Mindfulness-based cognitive therapy does not worsen depression symptoms

Researchers from the University of Wisconsin–Madison's Center for Healthy Minds (CHM), along with UW–Madison Department of Educational Psychology and a multi-university team, have found no evidence that mindfulness-based cognitive therapy (MBCT) increased a risk of symptom worsening, in a meta-analysis published in JAMA Network Open. 

MBCT is a widely-adopted, evidence-based intervention, used to help people with recurring depression from relapsing. The program combines cognitive behavioral therapy with mindfulness practices like meditation. A seminal 2016 meta-analysis combining results from nine studies of MBCT supported it as a leading treatment for depression, which affects nearly 332 million people worldwide. The meta-analysis also played an important role in MBCT being adopted as a recommended treatment for depression relapse prevention. However, since that time, the safety of MBCT has been questioned, following limited studies that revealed patient-reported harm. Importantly, these studies did not include a control (a group that receives no treatment, in order to provide a basis of comparison in results). The lack of a control makes it difficult to account for symptom worsening directly related to MBCT. 

"Due to the pervasiveness of global depression, as well as the wide dissemination of MBCT across healthcare systems, it is crucial to investigate any possible risk factors. "The original meta-analysis has been very influential, so we hoped we might be able to collaborate with the original authors to investigate this follow-up question about symptom worsening that was not asked in the original study," says Simon Goldberg, core faculty at the Center for Healthy Minds and Associate Professor at UW–Madison's Department of Counseling Psychology. 

The team reevaluated the 2016 meta-analysis individual participant data (IDP) for symptom worsening following treatment, relative to control conditions. De-identified IDP were gathered from nine randomized controlled trials evaluating MBCT for the prevention of depression relapse in 1,258 adult patients. The data was analyzed to compare the odds of increased depressive symptoms post-treatment, compared with controls. Some studies in the meta-analysis included patients taking antidepressants in the control group. 

Results showed no evidence that MBCT increased odds of depressive symptom worsening relative to control conditions. In some secondary analyses, there was evidence that MBCT decreased risk of symptom worsening relative to other treatments, including antidepressants. Taken together, the results support the continued dissemination of MBCT as an evidence-based treatment for recurrent depression.

It is important to note that the included trials focused on individuals in partial or full remission from recurrent depression, so the results may not fully apply to those with acute depression or other clinical populations. "We hope that future randomized control trials will include a broader assessment of patient experiences, however, we are optimistic following these important findings that MBCT is both helpful and not harmful to the average patient," Goldberg says.