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Key Studies That Inform Clinical Practice: Cognitive Behavioral and Mindfulness-Based Therapies

Key Studies That Inform Clinical Practice: Cognitive Behavioral and Mindfulness-Based Therapies

This month, we have selected 9 articles on cognitive behavioral and mindfulness-based treatments based on their clinical relevance and applicability, as well as their quality. Our goal is to help you stay up to date with the most current evidence-based information in the face of an overwhelming literature.

Brent DA, Brunwasser SM, Hollon SD, et al. Effect of a cognitive- behavioral prevention program on depression 6 years after implementation among at-risk adolescents: a randomized clinical trial. JAMA Psychiatry. 2015;72:1110-1118.

abstract available online
http://www.ncbi.nlm.nih.gov/pubmed/26421861

A family history of psychiatric disorders is an important component of history taking. It is now known that parents’ depression can increase the risk of depression in their children.

This randomized study evaluated the usefulness of a cognitive-behavioral prevention (CBP) program in reducing the incidence of depression in adolescents. The program held 90-minute group sessions once a week for 8 weeks, then once monthly for 6 months. CBP plus usual care (family-initiated mental health treatment) was compared with usual care alone.

The 316 participants were aged 13 to 17 years and had at least 1 parent with current or previous depressive episodes. The study included patients with so-called “subsyndromal” depressive symptoms or a previous depressive episode in remission, but it excluded those in a current depressive state. Follow-up was 75 months after the intervention. The Depression Symptoms Rating scale was used to evaluate the participants.

key findings: CBP is a promising intervention for the prevention of depression. Although participants received the most benefit from CBP in the early months of the study, at 75-month follow-up the incidence of depression was still lower among adolescents in the CBP group than among those who received usual care alone. Whether additional “booster” CBP sessions would provide further protection remains to be determined.

Kuyken W, Hayes R, Barrett B, et al. Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): a randomised controlled trial. Lancet. 2015;386: 63-73.

(free full article text available)
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)62222-4/fulltext [corrected link as of 9/13/2016]

Although maintenance antidepressant therapy is important to prevent recurrent depressive episodes, many patients may be interested in alternative treatments.

This study looked at whether mindfulness-based cognitive therapy with discontinuation of antidepressant treatment (MBCT-TS) was superior to maintenance antidepressant treatment. Participants were eligible if they had 3 or more previous major depressive episodes and were receiving therapeutic dosages of maintenance antidepressants. A total of 424 patients were enrolled: 212 were assigned to MBCT-TS and 212 received maintenance antidepressant therapy. The duration of this single-blind, parallel, randomized, controlled trial was 24 months. The participants were evaluated with the Structured Clinical Interview for DSM-IV (SCID), GRID-Hamilton Rating Scale for Depression, and 21-item self-report Beck Depression Inventory. Psychiatric comorbidity was assessed with the relevant SCID modules; medical comorbidities with the Medical Symptom Checklist; quality of life with the WHO Quality of Life instrument (WHOQOL-BREF); and health-related quality of life with the EQ-5D-3L.

clinical implications: In participants with a history of recurrent depressive episodes, MBCT-TS was not superior to maintenance antidepressant treatment in the prevention of relapse.

Both treatments did, however, seem to have a similar effect on participants’ quality of life and residual depressive symptoms, and they decreased relapse or recurrence. MBCT-TS can be further investigated as a potential alternative to pharmacotherapy for depression maintenance treatment.

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