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Clinical Trial Details — Status: Recruiting

Administrative data

NCT number NCT05347719
Other study ID # Pro00092709
Secondary ID
Status Recruiting
Phase N/A
First received
Last updated
Start date September 1, 2022
Est. completion date June 1, 2024

Study information

Verified date August 2023
Source Clemson University
Contact Lu Shi, Ph.D.
Phone 864-656-0495
Email lus@clemson.edu
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

Mindfulness Based Cognitive Therapy (MBCT) has shown to be an effective method of preventing relapse of an episode Major Depressive Disorder (MDD). MBCT is a group program that integrates mindfulness skills training with cognitive-behavioral strategies. However, the cost of MBCT is not affordable to many families. The aim of this study is to explore the feasibility and efficacy of an MBCT intervention designed to be delivered at low cost through a virtual delivery format. This study will recruit 240 participants who are in remission from depression and randomize them to an MBCT intervention group or treatment as usual (TAU) for the wait list control group. The wait list control group will complete the intervention after the MBCT intervention group. Assessment administered at pre-intervention (baseline), post-intervention for experimental group, and post-intervention for the wait list control group and follow-up for experimental group. The primary outcome is to test the efficacy of this community-based delivery in reducing depression severity and psychiatric distress in the relapse of an episode of MDD. The secondary outcomes include perceived stress, post-traumatic stress symptoms, adherence to treatment plans not given as part of this study, frequency of relapse of MDD, mindfulness skills, and quality of life. This study will also examine the following potential moderators and correlates of intervention outcomes: comorbid diagnoses, life events history, and MBCT intervention adherence. Finally, the study will examine the following mediators of intervention outcome: mindfulness skills, emotion regulation skills, executive functioning skills, savoring, and positive and negative affect.


Description:

Mindfulness Based Cognitive Therapy (MBCT) has shown to be an effective method of preventing relapse of an episode Major Depressive Disorder (MDD). MBCT is a group program that integrates mindfulness skills training with cognitive-behavioral strategies. However, the cost of MBCT is not affordable to many families. The aim of this study is to explore the feasibility and efficacy of an MBCT intervention designed to be delivered at low cost through a virtual delivery format. The study will recruit 240 participants who are in remission from depression and randomize them to an MBCT intervention group or treatment as usual (TAU) for the wait list control group. The wait list control group will complete the intervention after the MBCT intervention group. Assessments will be administered at pre-intervention (baseline), post-intervention for experimental group (week 8), and post-intervention for the wait list control group and follow-up for experimental group (week 16). The primary outcome is to test the efficacy of this community-based delivery in reducing depression severity and psychiatric distress in the relapse of an episode of MDD. The secondary outcomes include perceived stress, post-traumatic stress symptoms, adherence to treatment plans not given as part of this study, frequency of relapse of MDD, mindfulness skills, and quality of life. This study will also examine the following potential moderators and correlates of intervention outcomes: comorbid diagnoses, life events history, and MBCT intervention adherence. Finally, this study will examine the following mediators of intervention outcome: mindfulness skills, emotion regulation skills, executive functioning skills, savoring, and positive and negative affect.


Recruitment information / eligibility

Status Recruiting
Enrollment 92
Est. completion date June 1, 2024
Est. primary completion date May 31, 2024
Accepts healthy volunteers Accepts Healthy Volunteers
Gender All
Age group 18 Years and older
Eligibility Inclusion Criteria: - be over 18 years of age - be a resident of upstate South Carolina or Prisma Health beneficiary - have a SCID confirmed diagnosis of a prior MDD episode - be willing to share contact information - have English literacy 6th grade or above - be able to attend intervention sessions. Exclusion Criteria: - current psychosis, dementia, moderate to severe traumatic brain injury, or active suicidality - persistent antisocial behavior - persistent self-injury requiring clinical management - an acute episode of a substance use disorder episode (met two or more SUD criteria in the past two weeks, excluding for tobacco or marijuana use) - an acute episode of MDD (met two or more MDD criteria in the past two weeks) - an active diagnosis of Bipolar Disorder - previously completed or currently attending a standard MBCT intervention

Study Design


Intervention

Behavioral:
MBCT Intervention
Eight weekly two-hour mindful MBCT intervention sessions involving training in mindfulness meditation and cognitive-behavioral methods. Sessions will be designed to increase participant awareness of internal reactions that trigger relapse in MDD and to provide participants with techniques to detach from dysfunctional cognitive processes and redirect their attention to experiences. Outside of the sessions, participants will be assigned daily homework exercises and provided with handouts and audio recordings of mindfulness exercises to use in their practice.

