title: Mindfulness-based cognitive therapy for preventing relapse in recurrent depression: a randomized dismantling trial.
abstract: OBJECTIVE
  We compared mindfulness-based cognitive therapy (MBCT) with both cognitive psychological education (CPE) and treatment as usual (TAU) in preventing relapse to major depressive disorder (MDD) in people currently in remission following at least 3 previous episodes.
  
  
  METHODS
  A randomized controlled trial in which 274 participants were allocated in the ratio 2:2:1 to MBCT plus TAU, CPE plus TAU, and TAU alone, and data were analyzed for the 255 (93%; MBCT = 99, CPE = 103, TAU = 53) retained to follow-up. MBCT was delivered in accordance with its published manual, modified to address suicidal cognitions; CPE was modeled on MBCT, but without training in meditation. Both treatments were delivered through 8 weekly classes.
  
  
  RESULTS
  Allocated treatment had no significant effect on risk of relapse to MDD over 12 months follow-up, hazard ratio for MBCT vs. CPE = 0.88, 95% CI [0.58, 1.35]; for MBCT vs. TAU = 0.69, 95% CI [0.42, 1.12]. However, severity of childhood trauma affected relapse, hazard ratio for increase of 1 standard deviation = 1.26 (95% CI [1.05, 1.50]), and significantly interacted with allocated treatment. Among participants above median severity, the hazard ratio was 0.61, 95% CI [0.34, 1.09], for MBCT vs. CPE, and 0.43, 95% CI [0.22, 0.87], for MBCT vs. TAU. For those below median severity, there were no such differences between treatment groups.
  
  
  CONCLUSIONS
  MBCT provided significant protection against relapse for participants with increased vulnerability due to history of childhood trauma, but showed no significant advantage in comparison to an active control treatment and usual care over the whole group of patients with recurrent depression.
authors.affiliation: Department of Psychiatry, University of Oxford.
authors.forename: J Mark G
authors.initials: JM
authors.lastname: Williams
authors.affiliation: Department of Psychiatry, University of Oxford.
authors.forename: Catherine
authors.initials: C
authors.lastname: Crane
authors.affiliation: Department of Psychiatry, University of Oxford.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Barnhofer
authors.affiliation: Department of Psychiatry, University of Oxford.
authors.forename: Kate
authors.initials: K
authors.lastname: Brennan
authors.affiliation: Department of Psychiatry, University of Oxford.
authors.forename: Danielle S
authors.initials: DS
authors.lastname: Duggan
authors.affiliation: Department of Psychiatry, University of Oxford.
authors.forename: Melanie J V
authors.initials: MJ
authors.lastname: Fennell
authors.affiliation: Department of Psychiatry, University of Oxford.
authors.forename: Ann
authors.initials: A
authors.lastname: Hackmann
authors.affiliation: Department of Psychiatry, University of Oxford.
authors.forename: Adele
authors.initials: A
authors.lastname: Krusche
authors.affiliation: Department of Psychiatry, University of Oxford.
authors.forename: Kate
authors.initials: K
authors.lastname: Muse
authors.affiliation: Department of Psychiatry, University of Oxford.
authors.forename: Isabelle Rudolf
authors.initials: IR
authors.lastname: Von Rohr
authors.affiliation: Department of Psychiatry, University of Oxford.
authors.forename: Dhruvi
authors.initials: D
authors.lastname: Shah
authors.affiliation: Centre for Mindfulness Research and Practice, Bangor University.
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Crane
authors.affiliation: Centre for Mindfulness Research and Practice, Bangor University.
authors.forename: Catrin
authors.initials: C
authors.lastname: Eames
authors.affiliation: Centre for Mindfulness Research and Practice, Bangor University.
authors.forename: Mariel
authors.initials: M
authors.lastname: Jones
authors.affiliation: Centre for Mindfulness Research and Practice, Bangor University.
authors.forename: Sholto
authors.initials: S
authors.lastname: Radford
authors.affiliation: Centre for Mindfulness Research and Practice, Bangor University.
authors.forename: Sarah
authors.initials: S
authors.lastname: Silverton
authors.affiliation: North Wales Organisation for Randomised Trials in Health (NWORTH), Bangor University.
authors.forename: Yongzhong
authors.initials: Y
authors.lastname: Sun
authors.affiliation: Centre for Mindfulness Research and Practice, Bangor University.
authors.forename: Elaine
authors.initials: E
authors.lastname: Weatherley-Jones
authors.affiliation: North Wales Organisation for Randomised Trials in Health (NWORTH), Bangor University.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Whitaker
authors.affiliation: College of Medicine, Swansea University.
authors.forename: Daphne
authors.initials: D
authors.lastname: Russell
authors.affiliation: College of Medicine, Swansea University.
authors.forename: Ian T
authors.initials: IT
authors.lastname: Russell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003866:Depressive Disorder / Q000517:prevention & control / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D064866:Mindfulness / Q000379:methods*; D012008:Recurrence; D055502:Secondary Prevention; D016896:Treatment Outcome; D055815:Young Adult