Neuroscience and psychology
Mindfulness-based cognitive therapy (MBCT) improves resistant depression
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Ainhoa Pérez
Alumni
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MPH, MSc.
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A new clinical trial shows that mindfulness-based cognitive therapy (MBCT) offers an effective alternative for people with resistant depression. In this article, we analyze the most relevant results of this study published in The Lancet Psychiatry.
CONCLUSION AND CLINICAL RELEVANCE This clinical trial provides evidence that MBCT may be an effective alternative for people with resistant depression, consistent with previous studies. Although the decrease in scores is considered small to moderate by the authors according to Cohen's classic criteria, it should be noted that it is greater than the effect observed with conventional treatments and even more significant in a study conducted with people with treatment-resistant depression who had undergone at least 12 previous sessions of intensive psychotherapy in the preceding months. However, in our opinion, comparative studies between MBCT and usual psychotherapy are more interesting for establishing meta-analytic differences between effects. To date, there are very few such studies, and, as expected, the effect shown is less consistent and smaller than in non-active comparisons (usual therapy, waiting list, etc.). Given the variability between the forms of both interventions and the difference in effect size that might be expected, a large number of studies would be necessary for a combined effect to emerge that would show a sufficiently robust pattern that could not be explained by heterogeneity. However, this study shows another interesting aspect for us: that the very fact of offering sequential treatment may be positive in itself. At the individual level, it is perfectly reasonable to expect that some people will respond better to some practices than to others, which may be completely different. When faced with a person with refractory depression, perhaps doing something different is more important than continuing to do the same thing.
PATHOPHYSIOLOGY AND MECHANISMS
Resistant depression is a condition that results from the interaction between psychological, contextual, and biological factors, generally existing in an inhibitory neurobiological pattern that produces states of withdrawal, significantly affecting psychological health and quality of life. Mindfulness-based cognitive therapy combines mindfulness practices and cognitive strategies to promote the ability to distance oneself from emotional experiences, acting at the metacognitive and experiential levels. Some neurophysiological studies suggest that mindfulness modulates brain networks involved in emotional regulation and rumination (such as the dorsolateral prefrontal cortex and the insula), promoting self-regulation. Metacognitive work reduces reactivity by promoting the breaking of dysfunctional patterns.STUDY
A randomized controlled trial (Barnhofer et al., 2025) evaluated the clinical efficacy and cost-effectiveness of mindfulness-based cognitive therapy (MBCT) versus usual treatment in 234 adults with major depression that did not remit after at least 12 sessions of intensive psychotherapy. Participants were randomly assigned to MBCT plus usual treatment for 8 weeks, or usual treatment alone (potential access to NHS resources and medication, but no other psychotherapy during the study). The intervention included 9 sessions led by accredited therapists. An initial individual session was followed by eight group sessions of approximately two hours, spread over one session per week for 8 weeks, which included mindfulness training, guided meditation, body awareness, and cognitive strategies for coping with difficult emotions, as well as recorded home practice. Post-treatment assessments were conducted at 10 weeks, and a follow-up assessment was conducted at 34 weeks to evaluate the persistence of the treatment effect using validated questionnaires. The primary outcome was change in depressive symptoms at 34 weeks, measured using the PHQ-9. Anxiety, functioning, well-being, mindfulness skills, healthcare costs, and quality-adjusted life years (QALYs) were also assessed.MAIN RESULTS
After the intervention, the group assigned to MBCT plus usual treatment showed a significantly greater reduction in depressive symptoms, as well as a higher proportion of clinical improvement and recovery compared to the control group. More interestingly, the effect was maintained at 34 weeks post-treatment (d=-0.41). In addition, improvements were observed on scales of anxiety and subjective well-being, among others. No relevant differences in efficacy were observed between subgroups defined by age, severity, or use of antidepressants. Economic analysis indicated that mindfulness-based cognitive therapy was more cost-effective than usual treatment, with the potential to reduce overall costs by decreasing the use of other services. Most participants attended at least four sessions, and no serious adverse events were reported, supporting its feasibility in an online group format.CONCLUSION AND CLINICAL RELEVANCE This clinical trial provides evidence that MBCT may be an effective alternative for people with resistant depression, consistent with previous studies. Although the decrease in scores is considered small to moderate by the authors according to Cohen's classic criteria, it should be noted that it is greater than the effect observed with conventional treatments and even more significant in a study conducted with people with treatment-resistant depression who had undergone at least 12 previous sessions of intensive psychotherapy in the preceding months. However, in our opinion, comparative studies between MBCT and usual psychotherapy are more interesting for establishing meta-analytic differences between effects. To date, there are very few such studies, and, as expected, the effect shown is less consistent and smaller than in non-active comparisons (usual therapy, waiting list, etc.). Given the variability between the forms of both interventions and the difference in effect size that might be expected, a large number of studies would be necessary for a combined effect to emerge that would show a sufficiently robust pattern that could not be explained by heterogeneity. However, this study shows another interesting aspect for us: that the very fact of offering sequential treatment may be positive in itself. At the individual level, it is perfectly reasonable to expect that some people will respond better to some practices than to others, which may be completely different. When faced with a person with refractory depression, perhaps doing something different is more important than continuing to do the same thing.
#psychotherapy #mindfulness #meditation #mindfulness-basedcognitivetherapy #MBCT #depression
References:
Barnhofer, T et al, 2025. Mindfulness-based cognitive therapy versus treatment as usual after non-remission with NHS Talking Therapies high-intensity psychological therapy for depression: a UK-based clinical effectiveness and cost-effectiveness randomised, controlled, superiority trial. The Lancet Psychiatry, 12(6), 433-446. https://doi.org/10.1016/S2215-0366(25)00105-1
* The news published on studies do not represent an official position of ICNS, nor a clinical recommendation.
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