Exploring the Efficacy of Mindfulness-Based Cognitive Therapy

The provided content discusses mindfulness-based treatment approaches and their applications. The articles explore the efficacy of mindfulness-based cognitive therapy (MBCT) in preventing depressive relapses, as well as its impact on real-life positive affective experiences. Additionally, it examines the role of genes in MBCT-induced change and the potential benefits of non-pharmacological interventions for adults with depression. Overall, the content highlights the importance of evidence-based practices and suggests that mindfulness-based approaches may be effective in reducing relapse rates and improving mental health outcomes.

Running head: PROGRAMME EVALUATION
Programme evaluation
Name of the Student
Name of the University
Author Note

1PROGRAMME EVALUATION
Executive summary
Depression is a mood disorder. It affects the capability of a person to think, act and respond to
his surroundings. Depression is one of the most common mental disorders and is increasing at an
alarming rate. The person becomes socially isolated and starts developing feeling of despair and
self harm. Children belonging to the age group of 9-12 years are vulnerable to such episodes of
depression. Most of these children do not have access to proper antidepressants and often show
non-compliance to treatment methods. This assignment aims to design a research proposal that
will utilize evidence based results on the effectiveness of mindfulness based cognitive therapy as
an intervention.

2PROGRAMME EVALUATION
Table of Contents
1. Introduction..............................................................................................................................3
2. Literature review......................................................................................................................4
3. Methodology............................................................................................................................8
a. Proposal................................................................................................................................8
b. Participants...........................................................................................................................8
c. Measures...............................................................................................................................8
d. Data collection......................................................................................................................9
4. Results......................................................................................................................................9
5. Conclusion..............................................................................................................................10
References......................................................................................................................................11
APPENDIX 1.................................................................................................................................15

3PROGRAMME EVALUATION
1. Introduction
The term depression describes discouraged or low mood patterns, which occur due to loss
(death of a close person) or disappointment. Unlike low moods that have a tendency to resolve
with time or improvement in circumstances, depression gets aggravated and triggered by social
and environmental factors (Balázs et al., 2013). They are accompanied with self loathing and
pervasive worthlessness feelings. Depression is not just restricted to adults. It is a common
psychiatric condition that manifests itself in children and gets continued to adulthood. Pediatric
depression is quite different from the normal blues and emotional disturbances that a child
complains of. If sadness, grief and indifferent nature become persistent in a child, it forces the
child to withdraw from school, family life, social activities and play. Up to 8% teenagers had met
the criteria for depression in the year 2012 (Kessler & Bromet, 2013). This assignment focuses
on using cognitive behavioral therapy as an intervention for pediatric depression.
Mindfulness-based cognitive therapy (MBCT) is a psychological approach developed for
people who are at risk for relapse in depression (Gu et al., 2015). This therapy helps them to
realize their wellness in the long-term. Mindfulness Based Stress Reduction Program that was
developed by Jon Kabat-Zinn, at the University of Massachusetts Medical Center laid the
foundation for MBCT. It was initially formulated to assist people who suffered from chronic
physical pain. It included meditation techniques and made the participants more aware of their
present experiences. To cure depressive relapse, MBCT employs several cognitive therapy
exercises and depression focused education (Baer, 2015). The children will be better understand
their altering mood patterns, recognize changes in their feelings and thoughts and avoid painful
thinking.

4PROGRAMME EVALUATION
This program evaluation will act as an appraisal that will use reliable and valuable methods
to examine the outcome of MBCT in treating pediatric depression.
2. Literature review
Evidence based practice is defined as integrating clinical expertise with best available
research evidence to improve the values and outcomes in patients. The lowest level of evidence
is based on the opinion of the practitioner or client, followed by case reports and cross sectional
studies. The PICO framework was used to search for clinically relevant evidence (Cooke, Smith
& Booth, 2012) (Appendix 1). For this literature review, different databases like MEDLINE,
SCOPUS and Cochrane Library were used. The peer reviewed journals, published in English that
contained details on the effectiveness of MBCT on children and adolescents suffering from
depression were included in the selection criteria. The journals with date of publishing not more
than 5 years from the current year were selected. Exclusion criteria contained non-English
journals, published abstracts, dissertations and those with publication date prior to 2012.
Research provides evidence that mindfulness training reduces stress and improves self
confidence, optimism, self esteem attention and interpersonal relationships. Mindfulness-based
cognitive therapy (MBCT) is regarded as evidence based intervention strategy that focuses on
psychotherapeutic methods (Crane et al., 2016). These cognitive behavioral methods are
integrated for treating patients who suffer from depression. The clinical application of
mindfulness involves meditation. (Segal, Williams & Teasdale, 2012). Several clinical guidelines
recommend as a type of prophylactic treatment for recurrent depression or MDD (major
depressive disorder). Results from several studies suggest that MBCT is a cost-effective
intervention strategy. The MBCT manual was first published in 2002 and has shown great

