The Effectiveness of Mindfulness-based Cognitive Therapy for Depression: A Systematic Review

Abstract

Introduction Mindfulness-Based Cognitive Therapy (MBCT) is a psychological intervention developed by integrating Kabat-Zinn’s Mindfulness-Based Stress Reduction (MBSR) and Beck’s Cognitive Therapy. The therapy targets patients with depression by focusing on mindfulness training and cognitive restructuring. Patients with depression frequently exhibit distorted, negative cognitive processes that influence their affective responses and behaviors. The MBCT facilitates patients’ recognition of these thoughts and emotions, thereby reducing maladaptive responses and fostering adaptive behaviors. The MBCT has demonstrated efficacy in preventing depression relapse, alleviating symptoms in patients with chronic conditions, and enhancing overall psychological well-being, thus presenting a promising approach for both prevention and treatment. However, a systematic review on the effectiveness of MBCT in preventing relapse of depression and reducing depressive symptoms in Thailand has not yet been conducted.

Objective To assess the effectiveness of the mindfulness-based cognitive therapy program in preventing depression relapse and reducing depressive symptoms

Design This study employed a systematic literature review.

Methodology This systematic review was conducted following the principles of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The research question is whether Mindfulness-Based Cognitive Therapy (MBCT) is effective in preventing relapse and reducing depressive symptoms in patients with depression. The inclusion criteria for selecting studies were based on the PICO framework: P-Population included patients diagnosed with depression or those experiencing residual symptoms of depression following treatment or those with ongoing depressive symptoms; I- Intervention involved Mindfulness-Based Cognitive Therapy program used to treat patients with depression or those with depressive symptoms; C- Comparison included other therapeutic programs, current nursing practices, or antidepressant alone; O- Outcomes focused on prevention of relapse/recurrence and reduction of the severity of depressive symptoms. The literature search was conducted using both Thai and English language databases, including PubMed, Medline, PsycINFO, CINAHL, Web of Science, Embase, and ThaiJo. The keywords used for the search included “mindfulness-based cognitive therapy” or “MBCT,” “depression,” “depressive disorders,” and “cognitive therapy with mindfulness practice.” The research studies were confined as experimental or quasi-experimental studies published in English or Thai between January 1, 2002, and December 31, 2022. The studies were selected based on the defined criteria, and the quality of the studies was assessed using the Joanna Briggs Institute’s research quality assessment tools. The review process was conducted independently by three researchers. In cases of discrepancies in study selection or quality assessment were found, discussions were held to reach a consensus. Information regarding the researchers’ names, countries of study, characteristics of the therapeutic and comparison programs, research design, participants, and research outcomes of the selected studies was extracted into tables for synthesis and further reporting.

Results A total of 22 relevant studies were identified through the literature review based on the PICO criteria, with 18 studies from international sources and 4 from Thailand. The majority of the studies were randomized controlled trials (RCTs). The primary findings indicated that the MBCT program demonstrated high efficacy in preventing relapse among patients with a history of three or more episodes of depression, those exhibiting residual symptoms after treatment, and patients with depression persisting for more than two years. Furthermore, MBCT exhibited beneficial effects for patients who were non-responsive to antidepressants and for pregnant women at risk of relapse during gestation. Additional results revealed that the combination of MBCT with antidepressants significantly reduced relapse rates compared to those receiving antidepressants or standard therapy alone. The MBCT was also applied to patients with depression and chronic conditions, such as cancer, diabetes, and gastritis, and was found to attenuate depressive symptoms and anxiety associated with these conditions. The therapeutic approach has evolved from group-based to individual-based therapy, with an increasing trend toward online delivery, wherein therapists provide remote patient assistance.

Recommendation The Mindfulness-Based Cognitive Therapy (MBCT) program is effective in preventing relapse of depression and mitigating depressive symptoms, especially when combined with antidepressants or other forms of therapy. Therefore, nurses should consider applying the MBCT program in the care of patients with depression from diverse populations, adapting it to the specific context of each population while maintaining the core principles of MBCT. These principles include helping patients learn to be mindful of the present moment, enabling them to observe themselves separately from old patterns of thinking and emotions, and integrating these practices into their daily lives as part of a normal lifestyle. Additionally, the online version of the MBCT program should be implemented to increase accessibility for patients with depression or through a combined therapy approach. Further research is also recommended to evaluate the effectiveness of the MBCT program in preventing relapse and reducing depressive symptoms. Future studies should be designed as randomized controlled trials comparing MBCT with other therapeutic programs or antidepressant treatments and involve a large sample size to ensure the credibility of the research findings.