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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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In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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)
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measured
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“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
The cited source says what the claim attributes to it.
In the citing paper
“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]
The cited source says what the claim attributes to it.
In the citing paper
“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
The cited source says what the claim attributes to it.
In the citing paper
“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
The cited source says what the claim attributes to it.
In the citing paper
“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
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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
In the citing paper
“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
In the citing paper
“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)
In the citing paper
“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
In the citing paper
“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
In the citing paper
“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]
In the citing paper
“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
In the citing paper
“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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Metadata
- 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
- 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 (medical) › 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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