5PROGRAMME EVALUATION
implications in clinical effectiveness. Evidence from studies suggests that mindfulness enhances
cognitive and academic performances and improves holistic development of a depressed child.
According to Segal et al., (2013) MBCT Cognitive vulnerability to relapse and recurrence of
depression forms the basis of this intervention method. Research studies state that an increased
cognitive vulnerability to depressive recurrence and relapse is seen in patients who experience
severe major depression episodes. The increase in cognitive vulnerability is thought to occur as a
consequence of greater connectivity between depressogenic cognition and low mood during
these episodes. (Kuyken et al., 2015). MBCT targets this cognitive vulnerability. It has
successfully reduced the likelihood of any depressive episode configuration in becoming
reestablished. Research suggests that apart from meditation, the different mindfulness
approaches also include yoga, breathing exercises and body scan. Tai Chi is another approach
that focuses on mindfulness and has shown to increase the capacity for alertness and attention in
an individual. The therapeutic approaches that utilize yoga and Tai Chi combine movement with
focused attention on breathing patterns (Cramer et al., 2013). This gives rise to an outlet for
youth energy and may appeal to children and adolescent.
In a study (Bakker et al., 2014) conducted on 126 participants who reported recurrent MDD
and residual depressive symptoms, the positive effects of the therapy was measured.
Correlational analysis and RCT revealed that the genes OPRM1 and CHRM2 played a key role
in moderating the positive affect experience in MBCT group. The control group showed an
increase in the residual symptoms of depression and that was moderated by variations in the
DRD4 and BDNF genes. That deteriorated the effect of therapy. In another study, treatment as
usual (TAU) were compare dot that of MBCT on 130 adults suffering from residual depressive
symptoms. Worry (PSWQ), mindfulness (KIMS) and momentary negative and positive affect

6PROGRAMME EVALUATION
(ESM) were the main measures. Meditation analysis revealed that these measures mediated
MBCT efficacy. The effect of worry and anxiety on recurrent depressive symptoms was also
mediated by MNPA. 52 individuals were recruited in a study who complained of recurrent
MDD. An analysis of MBCT was performed. Following Trier Social Stress test, anxiety
regulation showed improvements and the effectiveness of MBCT on depression were partially
regulated (Britton et al., 2012). Depressive symptoms were shown to mediate the effects of
MBCT interventions on goal attainment likelihood. Goal specificity increase was associated with
a parallel increase in specificity of autobiographical memory. Depressed mood showed
reductions that were associated with an increase in goal likelihood. When the effectiveness of
non-intervention and MBCT were compared on 45 participants, a reduction in attention
facilitation for negative information was observed. Attention inhibition for positive information
was reduced. There was no change in facilitation of affective information in the control group
(De Raedt et al., 2012). MBCT showed a significant increase in positive emotion appraisal and
pleasantness activity. Momentary positive emotions received a boost on application of MBCT
therapy among 130 MDD patients. They began to engage in pleasant activities (Geschwind et al.,
2012).
On combined application of MBCT and TAU on 205 patients with recurrent depression, less
depressive symptoms appeared, mindfulness skills increased and rumination and worries showed
significant reduction (Van Aalderen et al., 2012). Mindfulness showed an increase in 71
individuals with recurrent MDD. MBCT therapy when compared to waitlist control, proved
effective in reducing ruminative thinking and depressive symptoms. However, attention
processes like orientation, alerting and executive attention did not show any significant
improvement (Van den Hurk et al., 2012). However, in a study conducted by Williams et al.,

7PROGRAMME EVALUATION
(2014), MBCT failed to show any significant improvements in 255 individuals suffering from
depression when compared to the control group. Only participants who had a history of
childhood trauma got protection against relapse of depression episodes. In a systematic review
based on meta-analysis, the effects of non-pharmacological intervention on preventing relapse of
depressive episodes were examined (Clarke et al., 2015). The review concluded that CBT,
MBCT and interpersonal psychotherapy were each found to be associated with drastic reduction
in relapse condition when compared to inactive and active controls for 12 months. However, it
concluded that the efficacy of MBCT may get restricted to respondents who recovered from
depression by use of several pharmacological means and by effects of nonspecific treatment. The
homogeneity of trials in the review was considered and it was concluded that majority of
participants showed better response to pharmacological treatments targeting depression. A meta-
analysis of 11 randomized controlled trials was conducted. Patients who reported of a history of
3 or more episodes of MDD were monitored for more than a year. The results showed that
MBCT was successful in reducing relapse rates in participants by more than 40% (Galante,
Iribarren, & Pearce, 2013).
When the evidences from several studies that illustrated the role of mindfulness based
cognitive therapy are taken together, the results suggest that MBCT is an intervention procedure
that is empirically supported and it reduces the risk of depression recurrence or relapse among
individuals. There must be trained practitioners who efficiently deliver the treatment. The
dissemination is often challenged by certain difficulties that arise while implementing the
program due to lack of sufficient MBCT practitioners.

