A systematic review of mechanisms of change in mindfulness-based cognitive therapy in the treatment of recurrent major depressive disorder.
BACKGROUND
The investigation of treatment mechanisms in randomized controlled trials has considerable clinical and theoretical relevance. Despite the empirical support for the effect of mindfulness-based cognitive therapy (MBCT) in the treatment of recurrent major depressive disorder (MDD), the specific mechanisms by which MBCT leads to therapeutic change remain unclear.


OBJECTIVE
By means of a systematic review we evaluate how the field is progressing in its empirical investigation of mechanisms of change in MBCT for recurrent MDD.


METHODS
To identify relevant studies, a systematic search was conducted. Studies were coded and ranked for quality.


RESULTS
The search produced 476 articles, of which 23 were included. In line with the theoretical premise, 12 studies found that alterations in mindfulness, rumination, worry, compassion, or meta-awareness were associated with, predicted or mediated MBCT's effect on treatment outcome. In addition, preliminary studies indicated that alterations in attention, memory specificity, self-discrepancy, emotional reactivity and momentary positive and negative affect might play a role in how MBCT exerts its clinical effects.


CONCLUSIONS
The results suggest that MBCT could work through some of the MBCT model's theoretically predicted mechanisms. However, there is a need for more rigorous designs that can assess greater levels of causal specificity.
Danish Center for Mindfulness at the Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark; Department of Psychology, Copenhagen University, Copenhagen, Denmark.
Anne Maj
AM
van der Velden
Mood Disorders Centre, University of Exeter, Exeter, UK; Department of Psychiatry, University of Oxford, Oxford, UK.
Willem
W
Kuyken
Wattar Gruppen, Kognitiv Center, Copenhagen, Denmark.
Ulla
U
Wattar
Department of Psychiatry, University of Oxford, Oxford, UK.
Catherine
C
Crane
Danish Center for Mindfulness at the Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark.
Karen Johanne
KJ
Pallesen
Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark.
Jesper
J
Dahlgaard
Danish Center for Mindfulness at the Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark.
Lone Overby
LO
Fjorback
Danish Center for Mindfulness at the Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark.
Jacob
J
Piet
D003865:Major Depressive Disorder / Q000523:psychology / Q000628:therapy*; D006801:Humans; D064866:Mindfulness; D012008:Recurrence; D016896:Treatment Outcome; D015928:Cognitive Behavioral Therapy
Depression; MBCT; Mediation; Mindfulness; Review; Treatment mechanisms