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Practice of therapy acquired regulatory skills and depressive relapse/recurrence prophylaxis following cognitive therapy or mindfulness based cognitive therapy.

Journal of consulting and clinical psychology
February 1, 2019
Zindel V Segal et al. (8 authors)
Journal ArticleRandomized Controlled TrialHuman StudyClinical
Study Details

Study Goal

The researchers aimed to determine whether the use of therapy-acquired regulatory skills, particularly decentering and distress tolerance, could prevent depressive relapse/recurrence in remitted depressed outpatients.

Results Summary

The study found that posttreatment growth in decentering (DC) and distress tolerance (DT) was associated with a reduced risk of depressive relapse/recurrence over 24 months, while residual symptoms (RS) showed no significant change. Continued practice of regulatory skills indirectly reduced relapse risk by strengthening DC.

Population

Remitted depressed outpatients (N = 166; 84 in cognitive therapy, 82 in mindfulness-based cognitive therapy).

Effective Dosage

8 weekly group sessions.

Duration

24-month follow-up after the 8-week intervention.

Interactions

None mentioned.

Extracted Claims (10)
InterventionDirectionEndpointPopulationDosageImpactClaim #
cognitive therapy (CT)
increase
decentering (DC)
remitted depressed outpatients
β = .177
posttreatment growth
#1
cognitive therapy (CT)
increase
distress tolerance (DT)
remitted depressed outpatients
β = .259
posttreatment growth
#2
cognitive therapy (CT)
no change
residual symptoms (RS)
remitted depressed outpatients
β = -.017
no change
#3
mindfulness-based cognitive therapy (MBCT)
increase
decentering (DC)
remitted depressed outpatients
β = .177
posttreatment growth
#4
mindfulness-based cognitive therapy (MBCT)
increase
distress tolerance (DT)
remitted depressed outpatients
β = .259
posttreatment growth
#5
mindfulness-based cognitive therapy (MBCT)
no change
residual symptoms (RS)
remitted depressed outpatients
β = -.017
no change
#6
decentering (DC) slope
decrease
relapse/recurrence
remitted depressed outpatients
Hazard Ratio (HR) = .232
significant predictor of relapse/recurrence prophylaxis
#7
practice of therapy-acquired regulatory skills
no change
relapse/recurrence
remitted depressed outpatients
β = .028
had no direct effect
#8
practice of therapy-acquired regulatory skills
increase
decentering (DC)
remitted depressed outpatients
β = .462
promoted increases
#9
decentering (DC)
decrease
relapse/recurrence
remitted depressed outpatients
β = -.270
predicted a reduced risk
#10
Abstract

BACKGROUND: To investigate whether usage of treatment-acquired regulatory skills is associated with prevention of depressive relapse/recurrence. METHOD: Remitted depressed outpatients entered a 24-month clinical follow up after either 8 weekly group sessions of cognitive therapy (CT; N = 84) or mindfulness-based cognitive therapy (MBCT; N = 82). The primary outcome was symptom return meeting the criteria for major depression on Module A of the SCID. RESULTS: Factor analysis identified three latent factors (53% of the variance): decentering (DC), distress tolerance (DT), and residual symptoms (RS), which were equivalent across CT and MBCT. Latent change score modeling of factor slopes over the follow up revealed positive slopes for DC (β = .177), and for DT (β = .259), but not for RS (β = -.017), indicating posttreatment growth in DC and DT, but no change in RS. Cox regression indicated that DC slope was a significant predictor of relapse/recurrence prophylaxis, Hazard Ratio (HR) = .232 90% Confidence Interval (CI) [.067, .806], controlling for past depressive episodes, treatment group, and medication. The practice of therapy-acquired regulatory skills had no direct effect on relapse/recurrence (β = .028) but predicted relapse/recurrence through an indirect path (β = -.125), such that greater practice of regulatory skills following treatment promoted increases in DC (β = .462), which, in turn, predicted a reduced risk of relapse/recurrence over 24 months (β = -.270). CONCLUSIONS: Preventing major depressive disorder relapse/recurrence may depend upon developing DC in addition to managing residual symptoms. Following the acquisition of therapy skills during maintenance psychotherapies, DC is strengthened by continued skill utilization beyond treatment termination. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Medical Subject Headings (MeSH)
AdultCognitive Behavioral TherapyDepressive Disorder, MajorFemaleHumansMaleMiddle AgedMindfulnessRecurrenceSecondary PreventionTreatment Outcome
Study Links
Quality Scores
SafetyNot Assessed
Efficacy85/10
Quality90/10
Citation Metrics
Total Citations25
Citations/Year4.2
Relative Citation Ratio1.84
NIH Percentile71.9%
Research Impact Scores
APT Score0.75
Weight Score2.49
Normalized Score0.72
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