8PROGRAMME EVALUATION
3. Methodology
a. Proposal
The research proposal aims to conduct a randomized clinical trial of MBCT in children. It
plans to train more than 4 experienced clinicians to conduct MBCT in the group following
proper protocol. Evidence based methods will be used to separate children who suffer from
anxiety and depression. The acceptability and feasibility of mindfulness based cognitive therapy
will be measured. Threats to internal validity like selection bias, confounding and regression
towards mean will be avoided by recruiting alike subjects in both the groups, negating the
existence of any third variable that affects our outcome and measuring the mean twice before the
intervention begins to remove effect of any extreme scores respectively.
b. Participants
English speaking children between ages 9-12, who are enrolled in some remedial programs
for depression in local community clinics will be invited for participation. Children who meet the
DSM-IV-TR diagnostic criteria will be enlisted (American Psychiatric Association, 2013).
Recruitment efforts will involve an initial mailing and phone calls to the respective parents of all
children who are eligible. Sample size should not be less than 40. Parents will be instructed to
sign the informed consent form showing their approval for the research study. Questionnaires
specific for the children and their parents were designed.
c. Measures
The enlisted children will be randomized into eight groups. Each of these groups will consist
of at least 5 children and 2 therapists. The interventions will be conducted at the schools they
attend. The intervention will be carried out for 12 weeks. Before the program is initiated, all

9PROGRAMME EVALUATION
children will be evaluated. Reevaluation will be carried out at the end of 6 months, following
completion of the intervention (Crane, 2017). If any children is undergoing medication
management, that will continue at the discretion of the concerned psychiatrist. Assessments will
be conducted in 3 waves. Time 1 will provide baseline measures for participants who enrolled in
immediate arm of the therapy. Time 2 will assess treatment effects in immediate arm and
baseline measures for delayed arm of the therapy. Time 3 will assess effects on delayed arm.
d. Data collection
Data from these 3 assessment phases will be combined and then analyzed in the form of a
single open clinical trial. Pre-test measures for all participants, that were taken before
participation in the therapeutic program will be compiled. The participant questionnaire will
evaluate the overall experience of the child regarding the program. The parent questionnaire will
be used to analyze their experience and perception of behavioral changes of their child. The post-
test measures will be similarly compiled. Sample t tests that are one-tailed dependent will be
conducted. This will help in evaluating the differences between the outcome variables of pre-test
and post-test results by using an alpha level of .10. The effect sizes will be calculated for
correlated samples.
4. Results
It is hypothesized that MBCT will act as a feasible implementation in clinically diagnosed
children aged 9-12, with depression. It will create high level of satisfaction and compliance to
treatment (Khoury et al., 2013). The clinical outcome measures are expected to display larger
reductions in MDD and will improve social-emotional functioning. MBCT will also lead to
larger scores on measures of attention in the participants.

10PROGRAMME EVALUATION
5. Conclusion
Nearly one in five children experience depressive symptoms that impair their life. Majority
of these children do not receive any treatment and their symptoms worsen over time. It leads to
chronic behavior problems and with increase in age the affected people become isolated and
develop suicidal thoughts. A time limited intervention therapy is required that will be conducted
in their schools and will have the potential to reach a greater number of children suffering from
MDD. Thus, this proposal seeks to investigate the effectiveness of MBCT on treating children
with depressive disorders.

11PROGRAMME EVALUATION
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(DSM-5®). American Psychiatric Pub. Baer, R. A. (Ed.). (2015). Mindfulness-based
treatment approaches: Clinician's guide to evidence base and applications. Academic
Press.
Bakker, J. M., Lieverse, R., Menne-Lothmann, C., Viechtbauer, W., Pishva, E., Kenis, G., ... &
Wichers, M. (2014). Therapygenetics in mindfulness-based cognitive therapy: do genes
have an impact on therapy-induced change in real-life positive affective
experiences?. Translational psychiatry, 4(4), e384.
Balázs, J., Miklósi, M., Keresztény, Á., Hoven, C. W., Carli, V., Wasserman, C., ... & Cotter, P.
(2013). Adolescent subthreshold‐depression and anxiety: Psychopathology, functional
impairment and increased suicide risk. Journal of child psychology and psychiatry, 54(6),
670-677.
Britton, W. B., Shahar, B., Szepsenwol, O., & Jacobs, W. J. (2012). Mindfulness-based cognitive
therapy improves emotional reactivity to social stress: results from a randomized
controlled trial. Behavior therapy, 43(2), 365-380.
Clarke, K., Mayo-Wilson, E., Kenny, J., & Pilling, S. (2015). Can non-pharmacological
interventions prevent relapse in adults who have recovered from depression? A
systematic review and meta-analysis of randomised controlled trials. Clinical psychology
review, 39, 58-70.

