A systematic review of mechanisms of change in mindfulness-based cognitive therapy in the treatment of recurrent major depressive disorder

AbstractBackgroundThe investigation of treatment mechanisms in randomized controlled trials has considerable clinical and theoretical relevance. Despite the empirical support for the effect of mindfulness-based cognitive therapy (MBCT) in the treatment of recurrent major depressive disorder (MDD), the specific mechanisms by which MBCT leads to therapeutic change remain unclear.ObjectiveBy means of a systematic review we evaluate how the field is progressing in its empirical investigation of mechanisms of change in MBCT for recurrent MDD.MethodTo identify relevant studies, a systematic search was conducted. Studies were coded and ranked for quality.ResultsThe search produced 476 articles, of which 23 were included. In line with the theoretical premise, 12 studies found that alterations in mindfulness, rumination, worry, compassion, or meta-awareness were associated with, predicted or mediated MBCT's effect on treatment outcome. In addition, preliminary studies indicated that alterations in attention, memory specificity, self-discrepancy, emotional reactivity and momentary positive and negative affect might play a role in how MBCT exerts its clinical effects.ConclusionThe results suggest that MBCT could work through some of the MBCT model's theoretically predicted mechanisms. However, there is a need for more rigorous designs that can assess greater levels of causal specificity

Mindfulness Training Changes Brain Dynamics During Depressive Rumination: A Randomized Controlled Trial

International audienceBACKGROUND: Depression is a leading cause of disability worldwide and its prevalence is on the rise. One of the most debilitating aspects of depression is the dominance and persistence of depressive rumination, a state of mind that is linked to onset and recurrence of depression. Mindfulness meditation trains adaptive attention regulation and present-moment embodied awareness, skills that may be particularly useful during depressive mind states characterized by negative ruminative thoughts. METHODS: In a randomized controlled functional magnetic resonance imaging study (N = 80), we looked at the neurocognitive mechanisms behind mindfulness-based cognitive therapy (n = 50) for recurrent depression compared with treatment as usual (n = 30) across experimentally induced states of rest, mindfulness practice and rumination, and the relationship with dispositional psychological processes. RESULTS: Mindfulness-based cognitive therapy compared with treatment as usual led to decreased salience network connectivity to the lingual gyrus during a ruminative state, and this change in salience network connectivity mediated improvements in the ability to sustain and control attention to body sensations. CONCLUSIONS: These findings showed that a clinically effective mindfulness intervention modulates neurocognitive functioning during depressive rumination and the ability to sustain attention to the body