A Study on Mindfulness-Based Cognitive Therapy and Cognitive Behavioral Therapy as a Combined Treatm

Task:

There are many therapies in psychology that are used to help clients with depression or depressive symptoms reach remission. Some concentrate on increasing adaptive behaviors while others focus on changing negative thought patterns. Mindfulness-Based Cognitive Therapy (MBCT) was originally used to prevent remission of depressive symptoms, but recent studies have shown its efficacy as a supplementary treatment for depression (Pots et al., 2014; Aalderen et al., 2011; Geschwind et al., 2012). MBCT, as a treatment, focuses on promoting positive mental health in the form of more objective thinking and psychological flexibility (Pots et al., 2014). For those who experience recurrent depression or depressive symptoms, rumination and the avoidance of emotion often maintain the disorder (Pots et al., 2014). In a nonjudgmental way, MBCT allows clients to engage with maladaptive thoughts in order to accept and regulate unpleasant emotions as they come and go (Pots et al., 2014). Using mindfulness and meditative strategies, clinicians teach clients to enhance positive emotionality and self-compassion while also regulating negative thought patterns (Pots et al., 2014).

Research Question: Previous studies have looked at the benefits of MBCT with treatment as usual, but have not looked at the effects of MBCT with particular types of therapy. The purpose of this experiment is to examine the combined effects of MBCT plus CBT for the treatment of depression. Will participants who receive MBCT and CBT show more improvement than those treated with CBT alone?

Study Hypothesis: Participants treated with the combined therapy (MBCT+CBT) will show significantly more improvement than those treated with CBT alone, and both groups will show increased improvement compared to no treatment.

Participants: The study plans to recruit 330 participants from a cluster of mental health practices in the South Bay Area. These participants would be referred by their clinician for the study with a diagnosis of mild to moderate depression. A leading clinician would interview all participants for inclusion and exclusion criteria. To be included in the study, the participants must be at least 18 and have a diagnosis of mild to moderate depression according to DSM-5 criteria. Further, they must receive scores between 13-28 on the Beck Depression Inventory (BDI) during their preliminary screening. Participants would be excluded from the study for any of the following: comorbid psychoses including bipolar disorder or mania; current suicidality or suicidal ideation; severe depression; dependence on alcohol or drugs; recent use or disuse of pharmacological drugs as treatment (within the last 3 months).

Method: A cluster sample of 330 participants would be randomly assigned to three groups: CBT+MBCT, CBT alone, and a waitlist control. Before starting treatment or the eight-week waiting period, each participant will complete a BDI and clinical interview to quantify their depressive symptoms and support their diagnosis of mild to moderate depression.
The CBT+MBCT group will participate in eight weeks of CBT and weekly MBCT group sessions that follow the original Segal et al. (2002) protocol. CBT will take place in one of five designated treatment facilities in the South Bay Area with a trained clinician. Sessions will be 50 minutes in length and individual, held once a week for a period of eight weeks. MBCT sessions will take place once a week in a group of 10-15 participants. Sessions will be an hour and a half in length, with daily homework requirements between sessions. A trained clinician with two or more years of experience of meditation will lead the group sessions. The CBT and MBCT clinicians will collaborate to offer the best possible treatment for each participant. After the eight-week treatment period, participants will again complete a BDI and clinical interview to reevaluate their depression and symptomatology.
The CBT group will participate in eight weeks of CBT with a trained clinician. These sessions will take place in one of five designated treatment facilities in the South Bay Area. Sessions will be 50 minutes in length, individualized and held once a week for a period of eight weeks. Length, duration, and process of CBT will be equal in both treatment groups. After the eight-week treatment period, participants in this group will complete another BDI and clinical interview to reassess their depression.
The waitlist control group will not participate in therapy for the eight-week treatment period. After the eight-week waiting period is over, they will complete another BDI and clinical interview to assess depression and depressive symptoms. They may then participate in their choice of CBT alone or MBCT+CBT for a period of eight weeks.
Following the eight-week treatment and waiting period, researchers will analyze the differences in the data between groups. Participants who dropped out of the study will be excluded in the final analysis, and results will be statistically controlled for.

Discussion: The study hopes to examine the combined therapeutic effects of MBCT and CBT as a course of treatment for adults with depression. Using the randomized, controlled trial design for this experiment ensures a high level of internal validity. Not only does the study use a waitlist control group, it also uses a CBT-only control to truly evaluate the effects of MBCT and CBT together. Therapeutic effects of CBT can be controlled for with the inclusion of the CBT alone control group. Maturation, history, and regression effects can be controlled for with use of the control conditions and the pretest/posttest design. Further, attrition rates can be statistically controlled for in the final analysis. Internal validity for the study is relatively high with few confounding variables like the differences between therapeutic settings or CBT and MBCT clinicians. The use of blindness is not possible in this study as clinicians and participants are aware of the condition that they are assigned to. Due to this, demand characteristics could do harm to the internal validity of the study.

External validity is moderate with use of random sampling. In this way, the sample should be able to generalize to the larger population of the South Bay Area. Unfortunately, it is hard to extend generalizability to larger areas of the state or country due to differing socioeconomic conditions and other demographic considerations. The Bay Area, and even the South Bay more specifically, is known for its population density and generally high cost of living. Therefore, the average Bay Area resident may have a higher SES, be of a particular ethnicity, hold a certain employment status, etc.

Construct validity is high with use of the reliable and valid Beck Depression Inventory. This is an excellent way to quantify depressive symptoms and measure improvement. The study, however, does rely on a clinical interview which lowers construct validity. It is imperative that diagnostic criteria between all clinicians be relatively equal to ensure that the study is treating what it intends to treat. Depressive diagnoses between clinicians could vary in severity and improvement of depression and depressive symptoms could be coded in different ways. Safeguards, like coding manuals, should be used to help prevent these differences, but there is no way to ensure that methods of diagnosis are completely identical between clinicians.

All in all, the study should help shed some light on the combined therapeutic effects of MBCT and CBT together as a course of treatment. However, further research is needed, perhaps on a larger scale, in other areas of the country and world to progress knowledge of this form of treatment for depression.