas increases in goal likelihood were associated with reductions in depressed mood. These results suggest that MBCT may enable participants to clarify their important goals and in doing so increase their confidence in their capacity to move in valued life directions.
The authors examined the effects of mindfulness training on 2 aspects of mode of processing in depressed participants: degree of meta-awareness and specificity of memory. Each of these has been suggested as a maladaptive aspect of a mode of processing linked to persistence and recurrence of symptoms. Twenty-seven depressed participants, all of whom had experienced suicidal crises, described warning signs for their last crisis. These descriptions were blind-rated independently for meta-awareness and specificity. Participants were then randomly allocated to receive mindfulness-based cognitive therapy (MBCT) plus treatment as usual (TAU) or TAU alone, and retested after 3 months. Results showed that, although comparable at baseline, patients randomized to MBCT displayed significant posttreatment differences in meta-awareness and specificity compared with TAU patients. These results suggest that mindfulness training may enable patients to reflect on memories of previous crises in a detailed and decentered way, allowing them to relate to such experiences in a way that is likely to be helpful in preventing future relapses.
Research into the effectiveness and mechanisms of mindfulness-based interventions (MBIs) requires reliable and valid measures of mindfulness. The 39-item Five Facet Mindfulness Questionnaire (FFMQ-39) is a measure of mindfulness commonly used to assess change before and after MBIs. However, the stability and invariance of the FFMQ factor structure have not yet been tested before and after an MBI; pre to post comparisons may not be valid if the structure changes over this period. Our primary aim was to examine the factor structure of the FFMQ-39 before and after mindfulness-based cognitive therapy (MBCT) in adults with recurrent depression in remission using confirmatory factor analysis (CFA). Additionally, we examined whether the factor structure of the 15-item version (FFMQ-15) was consistent with that of the FFMQ-39, and whether it was stable over MBCT. Our secondary aim was to assess the general psychometric properties of both versions. CFAs showed that pre-MBCT, a 4-factor hierarchical model (excluding the "observing" facet) best fit the FFMQ-39 and FFMQ-15 data, whereas post-MBCT, a 5-factor hierarchical model best fit the data for both versions. Configural invariance across the time points was not supported for both versions. Internal consistency and sensitivity to change were adequate for both versions. Both FFMQ versions did not differ significantly from each other in terms of convergent validity. Researchers should consider excluding the Observing subscale from comparisons of total scale/subscale scores before and after mindfulness interventions. Current findings support the use of the FFMQ-15 as an alternative measure in research where briefer forms are needed. (PsycINFO Database Record.
Research into the effectiveness and mechanisms of mindfulness-based interventions (MBIs) requires reliable and valid measures of mindfulness. The 39-item Five Facet Mindfulness Questionnaire (FFMQ-39) is a measure of mindfulness commonly used to assess change before and after MBIs. However, the stability and invariance of the FFMQ factor structure have not yet been tested before and after an MBI; pre to post comparisons may not be valid if the structure changes over this period. Our primary aim was to examine the factor structure of the FFMQ-39 before and after mindfulness-based cognitive therapy (MBCT) in adults with recurrent depression in remission using confirmatory factor analysis (CFA). Additionally, we examined whether the factor structure of the 15-item version (FFMQ-15) was consistent with that of the FFMQ-39, and whether it was stable over MBCT. Our secondary aim was to assess the general psychometric properties of both versions. CFAs showed that pre-MBCT, a 4-factor hierarchical model (excluding the "observing" facet) best fit the FFMQ-39 and FFMQ-15 data, whereas post-MBCT, a 5-factor hierarchical model best fit the data for both versions. Configural invariance across the time points was not supported for both versions. Internal consistency and sensitivity to change were adequate for both versions. Both FFMQ versions did not differ significantly from each other in terms of convergent validity. Researchers should consider excluding the Observing subscale from comparisons of total scale/subscale scores before and after mindfulness interventions. Current findings support the use of the FFMQ-15 as an alternative measure in research where briefer forms are needed. (PsycINFO Database Record.
