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As mindfulness-based cognitive therapy (MBCT) becomes an increasingly mainstream approach for recurrent depression, there is a growing need for practitioners who are able to teach MBCT. The requirements for being competent as a mindfulness-based teacher include personal meditation practice and at least a year of additional professional training. This study is the first to investigate the relationship between MBCT teacher competence and several key dimensions of MBCT treatment outcomes. Patients with recurrent depression in remission (N = 241) participated in a multi-centre trial of MBCT, provided by 15 teachers. Teacher competence was assessed using the Mindfulness-Based Interventions: Teaching Assessment Criteria (MBI:TAC) based on two to four randomly selected video-recorded sessions of each of the 15 teachers, evaluated by 16 trained assessors. Results showed that teacher competence was not significantly associated with adherence (number of MBCT sessions attended), possible mechanisms of change (rumination, cognitive reactivity, mindfulness, and self-compassion), or key outcomes (depressive symptoms at post treatment and depressive relapse/recurrence during the 15-month follow-up). Thus, findings from the current study indicate no robust effects of teacher competence, as measured by the MBI:TAC, on possible mediators and outcome variables in MBCT for recurrent depression. Possible explanations are the standardized delivery of MBCT, the strong emphasis on self-reliance within the MBCT learning process, the importance of participant-related factors, the difficulties in assessing teacher competence, the absence of main treatment effects in terms of reducing depressive symptoms, and the relatively small selection of videotapes. Further work is required to systematically investigate these explanations.

BackgroundThis study examined whether changes in mindfulness skills following Mindfulness-based Cognitive Therapy (MBCT) are predictive of long-term changes in personality traits. Methods Using data from the MOMENT study, we included 278 participants with recurrent depression in remission allocated to Mindfulness-Based Cognitive Therapy (MBCT). Mindfulness skills were measured with the FFMQ at baseline, after treatment and at 15-month follow-up and personality traits with the NEO-PI-R at baseline and follow-up. Results For 138 participants, complete repeated assessments of mindfulness and personality traits were available. Following MBCT participants manifested significant improvement of mindfulness skills. Moreover, at 15-month follow-up participants showed significantly lower levels of neuroticism and higher levels of conscientiousness. Large improvements in mindfulness skills after treatment predicted the long-term changes in neuroticism but not in conscientiousness, while controlling for use of maintenance antidepressant medication, baseline depression severity and change in depression severity during follow-up (IDS-C). In particular improvements in the facets of acting with awareness predicted lower levels of neuroticism. Sensitivity analyses with multiple data imputation yielded similar results. Limitations Uncontrolled clinical study with substantial attrition based on data of two randomized controlled trials. Conclusions The design of the present study precludes to establish whether there is any causal association between changes in mindfulness and subsequent changes in neuroticism. MBCT could be a viable intervention to directly target one of the most important risk factors for onset and maintenance of recurrent depression and other mental disorders, i.e. neuroticism.

The aim of this study was to explore the feasibility and effectiveness of mindful walking in nature as a possible means to maintain mindfulness skills after a mindfulness-based cognitive therapy (MBCT) or mindfulness-based stress reduction (MBSR) course. Mindful walking alongside the river Rhine took place for 1, 3, 6, or 10 days, with a control period of a similar number of days, 1 week before the mindful walking period. In 29 mindfulness participants, experience sampling method (ESM) was performed during the control and mindful walking period. Smartphones offered items on positive and negative affect and state mindfulness at random times during the day. Furthermore, self-report questionnaires were administered before and after the control and mindful walking period, assessing depression, anxiety, stress, brooding, and mindfulness skills. ESM data showed that walking resulted in a significant improvement of both mindfulness and positive affect, and that state mindfulness and positive affect prospectively enhanced each other in an upward spiral. The opposite pattern was observed with state mindfulness and negative affect, where increased state mindfulness predicted less negative affect. Exploratory questionnaire data indicated corresponding results, though non-significant due to the small sample size. This is the first time that ESM was used to assess interactions between state mindfulness and momentary affect during a mindfulness intervention of several consecutive days, showing an upward spiral effect. Mindful walking in nature may be an effective way to maintain mindfulness practice and further improve psychological functioning.

