Marleen J Ter Avest1, Elise Dusseldorp2, Marloes J Huijbers3, Joël R van Aalderen4, Mira B Cladder-Micus5, Philip Spinhoven6, Corina U Greven7, Anne E M Speckens8. 1. Center for Mindfulness, Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands. Electronic address: marleen.teravest@radboudumc.nl. 2. Methodology and Statistics, Institute of Psychology, Leiden University, Wassenaarseweg, 52, 2333 AK, Leiden, The Netherlands. Electronic address: elise.dusseldorp@fsw.leidenuniv.nl. 3. Center for Mindfulness, Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: marloes.huijbers@radboudumc.nl. 4. PsyQ Utrecht, Utrecht, The Netherlands. Electronic address: j.vanaalderen@psyq.nl. 5. Behavioural Science Institute, Radboud University, 6500 HE, Nijmegen, The Netherlands; Depression Expertise Centre, Pro Persona Mental Health Care, Reinier Postlaan 6, 6525 GC, Nijmegen, The Netherlands. Electronic address: m.cladder-micus@propersona.nl. 6. Faculty of Social and Behavioral Sciences, Institute of Psychology, Leiden University, Pieter de la Court Building, Wassenaarseweg, 52, 2333 AK, Leiden, The Netherlands; Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: spinhoven@fsw.leidenuniv.nl. 7. Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Nijmegen, The Netherlands; Karakter, Child and Adolescent Psychiatry, University Center, Nijmegen, The Netherlands; King's College London, Social, Genetic and Developmental Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, United Kingdom. Electronic address: c.greven@donders.ru.nl. 8. Center for Mindfulness, Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands. Electronic address: anne.speckens@radboudumc.nl.
Abstract
AIM: To identify moderators of treatment effect for Mindfulness-Based Cognitive Therapy (MBCT) versus Treatment As Usual (TAU) in depressed patients. METHODS: An individual patient data-analysis was performed on three randomized-controlled trials, investigating the effect of MBCT + TAU versus TAU alone (N = 292). Patients were either in (partial) remission, currently depressed or had chronic, treatment-resistant depression. Outcomes were depressive symptoms and quality of life. The QUalitative INteraction Trees (QUINT) method was used to identify subgroups that benefited more from either condition. RESULTS: MBCT + TAU outperformed TAU in reducing depressive symptoms. For both conditions, the effect of baseline depressive symptoms on post-treatment depressive symptoms was curvilinear. QUINT analyses revealed that MBCT + TAU was more beneficial than TAU for patients with an earlier onset and higher rumination levels in terms of depressive symptom reduction and for patients with a lower quality of life in terms of improving quality of life. CONCLUSIONS: The results suggest that MBCT might be more beneficial for those with earlier onset and higher levels of rumination and for patients with a lower quality of life. Sophisticated analytical techniques such as QUINT can be used in future research to improve personalized assignment of MBCT to patients. Long-term outcome could also be integrated in this.
AIM: To identify moderators of treatment effect for Mindfulness-Based Cognitive Therapy (MBCT) versus Treatment As Usual (TAU) in depressedpatients. METHODS: An individual patient data-analysis was performed on three randomized-controlled trials, investigating the effect of MBCT + TAU versus TAU alone (N = 292). Patients were either in (partial) remission, currently depressed or had chronic, treatment-resistant depression. Outcomes were depressive symptoms and quality of life. The QUalitative INteraction Trees (QUINT) method was used to identify subgroups that benefited more from either condition. RESULTS: MBCT + TAU outperformed TAU in reducing depressive symptoms. For both conditions, the effect of baseline depressive symptoms on post-treatment depressive symptoms was curvilinear. QUINT analyses revealed that MBCT + TAU was more beneficial than TAU for patients with an earlier onset and higher rumination levels in terms of depressive symptom reduction and for patients with a lower quality of life in terms of improving quality of life. CONCLUSIONS: The results suggest that MBCT might be more beneficial for those with earlier onset and higher levels of rumination and for patients with a lower quality of life. Sophisticated analytical techniques such as QUINT can be used in future research to improve personalized assignment of MBCT to patients. Long-term outcome could also be integrated in this.