PS2-43: Internet Delivered Mindfulness-based Cognitive Therapy for Reducing Residual Depressive Symptoms: An Open Trial and Quasi-experimental Comparison to Propensity Matched Controls
Arne Beck, Sona Dimidjian, Jennifer Boggs, Jennifer Felder, Zindel Segal
Clinical medicine & research September 1, 2014 DOI: 10.3121/cmr.2014.1250.ps2-43 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Uncontrolled pre-post study with propensity-matched case-control comparison Peer reviewed |
|---|---|
| Sample size | 100 |
| Population | Recurrently depressed adult patients in clinical remission with PHQ-9 scores of 12 or below, recruited from primary care and behavioral health clinics at Kaiser Permanente Colorado; a residual depressive symptom subsample (N = 42) had PHQ-9 scores of 5 to 12 |
| Duration | 8-week program |
| Measures | PHQ-9 |
| Topics | Meditation |
| Keywords | Online depression treatment |
| Key findings | Depressive symptoms (PHQ-9) decreased significantly over 8 weeks for the full MMB sample (d = 0.57) and the residual-symptom subsample (d = 1.09). Compared with propensity-matched usual-care controls, MMB participants improved 3.57 points more on average (d = 0.78); in the residual-symptom subgroup, controls showed no significant change while MMB participants improved (d = 1.54). The authors conclude further controlled trials are needed. |
Abstract
Background/Aims: The persistence of residual depressive symptoms (RDS) among patients in clinical remission predicts a negative prognosis and is considered an important target for adjunctive treatment. Mindfulness-Based Cognitive Therapy (MBCT) is effective in reducing RDS. Delivered in 8 in-person group sessions, MBCT teaches disengagement from depression-related ruminative thought patterns to reduce RDS and vulnerability to relapse. However, MBCT faces barriers to dissemination including service costs and access. We developed an 8 session web-based version of MBCT (Mindful Mood Balance, or MMB), incorporating experiential practice, video-based vicarious learning, and didactic information that replicate core components of in-person MBCT.
Methods: Recurrently depressed patients (N = 100, with a PHQ-9 score ≤ 12) were recruited from primary care and behavioral health clinics at Kaiser Permanente Colorado to participate in the MMB program. The primary outcome measure was change in PHQ-9 scores over the 8 week program for the full sample of patients and for the RDS subsample (N = 42) at elevated risk for recurrence based on initial PHQ-9 scores ranging from 5 to 12. In addition, we compared 8 week changes in PHQ-9 scores for MMB participants to a sample of propensity matched case-control patients (N = 100) who received treatment as usual for depression, including psychotherapy and/or antidepressants.
Results: Significant reductions in depressive symptoms at 8 weeks were observed for the full sample and RDS subsample of MMB participants (t = −2.83, P = 0.007; and t = −3.54, P = 0.003, corresponding to effect sizes of d = .57 and d = 1.09, respectively). The average difference in the change from pre to post for MMB participants compared to propensity matched controls was 3.57 (se = 0.65, t = 5.52, P <0.0001, effect size d = 0.78). Within the RDS subgroup, propensity matched controls showed no significant change in PHQ-9 scores (0.76 (sd = 5.76), t = 0.86, P = 0.40), whereas MMB participants had an average decrease of 1.98 (sd = 2.57, t = −4.99, pP <0.0001), corresponding to an effect size of d = 1.54.
Conclusions: Findings from this first study of an online MBCT program for management of RDS support the clinical benefits of this approach. Further controlled trials are required to establish its effectiveness as an adjunctive treatment for managing unipolar mood disorders.