BackgroundChronic and treatment‐resistant depressions pose serious problems in mental health care. Mindfulness‐based cognitive therapy (MBCT) is an effective treatment for remitted and currently depressed patients. It is, however, unknown whether MBCT is effective for chronic, treatment‐resistant depressed patients. Method A pragmatic, multicenter, randomized‐controlled trial was conducted comparing treatment‐as‐usual (TAU) with MBCT + TAU in 106 chronically depressed outpatients who previously received pharmacotherapy (≥4 weeks) and psychological treatment (≥10 sessions). Results Based on the intention‐to‐treat (ITT) analysis, participants in the MBCT + TAU condition did not have significantly fewer depressive symptoms than those in the TAU condition (–3.23 [–6.99 to 0.54], d = 0.35, P = 0.09) at posttreatment. However, compared to TAU, the MBCT + TAU group reported significantly higher remission rates (χ2(2) = 4.25, φ = 0.22, P = 0.04), lower levels of rumination (–3.85 [–7.55 to –0.15], d = 0.39, P = 0.04), a higher quality of life (4.42 [0.03–8.81], d = 0.42, P = 0.048), more mindfulness skills (11.25 [6.09–16.40], d = 0.73, P < 0.001), and more self‐compassion (2.91 [1.17–4.65], d = 0.64, P = 0.001). The percentage of non‐completers in the MBCT + TAU condition was relatively high (n = 12, 24.5%). Per‐protocol analyses revealed that those who completed MBCT + TAU had significantly fewer depressive symptoms at posttreatment compared to participants receiving TAU (–4.24 [–8.38 to –0.11], d = 0.45, P = 0.04). Conclusion Although the ITT analysis did not reveal a significant reduction in depressive symptoms of MBCT + TAU over TAU, MBCT + TAU seems to have beneficial effects for chronic, treatment‐resistant depressed patients in terms of remission rates, rumination, quality of life, mindfulness skills, and self‐compassion. Additionally, patients who completed MBCT showed significant reductions in depressive symptoms. Reasons for non‐completion should be further investigated.

BackgroundA recent randomized controlled trial provided preliminary evidence for the effectiveness of mindfulness based cognitive therapy (MBCT) for the top 10% frequent attenders in primary care with persistent medically unexplained symptoms (MUS). This qualitative study aims to explore working mechanisms and possible barriers of MBCT in this population. Methods Twelve participants of the trial were interviewed about their experiences. This was done before and after the MBCT course, and 12 months later. Written evaluations of participants and notes of participant observers were used for data-triangulation. Results In total, 35 qualitative interviews were conducted. MBCT initiated a process of change, starting with awareness of the present moment, the associated sensory experiences, thoughts and emotions and accepting rather than resisting these. Participants started to recognize their own behavioral patterns and change them, thus improving self-care. Self-compassion seemed to result from and facilitate this process. Main barriers were concurrent social problems and the inability or unwillingness to accept symptoms. Conclusions MBCT can start a process of change in patients with persistent MUS. Awareness and acceptance of painful symptoms and emotions are key factors in this process. Change of unhelpful behavioral patterns and increased self-care and self-compassion can result from this process.

Studies examining mindfulness in relation to personality traits have been mainly conducted in non-clinical samples and resulted in mixed findings. The present cross-sectional study examined which mindfulness facets are most strongly associated with Big Five personality domains and facets implicated in the onset and possible relapse/recurrence of recurrent depression. Using data from the MOMENT study, we included 278 adult persons with recurrent depression in remission (SCID-I), who had completed baseline measurements of mindfulness (FFMQ) and personality (NEO PI-R). Using exploratory factor analysis, we observed that the mindfulness facets of acting with awareness, non-judging and non-reactivity loaded positively and the neuroticism facets loaded negatively on the first factor (called self-regulation) and that the mindfulness facets of observing and describing and the openness to experience facets loaded positively on the second factor (called self-awareness) of the identified five-factor solution. Lower-level facet analyses taking the multidimensional nature of mindfulness and personality traits into account clearly show that mindful self-regulation skills are associated with neuroticism, which is a known risk factor for relapse/recurrence of depression in persons with recurrent depression. Future longitudinal studies are needed to assess whether these mindful self-regulation skills may constitute a protective factor in the relationship of neuroticism with depression.

BackgroundMindfulness Based Cognitive Therapy (MBCT) has been shown to reduce the risk of relapse in patients with recurrent depression, but relapse rates remain high. To further improve outcome for this group of patients, follow-up interventions may be needed. Compassion training focuses explicitly on developing self-compassion, one of the putative working mechanisms of MBCT. No previous research has been done on the effectiveness of compassion training following MBCT in patients with recurrent depression. Aims To investigate the effectiveness of Mindfulness-Based Compassionate Living (MBCL) in reducing (residual) depressive symptoms in patients with recurrent depression who previously participated in MBCT. Methods/design A randomized controlled trial comparing MBCL in addition to treatment as usual (TAU) with TAU only, in patients suffering from recurrent depressive episodes who completed an MBCT course in the past. Assessments will take place at baseline, post-treatment and at six months follow-up. After the control period, patients randomized to the TAU condition will be offered MBCL as well. Outcome measures Primary outcome measure is severity of depressive symptoms according to the Beck Depression Inventory-II (BDI-II) at post-treatment. Secondary outcome measures are presence or absence of DSM-IV depressive disorder, rumination, self-compassion, mindfulness skills, positive affect, quality of life, experiential avoidance and fear of self-compassion. Discussion Our study is the first randomized controlled trial to examine the effectiveness of compassion training following MBCT in a recurrently depressed population.

