Efficacy of Mindfulness-Based Cognitive Therapy in Prevention of Depressive Relapse: An Individual Patient Data Meta-analysis From Randomized Trials
Open accessAbstract
IMPORTANCE: Relapse prevention in recurrent depression is a significant public health problem, and antidepressants are the current first-line treatment approach. Identifying an equally efficacious nonpharmacological intervention would be an important development. OBJECTIVE: To conduct a meta-analysis on individual patient data to examine the efficacy of mindfulness-based cognitive therapy (MBCT) compared with usual care and other active treatments, including antidepressants, in treating those with recurrent depression. DATA SOURCES: English-language studies published or accepted for publication in peer-reviewed journals identified from EMBASE, PubMed/Medline, PsycINFO, Web of Science, Scopus, and the Cochrane Controlled Trials Register from the first available year to November 22, 2014. Searches were conducted from November 2010 to November 2014. STUDY SELECTION: Randomized trials of manualized MBCT for relapse prevention in recurrent depression in full or partial remission that compared MBCT with at least 1 non-MBCT treatment, including usual care. DATA EXTRACTION AND SYNTHESIS: This was an update to a previous meta-analysis. We screened 2555 new records after removing duplicates. Abstracts were screened for full-text extraction (S.S.) and checked by another researcher (T.D.). There were no disagreements. Of the original 2555 studies, 766 were evaluated against full study inclusion criteria, and we acquired full text for 8. Of these, 4 studies were excluded, and the remaining 4 were combined with the 6 studies identified from the previous meta-analysis, yielding 10 studies for qualitative synthesis. Full patient data were not available for 1 of these studies, resulting in 9 studies with individual patient data, which were included in the quantitative synthesis. RESULTS: Of the 1258 patients included, the mean (SD) age was 47.1 (11.9) years, and 944 (75.0%) were female. A 2-stage random effects approach showed that patients receiving MBCT had a reduced risk of depressive relapse within a 60-week follow-up period compared with those who did not receive MBCT (hazard ratio, 0.69; 95% CI, 0.58-0.82). Furthermore, comparisons with active treatments suggest a reduced risk of depressive relapse within a 60-week follow-up period (hazard ratio, 0.79; 95% CI, 0.64-0.97). Using a 1-stage approach, sociodemographic (ie, age, sex, education, and relationship status) and psychiatric (ie, age at onset and number of previous episodes of depression) variables showed no statistically significant interaction with MBCT treatment. However, there was some evidence to suggest that a greater severity of depressive symptoms prior to treatment was associated with a larger effect of MBCT compared with other treatments. CONCLUSIONS AND RELEVANCE: Mindfulness-based cognitive therapy appears efficacious as a treatment for relapse prevention for those with recurrent depression, particularly those with more pronounced residual symptoms. Recommendations are made concerning how future trials can address remaining uncertainties and improve the rigor of the field.
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An individual-patient data meta-analysis found MBCT compared with continuation of antidepressants was associated with reduced relapse or recurrence risk (HR 0.77, 95% CI 0.66-0.98) over 60 weeks across four studies.
“An individual-patient data meta-analysis found evidence that MBCT compared to continuation of antidepressant treatment was associated with a reduction in the risk of relapse or recurrence, with a hazard ratio (HR) of 0.77 (95% confidence interval (CI) 0.66 to 0.98) over 60 weeks (4 studies) (Kuyken 2016).”
From Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (2021) · cites this paper as Kuyken 2016
The Results section reports an individual-patient-data comparison of MBCT with antidepressant medication across four studies, with reduced relapse risk over 60 weeks and an HR of 0.77. The reported 95% CI is 0.60–0.98, not the claimed 0.66–0.98. (LLM, conf=0.92)
Experimental — accuracy not yet measuredIn two meta-analyses of RCTs of mindfulness-based interventions, serious adverse events occurred for ≤2% of participants and at similar rates across meditation and non-meditation control conditions.
“In two meta-analyses of RCTs of mindfulness-based interventions, Kuyken et al. (2016) and Wong et al., (2018) reported serious (i.e., life threatening) adverse events occurring for ≤2% of participants and at similar rates across meditation and non-meditation control conditions.”
