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BackgroundThe investigation of treatment mechanisms in randomized controlled trials has considerable clinical and theoretical relevance. Despite the empirical support for the effect of mindfulness-based cognitive therapy (MBCT) in the treatment of recurrent major depressive disorder (MDD), the specific mechanisms by which MBCT leads to therapeutic change remain unclear.
Objective
By means of a systematic review we evaluate how the field is progressing in its empirical investigation of mechanisms of change in MBCT for recurrent MDD.
Method
To identify relevant studies, a systematic search was conducted. Studies were coded and ranked for quality.
Results
The search produced 476 articles, of which 23 were included. In line with the theoretical premise, 12 studies found that alterations in mindfulness, rumination, worry, compassion, or meta-awareness were associated with, predicted or mediated MBCT's effect on treatment outcome. In addition, preliminary studies indicated that alterations in attention, memory specificity, self-discrepancy, emotional reactivity and momentary positive and negative affect might play a role in how MBCT exerts its clinical effects.
Conclusion
The results suggest that MBCT could work through some of the MBCT model's theoretically predicted mechanisms. However, there is a need for more rigorous designs that can assess greater levels of causal specificity.
BackgroundThe investigation of treatment mechanisms in randomized controlled trials has considerable clinical and theoretical relevance. Despite the empirical support for the effect of mindfulness-based cognitive therapy (MBCT) in the treatment of recurrent major depressive disorder (MDD), the specific mechanisms by which MBCT leads to therapeutic change remain unclear.
Objective
By means of a systematic review we evaluate how the field is progressing in its empirical investigation of mechanisms of change in MBCT for recurrent MDD.
Method
To identify relevant studies, a systematic search was conducted. Studies were coded and ranked for quality.
Results
The search produced 476 articles, of which 23 were included. In line with the theoretical premise, 12 studies found that alterations in mindfulness, rumination, worry, compassion, or meta-awareness were associated with, predicted or mediated MBCT's effect on treatment outcome. In addition, preliminary studies indicated that alterations in attention, memory specificity, self-discrepancy, emotional reactivity and momentary positive and negative affect might play a role in how MBCT exerts its clinical effects.
Conclusion
The results suggest that MBCT could work through some of the MBCT model's theoretically predicted mechanisms. However, there is a need for more rigorous designs that can assess greater levels of causal specificity.
Mindfulness-based interventions, in particular, mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT), have been implemented and disseminated globally, and their efficacy is supported by evidence from several recent meta-analyses. As MBSR and MBCT are being integrated into the mainstream of society, including the fields of medicine, health care, education and leadership, there is an increasing need to educate and train professionals to teach and deliver these approaches and interventions. However, as capacity needs increase, the central risk is that the quality and integrity of mindfulness-based interventions could be lost if prospective teachers are not adequately trained to deliver such interventions. To help minimise this risk, we argue that the education and training of future MBSR and MBCT teachers need to be carried out through structured and systematic training pathways that are founded in mindfulness practice and study and closely examined and attended to by senior teachers with many years of contemplative practice and teaching experience. Indeed, prominent people in the field argue that the ongoing formation of mindfulness-based teachers is critical to maintaining and protecting the quality and integrity of MBSR and MBCT. Committed to translating and integrating mindfulness into a twenty-first century context and lexicon—while honouring the universal essence and deep roots of mindfulness practice arising out of classical Buddhist meditation practices—modern scientific research has been conducted, education and professional training standards have been proposed and tools for assessment of mindfulness-based teaching competencies have been developed and applied, all in service of this implementation, dissemination and capacity building process.