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IntroductionAbout 30% of depressed patients suffer from a protracted course in which the disorder continues to cause significant burden despite treatment efforts. While originally developed for relapse prevention, mindfulness-based cognitive therapy (MBCT) has increasingly been investigated in depressed patients with such ‘difficult-to-treat’ courses. This is a protocol for an individual participant data (IPD) meta-analysis aiming to determine efficacy and potential moderators of MBCT treatment effects in this group based on evidence from randomised controlled trials.Methods and analysisSystematic searches in PubMed, Web of Science, Scopus, PsycINFO, EMBASE and the Cochrane Controlled Trials Register for randomised controlled trials were completed on 17 June 2024. Authors of identified studies have contributed IPD, and data extractions have been completed. An update search will be conducted immediately before the start of data analyses. We will investigate the following outcomes: (a) self-reported and observer-reported severity of depression symptomatology, (b) remission and (c) clinically meaningful improvement and deterioration. One-stage and two-stage IPD-MA will be conducted with one-stage models using the observed IPD from all studies simultaneously as the primary approach. One-stage IPD models will include stratified study intercepts and error terms as well as random effects to capture between-study heterogeneity. Moderator analyses will test treatment-covariate interactions for both individual patient-level and study-level characteristics.Ethics and disseminationThe results will inform understanding of the use of MBCT in patients with current ‘difficult-to-treat’ depression and will contribute to arguments in favour of or against implementing MBCT as a treatment for this group. They will be published in a peer-reviewed journal and made available to stakeholders in accessible formats. No local ethical review was necessary following consultation with the Ethics and Governance Board of the University of Surrey. Guidance on patient data storage and management will be adhered to throughout.PROSPERO registration numberCRD42022332039.

It has been found that Mindfulness-based cognitive therapy (MBCT) reduces rumination in remitted and currently depressed patients. However, less is known about the effects of MBCT on rumination in chronically and treatment-resistant depressed patients. Typically, questionnaires are used to assess rumination, but this introduces the risk of response and recall biases. A recent systematic review (van der Velden et al. Clinical Psychology Review 37:26–39, 2015) proposes to also include behavioural measures. A behavioural measure that has previously been used to assess rumination in dysphoric students is the breathing focus task (BFT). The first aim of this research was to investigate whether the BFT can be used in chronically, treatment-resistant depressed patients to measure rumination. We therefore administered the BFT in patients with chronic, treatment-resistant depression (n = 73) and compared them with never-depressed controls (n = 106). Patients reported significantly more negative thought intrusions and subsequent sad mood. Secondly we tested in a randomized-controlled trial whether MBCT in combination with treatment-as-usual (MBCT + TAU, n = 26) compared with TAU (n = 36) reduces rumination assessed with the BFT in chronically, treatment-resistant depressed patients. Negative thought intrusions significantly decreased in the MBCT + TAU condition, compared with TAU. The results show that MBCT reduces rumination assessed with the BFT in chronically, treatment-resistant depressed patients.

Objectives Mindfulness is a multifaceted concept which might be best captured by person-centered profiles rather than by variable-centered assessment of its subcomponents. Patients with different mindfulness profiles may vary in mental health status and might experience differential clinical outcomes of Mindfulness-Based Cognitive Therapy (MBCT). We therefore aimed to assess the relationship between mindfulness profiles and mental health in patients with major depressive disorder (MDD) and to examine whether mindfulness profiles are predictive for MBCT-induced changes in mental health. Method Latent profile analysis (LPA), a method used to identify hidden subgroups of individuals within a population, was performed on pre-MBCT subscale scores of the Five Facet Mindfulness Questionnaire in patients with current or remitted MDD ( n =754). Equality of means of pre-MBCT, post-MBCT, and residualized change scores of several mental health measures across the latent profiles was tested. Results LPA identified four distinct mindfulness profiles. Three profiles were similar to previously identified profiles in another MDD sample (“very low mindfulness,” “high mindfulness,” “non-judgmentally aware”) and one profile was similar to that identified in non-clinical populations (“judgmentally observing”). The “high mindfulness” subgroup scored best, the “very low mindfulness” worst, and the other subgroups intermediate on mental health in terms of depressive symptoms, worry, overall functional impairment, and self-compassion. Mindfulness profiles were not predictive of MBCT-induced changes in mental health. Conclusions Mindfulness profiles were differentially related to mental health, but were not predictive of treatment outcome. Future research would benefit from longitudinal assessment of latent mindfulness profiles to examine whether a patient’s profile changes after MBCT and whether hypothesized change in profile would be related to treatment outcome. Preregistration This study was not preregistered.

