The effectiveness of mindfulness-based cognitive therapy for major depressive disorder: evidence from routine outcome monitoring data

Mindfulness-based cognitive therapy (MBCT) significantly reduced depressive symptoms in a large naturalistic cohort of 765 patients with major depressive disorder treated in a real-world outpatient clinic in the Netherlands. Depressive symptoms decreased by an average of 7.7 points on a self-report scale, a large effect. Improvements in worry, mindfulness skills, and self-compassion also occurred and were linked to changes in depression. The benefits were independent of whether patients had recurrent depression or were currently in remission. Patients who were unemployed showed less improvement. Treatment adherence was high at 94%, though patients with lower education were more likely to not complete the program. The findings show that MBCT works as well in routine clinical practice as in controlled research settings.

Study at a glance

Abstract

Background Meta-analyses show efficacy of mindfulness-based cognitive therapy (MBCT) in terms of relapse prevention and depressive symptom reduction in patients with major depressive disorder (MDD). However, most studies have been conducted in controlled research settings. Aims We aimed to investigate the effectiveness of MBCT in patients with MDD presenting in real-world clinical practice. Moreover, we assessed whether guideline recommendations for MBCT allocation in regard to recurrence and remission status of MDD hold in clinical practice. Method This study assessed a naturalistic cohort of patients with (recurrent) MDD, either current or in remission (n = 765), who received MBCT in a university hospital out-patient clinic in The Netherlands. Outcome measures were self-reported depressive symptoms, worry, mindfulness skills and self-compassion. Predictors were MDD recurrence and remission status, and clinical and sociodemographic variables. Outcome and predictor analyses were conducted with linear regression. Results MBCT adherence was high (94%). Patients with a lower level of education had a higher chance of non-adherence. Attending more sessions positively influenced improvement in depressive symptoms. Depressive symptoms significantly reduced from pre- to post-MBCT (Δ mean = 7.7, 95%CI = 7.0–8.5, Cohen's d = 0.75). Improvement of depressive symptoms was independent from MDD recurrence and remission status. Unemployed patients showed less favourable outcomes. Worry, mindfulness skills and self-compassion all significantly improved. These improvements were related to changes in depressive symptoms. Conclusions Previous efficacy results in controlled research settings are maintained in clinical practice. Results illustrate that MBCT is effective in routine clinical practice for patients suffering from MDD, irrespective of MDD recurrence and remission status.