From Prevalence of meditation-related adverse effects in a population-based sample in the United States (2022) · cites this paper as Kuyken et al. (2016)
The Methods describe a meta-analysis of mindfulness-based cognitive therapy trials, and the Discussion’s Summary of Results says adverse events were formally recorded in 6 of 9 studies, with none attributed to MBCT. The paper does not report that serious adverse events occurred in ≤2% of participants or that their rates were similar across MBCT and control conditions; its Strengths and Limitations section says adverse events were not systematically recorded or reported. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe evidence supporting the efficacy of MBPs in the treatment of physical and psychological health challenges in some areas is strong and building.
“The evidence supporting their ef fi cacy in the treatment of physical and psychological health challenges in some areas is strong and building (e.g. see recent meta-analyses and reviews Carlson, 2012; Khoury et al. 2013; Kuyken et al. 2016).”
From What defines mindfulness-based programs? The warp and the weft (2017) · cites this paper as Kuyken et al. 2016
The Discussion (Summary of Results) reports clear evidence that mindfulness-based cognitive therapy reduces depressive relapse compared with usual care and maintenance antidepressants, supporting the claim for one psychological-health challenge. The paper does not assess physical-health challenges or mindfulness-based programs broadly, so it cannot support those parts of the sentence. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIntegrating mindfulness into manualized group treatments has potential for treating depression and anxiety disorders and preventing relapse in these conditions.
“By integrating mindfulness into manualized group treatments such as mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT), there is potential for not only treating individuals afflicted with depression and anxiety disorders but also preventing relapse in these conditions [12–18].”
From Emotion Regulation as a Mechanism of Mindfulness in Individual Cognitive-Behavioral Therapy for Depression and Anxiety Disorders (2024) · cites this paper as [17]
The Study Selection section describes trials of manualized MBCT for relapse prevention in people with recurrent depression in full or partial remission, and the Conclusions and Relevance section reports that MBCT appears efficacious for that purpose. These passages do not support the broader claims about MBSR, treating active depression or anxiety disorders, or preventing anxiety relapse. No page numbers are available in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredMindfulness-based group interventions have revealed beneficial clinical effects on depression and anxiety disorders.
“Moreover, while mindfulness-based group interventions have revealed beneficial clinical effects on depression and anxiety disorders [14–18, 78]”
From Emotion Regulation as a Mechanism of Mindfulness in Individual Cognitive-Behavioral Therapy for Depression and Anxiety Disorders (2024) · cites this paper as [17]
The Discussion’s Summary of Results reports that mindfulness-based cognitive therapy reduced depressive relapse or recurrence compared with usual care and maintenance antidepressants. The paper addresses relapse prevention in people with recurrent depression, not beneficial effects on anxiety disorders; its depression finding is also narrower than a general claim about effects on depression. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Previous research has found that mindfulness and CBT are effective for anxiety and depression, confirming the review's findings.
“Previous research has found that mindfulness and CBT are effective for anxiety and depression [85-88], confirming our findings.”
From Psychological Interventions and Those With Elements of Positive Psychology for Child and Youth Mental Health During the COVID-19 Pandemic: Literature Review, Lessons Learned, and Areas for Future Knowledge Dissemination (2024) · cites this paper as [86]
The Discussion’s Summary of Results reports that mindfulness-based cognitive therapy (MBCT) reduced depressive relapse or recurrence compared with usual care and maintenance antidepressants. The source studies MBCT as a combined intervention for people with recurrent depression; it does not establish that mindfulness and CBT separately are effective for both anxiety and depression. Page numbers are unavailable in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredRecent meta-analyses support MBCT as an efficacious treatment strategy for relapse prevention compared to no intervention.
“Recent meta-analyses have provided support for MBCT as an efficacious treatment strategy for relapse prevention compared to no intervention (Kuyken et al., 2016)”
From The State- and Trait-Level Effects and Candidate Mechanisms of Four Mindfulness-Based Cognitive Therapy (MBCT) Practices: Two Exploratory Studies (2023) · cites this paper as Kuyken et al., 2016
The Discussion’s Summary of Results reports that MBCT significantly reduced depressive relapse compared with usual care. The Methods describe the comparator as treatment as usual, not no intervention, so the cited meta-analysis does not establish the claim with that specific comparator. (LLM, conf=0.86)
Experimental — accuracy not yet measuredMeta-analyses involving hundreds of RCTs suggest that meditation training can decrease psychological symptoms and increase aspects of well-being and positive functioning.
“Meta-analyses involving hundreds of randomized controlled trials (RCTs) suggest that meditation training can decrease psychological symptoms (eg, depression, anxiety, stress) and increase aspects of well-being and positive functioning (eg, meaning in life, compassion, prosocial behavior) [6-15].”
