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Does mindfulness-based cognitive therapy with tapering support reduce risk of relapse/recurrence in major depressive disorder by enhancing positive affect? A secondary analysis of the PREVENT trial.
Journal of Consulting and Clinical Psychology ( IF 4.5 ) Pub Date : 2024-09-01 , DOI: 10.1037/ccp0000902
Barnaby D Dunn,Laura Warbrick,Rachel Hayes,Jesus Montero-Marin,Nigel Reed,Tim Dalgleish,Willem Kuyken
Journal of Consulting and Clinical Psychology ( IF 4.5 ) Pub Date : 2024-09-01 , DOI: 10.1037/ccp0000902
Barnaby D Dunn,Laura Warbrick,Rachel Hayes,Jesus Montero-Marin,Nigel Reed,Tim Dalgleish,Willem Kuyken
OBJECTIVE
Mindfulness-based cognitive therapy (MBCT) is a viable alternative to maintenance antidepressant medication (M-ADM) to reduce risk of relapse/recurrence (RR) in recurrent depression, but its mechanism of action is not yet fully articulated. This secondary analysis of the PREVENT trial examined if MBCT with support to taper medication (MBCT-TS) reduces risk of RR in part by enhancing positive affect (PA).
METHOD
In a single-blind, parallel, group randomized controlled trial, adults with ≥3 prior depressive episodes, but not currently in episode and who were taking M-ADM, were randomized to receive either MBCT-TS or ongoing maintenance M-ADM. The primary outcome was RR over 24-month follow-up. Levels of positive affect were assessed at intake and posttreatment. The original PREVENT trial was preregistered (ISRCTN 26666654), but this secondary analysis was not.
RESULTS
Four hundred and twenty-four individuals (predominantly female and of White British ethnicity) were recruited, with 212 randomized to each arm. MBCT-TS led to significantly greater PA relative to M-ADM at posttreatment assessment (Δ = 2.78, 95% CI [1.47, 4.08], p < .001). RR was experienced during follow-up by 194 individuals (100 M-ADM; 94 MBCT-TS). Greater intake PA predicted a reduced hazard of RR across treatments (p < .001; hazard ratio = .96, 95% CI [0.94, 0.98]). In individuals who had not relapsed by posttreatment with complete data (121 M-ADM; 145 MBCT-TS), greater increase in PA from intake to posttreatment mediated reduced risk of subsequent RR (p = .04).
CONCLUSIONS
These findings suggest that greater levels of PA predict reduced risk of RR and that MBCT-TS in part acts to protect from RR when withdrawing from M-ADM by increasing PA. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
中文翻译:
基于正念的认知疗法和逐渐减量支持是否通过增强积极情感来降低重度抑郁症的复发/复发风险?PREVENT 试验的二次分析。
目的 基于正念的认知疗法 (MBCT) 是维持抗抑郁药物 (M-ADM) 的可行替代方案,可降低复发性抑郁症的复发/复发 (RR) 风险,但其作用机制尚未完全阐明。这项对 PREVENT 试验的二次分析检查了 MBCT 联合支持减量药物 (MBCT-TS) 是否部分通过增强积极影响 (PA) 来降低 RR 的风险。方法 在一项单盲、平行、组随机对照试验中,既往抑郁发作 ≥3 次但目前未发作且正在服用 M-ADM 的成年人被随机分配接受 MBCT-TS 或持续维持 M-ADM。主要结局是 24 个月随访的 RR。在摄入和治疗后评估积极影响水平。最初的 PREVENT 试验是预先注册的 (ISRCTN 26666654),但这项二次分析不是。结果 招募了 424 人 (主要是女性和英国白人) ,每组 212 人随机分配。在治疗后评估中,相对于 M-ADM,MBCT-TS 导致 PA 显著更高 (Δ = 2.78, 95% CI [1.47, 4.08],p < .001)。194 例 (100 例 M-ADM;94 例 MBCT-TS) 在随访期间经历了 RR。较高的摄入量 PA 预测了不同治疗中 RR 的风险降低 (p < .001;风险比 = .96, 95% CI [0.94, 0.98])。在具有完整数据的治疗后未复发的个体 (121 M-ADM;145 MBCT-TS) 中,从摄入到治疗后 PA 的更大增加介导了后续 RR 的风险降低 (p = .04)。结论 这些发现表明,更高水平的 PA 预示着 RR 风险的降低,并且 MBCT-TS 在一定程度上通过增加 PA 来防止 RR 退出 M-ADM。 (PsycInfo 数据库记录 (c) 2024 APA,保留所有权利)。
更新日期:2024-09-01
中文翻译:
![](https://scdn.x-mol.com/jcss/images/paperTranslation.png)
基于正念的认知疗法和逐渐减量支持是否通过增强积极情感来降低重度抑郁症的复发/复发风险?PREVENT 试验的二次分析。
目的 基于正念的认知疗法 (MBCT) 是维持抗抑郁药物 (M-ADM) 的可行替代方案,可降低复发性抑郁症的复发/复发 (RR) 风险,但其作用机制尚未完全阐明。这项对 PREVENT 试验的二次分析检查了 MBCT 联合支持减量药物 (MBCT-TS) 是否部分通过增强积极影响 (PA) 来降低 RR 的风险。方法 在一项单盲、平行、组随机对照试验中,既往抑郁发作 ≥3 次但目前未发作且正在服用 M-ADM 的成年人被随机分配接受 MBCT-TS 或持续维持 M-ADM。主要结局是 24 个月随访的 RR。在摄入和治疗后评估积极影响水平。最初的 PREVENT 试验是预先注册的 (ISRCTN 26666654),但这项二次分析不是。结果 招募了 424 人 (主要是女性和英国白人) ,每组 212 人随机分配。在治疗后评估中,相对于 M-ADM,MBCT-TS 导致 PA 显著更高 (Δ = 2.78, 95% CI [1.47, 4.08],p < .001)。194 例 (100 例 M-ADM;94 例 MBCT-TS) 在随访期间经历了 RR。较高的摄入量 PA 预测了不同治疗中 RR 的风险降低 (p < .001;风险比 = .96, 95% CI [0.94, 0.98])。在具有完整数据的治疗后未复发的个体 (121 M-ADM;145 MBCT-TS) 中,从摄入到治疗后 PA 的更大增加介导了后续 RR 的风险降低 (p = .04)。结论 这些发现表明,更高水平的 PA 预示着 RR 风险的降低,并且 MBCT-TS 在一定程度上通过增加 PA 来防止 RR 退出 M-ADM。 (PsycInfo 数据库记录 (c) 2024 APA,保留所有权利)。