Increased tendencies towards ruminative responses to negative mood and anxious worry are important vulnerability factors for relapse to depression. In this study, we investigated the trajectories of change in rumination and anxious worry over the course of an eight-week programme of mindfulness-based cognitive therapy (MBCT) for relapse prevention in patients with a history of recurrent depression. One hundred and four participants from the MBCT-arm of a randomized-controlled trial provided weekly ratings. Mixed linear models indicated that changes in rumination and worry over the course of the programme followed a general linear trend, with considerable variation around this trend as indicated by significant increases in model fit following inclusion of random slopes. Exploration of individual trajectories showed that, despite considerable fluctuation, there is little evidence to suggest that sudden gains are a common occurrence. The findings are in line with the general notion that, in MBCT, reductions in vulnerability are driven mainly through regular and consistent practice, and that sudden cognitive insights alone are unlikely to lead into lasting effects.
This review investigates how recent neuroimaging findings on vulnerability for depression and the mechanisms of mindfulness may serve to inform and enhance the understanding that is guiding the use of mindfulness training in the prevention and treatment of recurrent and chronic depression. In particular, we review evidence suggesting that alterations in default-mode-network activity and connectivity represent a fundamental deficit underlying cognitive vulnerability for depression and explore the ways in which mindfulness meditation may reverse such alterations. Furthermore, we discuss findings from studies that have investigated the effects of mindfulness on emotion-regulatory capacities. These findings suggest mindful emotion regulation has a characteristic neural signature that is particularly conducive to therapeutic learning. We conclude that training in mindfulness has unique strengths for addressing neural mechanisms associated with cognitive vulnerabilities for recurrent and chronic depression and propose future lines of research to more effectively harness this potential.
This review investigates how recent neuroimaging findings on vulnerability for depression and the mechanisms of mindfulness may serve to inform and enhance the understanding that is guiding the use of mindfulness training in the prevention and treatment of recurrent and chronic depression. In particular, we review evidence suggesting that alterations in default-mode-network activity and connectivity represent a fundamental deficit underlying cognitive vulnerability for depression and explore the ways in which mindfulness meditation may reverse such alterations. Furthermore, we discuss findings from studies that have investigated the effects of mindfulness on emotion-regulatory capacities. These findings suggest mindful emotion regulation has a characteristic neural signature that is particularly conducive to therapeutic learning. We conclude that training in mindfulness has unique strengths for addressing neural mechanisms associated with cognitive vulnerabilities for recurrent and chronic depression and propose future lines of research to more effectively harness this potential.
Mindfulness-based interventions for the prevention and treatment of depression are predicated on the idea that interoceptive awareness represents a crucial foundation for the cultivation of adaptive ways of responding to negative thoughts and mood states such as the ability to decenter. The current study used a multi-dimensional self-report assessment of interoceptive awareness, including regulatory and belief-related aspects of the construct, in order to characterize deficits in interoceptive awareness in depression, investigate whether brief mindfulness training could reduce these deficits, and to test whether the training unfolds its beneficial effects through the above-described pathway. Currently depressed patients (n = 67) were compared to healthy controls (n = 25) and then randomly allocated to receive either a brief training in mindfulness (per-protocol sample of n = 32) or an active control training (per-protocol sample of n = 28). Patients showed significant deficits across a range of regulatory and belief-related aspects of interoceptive awareness, mindfulness training significantly increased regulatory and belief-related aspects of interoceptive awareness, and reductions in depressive symptoms were mediated through a serial pathway in which training-related increases in aspects of interoceptive awareness were positively associated with the ability to decenter, which in turn was associated with reduced symptoms of depression. These results support the role of interoceptive awareness in facilitating adaptive responses to negative mood.