From Testing the efficacy of a multicomponent, self-guided, smartphone-based meditation app: Three-armed randomized controlled trial (2020) · cites this paper as [11]
The Results section (Does MBCT Reduce Depressive Relapse Compared With Control Conditions?; page unavailable) reports that mindfulness-based cognitive therapy reduced depressive relapse across nine trials. This supports a narrower claim about depression, but this paper does not establish effects on anxiety, stress, well-being, compassion, or prosocial behavior, and its meta-analysis did not involve hundreds of RCTs. (LLM, conf=0.88)
Experimental — accuracy not yet measuredMindfulness-based interventions are promising non-pharmacological interventions for mental disorders or symptoms.
“Mindfulness-based interventions are promising non-pharmacological interventions for mental disorders or symptoms, and performance has been found to be equivalent to evidence-based treatments, such as cognitive behavioral therapy and antidepressant medication for some disorders [1, 2].”
From Mindfulness-based stress reduction adapted to pregnant women with psychosocial vulnerabilities—a protocol for a randomized feasibility study in a Danish hospital-based outpatient setting (2021) · cites this paper as [2]
The Abstract’s Conclusions and Relevance (page not available) describe mindfulness-based cognitive therapy as efficacious for preventing relapse in recurrent depression, supporting its promise as a nonpharmacological intervention. The paper does not establish that mindfulness-based interventions generally are promising across mental disorders or symptoms; its finding is limited to this therapy and condition. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe performance of mindfulness-based interventions is equivalent to evidence-based treatments such as cognitive behavioral therapy and antidepressant medication for some disorders.
“Mindfulness-based interventions are promising non-pharmacological interventions for mental disorders or symptoms, and performance has been found to be equivalent to evidence-based treatments, such as cognitive behavioral therapy and antidepressant medication for some disorders [1, 2].”
From Mindfulness-based stress reduction adapted to pregnant women with psychosocial vulnerabilities—a protocol for a randomized feasibility study in a Danish hospital-based outpatient setting (2021) · cites this paper as [2]
The Discussion (Conclusions; page not provided) says MBCT’s protective effects against depressive relapse are comparable with those of cognitive therapy. The Results (page not provided) report a lower relapse risk with MBCT than with antidepressant medication, not equivalent performance. The paper addresses MBCT for relapse prevention in recurrent depression, not mindfulness-based interventions across multiple disorders, and does not report a direct comparison with cognitive behavioral therapy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn a meta-analysis of mindfulness-based cognitive therapy for relapse prevention in recurrent depression, over half of the studies only reported SAEs.
“For example, in a metaanalysis of mindfulness-based cognitive therapy for relapse prevention in recurrent depression over half of the studies only reported SAEs (109).”
From Adverse events in meditation practices and meditation‐based therapies: a systematic review (2020) · cites this paper as [109]
The Discussion’s Summary of Results says adverse events were formally recorded in 6 of 9 studies, and Strengths and Limitations says adverse events were not systematically recorded or reported. Neither passage says that over half of the studies reported only serious adverse events (SAEs); the claimed reporting restriction is unsupported. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThis review could not confirm the significant effect of MBCT versus continuation of antidepressants on reducing relapse or recurrence at 60 weeks found in an individual-patient data meta-analysis.
“Our review could not confirm this significant effect at 60 weeks”
From Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (2021) · cites this paper as Kuyken 2016
MBSR/MBCT have demonstrated effectiveness in those with recurrent depression (MBCT) and chronic pain (MBSR).
“These programmes have demonstrated effectiveness in those with recurrent depression (MBCT) and chronic pain (MBSR).5 6”
From Target mechanisms of mindfulness-based programmes and practices: a scoping review (2024) · cites this paper as [6]
Prophylactic interventions reduce MDD relapse vulnerability.
“given evidence that prophylactic interventions reduce MDD relapse vulnerability (Guidi and Fava, 2020, Kuyken et al., 2016)”
From Static and treatment-responsive brain biomarkers of depression relapse vulnerability following prophylactic psychotherapy: Evidence from a randomized control trial (2022) · cites this paper as Kuyken et al., 2016
MBCT is an adaptation developed to teach those at high risk of depressive relapse skills to stay well and has been shown to be effective.
“MBCT is an adaptation developed to teach those at high risk of depressive relapse skills to stay well and has been shown to be effective (Kuyken et al. 2016).”
