The contributions of focused attention and open monitoring in mindfulness-based cognitive therapy for affective disturbances: A 3-armed randomized dismantling trial.

Brendan Cullen,Willoughby B Britton,Nisha Kini,Julie Flahive,Hadley Rahrig,Jared R Lindahl,Kristina Eichel,Benjamin Hon Kei Yip

doi:10.1371/journal.pone.0244838

Brendan Cullen, Willoughby B Britton + Show 6 more

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https://doi.org/10.1371/journal.pone.0244838

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Abstract

ObjectiveMindfulness-based cognitive therapy (MBCT) includes a combination of focused attention (FA) and open monitoring (OM) meditation practices. The aim of this study was to assess both short- and long-term between- and within-group differences in affective disturbance among FA, OM and their combination (MBCT) in the context of a randomized controlled trial.MethodOne hundred and four participants with mild to severe depression and anxiety were randomized into one of three 8-week interventions: MBCT (n = 32), FA (n = 36) and OM (n = 36). Outcome measures included the Inventory of Depressive Symptomatology (IDS), and the Depression Anxiety Stress Scales (DASS). Mixed effects regression models were used to assess differential treatment effects during treatment, post-treatment (8 weeks) and long-term (20 weeks). The Reliable Change Index (RCI) was used to translate statistical findings into clinically meaningful improvements or deteriorations.ResultsAll treatments demonstrated medium to large improvements (ds = 0.42–1.65) for almost all outcomes. While all treatments were largely comparable in their effects at post-treatment (week 8), the treatments showed meaningful differences in rapidity of response and pattern of deteriorations. FA showed the fastest rate of improvement and the fewest deteriorations on stress, anxiety and depression during treatment, but a loss of treatment-related gains and lasting deteriorations in depression at week 20. OM showed the slowest rate of improvement and lost treatment-related gains for anxiety, resulting in higher anxiety in OM at week 20 than MBCT (d = 0.40) and FA (d = 0.36), though these differences did not reach statistical significance after correcting for multiple comparisons (p’s = .06). MBCT and OM showed deteriorations in stress, anxiety and depression at multiple timepoints during treatment, with lasting deteriorations in stress and depression. MBCT showed the most favorable pattern for long-term treatment of depression.ConclusionsFA, OM and MBCT show different patterns of response for different dimensions of affective disturbance.Trial registrationThis trial is registered at (v NCT01831362); www.clinicaltrials.gov.

Highlights

Mindfulness-based programs (MBPs) are a popular approach to addressing mild to severe emotional stress, depression and anxiety [1]
These foundational MBPs draw from Buddhist formulations of meditation practice, which typically begin with concentration or tranquility practices and are followed by “insight” practices
Baseline Depression Anxiety Stress Scales (DASS) anxiety scores were significantly higher in the open monitoring (OM) group (p = .04) this was accounted for by baseline-adjusted estimates for between-group comparisons resulting from the mixed effects ANCOVA models

Summary

Introduction

Mindfulness-based programs (MBPs) are a popular approach to addressing mild to severe emotional stress, depression and anxiety [1]. The two most common MBPs are mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT), which include under the broader umbrella term of “mindfulness” multiple meditation techniques that could be differentiated from one another in order to determine their isolated and aggregated effects [5]. These foundational MBPs draw from Buddhist formulations of meditation practice, which typically begin with concentration or tranquility practices and are followed by “insight” practices. FA and OM are the foundation of MBPs such as MBSR and MBCT, with both programs dedicating approximately half of treatment time to FA and the other half to OM [5,6,8]

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