Mechanisms of mindfulness-based cognitive therapy in difficult-to-treat depression: moderation and mediation analyses from the RESPOND trial.
Psychological Medicine July 13, 2026 Thorsten Barnhofer, Barnaby D. Dunn, Clara Strauss et al.
Mindfulness-based cognitive therapy (MBCT) plus treatment as usual leads to greater symptom improvement than treatment as usual alone in adults with difficult-to-treat depression who have not remitted after high-intensity psychological therapy. The therapy works partly by increasing decentering—the ability to observe thoughts and feelings as temporary mental events—and this mechanism remains effective even when depressive symptoms are severe. Higher baseline depression severity does not limit the acquisition of decentering skills or the overall treatment effect; instead, decentering is more strongly linked to symptom reduction in those with more severe depression. These findings support using MBCT across a broad range of symptom severity.