From What defines mindfulness-based programs? The warp and the weft (2017) · cites this paper as Kuyken et al. 2016
MBCT literature suggests that individuals with higher baseline symptom severity may derive greater benefit from including mindfulness in treatment as compared to those with milder symptoms.
“The MBCT literature suggests that individuals with higher baseline symptom severity may derive greater benefit from including mindfulness in treatment as compared to those with milder symptoms (e.g., Arch & Ayers, 2013; Kuyken et al., 2016; Ma & Teasdale, 2004; Piet & Hougaard, 2011; Williams et al., 2014).”
From A randomised trial comparing a brief online delivery of mindfulness-plus-values versus values only for symptoms of depression: Does baseline severity matter? (2020) · cites this paper as Kuyken et al., 2016
When directly compared, MBIs produce outcomes very similar to frontline evidence-based treatments such as CBT and antidepressants.
“When compared directly, MBIs produce outcomes very similar to frontline, evidence-based treatments (for example, CBT and antidepressants)6,79.”
From A common factors perspective on mindfulness-based interventions (2022) · cites this paper as [79]
Greater symptom severity is associated with larger improvement following MBCT for individuals with current or remitted depression.
“For example, greater symptom severity is associated with larger improvement following mindfulness-based cognitive therapy for individuals with current or remitted depression79”
From A common factors perspective on mindfulness-based interventions (2022) · cites this paper as [79]
Prior work has identified some baseline patient characteristics that predict MBI treatment response.
“Prior work has identified some baseline patient characteristics that predict MBI treatment response.”
From A common factors perspective on mindfulness-based interventions (2022) · cites this paper as [79]
MBCT reduces depressive relapse risk when added to usual care and has comparable efficacy to maintenance antidepressant medication, based on at least nine clinical trials with 1258 participants.
“There is evidence from at least nine clinical trials (n = 1258) that MBCT reduces the risk of relapse to depression when added to usual care, and demonstrates comparable efficacy to maintenance antidepressant medication (Kuyken et al. 2016).”
From The Effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) in Real-World Healthcare Services (2020) · cites this paper as Kuyken et al. 2016
Existing clinical trials of MBCT for relapse prevention in depression have also focussed largely on Caucasian samples and/or have not reported information on the ethnicity of participants.
“Existing clinical trials of MBCT for relapse prevention in depression have also focussed largely on Caucasian samples and/or have not reported information on the ethnicity of participants (e.g. Goldberg et al. 2018; Kuyken et al. 2016).”
From The Effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) in Real-World Healthcare Services (2020) · cites this paper as Kuyken et al. 2016
Neither age nor gender was associated with the degree of reduction in depressive symptoms during treatment, indicating that outcomes do not seem to be influenced by these sociodemographic variables.
“Consistent with Kuyken et al. (2016), neither age nor gender was associated with the degree of reduction in depressive symptoms during treatment, indicating that outcomes do not seem to be influenced by these sociodemographic variables.”
From The Effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) in Real-World Healthcare Services (2020) · cites this paper as Kuyken et al. (2016)
Mindfulness-based interventions have been shown to have large beneficial effects on depression in patients with depressive disorders and to be effective in preventing relapse.
“MBIs have been shown to have large beneficial effects on depression in patients with depressive disorders and to be effective in preventing relapse (Hofmann et al., 2010; Piet and Hougaard, 2011; Kuyken et al., 2016).”
From The effectiveness of a body-affective mindfulness intervention for multiple sclerosis patients with depressive symptoms: A randomized controlled clinical trial (2017) · cites this paper as Kuyken et al., 2016
Reviews of randomized trials have shown that adverse effects, when reported, are no more common in mindfulness-based programs than in control groups.
“Reviews of randomized trials have shown that adverse effects, when reported, are no more common in MBPs than in control groups (Kuyken et al. 2016; Wong et al. 2018).”
From Frequency of Self-reported Unpleasant Events and Harm in a Mindfulness-Based Program in Two General Population Samples (2021) · cites this paper as Kuyken et al. 2016
An individual patient data (IPD) meta-analysis observed that MBCT resulted in a reduced risk of depressive relapse compared with those who did not receive MBCT (HR 0.69; 95% CI 0.58 to 0.82), with any active treatment (HR 0.79; 95% CI 0.64 to 0.97) and with mADM (HR 0.77; 95% CI 0.60 to 0.98).
