Online Mindfulness-Based Cognitive Therapy in Patients with Depression
Post by Stephanie Williams
What's the science?
Many individuals with depression experience residual symptoms after receiving treatment. Some individuals may even experience a relapse after treatment. To combat relapse and to encourage full remission of symptoms, a mindfulness-based cognitive therapy program was designed to teach individuals to regulate their emotions by breaking out of harmful ruminating thought patterns. The program was designed with an online framework in order to bypass the usual barriers to in person-psychological interventions, including in-person travel times, service costs, and long waiting list times, among others. This week in JAMA Psychiatry, Segal and colleagues assess whether the addition of an online mindfulness-based cognitive therapy program to regular treatment for depression can reduce residual symptoms, decrease relapse, and increase remission.
How did they do it?
To assess how well the online cognitive therapy program (“Mindful Mood Balance'') could help reduce depressive symptoms, the authors randomly assigned a large cohort (N=460) of participants with depression to one of two groups and assessed their progress over a 15 month period. The first 3 months of the study consisted of an active intervention phase, and the remaining 12 months were used as a follow-up phase. The treatment for the ‘usual depression care’ group included regular access to psychotropic medication and cognitive therapy sessions. The treatment for the mindfulness group was identical, except for the addition of the online mindfulness cognitive therapy program. To qualify for the study, participants must have experienced one depressive episode, have scored between 5 and 9 on PHQ-9, and have been older than 18. The mindfulness-based online cognitive therapy program was segmented into eight sessions. The core idea of the program was to teach participants how to break out of habitual, dysfunctional cognitive patterns (eg. depression-related rumination). To assess the effect of the program on participants’ moods, the authors administered a standard 9-item questionnaire, the PHQ-9, which is known to track depression severity. The authors assessed 3 primary outcomes of interest using the PHQ-9 results, including 1) the amount of reduction in residual symptom severity 2) the rate of remission (a score of 5 on the PHQ-9 was used as a threshold for remission) and 3) the rate of depressive relapse. The authors also administered a seven-item questionnaire related to generalized anxiety disorder, called GAD-7. They used this survey to assess the reduction in each participant’s anxiety symptoms.
What did they find?
The authors found that the group that received the additional online mindfulness training showed a significantly greater reduction in symptoms across the entire study period compared to the usual depression care group. When the authors compared the reduction in residual symptoms for the two groups across the 12-month follow-up phase of the study, they found that patients who received the additional online training maintained their initial gains in symptom reduction. The authors also found residual symptoms of individuals who received usual depression care without the online program continued to decrease over the 12-month follow-up phase. When the authors assessed the rate of remission among subjects, they found that individuals in the group who received the additional online module achieved remission of their symptoms at a significantly higher rate (59.4%) compared to the group with standard treatment alone (47.0 %). The individuals in the online program treatment group continued to maintain their low rates of remission across the 12-month follow-up phase, while the standard treatment group showed increased rates of remission across the 12-month follow-up phase. When the authors assessed the relapse rate, they found a lower rate of relapse in the mindfulness program group (13.5%) compared to the group that received usual depression care (23%). Results from the generalized anxiety survey showed that the group receiving the additional online treatment showed a mean decrease in their anxiety scores.
What's the impact?
The authors show that the addition of a low-cost, accessible online program can significantly attenuate depressive symptoms better than usual depressive care alone. These results will inform the treatment of future patients with depression, and provide encouraging evidence that better symptom reduction and remission can be achieved using additional treatment strategies.
Segal et al. Outcomes of Online Mindfulness-Based Cognitive Therapy for Patients with Residual Depressive Symptoms. Jama Psychiatry. (2020). Access the original scientific publication here.