Mindfulness-based interventions for the prevention and treatment of depression are predicated on the idea that interoceptive awareness represents a crucial foundation for the cultivation of adaptive ways of responding to negative thoughts and mood states such as the ability to decenter. The current study used a multi-dimensional self-report assessment of interoceptive awareness, including regulatory and belief-related aspects of the construct, in order to characterize deficits in interoceptive awareness in depression, investigate whether brief mindfulness training could reduce these deficits, and to test whether the training unfolds its beneficial effects through the above-described pathway. Currently depressed patients (n = 67) were compared to healthy controls (n = 25) and then randomly allocated to receive either a brief training in mindfulness (per-protocol sample of n = 32) or an active control training (per-protocol sample of n = 28). Patients showed significant deficits across a range of regulatory and belief-related aspects of interoceptive awareness, mindfulness training significantly increased regulatory and belief-related aspects of interoceptive awareness, and reductions in depressive symptoms were mediated through a serial pathway in which training-related increases in aspects of interoceptive awareness were positively associated with the ability to decenter, which in turn was associated with reduced symptoms of depression. These results support the role of interoceptive awareness in facilitating adaptive responses to negative mood.
BACKGROUND:Extending previous research, we applied latent profile analysis in a sample of adults with a history of recurrent depression to identify subgroups with distinct response profiles on the Five Facet Mindfulness Questionnaire and understand how these relate to psychological functioning.
METHOD:
The sample was randomly divided into two subsamples to first examine the optimal number of latent profiles (test sample; n = 343) and then validate the identified solution (validation sample; n = 340).
RESULTS:
In both test and validation samples, a four-profile solution was revealed where two profiles mapped broadly onto those previously identified in nonclinical samples: "high mindfulness" and "nonjudgmentally aware." Two additional subgroups, "moderate mindfulness" and "very low mindfulness," were observed. "High mindfulness" was associated with the most adaptive psychological functioning and "very low mindfulness" with the least adaptive.
CONCLUSIONS:
In most people with recurrent depression, mindfulness skills are expressed evenly across different domains. However, in a small minority a meaningful and replicable uneven profile indicating nonjudgmental awareness is observable. Current findings require replication and future research should examine the extent to which profiles change from periods of wellness to illness in people with recurrent depression and how profiles are influenced by exposure to mindfulness-based intervention.
BACKGROUND:Extending previous research, we applied latent profile analysis in a sample of adults with a history of recurrent depression to identify subgroups with distinct response profiles on the Five Facet Mindfulness Questionnaire and understand how these relate to psychological functioning.
METHOD:
The sample was randomly divided into two subsamples to first examine the optimal number of latent profiles (test sample; n = 343) and then validate the identified solution (validation sample; n = 340).
RESULTS:
In both test and validation samples, a four-profile solution was revealed where two profiles mapped broadly onto those previously identified in nonclinical samples: "high mindfulness" and "nonjudgmentally aware." Two additional subgroups, "moderate mindfulness" and "very low mindfulness," were observed. "High mindfulness" was associated with the most adaptive psychological functioning and "very low mindfulness" with the least adaptive.
CONCLUSIONS:
In most people with recurrent depression, mindfulness skills are expressed evenly across different domains. However, in a small minority a meaningful and replicable uneven profile indicating nonjudgmental awareness is observable. Current findings require replication and future research should examine the extent to which profiles change from periods of wellness to illness in people with recurrent depression and how profiles are influenced by exposure to mindfulness-based intervention.
In previously depressed individuals, reflective thinking may easily get derailed and lead to detrimental effects. This study investigated the conditions in which such thinking is, or is not, adaptive. Levels of mindfulness and autobiographical memory specificity were assessed as potential moderators of the relationship between reflective thinking and depressive symptoms. Two hundred seventy-four individuals with a history of three or more previous episodes of depression completed self-report measures of depressive symptoms, rumination—including subscales for reflection and brooding—and mindfulness, as well as an autobiographical memory task to assess memory specificity. In those low in both mindfulness and memory specificity, higher levels of reflection were related to more depressive symptoms, whereas in all other groups higher levels of reflection were related to fewer depressive symptoms. The results demonstrate that the relation between reflective pondering and depressive symptoms varies depending on individual state or trait factors. In previously depressed individuals, the cognitive problem-solving aspect of reflection may be easily hampered when tendencies toward unspecific processing are increased, and awareness of mental processes such as self-judgment and reactivity is decreased.
