Abstract
The aim of this study was to assess the feasibility, acceptability and preliminary effectiveness of Mindfulness-Based Compassionate Living (MBCL) as a follow-up intervention to Mindfulness Based Cognitive Therapy in adults with recurrent depression. We conducted an uncontrolled study in 17 patients with recurrent depression, in two successive groups. The first group contained novices to compassion training (N = 14); in the second group, ten of these participated again, in addition to three new participants (N = 13). The overall group contained 15 females and 2 males, aged between 37 and 71. The MBCL program was qualitatively evaluated using post-intervention focus group interviews in both groups. In addition, self-report questionnaires assessing depressive symptoms, worry and both self-compassion and mindfulness skills were administered before and after MBCL. No patients dropped out of the intervention. Average attendance was 7.52 (SD 0.73) out of eight sessions. Helpful elements were theory on the emotion regulation systems, practicing self-compassion explicitly and embodiment of a compassionate attitude by the teachers. Unhelpful elements were the lack of a clear structure, lack of time to practice compassion for self and the occurrence of the so-called back draft effect. We adapted the program in accordance with the feedback of the participants. Preliminary results showed a reduction in depressive symptoms in the second group, but not in the first group, and an increase in self-compassion in both groups. Worry and overall mindfulness did not change. MBCL appears to be feasible and acceptable for patients suffering from recurrent depressive symptoms who previously participated in MBCT. Selection bias may have been a factor as only experienced and motivated participants were used; this, however, suited our intention to co-create MBCL in close collaboration with knowledgeable users. Examination of the effectiveness of MBCL in a sufficiently powered randomised controlled trial is needed.
Highlights
Major depressive disorder (MDD) is one of the most prevalent psychiatric disorders
No reduction was found in worry, nor improvement in mindfulness skills overall
This might be explained by the fact that all participants already participated in an MBCT course before taking part in the compassion training
Summary
Major depressive disorder (MDD) is one of the most prevalent psychiatric disorders. It is characterized by high relapse rates (Mueller et al 1999; Solomon et al 2000), partly due to persistence of residual symptoms after remission (Hardeveld et al 2010). Given the increasing risk of relapse after each successive episode, prevention of relapse is as important as acute treatment (Hardeveld et al 2010). A meta-analysis (Kuyken et al 2016) showed that MBCT for patients with recurrent depression in remission resulted in a reduction of the risk of Mindfulness (2018) 9:412–422 a relapse/recurrence of 31%. A growing number of studies indicate that MBCT may be effective in decreasing current depression (Strauss et al 2014). Van Aalderen et al (2015) reported effectiveness of MBCT to be comparable in both remitted and currently depressed patients substantiating effectiveness and acceptability of MBCT as acute treatment of depression
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