Does mindfulness-based cognitive therapy with tapering support reduce risk of relapse/recurrence in major depressive disorder by enhancing positive affect? A secondary analysis of the PREVENT trial.

IF 4.5 1区心理学 Q1 PSYCHOLOGY, CLINICAL

Journal of consulting and clinical psychology Pub Date : 2024-09-01 DOI:10.1037/ccp0000902

Barnaby D Dunn,Laura Warbrick,Rachel Hayes,Jesus Montero-Marin,Nigel Reed,Tim Dalgleish,Willem Kuyken

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引用次数: 0

Abstract

OBJECTIVE Mindfulness-based cognitive therapy (MBCT) is a viable alternative to maintenance antidepressant medication (M-ADM) to reduce risk of relapse/recurrence (RR) in recurrent depression, but its mechanism of action is not yet fully articulated. This secondary analysis of the PREVENT trial examined if MBCT with support to taper medication (MBCT-TS) reduces risk of RR in part by enhancing positive affect (PA). METHOD In a single-blind, parallel, group randomized controlled trial, adults with ≥3 prior depressive episodes, but not currently in episode and who were taking M-ADM, were randomized to receive either MBCT-TS or ongoing maintenance M-ADM. The primary outcome was RR over 24-month follow-up. Levels of positive affect were assessed at intake and posttreatment. The original PREVENT trial was preregistered (ISRCTN 26666654), but this secondary analysis was not. RESULTS Four hundred and twenty-four individuals (predominantly female and of White British ethnicity) were recruited, with 212 randomized to each arm. MBCT-TS led to significantly greater PA relative to M-ADM at posttreatment assessment (Δ = 2.78, 95% CI [1.47, 4.08], p < .001). RR was experienced during follow-up by 194 individuals (100 M-ADM; 94 MBCT-TS). Greater intake PA predicted a reduced hazard of RR across treatments (p < .001; hazard ratio = .96, 95% CI [0.94, 0.98]). In individuals who had not relapsed by posttreatment with complete data (121 M-ADM; 145 MBCT-TS), greater increase in PA from intake to posttreatment mediated reduced risk of subsequent RR (p = .04). CONCLUSIONS These findings suggest that greater levels of PA predict reduced risk of RR and that MBCT-TS in part acts to protect from RR when withdrawing from M-ADM by increasing PA. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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以正念为基础的认知疗法是否能通过增强积极情绪来降低重度抑郁障碍的复发风险？PREVENT 试验的二次分析。

目的基于正念的认知疗法（MBCT）是维持性抗抑郁药物治疗（M-ADM）的可行替代方案，可降低复发性抑郁症患者的复发风险，但其作用机制尚未完全阐明。在一项单盲、平行、分组随机对照试验中，既往抑郁发作次数≥3 次但目前未发作且正在服用 M-ADM 的成人被随机分配接受 MBCT-TS 或持续维持 M-ADM。主要结果是随访24个月的RR。积极情绪水平在接受治疗时和治疗后进行评估。最初的 PREVENT 试验已预先登记（ISRCTN 26666654），但该二次分析未预先登记。结果招募了 424 人（主要为女性和英国白人），每组随机分配 212 人。在治疗后评估中，MBCT-TS 的 PA 明显高于 M-ADM（Δ = 2.78，95% CI [1.47, 4.08]，p < .001）。194人（100人M-ADM；94人MBCT-TS）在随访期间出现了RR。摄入更多的 PA 可以降低各种治疗的 RR 风险（p < .001；风险比 = .96，95% CI [0.94，0.98]）。在治疗后数据完整且未复发的个体中（121 例 M-ADM；145 例 MBCT-TS），从摄入 PA 到治疗后 PA 的增幅越大，随后 RR 的风险就越低（p = .04）。(PsycInfo Database Record (c) 2024 APA，保留所有权利）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of consulting and clinical psychology PSYCHOLOGY, CLINICAL-

CiteScore

9.00

自引率

3.40%

发文量

期刊介绍： The Journal of Consulting and Clinical Psychology® (JCCP) publishes original contributions on the following topics: the development, validity, and use of techniques of diagnosis and treatment of disordered behaviorstudies of a variety of populations that have clinical interest, including but not limited to medical patients, ethnic minorities, persons with serious mental illness, and community samplesstudies that have a cross-cultural or demographic focus and are of interest for treating behavior disordersstudies of personality and of its assessment and development where these have a clear bearing on problems of clinical dysfunction and treatmentstudies of gender, ethnicity, or sexual orientation that have a clear bearing on diagnosis, assessment, and treatmentstudies of psychosocial aspects of health behaviors. Studies that focus on populations that fall anywhere within the lifespan are considered. JCCP welcomes submissions on treatment and prevention in all areas of clinical and clinical–health psychology and especially on topics that appeal to a broad clinical–scientist and practitioner audience. JCCP encourages the submission of theory–based interventions, studies that investigate mechanisms of change, and studies of the effectiveness of treatments in real-world settings. JCCP recommends that authors of clinical trials pre-register their studies with an appropriate clinical trial registry (e.g., ClinicalTrials.gov, ClinicalTrialsRegister.eu) though both registered and unregistered trials will continue to be considered at this time.