Objectives Mindfulness-Based Cognitive Therapy (MBCT) reduces recurrence and current depressive symptoms in patients with major depressive disorder (MDD). To understand how and for whom MBCT works, a person-centered approach focusing on mindfulness profiles can be useful. Four mindfulness profiles, each associated differently with mental health outcomes, have previously been identified. So far, no studies have examined whether profiles change after MBCT and whether these changes are related to treatment outcome. Method Latent transition analysis (LTA) was performed on pre- and post-MBCT subscale scores of the Five Facet Mindfulness Questionnaire (FFMQ) in patients with current or remitted MDD ( n =500). LTA allowed the assessment of individual changes in mindfulness profile after MBCT and the relation between profile change and corresponding changes in measures of mental health, including depressive symptoms, overall functional impairment, worry, and self-compassion. Results LTA re-established the four profiles previously identified cross-sectionally: “Very low mindfulness” (VLM), “Non-judgmentally aware” (NJA), “Judgmentally observing” (JO), and “High mindfulness” (HM). For 71 out of 168 patients with VLM profiles changed to NJA and for another 30 to HM. For 49 out of the 129 patients with NJA and for 37 out of 141 patients with JO profiles changed to HM. All 61 patients starting with HM kept HM. In general, change was related to greater than average improvement in mental health, while no change in profile was related to less than average improvement in mental health (except for HM). Conclusions Our findings indicate that changes in mindfulness profile after MBCT was differentially related to clinical change. These results from a person-centered approach offer new avenues to further elucidate the working mechanism of MBCT and improve its outcome. Preregistration This study was not preregistered.

BackgroundPreliminary evidence suggests that Mindfulness-Based Cognitive Therapy (MBCT) is a promising treatment for bipolar disorder (BD). A proposed working mechanism of MBCT in attenuating depressive symptoms is reducing depressive rumination. The primary aim of this study was to investigate the effect of MBCT on self-reported trait depressive rumination and an experimental state measure of negative intrusive thoughts in BD patients. Exploratively, we investigated the effect of MBCT on positive rumination and positive intrusive thoughts.MethodsThe study population consisted of a subsample of bipolar type I or II patients participating in a multicenter randomized controlled trial comparing MBCT + treatment as usual (TAU) (N = 25) to TAU alone (N = 24). Trait depressive rumination (RRS brooding subscale) and intrusive thoughts (breathing focus task (BFT)) were assessed at baseline (full subsample) and post-treatment (MBCT + TAU; n = 15, TAU; n = 15). During the BFT, participants were asked to report negative, positive and neutral intrusive thoughts while focusing on their breathing.ResultsCompared to TAU alone, MBCT + TAU resulted in a significant pre- to post-treatment reduction of trait depressive rumination (R2 = .16, F(1, 27) = 5.15, p = 0.031; medium effect size (f2 = 0.19)) and negative intrusive thoughts on the BFT (R2 = .15, F(1, 28) = 4.88, p = 0.036; medium effect size (f2 = 0.17)). MBCT did not significantly change positive rumination or positive intrusive thoughts.ConclusionsMBCT might be a helpful additional intervention to reduce depressive rumination in BD which might reduce risk of depressive relapse or recurrence. Considering the preliminary nature of our findings, future research should replicate our findings and explore whether this reduction in rumination following MBCT indeed mediates a reduction in depressive symptoms and relapse or recurrence in BD.

