Association between Decentering and Reductions in Relapse/Recurrence in Mindfulness-Based Cognitive Therapy for Depression in Adults: A Randomized Controlled Trial

Decentering, the ability to view thoughts and feelings as temporary mental events, may help prevent relapse in major depression. In a randomized trial, 227 formerly depressed adults received mindfulness-based cognitive therapy (MBCT), relaxation group therapy, or treatment as usual. During acute treatment, depression symptoms increased in the relaxation and treatment-as-usual groups but not in MBCT. Gains in decentering from mid- to post-treatment predicted reduced depression across MBCT and treatment as usual, but not relaxation therapy. Those who improved in decentering had the lowest relapse rates over 12 months, regardless of group. Results suggest decentering is a non-specific mechanism for reducing depression relapse.

Study at a glance

Abstract

Objective: “Decentering” is defined as the ability to observe one’s thoughts and feelings as temporary, objective events in the mind (Safran & Segal, 1990), and is increasingly regarded as a candidate mechanism in mindfulness-based interventions. The current study sought to examine the role of decentering, and other related variables, in the efficacy of Mindfulness-based cognitive therapy (MBCT) as compared to two active comparison conditions. Method: Formerly depressed individuals (N = 227), randomly assigned to MBCT (n = 74), relaxation group therapy (RGT; n = 77) or treatment-as-usual (TAU; n = 76), completed self-report measures of decentering and symptoms of depression at pre-, mid-, and post-treatment, and relapse was assessed at 3, 6, 9, and 12 months, post-treatment. Results: With regard to the acute treatment phase, results indicated that, whereas levels of depression increased in both RGT and TAU, MBCT patients remained free from symptom gains. Moreover, gains in decentering from mid- to post-treatment predicted reductions in depression from pre- to post-treatment for MBCT and TAU, but not for RGT. Participants who experienced increases in decentering, measured from mid- to post-treatment, generally evidenced the lowest levels of relapse/recurrence (during the four follow-up assessments), largely irrespective of treatment group. However, results related to change in decentering should be considered exploratory due to small cell sizes among participants who did not experience gains in decentering.Conclusions: Taken together, these results suggest that decentering is a potent mechanism for reduction of relapse in major depression, albeit one that is non-specific to MBCT.