“An individual patient data (IPD) meta-analysis observed that MBCT resulted in a reduced risk of depressive relapse compared with those who did not receive MBCT (HR 0.69; 95% CI 0.58 to 0.82), with any active treatment (HR 0.79; 95% CI 0.64 to 0.97) and with mADM (HR 0.77; 95% CI 0.60 to 0.98).6”
From Mindfulness-based cognitive therapy for prevention and time to depressive relapse: Systematic review and network meta-analysis (2021) · cites this paper as [6]
There is accumulating evidence for the efficacy of CBT and MBCT.
“Thus, although there is accumulating evidence for the efficacy of these approaches (Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012; Kuyken et al., 2016), their wide-spread availability is currently limited.”
From Beneficial effects of training in self-distancing and perspective broadening for people with a history of recurrent depression (2017) · cites this paper as Kuyken et al., 2016
The inclusion criteria for trials of intensive preventive clinical interventions such as MBCT match those of the current study (recurrent depression with at least three previous episodes).
“This also matches the inclusion criteria for trials of intensive preventive clinical interventions such as MBCT (Kuyken et al., 2016).”
From Beneficial effects of training in self-distancing and perspective broadening for people with a history of recurrent depression (2017) · cites this paper as Kuyken et al., 2016
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Warriner, S., Crane, C., Dymond, M., & Krusche, A. (2018) · Midwifery · doi:10.1016/j.midw.2018.05.004 · Cited by 57 · see citing works
Self-citationMindfulness-based cognitive therapy for bipolar disorder: A systematic review and meta-analysis
Xuan, R., Li, X., Qiao, Y., Guo, Q., Liu, X., Deng, W., Hu, Q., Wang, K., & Zhang, L. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.113116 · Cited by 56 · see citing works
Mander, J., Blanck, P., Neubauer, A. B., Kröger, P., Flückiger, C., Lutz, W., Barnow, S., Bents, H., & Heidenreich, T. (2019) · Journal of Clinical Psychology · doi:10.1002/jclp.22695 · Cited by 56 · see citing works
- Authors
- Kuyken, W., Warren, F. C., Taylor, R. S., Whalley, B., Crane, C., Bondolfi, G., Hayes, R., Huijbers, M., Ma, H., Schweizer, S., Segal, Z., Speckens, A., Teasdale, J. D., Van Heeringen, K., Williams, M., Byford, S., Byng, R., & Dalgleish, T.
- Affiliations
- Warneford Hospital (GB)
- University of Exeter (GB)
- University of Plymouth (GB)
- University of Geneva (CH)
- Radboud University Nijmegen (NL)
- MRC Cognition and Brain Sciences Unit (GB)
- University of Toronto (CA)
- University Department of Psychiatry, University Hospital, Gent, Belgium
- King's College London (GB)
- Corresponding author
- Kuyken, Willem
- ORCID
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2016-06-01
- Volume
- 73
- Issue
- 6
- Pages
- 565
- ISSN
- 2168-622X (ISSN-L)
- PMC
- PMC6640038
- OpenAlex
- W2338885995
- Semantic Scholar
- 46637981539b24d876b81a424bb20d3d017ee9c2
- Cited by
- 821
- References
- 46
- Citations by year
- 2026: 78 · 2025: 73 · 2024: 69 · 2023: 63 · 2022: 96 · 2021: 94 · 2020: 102 · 2019: 96 · 2018: 70 · 2017: 65 · 2016: 13 · 2015: 1 · 2012: 1
- FWCI
- 12.05
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Open Research Exeter (University of Exeter) (acceptedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Figshare (acceptedVersion)
- Radboud Repository (Radboud University) (acceptedVersion)
- Research Portal (King's College London) (submittedVersion, other-oa)
- PEARL (University of Plymouth) (submittedVersion)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Funders
- Royal Devon and Exeter NHS Foundation Trust
- Wellcome Trust (104908/Z/14/Z, GR 067797, 104908)
- National Institute for Health and Care Research (08/56/01, NF-SI-0514-10155)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- mindfulness-based cognitive therapy, depressive relapse prevention, recurrent depression, antidepressants, usual care, non-pharmacological treatment, relapse risk, remission, treatment efficacy comparison, relapse-free survival
- MeSH terms
- Combined Modality Therapy, Depressive Disorder, Humans, Recurrence, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Treatment Outcome, Mindfulness
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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