A systematic review of mechanisms of change in mindfulness-based cognitive therapy in the treatment of recurrent major depressive disorder

Clin Psychol Rev. 2015 Apr:37:26-39. doi: 10.1016/j.cpr.2015.02.001. Epub 2015 Feb 11.


Background: The investigation of treatment mechanisms in randomized controlled trials has considerable clinical and theoretical relevance. Despite the empirical support for the effect of mindfulness-based cognitive therapy (MBCT) in the treatment of recurrent major depressive disorder (MDD), the specific mechanisms by which MBCT leads to therapeutic change remain unclear.

Objective: By means of a systematic review we evaluate how the field is progressing in its empirical investigation of mechanisms of change in MBCT for recurrent MDD.

Method: To identify relevant studies, a systematic search was conducted. Studies were coded and ranked for quality.

Results: The search produced 476 articles, of which 23 were included. In line with the theoretical premise, 12 studies found that alterations in mindfulness, rumination, worry, compassion, or meta-awareness were associated with, predicted or mediated MBCT's effect on treatment outcome. In addition, preliminary studies indicated that alterations in attention, memory specificity, self-discrepancy, emotional reactivity and momentary positive and negative affect might play a role in how MBCT exerts its clinical effects.

Conclusion: The results suggest that MBCT could work through some of the MBCT model's theoretically predicted mechanisms. However, there is a need for more rigorous designs that can assess greater levels of causal specificity.

Keywords: Depression; MBCT; Mediation; Mindfulness; Review; Treatment mechanisms.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Depressive Disorder, Major / psychology
  • Depressive Disorder, Major / therapy*
  • Humans
  • Mindfulness*
  • Recurrence
  • Treatment Outcome