Elsevier

Clinical Psychology Review

Volume 37, April 2015, Pages 26-39
Clinical Psychology Review

A systematic review of mechanisms of change in mindfulness-based cognitive therapy in the treatment of recurrent major depressive disorder

https://doi.org/10.1016/j.cpr.2015.02.001Get rights and content
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Highlights

  • Mindfulness-based cognitive therapy for recurrent major depression

  • A systematic review of 23 clinical trials investigating mechanisms of change

  • MBCT may work according to the theoretically proposed mechanisms.

  • Better designs that can assess greater causal specificity are needed.

  • We provide recommendations for future research.

Abstract

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.

Method

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.

Conclusion

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.

Keywords

Mindfulness
MBCT
Depression
Mediation
Treatment mechanisms
Review

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