Journal of Consulting and Clinical Psychology
December 3, 2013
J. Mark G. Williams, Catherine Crane, Thorsten Barnhofer et al.
418 citations
Mindfulness-based cognitive therapy (MBCT) plus treatment as usual (TAU) did not significantly reduce the risk of relapse to major depressive disorder over 12 months compared with cognitive psychological education (CPE) plus TAU or TAU alone among people with at least three previous episodes. The hazard ratio for MBCT versus CPE was 0.88, and for MBCT versus TAU was 0.69, both with confidence intervals crossing 1.0. However, severity of childhood trauma influenced relapse risk: each one-standard-deviation increase in trauma severity raised the hazard ratio to 1.26. Among participants with above-average childhood trauma, MBCT offered significant protection compared with TAU (hazard ratio 0.43) and a non-significant advantage over CPE. For those with below-average trauma, no differences between treatments appeared.
Behaviour Research and Therapy
February 13, 2009
Thorsten Barnhofer, Catherine Crane, Emily Hargus et al.
398 citations
Mindfulness-Based Cognitive Therapy (MBCT), which combines mindfulness meditation with cognitive therapy techniques, reduced depressive symptoms from severe to mild in patients with chronic-recurrent depression who had at least three previous episodes and a history of suicidal ideation. In a pilot study, patients randomly assigned to MBCT plus treatment-as-usual showed a significant decrease in self-reported depression and in the number meeting full diagnostic criteria, while those receiving treatment-as-usual alone showed no significant change. The findings, though limited by a small sample size, provide preliminary evidence that MBCT can alleviate current symptoms in this difficult-to-treat population.
Emotion
February 1, 2010
Emily Hargus, Catherine Crane, Thorsten Barnhofer et al.
213 citations
Depressed participants who had experienced suicidal crises described warning signs for their last crisis. Those randomly assigned to mindfulness-based cognitive therapy plus treatment as usual, compared with treatment as usual alone, showed significant improvements in meta-awareness and memory specificity after three months. Mindfulness training may help patients reflect on past crises in a detailed and decentered way, which could aid in preventing relapse.
Neuropsychology Review
August 4, 2021
Tim Whitfield, Thorsten Barnhofer, Rebecca L. Acabchuk et al.
193 citations
Mindfulness-based programs (MBPs) show a small but significant benefit for cognitive performance, particularly for executive function and working memory, according to a meta-analysis of 56 randomized controlled trials involving 2,931 adults. The overall effect favoring MBPs over comparators was small (g = 0.15). Benefits were strongest for non-clinical samples and adults over 60, and when MBPs were compared to inactive controls rather than active ones. No significant effects were found for other cognitive domains. Most studies had unclear risk of bias, and some statistical results were unreliable. The findings partially support the idea that mindfulness practice can enhance certain cognitive abilities.
Mindfulness
March 1, 2010
Thorsten Barnhofer, Tobias Chittka, Helen Nightingale et al.
99 citations
Both mindfulness breathing meditation and loving-kindness meditation shift brain activity toward greater left prefrontal activation, which is linked to approach motivation and positive emotion, in people with a history of depression. A 15-minute session of either meditation produced this change, and the effect depended on each person's tendency to brood. Those who ruminate a lot responded better to breathing meditation, while those low in brooding responded better to loving-kindness meditation. A comparison with a rest group showed the changes were not just due to time passing. The findings suggest both types of meditation can benefit previously depressed individuals, but the best choice may depend on the person's brooding tendency.
British Journal of Clinical Psychology
March 2, 2009
Silvia R. Hepburn, Catherine Crane, Thorsten Barnhofer et al.
74 citations
Mindfulness-based cognitive therapy (MBCT) may reduce thought suppression in people with a history of depression and suicidality, but effects depend on how thought suppression is measured. In a randomized controlled trial, 68 participants were assigned to MBCT or a waitlist control. MBCT did not reduce thought suppression on the White Bear Suppression Inventory, but it did significantly reduce self-reported attempts to suppress thoughts in the previous week. The findings provide preliminary evidence that MBCT for suicidality could lessen thought suppression, though different measures yield different results and further research is needed.
Psychosomatic Medicine
May 5, 2021
Thorsten Barnhofer, Tim Jonas Reeß, Maria Fißler et al.