Locations

Country Name City State
United States Clemson University Clemson South Carolina
United States Prisma Health Greenville South Carolina

Sponsors (2)

Lead Sponsor Collaborator
Clemson University Prisma Health-Upstate

Country where clinical trial is conducted

United States, 

References & Publications (34)

Ames CS, Richardson J, Payne S, Smith P, Leigh E. Mindfulness-based cognitive therapy for depression in adolescents. Child Adolesc Ment Health. 2014 Feb;19(1):74-78. doi: 10.1111/camh.12034. Epub 2013 Aug 28. — View Citation

Baer RA, Smith GT, Lykins E, Button D, Krietemeyer J, Sauer S, Walsh E, Duggan D, Williams JM. Construct validity of the five facet mindfulness questionnaire in meditating and nonmeditating samples. Assessment. 2008 Sep;15(3):329-42. doi: 10.1177/1073191107313003. Epub 2008 Feb 29. — View Citation

Batink T, Peeters F, Geschwind N, van Os J, Wichers M. How does MBCT for depression work? studying cognitive and affective mediation pathways. PLoS One. 2013 Aug 23;8(8):e72778. doi: 10.1371/journal.pone.0072778. eCollection 2013. — View Citation

Bryan F. Savoring Beliefs Inventory (SBI): A scale for measuring beliefs about savouring. Journal of Mental Health. 2003; 12(2):175-196.

Cazanescu, DG, Tecuta, L, Cândea, DM, & Szentagotai-Tatar, A. Savoring as mediator between irrational beliefs, depression, and joy. Journal of Rational-Emotive & Cognitive-Behavior Therapy. 2019; 37(1): 84-95.

Chawla N, Collin S, Bowen S, Hsu S, Grow J, Douglass A, Marlatt GA. The mindfulness-based relapse prevention adherence and competence scale: development, interrater reliability, and validity. Psychother Res. 2010 Jul;20(4):388-97. doi: 10.1080/10503300903544257. — View Citation

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Gross, J. J., & Thompson, R. A. (2006). Emotion regulation: Conceptual foundations. Handbook of emotion regulation.

Hanson HM, Salmoni AW. Stakeholders' perceptions of programme sustainability: findings from a community-based fall prevention programme. Public Health. 2011 Aug;125(8):525-32. doi: 10.1016/j.puhe.2011.03.003. Epub 2011 Jul 29. — View Citation

IsHak WW, Greenberg JM, Balayan K, Kapitanski N, Jeffrey J, Fathy H, Fakhry H, Rapaport MH. Quality of life: the ultimate outcome measure of interventions in major depressive disorder. Harv Rev Psychiatry. 2011 Sep-Oct;19(5):229-39. doi: 10.3109/10673229.2011.614099. — View Citation

Joormann J, Stanton CH. Examining emotion regulation in depression: A review and future directions. Behav Res Ther. 2016 Nov;86:35-49. doi: 10.1016/j.brat.2016.07.007. Epub 2016 Jul 28. — View Citation

Kaufman EA, Xia M, Fosco G, Yaptangco M, Skidmore CR, Crowell, SE. The Difficulties in Emotion Regulation Scale Short Form (DERS-SF): Validation and replication in adolescent and adult samples. Journal of Psychopathology and Behavioral Assessment. 2016; 38(3), 443-455.

Kessing LV, Hansen MG, Andersen PK, Angst J. The predictive effect of episodes on the risk of recurrence in depressive and bipolar disorders - a life-long perspective. Acta Psychiatr Scand. 2004 May;109(5):339-44. doi: 10.1046/j.1600-0447.2003.00266.x. — View Citation

Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005 Jun;62(6):593-602. doi: 10.1001/archpsyc.62.6.593. Erratum In: Arch Gen Psychiatry. 2005 Jul;62(7):768. Merikangas, Kathleen R [added]. — View Citation

Kripalani S, Risser J, Gatti ME, Jacobson TA. Development and evaluation of the Adherence to Refills and Medications Scale (ARMS) among low-literacy patients with chronic disease. Value Health. 2009 Jan-Feb;12(1):118-23. doi: 10.1111/j.1524-4733.2008.00400.x. — View Citation

Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001 Sep;16(9):606-13. doi: 10.1046/j.1525-1497.2001.016009606.x. — View Citation

Kuyken W, Watkins E, Holden E, White K, Taylor RS, Byford S, Evans A, Radford S, Teasdale JD, Dalgleish T. How does mindfulness-based cognitive therapy work? Behav Res Ther. 2010 Nov;48(11):1105-12. doi: 10.1016/j.brat.2010.08.003. Epub 2010 Aug 13. — View Citation

Lengacher CA, Kip KE, Reich RR, Craig BM, Mogos M, Ramesar S, Paterson CL, Farias JR, Pracht E. A Cost-Effective Mindfulness Stress Reduction Program: A Randomized Control Trial for Breast Cancer Survivors. Nurs Econ. 2015 Jul-Aug;33(4):210-8, 232. — View Citation

Lorant V, Croux C, Weich S, Deliege D, Mackenbach J, Ansseau M. Depression and socio-economic risk factors: 7-year longitudinal population study. Br J Psychiatry. 2007 Apr;190:293-8. doi: 10.1192/bjp.bp.105.020040. — View Citation

Ma SH, Teasdale JD. Mindfulness-based cognitive therapy for depression: replication and exploration of differential relapse prevention effects. J Consult Clin Psychol. 2004 Feb;72(1):31-40. doi: 10.1037/0022-006X.72.1.31. — View Citation

