Mindfulness-Based Compassionate Living Lowers Depression Severity

Avatar photoSheila Jacobs
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mindfulness
mindfulness
The investigators sought to evaluate the efficacy of MBCL and its consolidation at follow-up in adult patients with recurrent depression who had previously received mindfulness-based cognitive therapy.

Mindfulness-based compassionate living (MBCL) seems to be effective in decreasing depressive symptoms in adults with recurrent depressive disorder. A 2-part study (ClinicalTrials.gov identifier: NCT02059200) was conducted at Radboud University Medical Centre, located in Nijmegen, The Netherlands, and results were published in the Journal of Affective Disorders.

The investigators sought to evaluate the efficacy of MBCL and its consolidation at follow-up in adult patients with recurrent depression who had previously received mindfulness-based cognitive therapy (MBCT) and were recruited between July 2013 and December 2014. The study population comprised adults ≥18 years of age, who had been diagnosed with recurrent depressive disorder and had previously been enrolled in an MBCT course at the same institution, with ≥4 sessions that occurred at least 1 year prior to this study.

In a parallel-group, randomized controlled trial (part 1), MBCL plus treatment as usual (TAU) was compared with TAU alone, and part 2 involved an uncontrolled, follow-up study. The primary study outcome was the severity of depressive symptoms, measured by the Beck Depression Inventory-II. A total of 122 patients were enrolled in the study, randomized in a 1:1 ratio to each group. MBCL involved 8 2.5-hour sessions once every 2 weeks and was delivered in groups of 8 to 10 patients.

In the RCT portion, the MBCL-plus-TAU arm exhibited significantly fewer depressive symptoms following MBCL than the TAU-alone arm (d, 0.35; P =.034), with the number needed to treat being 5. There were also significant reductions in rumination (d, 0.38; P =.011), self-compassion (d, 0.41; P =.002), and quality of life (d, 0.63; P <.0001) in the MBCL group, and younger age appeared to aid in the benefit of MBCL.

In part 2 of the study, 57 out of 61 patients accepted the invitation to participate in MBCL following completion of the TAU portion, producing a combined sample of 119 individuals. From the start of treatment to the end of treatment, no statistically significant difference was found relative to reduction in depressive symptoms in the combined sample (d, 0.41; P =.064). A significant difference, however, was reported in diagnostic status in the combined sample, with 33.1% depressed at baseline and 25.7% depressed at posttreatment (P =.002). The results at 6-month follow-up demonstrated a continued improvement in depressive symptoms among participants (P ≤.001). There were 2 suicides in the intervention group, although they occurred before or in the early stages of MBCL.

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The investigators concluded that findings from this study should be replicated in a prospective, sequential trial in which MBCT plus MBCL is compared with MBCT alone. Alternatively, MBCT can be used as an active control to MBCL, in order to correct for the potential double dosage effect.

The researchers noted that “the more active and explicit compassionate approach to difficult experiences in MBCL, compared with the more implicit focus on compassion in MBCT” may play a role in the promising quality of life improvements seen with MBCL.

Reference

Schuling R, Huijbers MJ, van Ravesteijn H, et al. Recovery from recurrent depression: Randomized controlled trial of the efficacy of mindfulness-based compassionate living compared with treatment-as-usual on depressive symptoms and its consolidation at longer term follow-up [published online May 4, 2020]. J Affect Disord.

doi: 10.1016/j.jad.2020.03.182.