BACKGROUND:Previous studies have suggested that patients' treatment preferences may influence treatment outcome. The current study investigated whether preference for either mindfulness-based cognitive therapy (MBCT) or maintenance antidepressant medication (mADM) to prevent relapse in recurrent depression was associated with patients' characteristics, treatment adherence, or treatment outcome of MBCT. METHODS: The data originated from two parallel randomised controlled trials, the first comparing the combination of MBCT and mADM to MBCT in patients preferring MBCT (n=249), the second comparing the combination to mADM alone in patients preferring mADM (n=68). Patients' characteristics were compared across the trials (n=317). Subsequently, adherence and clinical outcomes were compared for patients who all received the combination (n=154). RESULTS: Patients with a preference for mADM reported more previous depressive episodes and higher levels of mindfulness at baseline. Preference did not affect adherence to either MBCT or mADM. With regard to treatment outcome of MBCT added to mADM, preference was not associated with relapse/recurrence (χ(2)=0.07; p=.80), severity of (residual) depressive symptoms during the 15-month follow-up period (β=-0.08, p=.49), or quality of life. LIMITATIONS: The group preferring mADM was relatively small. The influence of preferences on outcome may have been limited in the current study because both preference groups received both interventions. CONCLUSIONS: The fact that patients with a preference for medication did equally well as those with a preference for mindfulness supports the applicability of MBCT for recurrent depression. Future studies of MBCT should include measures of preferences to increase knowledge in this area.

As mindfulness-based cognitive therapy (MBCT) becomes an increasingly mainstream approach for recurrent depression, there is a growing need for practitioners who are able to teach MBCT. The requirements for being competent as a mindfulness-based teacher include personal meditation practice and at least a year of additional professional training. This study is the first to investigate the relationship between MBCT teacher competence and several key dimensions of MBCT treatment outcomes. Patients with recurrent depression in remission (N = 241) participated in a multi-centre trial of MBCT, provided by 15 teachers. Teacher competence was assessed using the Mindfulness-Based Interventions: Teaching Assessment Criteria (MBI:TAC) based on two to four randomly selected video-recorded sessions of each of the 15 teachers, evaluated by 16 trained assessors. Results showed that teacher competence was not significantly associated with adherence (number of MBCT sessions attended), possible mechanisms of change (rumination, cognitive reactivity, mindfulness, and self-compassion), or key outcomes (depressive symptoms at post treatment and depressive relapse/recurrence during the 15-month follow-up). Thus, findings from the current study indicate no robust effects of teacher competence, as measured by the MBI:TAC, on possible mediators and outcome variables in MBCT for recurrent depression. Possible explanations are the standardized delivery of MBCT, the strong emphasis on self-reliance within the MBCT learning process, the importance of participant-related factors, the difficulties in assessing teacher competence, the absence of main treatment effects in terms of reducing depressive symptoms, and the relatively small selection of videotapes. Further work is required to systematically investigate these explanations.

As mindfulness-based cognitive therapy (MBCT) becomes an increasingly mainstream approach for recurrent depression, there is a growing need for practitioners who are able to teach MBCT. The requirements for being competent as a mindfulness-based teacher include personal meditation practice and at least a year of additional professional training. This study is the first to investigate the relationship between MBCT teacher competence and several key dimensions of MBCT treatment outcomes. Patients with recurrent depression in remission (N = 241) participated in a multi-centre trial of MBCT, provided by 15 teachers. Teacher competence was assessed using the Mindfulness-Based Interventions: Teaching Assessment Criteria (MBI:TAC) based on two to four randomly selected video-recorded sessions of each of the 15 teachers, evaluated by 16 trained assessors. Results showed that teacher competence was not significantly associated with adherence (number of MBCT sessions attended), possible mechanisms of change (rumination, cognitive reactivity, mindfulness, and self-compassion), or key outcomes (depressive symptoms at post treatment and depressive relapse/recurrence during the 15-month follow-up). Thus, findings from the current study indicate no robust effects of teacher competence, as measured by the MBI:TAC, on possible mediators and outcome variables in MBCT for recurrent depression. Possible explanations are the standardized delivery of MBCT, the strong emphasis on self-reliance within the MBCT learning process, the importance of participant-related factors, the difficulties in assessing teacher competence, the absence of main treatment effects in terms of reducing depressive symptoms, and the relatively small selection of videotapes. Further work is required to systematically investigate these explanations.