Changes in attentional processing of emotional information following mindfulness-based cognitive therapy in people with a history of depression: towards an open attention for all emotional experiences

Mindfulness-based cognitive therapy (MBCT) has been demonstrated to be successful in the prevention of relapse in patients with recurrent major depressive disorder (MDD). With regard to its working mechanisms, it is hypothesized that mindfulness meditation influences the processing of emotional information and that it could therefore reduce cognitive vulnerability factors that are observed during and after remission of depressive episodes. In this study we investigated the effects of an 8 week MBCT training versus no intervention on the facilitation and inhibition of attention for sad versus happy faces in a group of people with a history of MDD, N = 45. The comparison group consisted of a non-treatment seeking group with a history of MDD, recruited from the community, N = 26. At baseline, we found that formerly depressed patients who applied for MBCT training inhibited attention for positive information, and showed facilitation of attention for negative information. However, the comparison group did not show similar attentional characteristics. After MBCT, participants showed a reduced facilitation of attention for negative information and a reduced inhibition of attention for positive information, which is indicative of open attention towards all emotional information

Design of an RCT on cost-effectiveness of group schema therapy versus individual schema therapy for patients with Cluster-C personality disorder:the QUEST-CLC study protocol

BACKGROUND: Given the high prevalence of Cluster-C Personality Disorders (PDs) in clinical populations, disease burden, high societal costs and poor prognosis of comorbid disorders, a major gain in health care can be achieved if Cluster-C PDs are adequately treated. The only controlled cost-effectiveness study published so far found Individual Schema Therapy (IST) to be superior to Treatment as Usual (TAU). Group ST (GST) might improve cost-effectiveness as larger numbers can be treated in (>50%) less time compared to IST. However, to date there is no RCT supporting its (cost-) effectiveness. The overall aim of this study is to assess the evidence for GST for Cluster-C PDs and to improve treatment allocation for individual patients. Three main questions are addressed: 1) Is GST for Cluster-C PDs (cost-)effective compared to TAU? 2) Is GST for Cluster-C PDs (cost-) effective compared to IST? 3) Which patient-characteristics predict better response to GST, IST, or TAU? METHODS: In a multicenter RCT, the treatment conditions GST, IST, and TAU are compared in 378 Cluster-C PD patients within 10 sites. GST and IST follow treatment protocols and are completed within 1 year. TAU is the optimal alternative treatment available at the site according to regular procedures. Severity of the Cluster-C PD is the primary outcome, assessed with clinical interviews by independent raters blind for treatment. Functioning and wellbeing are important secondary outcomes. Assessments take place at week 0 (baseline), 17 (mid-GST), 34 (post-GST), 51 (post-booster sessions of GST), and 2 years (FU). Patient characteristics predicting better response to a specific treatment are studied, e.g., childhood trauma, autistic features, and introversion. A tool supporting patients and clinicians in matching treatment to patient will be developed. An economic evaluation investigates the cost-effectiveness and cost-utility from a societal perspective. A process evaluation by qualitative methods explores experiences of participants, loved ones and therapists regarding recovery, quality of life, and improving treatment. DISCUSSION: This study will determine the (cost-)effectiveness of treatments for Cluster-C PDs regarding treatment type as well as optimal matching of patient to treatment and deliver insight into which aspects help Cluster-C-PD patients recover and create a fulfilling life. TRIAL REGISTRATION: Dutch Trial Register: NL9209 . Registered on 28-01-2021

Additional file 1 of Design of an RCT on cost-effectiveness of group schema therapy versus individual schema therapy for patients with Cluster-C personality disorder: the QUEST-CLC study protocol

Additional file 1