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Cited by 159Digital Mental Health InterventionsMindfulness and Compassion InterventionsAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Outcomes of Online Mindfulness-Based Cognitive Therapy for Patients With Residual Depressive Symptoms: A Randomized Clinical Trial

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Segal, Zindel V., Dimidjian, Sona, Beck, Arne, Boggs, Jennifer M., Vanderkruik, Rachel, Metcalf, Christina A., Gallop, Robert, Felder, Jennifer N. +1 more·2020·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2019.4693PMC PMC6990961
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Abstract

Importance: Patients with residual depressive symptoms face a gap in care because few resources, to date, are available to manage the lingering effects of their illness. Objective: To evaluate the effectiveness for treating residual depressive symptoms with Mindful Mood Balance (MMB), a web-based application that delivers mindfulness-based cognitive therapy, plus usual depression care compared with usual depression care only. Design, Setting, and Participants: This randomized clinical trial was conducted in primary care and behavioral health clinics at Kaiser Permanente Colorado, Denver. Adults identified with residual depressive symptoms were recruited between March 2, 2015, and November 30, 2018. Outcomes were assessed for a 15-month period, comprising a 3-month intervention interval and a 12-month follow-up period. Interventions: Patients were randomized to receive usual depression care (UDC; n = 230) or MMB plus UDC (n = 230), which included 8 sessions delivered online for a 3-month interval plus minimal phone or email coaching support. Main Outcomes and Measures: Primary outcomes were reduction in residual depressive symptom severity, assessed using the Patient Health Questionaire-9 (PHQ-9); rates of depressive relapse (PHQ-9 scores ≥15); and rates of remission (PHQ-9 scores <5). Secondary outcomes included depression-free days, anxiety symptoms (General Anxiety Disorder-7 Item Scale), and functional status (12-Item Short Form Survey). Results: Among 460 randomized participants (mean [SD] age, 48.30 [14.89] years; 346 women [75.6%]), data were analyzed for the intent-to-treat sample, which included 362 participants (78.7%) at 3 months and 330 (71.7%) at 15 months. Participants who received MMB plus UDC had significantly greater reductions in residual depressive symptoms than did those receiving UDC only (mean [SE] PHQ-9 score, 0.95 [0.39], P < .02). A significantly greater proportion of patients achieved remission in the MMB plus UDC group compared with the UDC only group (PHQ-9 score, <5: β [SE], 0.38 [0.14], P = .008), and rates of depressive relapse were significantly lower in the MMB plus UDC group compared with the UDC only group (hazard ratio, 0.61; 95% CI, 0.39-0.95; P < .03). Compared with the UDC only group, the MMB plus UDC group had decreased depression-free days (mean [SD], 281.14 [164.99] days vs 247.54 [158.32] days; difference, -33.60 [154.14] days; t = -2.33; P = .02), decreased anxiety (mean [SE] General Anxiety Disorder-7 Item Scale score, 1.21 [0.42], P = .004), and improved mental functioning (mean [SE] 12-Item Short Form Survey score, -5.10 [1.37], P < .001), but there was no statistically significant difference in physical functioning. Conclusions and Relevance: Use of MMB plus UDC resulted in significant improvement in depression and functional outcomes compared with UDC only. The MMB web-based treatment may offer a scalable approach for the management of residual depressive symptoms. Trial Registration: ClinicalTrials.gov identifier: NCT02190968.

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Authors
Segal, Z. V., Dimidjian, S., Beck, A., Boggs, J. M., Vanderkruik, R., Metcalf, C. A., Gallop, R., Felder, J. N., & Levy, J.
Affiliations
  • University of Toronto (CA)
  • University of Colorado Boulder (US)
  • Kaiser Permanente (US)
  • West Chester University (US)
  • University of California, San Francisco (US)
  • University of Colorado Boulder, Boulder
Corresponding author
Segal, Zindel V.
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2020-06-01
Volume
77
Issue
6
Pages
563
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2019.4693
PMC
PMC6990961
OpenAlex
W3004258958
Cited by
159
References
59
Citations by year
2026: 20 · 2025: 38 · 2024: 23 · 2023: 23 · 2022: 26 · 2021: 18 · 2020: 11
FWCI
17.63
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Mental Health
Topics
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
residual depressive symptoms, mindfulness-based cognitive therapy, online therapy, online intervention, depression relapse, remission, anxiety symptoms, functional status, primary care
MeSH terms
Anxiety, Depression, Female, Humans, Male, Middle Aged, Quality of Life, Remission Induction, Cognitive Behavioral Therapy, Single-Blind Method, Treatment Outcome, Internet, Mindfulness

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