Mindfulness-Based Cognitive Therapy and the Prevention of Depressive Relapse: Measures, Mechanisms, and Mediators.

Mindfulness-basedapproaches toclinical interventionsare receiving increasing attention in psychiatric research.1 The article in this issueof JAMAPsychiatrybyKuykenet al2 is an importantmeta-analysis ofmindfulness-basedcognitive therapy (MBCT) in the prevention of depression relapse. This meta-analysiswasconducted at the individual patient level and included 9 randomized clinical trials, with data available for 1258 patients who participated in studies in which MBCT was comparedwith at least 1 non-MBCT treatment. The findings indicate that MBCT produced a reduced risk of depressive relapsewithina60-week follow-upperiodcomparedwith other active treatments.Mindfulness-based cognitive therapy wasmost effective for patientswith greater depressive severity before treatment. Scientific research onmindfulness and other related practices derived fromcontemplative traditions is enjoying a surge in interest.1,3 Theeffectofmindfulness-based interventionson basic biobehavioral processes, such as attention and emotion regulation,3 is being actively addressed in basic research, and thefindings fromthiscorpusofworksuggestsomepromisethat mindfulness-basedpracticesmaymodulatebothattentionand emotion. These processes are key targets in depressive relapse becausebothbiasedattentionandimpairments inemotionregulation are 2 core psychological processes that are implicated in vulnerability to depressive relapse.4 Mindfulness practices were not originally developed as therapeutic treatments.5 They emerged originally in contemplative traditions for thepurposesof cultivatingwell-beingand virtue. Thequestionsofwhether andhowtheymight behelpful inalleviatingsymptomsofdepressionandother relatedpsychopathologies are quite new, and the evidence base is in its embryonic stage.Tomyknowledge, thearticlebyKuykenetal2 is the most comprehensive meta-analysis to date to provide evidence for the effectiveness of MBCT in the prevention of depressive relapse.However, thearticle also raisesmanyquestions, and the limited nature of the extant evidence underscores the critical need for additional research. The remainder of this commentary will highlight the key questions and issues that represent immediate research needs.