Mindfulness-based cognitive therapy for residual depressive symptoms and relapse prophylaxis

Mindfulness-based cognitive therapy (MBCT) reduces the risk of depressive relapse by about 30-40% compared to usual care, performing as well as maintenance antidepressant medication. Recent trials compare MBCT against active interventions rather than treatment-as-usual, and researchers are extending it to new conditions such as acute depression, health anxiety, social anxiety, fibromyalgia, and multiple chemical sensitivities, as well as adapting it for online delivery. Neuroimaging studies show that mindfulness-based therapies increase activity in brain regions involved in self-focus, emotion regulation (prefrontal cortex), and interoceptive awareness (insula). The strongest evidence supports MBCT for preventing relapse or treating residual depressive symptoms, with early data suggesting broader uses.

Study at a glance

Abstract

PURPOSE OF REVIEW: The article reviews the recent evidence for mindfulness-based cognitive therapy (MBCT) for patients with residual depressive symptoms or in remitted patients at increased risk for relapse. RECENT FINDINGS: Randomized controlled trials have shifted focus from comparing MBCT with treatment-as-usual to comparing MBCT against interventions. These studies have provided evidence for the efficacy of MBCT on par with maintenance antidepressant pharmacotherapy and leading to a relative reduction of risk on the order of 30-40%. Perhaps fuelled by these data, recent efforts have focused on extending MBCT to novel populations, such as acutely depressed patients, those diagnosed with health anxiety, social anxiety, fibromyalgia, or multiple chemical sensitivities as well migrating MBCT to online platforms so that it is more widely available. Neuroimaging studies of patients in structured therapies which feature mindfulness meditation, have reported findings that parallel behavioral changes, such as increased activation in brain regions subsuming self-focus and emotion regulation (prefrontal cortex) and interoceptive awareness (insula). SUMMARY: The current evidence base for MBCT is strongest for its application as a prophylactic intervention or for residual depressive symptoms, with early data suggesting additional indications outside the mood disorders. Future work will need to address dose-effect relationships between mindfulness practice and clinical benefits, as well as establishing the rates of uptake for online MBCT so that its benefits can be compared to in-person groups. Additionally, validating current or novel neural markers of MBCT treatment response will allow for patient matching and optimization of treatment response.