Objectives In recent years, there has been a growing interest in the assessment of mindfulness skills. The present study describes the validation of the Dutch Comprehensive Inventory of Mindfulness Experiences (CHIME) and the development of a short form. Methods The original scale was translated into Dutch. The psychometric properties of the CHIME were examined, including its factor structure, internal consistency, and convergent and discriminant validity in a group of 481 participants consisting of clinical and non-clinical samples. In addition, a 24-item short form (CHIME-SF) was developed and its psychometric properties were assessed in the same sample. Results Confirmatory factor analyses showed an acceptable model fit of an 8-factor structure of the CHIME with the following subscales: awareness of internal experiences, awareness of external experiences, acting with awareness, accepting and non-judgmental attitude, nonreactive decentering, openness to experiences, awareness of thought’s relativity, and insightful understanding ( χ 2  = 1534.90, df = 601, χ 2 / df = 2.55, CFI = 0.90, RMSEA = 0.057 [90% CI 0.053, 0.060], SRMR = 0.06). The CHIME-SF showed a good model fit ( χ 2  = 486.13, df = 224, χ 2 /df = 0.17, CFI = 0.95, RMSEA = 0.049 [90% CI 0.043, 0.055], SRMR = 0.05.) and the subscales of the CHIME and CHIME-SF showed high corrected correlations ( r c  = .69–.88). The CHIME and the CHIME-SF proved to be sensitive to change. Conclusions The results indicate that the Dutch version of the CHIME and CHIME-SF are valid instruments to assess mindfulness skills in clinical and non-clinical populations. The psychometric properties of the CHIME-SF should be further evaluated in an independent sample.

Background Major depression is a common psychiatric disorder, frequently taking a chronic course. Despite provision of evidence-based treatments, including antidepressant medication and psychological treatments like cognitive behavioral therapy or interpersonal therapy, a substantial amount of patients do not recover. Mindfulness-Based Cognitive Therapy (MBCT) has been found to be effective in reducing relapse in recurrent depression, as well as lowering symptom levels in acute depression. The effectiveness of MBCT for chronic, treatment-resistant depression has only be studied in a few pilot trials. A large randomized controlled trial is necessary to examine the effectiveness of MBCT in reducing depressive symptoms in chronic, treatment-resistant depression. Methods/Design A randomized-controlled trial is conducted to compare MBCT with treatment-as-usual (TAU). Patients with chronic, treatment-resistant depression who have received antidepressant medication and cognitive behavioral therapy or interpersonal therapy are included. Assessments take place at baseline and post intervention/TAU-period. The primary outcome are depressive symptoms. Secondary outcomes are: remission rates, quality of life, rumination, mindfulness skills and self-compassion. Patients in the TAU condition are offered to participate in the MBCT after the post TAU-period assessment. From all completers of the MBCT (MBCT condition and patients participating after the TAU-period), follow-up assessments are taken at three and six months after the completion of the MBCT. Discussion This trial will result in valuable information about the effectiveness of MBCT in chronic, treatment-resistant depressed patients who previously received antidepressant medication and psychological treatment. Trial registration trialregister.nl NTR4843 , registered 14 th October 2014.

Major depression is a common psychiatric disorder, frequently taking a chronic course. Despite provision of evidence-based treatments, including antidepressant medication and psychological treatments like cognitive behavioral therapy or interpersonal therapy, a substantial amount of patients do not recover. Mindfulness-Based Cognitive Therapy (MBCT) has been found to be effective in reducing relapse in recurrent depression, as well as lowering symptom levels in acute depression. The effectiveness of MBCT for chronic, treatment-resistant depression has only be studied in a few pilot trials. A large randomized controlled trial is necessary to examine the effectiveness of MBCT in reducing depressive symptoms in chronic, treatment-resistant depression. A randomized-controlled trial is conducted to compare MBCT with treatment-as-usual (TAU). Patients with chronic, treatment-resistant depression who have received antidepressant medication and cognitive behavioral therapy or interpersonal therapy are included. Assessments take place at baseline and post intervention/TAU-period. The primary outcome are depressive symptoms. Secondary outcomes are: remission rates, quality of life, rumination, mindfulness skills and self-compassion. Patients in the TAU condition are offered to participate in the MBCT after the post TAU-period assessment. From all completers of the MBCT (MBCT condition and patients participating after the TAU-period), follow-up assessments are taken at three and six months after the completion of the MBCT. This trial will result in valuable information about the effectiveness of MBCT in chronic, treatment-resistant depressed patients who previously received antidepressant medication and psychological treatment.