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.