24 citations
Mindfulness-based interventions reduce activation in the right dorsolateral prefrontal cortex when depressed patients view angry faces, a change linked to improved ability to decenter from negative thoughts, reduced brooding, and fewer depressive symptoms. In a randomized trial, patients with recurrent depression received either a two-week mindfulness-based intervention or psychoeducation and rest. After the mindfulness intervention, decreased right dlPFC activation correlated with greater decentering, less brooding, and lower symptom scores. The psychoeducation group showed decreased amygdala response to happy faces. The findings suggest mindfulness may help patients avoid elaborating or suppressing negative emotions, a potential mechanism for preventing mood escalation.
PLoS One
January 1, 2023
Marco Schlosser, Harriet Demnitz-King, Thorsten Barnhofer et al.
13 citations
Older adults with subjective cognitive decline (SCD) recruited from memory clinics are at higher risk for dementia and often have reduced well-being due to memory concerns and fear of dementia. A randomized trial compared an 8-week caring mindfulness-based approach for seniors (CMBAS) with a health self-management program (HSMP) in 147 participants. The mindfulness program showed a small advantage over HSMP in improving a sense of connection immediately after the intervention. However, overall psychological well-being, quality of life, and other composite measures did not increase in either group. The findings suggest that these brief non-pharmacological interventions had only limited effects on well-being in SCD.
The lancet. Psychiatry
June 1, 2025
Thorsten Barnhofer, Barnaby D. Dunn, Clara Strauss et al.
9 citations
About half of patients with depression who complete the UK National Health Service Talking Therapies stepped care pathway still have symptoms. A randomized trial tested whether adding mindfulness-based cognitive therapy (MBCT) via videoconference to treatment as usual improves outcomes for these patients. At 34 weeks, the MBCT group had significantly lower depression scores than the treatment-as-usual group (adjusted difference -2.49 points on the PHQ-9). The MBCT group also had slightly lower healthcare costs and higher quality-of-life scores, with a 99% chance of being cost-effective at the £20,000 per QALY threshold. No serious adverse events occurred. MBCT is an effective and scalable further-line treatment for depression that does not remit after psychological therapy.
Alzheimer s & Dementia
December 1, 2020
Tim Whitfield, Thorsten Barnhofer, Rebecca L. Acabchuk et al.
6 citations
A systematic review and meta-analysis of 46 studies examined whether mindfulness-based programs improve cognitive performance across the adult lifespan. When combining healthy and clinical studies of working-age adults (18–65 years), there was no significant effect of mindfulness training on cognitive performance compared to control conditions. However, a small but significant positive effect was observed for older adults (over 65), including those with subjective or objective cognitive impairment. The cognitive domains most frequently measured were executive function and attention. The findings suggest that mindfulness-based programs may confer cognitive benefits primarily for older adults, with no evidence of benefit for younger populations.
Psychiatry Research
November 1, 2024
Jonathan Hamilton, Thorsten Barnhofer
2 citations
Decentering skills, the core ability cultivated in mindfulness-based interventions, continue to increase over six months of practice and drive reductions in depressive symptoms. In a blended online and in-person program, 44 adults with persistent depression provided self-reports at three time points. Thirty-one participants completed the intervention, averaging 68.6% of assigned practices. Statistical modeling showed that changes in decentering preceded and predicted later symptom improvements, suggesting that longer practice periods help move patients closer to recovery or remission.
April 13, 2021
Marco Schlosser, Thorsten Barnhofer, Florence Requier et al.
2 citations
A theory-based classification of meditation practices—attentional, constructive, and deconstructive—can guide the creation of composite scores from existing psychological questionnaires. In three samples (meditation-naïve older adults, meditation-naïve older adults with subjective cognitive decline, and long-term meditators with at least 10,000 hours of practice), these composite scores showed adequate psychometric properties, including low floor and ceiling effects, interpretability, and convergent validity with well-being, anxiety, and depression measures. Confirmatory factor analyses supported the predicted three-factor structure. The findings suggest that theoretical models of meditation mechanisms can yield empirically meaningful composite scores for research.
Psychotherapy and Psychosomatics
June 12, 2026
Thorsten Barnhofer, Maria Niemi, Johannes Michalak et al.
1 citation
For adults with difficult-to-treat depression—those who have not responded to prior treatments, have treatment-resistant depression, or have a chronic course—mindfulness-based cognitive therapy (MBCT) is likely superior to usual care, reducing depressive symptoms by a standardized mean difference of -0.40 at post-treatment and -0.41 at medium-term follow-up. There was a 92% and 85% probability, respectively, that these benefits exceeded a minimal important difference. However, MBCT did not show clear superiority over other active psychosocial interventions, and no robust moderators of outcome were identified across baseline severity, chronicity, or comorbidity.