12PROGRAMME EVALUATION
Cooke, A., Smith, D., & Booth, A. (2012). Beyond PICO: the SPIDER tool for qualitative
evidence synthesis. Qualitative Health Research, 22(10), 1435-1443.
Cramer, H., Lauche, R., Langhorst, J., & Dobos, G. (2013). Yoga for depression: A systematic
review and meta‐analysis. Depression and anxiety, 30(11), 1068-1083.
Crane, C., Byford, S., Kuyken, W., Schweizer, S., Speckens, A., Hayes, R., ... & Williams, M.
(2016). Efficacy of Mindfulness-Based Cognitive Therapy in Prevention of Depressive
Relapse.
Crane, R. (2017). Mindfulness-based cognitive therapy: Distinctive features. Taylor & Francis.
De Raedt, R., Baert, S., Demeyer, I., Goeleven, E., Raes, A., Visser, A., ... & Speckens, A.
(2012). Changes in attentional processing of emotional information following
mindfulness-based cognitive therapy in people with a history of depression: Towards an
open attention for all emotional experiences. Cognitive therapy and research, 36(6), 612-
620.
Galante, J., Iribarren, S. J., & Pearce, P. F. (2013). Effects of mindfulness-based cognitive
therapy on mental disorders: a systematic review and meta-analysis of randomised
controlled trials. Journal of Research in Nursing, 18(2), 133-155.
Geschwind, N., Peeters, F., Huibers, M., van Os, J., & Wichers, M. (2012). Efficacy of
mindfulness-based cognitive therapy in relation to prior history of depression:
randomised controlled trial. The British Journal of Psychiatry, 201(4), 320-325.
Gu, J., Strauss, C., Bond, R., & Cavanagh, K. (2015). How do mindfulness-based cognitive
therapy and mindfulness-based stress reduction improve mental health and wellbeing? A

13PROGRAMME EVALUATION
systematic review and meta-analysis of mediation studies. Clinical psychology
review, 37, 1-12.
Kessler, R. C., & Bromet, E. J. (2013). The epidemiology of depression across cultures. Annual
review of public health, 34, 119-138.
Khoury, B., Lecomte, T., Fortin, G., Masse, M., Therien, P., Bouchard, V., ... & Hofmann, S. G.
(2013). Mindfulness-based therapy: a comprehensive meta-analysis. Clinical psychology
review, 33(6), 763-771.
Kuyken, W., Hayes, R., Barrett, B., Byng, R., Dalgleish, T., Kessler, D., ... & Causley, A.
(2015). Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy
compared with maintenance antidepressant treatment in the prevention of depressive
relapse or recurrence (PREVENT): a randomised controlled trial. The Lancet, 386(9988),
63-73.
Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2012). Mindfulness-based cognitive therapy
for depression. Guilford Press.
Van Aalderen, J. R., Donders, A. R. T., Giommi, F., Spinhoven, P., Barendregt, H. P., &
Speckens, A. E. M. (2012). The efficacy of mindfulness-based cognitive therapy in
recurrent depressed patients with and without a current depressive episode: a randomized
controlled trial. Psychological medicine, 42(5), 989-1001.
Van den Hurk, P. A. M., Van Aalderen, J. R., Giommi, F., Donders, R., Barendregt, H. P., &
Speckens, A. E. M. (2012). An investigation of the role of attention in mindfulness-bases
cognitive therapy for recurrently depressed patients.

14PROGRAMME EVALUATION
Williams, J. M. G., Crane, C., Barnhofer, T., Brennan, K., Duggan, D. S., Fennell, M. J., ... &
Shah, D. (2014). Mindfulness-based cognitive therapy for preventing relapse in recurrent
depression: a randomized dismantling trial. Journal of consulting and clinical
psychology, 82(2), 275.

15PROGRAMME EVALUATION
APPENDIX 1
P I C O
Population, Patient
or Problem
Intervention Comparison Outcome
Children, young,
adolescent,
depression, recurrent
MDD
Cognitive therapy,
Meta-analysis,
Mindfulness based
cognitive therapy,
meditation, yoga
Physical therapy only,
medication in
depression
Decrease relapse of
depression, avoid
depression, improve
mind skills