Long-term vulnerability to depression is related to the presence of perceived discrepancies between the actual self and ideal self-guides. This study examined the immediate effects of an 8-week course of Mindfulness-Based Cognitive Therapy (MBCT) on self-discrepancies in individuals currently in recovery, with a history of affective disorder that included suicidal ideation and behaviour. Results indicated significant time × group interactions for both ideal self similarity and ideal self likelihood ratings, primarily accounted for by increases in self-discrepancy from pre-test to post-test in the waiting list group which were not seen in those receiving MBCT. Changes in self-discrepancy were not associated with changes in residual depressive symptoms, but in the MBCT group there was a significant association between increases in ideal self similarity and the adoption of more adaptive ideal self-guides post treatment. MBCT may protect against increases in self-discrepancy in people vulnerable to relapse to depression and may also facilitate a shift in the goals of self-regulation.
Objective: We compared mindfulness-based cognitive therapy (MBCT) with both cognitive psychological education (CPE) and treatment as usual (TAU) in preventing relapse to major depressive disorder (MDD) in people currently in remission following at least 3 previous episodes. Method: A randomized controlled trial in which 274 participants were allocated in the ratio 2:2:1 to MBCT plus TAU, CPE plus TAU, and TAU alone, and data were analyzed for the 255 (93%; MBCT = 99, CPE = 103, TAU = 53) retained to follow-up. MBCT was delivered in accordance with its published manual, modified to address suicidal cognitions; CPE was modeled on MBCT, but without training in meditation. Both treatments were delivered through 8 weekly classes. Results: Allocated treatment had no significant effect on risk of relapse to MDD over 12 months follow-up, hazard ratio for MBCT vs. CPE = 0.88, 95% CI [0.58, 1.35]; for MBCT vs. TAU = 0.69, 95% CI [0.42, 1.12]. However, severity of childhood trauma affected relapse, hazard ratio for increase of 1 standard deviation = 1.26 (95% CI [1.05, 1.50]), and significantly interacted with allocated treatment. Among participants above median severity, the hazard ratio was 0.61, 95% CI [0.34, 1.09], for MBCT vs. CPE, and 0.43, 95% CI [0.22, 0.87], for MBCT vs. TAU. For those below median severity, there were no such differences between treatment groups. Conclusion: MBCT provided significant protection against relapse for participants with increased vulnerability due to history of childhood trauma, but showed no significant advantage in comparison to an active control treatment and usual care over the whole group of patients with recurrent depression.
Objective: We compared mindfulness-based cognitive therapy (MBCT) with both cognitive psychological education (CPE) and treatment as usual (TAU) in preventing relapse to major depressive disorder (MDD) in people currently in remission following at least 3 previous episodes. Method: A randomized controlled trial in which 274 participants were allocated in the ratio 2:2:1 to MBCT plus TAU, CPE plus TAU, and TAU alone, and data were analyzed for the 255 (93%; MBCT = 99, CPE = 103, TAU = 53) retained to follow-up. MBCT was delivered in accordance with its published manual, modified to address suicidal cognitions; CPE was modeled on MBCT, but without training in meditation. Both treatments were delivered through 8 weekly classes. Results: Allocated treatment had no significant effect on risk of relapse to MDD over 12 months follow-up, hazard ratio for MBCT vs. CPE = 0.88, 95% CI [0.58, 1.35]; for MBCT vs. TAU = 0.69, 95% CI [0.42, 1.12]. However, severity of childhood trauma affected relapse, hazard ratio for increase of 1 standard deviation = 1.26 (95% CI [1.05, 1.50]), and significantly interacted with allocated treatment. Among participants above median severity, the hazard ratio was 0.61, 95% CI [0.34, 1.09], for MBCT vs. CPE, and 0.43, 95% CI [0.22, 0.87], for MBCT vs. TAU. For those below median severity, there were no such differences between treatment groups. Conclusion: MBCT provided significant protection against relapse for participants with increased vulnerability due to history of childhood trauma, but showed no significant advantage in comparison to an active control treatment and usual care over the whole group of patients with recurrent depression.
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