May 29, 2019
Michael Lifshitz, Matthew D. Sacchet, Julia M. Huntenburg et al.
1 citation
Major depressive disorder involves abnormal communication between large-scale brain networks. A randomized, active-controlled trial tested whether mindfulness-based therapy could alter resting-state functional connectivity in clinically depressed patients. A brief, clinically effective mindfulness intervention functionally decoupled top-down control regions from brain areas involved in sensory, affective, and attentional processing. These findings identify specific neural targets of mindfulness training, offering new insight into how this therapeutic approach works.
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.
Mindfulness
July 1, 2025
Jonathan Hamilton, Kate Brennan, Daniel Brown et al.
A blended individual mindfulness-based intervention, combining brief therapist support with patient-led practice, shows promise for reducing depression symptoms. Of 39 patients with persistent depression who started the 12-week program, 24 completed it. Completers engaged in 89% of formal practices and showed large reductions in symptoms, with 75% moving below the clinical threshold. Patients found the approach acceptable but requested longer therapist sessions. The intervention may help make mindfulness-based treatments more accessible and sustainable for people with depression.
Mindfulness
March 1, 2021
Kate Williams, Rebecca Elliott, Thorsten Barnhofer et al.
Mindfulness-based cognitive therapy (MBCT) helps people with remitted major depression evaluate situations less negatively and more positively, a shift that correlates with increased mindfulness. In a non-randomized trial, 40 participants received MBCT, 33 continued treatment as usual, and 42 never-depressed controls were assessed. After the 8-week MBCT program, only the MBCT group showed a change in emotion evaluation ratings, from more negative to more positive, while both the MBCT and treatment-as-usual groups improved slightly in recognizing facial emotions. The findings suggest MBCT specifically encourages more positive appraisals of life events rather than altering basic emotion processing.
Mindfulness
December 1, 2010
Catherine Crane, Danka Jandric, Thorsten Barnhofer et al.
Conditional goal setting (CGS), the tendency to make happiness conditional on achieving lower-order goals, is linked to depression and lower dispositional mindfulness. In a pilot randomized trial of Mindfulness-Based Cognitive Therapy (MBCT) over 3–4 months, increases in dispositional mindfulness were associated with decreases in CGS, though this effect was not specific to the meditation-trained group. In 55 healthy participants, brief meditation—particularly loving kindness meditation—unexpectedly increased CGS, an effect limited to those low in goal re-engagement ability. Longer-term mindfulness gains may reduce CGS in depressed patients, but initial reactions to meditation can be counterintuitive, warranting further research.
Thorsten Barnhofer
Depression often becomes recurrent or chronic as maintaining mechanisms grow entrenched and repeated stress alters biological functioning. Mindfulness training offers a new approach that may counter these mechanisms and potentially reverse maladaptive plasticity, though research on its biological effects is lacking. This review outlines psychobiological mechanisms underlying persistent depression, explains why mindfulness training may address them, and reviews evidence for reversibility. The authors call for studies on sustained mindfulness training to clarify the timescales of cascading effects and whether they can change persistent depressive trajectories.
Emilia Winnebeck, Maria Fißler, Matti Gärtner et al.
A brief mindfulness-based intervention (MBI) of three individual sessions plus regular home practice reduced depression symptoms more than a control condition with psycho-education and rest in 74 patients with chronic or recurrent depression. Only the MBI group showed increases in mindfulness and decreases in ruminative tendencies and cognitive reactivity. The results support a stress-buffering role for mindfulness and indicate that even short, targeted mindfulness training can alleviate symptoms in acutely depressed patients with a long-term history.
Johannes Michalak, Maria Niemi, Maria Velana et al.
preprint
Negative effects of Mindfulness-Based Cognitive Therapy (MBCT) and Cognitive Behavioral Analysis System of Psychotherapy (CBASP) in adults with difficult-to-treat depression are poorly understood. This protocol describes a planned individual patient data meta-analysis of randomized controlled trials to assess the incidence of clinically significant deterioration, suicidality, adverse events, and depressive symptom change. The primary outcome is a ≥6-point increase on the PHQ-9. The analysis aims to provide robust estimates of negative effects to inform clinical practice and guidelines on patient safety.