Feasibility and Acceptability of Mindfulness-Based Cognitive Therapy Compared with Mindfulness-Based Stress Reduction and Treatment as Usual in People with Depression and Cardiovascular Disorders: A three-arm Randomised Controlled Trial
Alsubaie, M; Dickens, C; Dunn, BD; et al.Gibson, A; Ukoumunne, OC; Evans, A; Vicary, R; Gandhi, M; Kuyken, W
Date: 21 July 2018
Article
Journal
Mindfulness
Publisher
Springer Verlag
Publisher DOI
Abstract
Depression co-occurs in 20 % of people with cardiovascular disorders, can persist for years, and
predicts worse physical health outcomes. While psychosocial treatments have been shown to treat acute
depression effectively in those with comorbid cardiovascular disorders, to date, there has been no evaluation of
approaches aiming to ...
Depression co-occurs in 20 % of people with cardiovascular disorders, can persist for years, and
predicts worse physical health outcomes. While psychosocial treatments have been shown to treat acute
depression effectively in those with comorbid cardiovascular disorders, to date, there has been no evaluation of
approaches aiming to prevent relapse and treat residual depression symptoms in this group. Consequently, the
current study aimed to examine the feasibility and acceptability of a randomised controlled trial design
evaluating an adapted version of mindfulness-based cognitive therapy (MBCT) designed specifically for people
with co-morbid depression and cardiovascular disorders. A 3-arm feasibility randomised controlled trial was
conducted, comparing MBCT adapted for people with cardiovascular disorders plus treatment as usual (TAU),
mindfulness-based stress reduction (MBSR) plus TAU, and TAU alone. Participants completed a set of selfreport
measures of depression severity, anxiety, quality of life, illness perceptions, mindfulness, self-compassion
and affect and had their blood pressure taken immediately before, after, and three months following the
intervention. Those in the adapted-MBCT arm additionally underwent a qualitative interview to gather their
views about the adapted intervention. 3,400 potentially eligible participants were approached when attending an
outpatient appointment at a cardiology clinic or via a GP letter following a case note search. 242 (7.1 %) were
interested in taking part, 59 (1.7 %) were screened as being suitable, and 33 (<1 %) were eventually randomised
to the three groups. Of 11 participants randomised to adapted MBCT, seven completed the full course, levels of
home mindfulness practice were high, and positive qualitative feedback about the intervention was given.
Twenty-nine out of 33 randomised participants completed all the assessment measures at all three-time points.
The means PHQ-9 scores for the MBCT-HeLM group were lower at post-intervention and at the three-month
follow-up compared to the MBSR and TAU groups. The sample was heterogeneous in terms of whether they
reported current depression or had a history of depression and the time since the onset of cardiovascular
disorders (one to 25 years). The adapted MBCT intervention was feasible and acceptable to participants,
however, certain aspects of the trial design were not. In particular, low recruitment rates were achieved and
there was a high withdrawal rate between screening and randomisation. Moreover, the heterogeneity in the
sample was high, meaning the adapted intervention was unlikely to be well tailored to all the participants needs.
This suggests that if the decision is made to move to a definitive trial, study recruitment procedures will need to
be revised to recruit a target sample that optimally matches the adapted intervention.
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