Abstract
BackgroundOver the past two decades there has been a growing number of randomized clinical trials supporting the efficacy of mindfulness-based cognitive therapy (MBCT) in the treatment of several psychiatric disorders. Since evidence for its effectiveness in routine clinical practice is lagging behind, we aimed to examine adherence, outcome and predictors of MBCT in a well-characterized, heterogeneous outpatient population in routine clinical practice. MethodsData were collected from a naturalistic uncontrolled cohort of 998 patients formally diagnosed with mainly depression, anxiety disorders, personality disorders, somatoform disorders and/or ADHD. Patients received protocolized MBCT and completed self-report questionnaires pre- and post-treatment on overall functioning (Outcome Questionnaire, primary outcome), depressive symptoms, worry, mindfulness skills and self-compassion. Pre-to post-treatment changes were analysed for the overall sample and each diagnostic category separately with paired sample t-tests, reliable change indices (only overall sample) and repeated measures ANOVA for groups with and without comorbidity. Multiple linear regression was carried out to assess possible predictors of adherence and change in overall functioning. ResultsAdherence was high (94%) but negatively affected by lower levels of education, more comorbidity and presence of ADHD. Outcome in terms of improvement in overall functioning was good in the overall sample (Cohen's d = 0.50, 30% showed reliable improvement vs. 3.5% reliable deterioration) and within each diagnostic category (Cohen's d range = 0.37–0.61). Worse overall functioning at baseline was the only predictor for a larger treatment effect. ConclusionsAfter MBCT, overall functioning improved in a large heterogeneous psychiatric outpatient population independent of diagnosis or comorbidity.
Highlights
Mental health disorders are considered the leading cause of public health challenges in the World Health Organization (WHO) European Region, measured by prevalence, burden of disease and disability (World Health Organisation, 2015)
Addi tionally, we explored whether changes in overall functioning were associated with changes in potential mediators mindfulness skills, selfcompassion and worry
Overall functioning after mindfulness-based cognitive therapy (MBCT) was examined in routine clinical practice in a heterogeneous psychiatric outpatient population, consisting of patients diagnosed with depression in remission, current depression, anxiety disorders, personality disorders, somatoform disorders and/or ADHD, with 24.9% of patients having two or more psychiatric diagnoses
Summary
Mental health disorders are considered the leading cause of public health challenges in the World Health Organization (WHO) European Region, measured by prevalence, burden of disease and disability (World Health Organisation, 2015). Over the past two decades meta-analyses have revealed promising effects of mindfulness-based interventions (MBIs) across psychiatric disorders Over the past two decades there has been a growing number of randomized clinical trials supporting the efficacy of mindfulness-based cognitive therapy (MBCT) in the treatment of several psychiatric disorders. Since evidence for its effectiveness in routine clinical practice is lagging behind, we aimed to examine adherence, outcome and predictors of MBCT in a well-characterized, heterogeneous outpatient population in routine clinical practice. Patients received protocolized MBCT and completed self-report questionnaires pre- and post-treatment on overall func tioning (Outcome Questionnaire, primary outcome), depressive symptoms, worry, mindfulness skills and selfcompassion. Conclusions: After MBCT, overall functioning improved in a large heterogeneous psychiatric outpatient popula tion independent of diagnosis or comorbidity
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