Web-Based Mindful Mood Balance: A Valuable Adjunctive Therapy for Residual Depressive Symptoms

Mindful mood balance (MMB), in addition to usual care for depression, is associated with greater reductions in depressive and anxiety symptoms, higher rates of remission, and higher levels of quality of life in patients with residual depressive symptoms, according to a study published in JAMA Psychiatry.

In this 2-group, single-blind, randomized clinical trial, adults aged ≥18 years who had residual depressive symptoms (N=460; 75.6% women) were randomized to receive 8 sessions of usual care (n=230) or MMB plus usual care (n=230). Primary endpoints were reductions in residual symptom severity, rates of remission, and depressive relapse as assessed via the Patient Health Questionnaire-9 (PHQ-9). Secondary endpoints were reductions in anxiety symptoms, indexed by the General Anxiety Disorder-7 Item Scale, and physical and mental functional status.

Patients in the adjunctive MMB cohort had significantly greater reductions in residual depressive symptoms over the entire study period compared with patients in the usual care alone group (mean difference, -2.55 vs -1.64; mean group difference in PHQ-9, 0.91; t=2.34; P =.02). During the 12-month follow-up period, the initial gains on the PHQ-9 were maintained in the adjunctive MMB group, with a nonsignificant mean increase of 0.15. The usual care group had continued improvement that was significantly greater than that in the adjunctive MMB group (t=2.81; P =.003). During the entire study period, the adjunctive MMB group had higher rates of remission (59.4%) compared with the usual care control group (47.0%).

Limitations included the lack of diversity in the sample. The assessment of patients with residual depressive symptoms was based on self-reported symptoms, which did not allow for full characterization of the prior duration symptoms. Depressive relapse is often assessed via structured interviews; therefore, the group difference in residual symptoms favoring MMB plus usual care may reflect different rates of clinical deterioration rather than a discrete episode. MMB completion rates of 27% were lower than reported in recent reviews.

“The addition of MMB to [usual depression care] delivered by an integrated health system provides a pragmatic and accessible strategy to address the suboptimal treatment of patients with [residual depressive symptoms] in primary care and employment settings,” the researchers wrote. “In settings that use routine monitoring of depressive symptoms, MMB can be integrated as an augmentation strategy or second care step for patients who achieve only partial remission after acute phase treatment. Providing the right treatment at the right time can optimize depression outcomes by reducing undertreatment and lowering patients’ future risk,” they concluded.

Reference

Segal ZV, Dimidjian S, Beck A, et al. Outcomes of online mindfulness-based cognitive therapy for patients with residual depressive symptoms: a randomized clinical trial [published online January 29, 2020]. JAMA Psychiatry. doi: 10.1001/jamapsychiatry.2019.4693