MacKenzie MB, Kocovski NL. Mindfulness-based cognitive therapy for depression: trends and developments. Psychol Res Behav Manag. 2016 May 19;9:125-32. doi: 10.2147/PRBM.S63949. eCollection 2016. — View Citation

Mason O, Hargreaves I. A qualitative study of mindfulness-based cognitive therapy for depression. Br J Med Psychol. 2001 Jun;74(Pt 2):197-212. — View Citation

Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006 Nov;3(11):e442. doi: 10.1371/journal.pmed.0030442. — View Citation

Michalak J, Holz A, Teismann T. Rumination as a predictor of relapse in mindfulness-based cognitive therapy for depression. Psychol Psychother. 2011 Jun;84(2):230-6. doi: 10.1348/147608310X520166. Epub 2011 Apr 13. — View Citation

Mueller TI, Leon AC, Keller MB, Solomon DA, Endicott J, Coryell W, Warshaw M, Maser JD. Recurrence after recovery from major depressive disorder during 15 years of observational follow-up. Am J Psychiatry. 1999 Jul;156(7):1000-6. doi: 10.1176/ajp.156.7.1000. — View Citation

Piet J, Hougaard E. The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: a systematic review and meta-analysis. Clin Psychol Rev. 2011 Aug;31(6):1032-40. doi: 10.1016/j.cpr.2011.05.002. Epub 2011 May 15. — View Citation

Ruggiero KJ, Del Ben K, Scotti JR, Rabalais AE. Psychometric properties of the PTSD Checklist-Civilian Version. J Trauma Stress. 2003 Oct;16(5):495-502. doi: 10.1023/A:1025714729117. — View Citation

Segal ZV, Williams M, & Teasdale J. (2018). Mindfulness-based cognitive therapy for depression. Guilford Publications.

Sharplin GR, Jones SB, Hancock B, Knott VE, Bowden JA, Whitford HS. Mindfulness-based cognitive therapy: an efficacious community-based group intervention for depression and anxiety in a sample of cancer patients. Med J Aust. 2010 Sep 6;193(S5):S79-82. doi: 10.5694/j.1326-5377.2010.tb03934.x. — View Citation

Stirman SW, Miller CJ, Toder K, Calloway A. Development of a framework and coding system for modifications and adaptations of evidence-based interventions. Implement Sci. 2013 Jun 10;8:65. doi: 10.1186/1748-5908-8-65. — View Citation

Warttig SL, Forshaw MJ, South J, White AK. New, normative, English-sample data for the Short Form Perceived Stress Scale (PSS-4). J Health Psychol. 2013 Dec;18(12):1617-28. doi: 10.1177/1359105313508346. Epub 2013 Oct 22. — View Citation

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* Note: There are 34 references in allClick here to view all references

Outcome

Type Measure Description Time frame Safety issue
Other Change in Emotion regulation Emotion regulation will be assessed with the Difficulties in Emotion Regulation Scale-Short Form (Kaufman et al., 2016), an 18-item measure used to identify emotional regulation issues in adults. Higher values reflect greater difficulty with emotion regulation Baseline, 8 weeks (post-intervention for experimental group), 16 weeks (follow-up for experimental group, post-intervention for control group)
Other Change in Savoring The Savoring Beliefs Inventory (Bryant, 2003) is a 24-item questionnaire consisting of three subscales: anticipating, savoring the moment, and reminiscing. Half of the items are positively formulated, while the other half are negatively framed. Each item is rated on a 7-point Likert scale ranging from "strongly disagree" to "strongly agree." Higher scores indicate higher levels of savoring. Baseline, 8 weeks (post-intervention for experimental group), 16 weeks (follow-up for experimental group, post-intervention for control group)
Other Intervention fidelity Intervention fidelity will be assessed with the Mindfulness-Based Relapse Prevention Adherence and Competence Scale (MBRP-AC; Chawla et al., 2010). All sessions will be audio recorded. Two members of the research team will rate 50% of a random selection of sessions using the MBRP-AC. Raters will code at least 10 practice sessions, which will be reviewed with the research team until acceptable reliability is achieved, and they will attend regular recalibration meetings to prevent drift. Group facilitators will also meet weekly with the licensed clinical psychologist, a member of the research team, for supervision. Intervention fidelity will be assessed over the course of 8 weeks for each intervention group cohort.
Primary Change in Depression Severity Depression severity will be assessed with the Patient Health Questionnaire (PHQ-9; Kroenke, Spitzer & Williams 2001). PHQ-9 scores of 5, 10, 15, and 20 represents mild, moderate, moderately severe, and severe depression. Baseline, 8 weeks (post-intervention for experimental group), 16 weeks (follow-up for experimental group, post-intervention for control group)
Primary Change in Psychiatric Distress Psychiatric distress will be measured using the depression and anxiety subscales of the Brief Symptom Inventory (BSI; Derogatis & Melisaratos,1983). Items, such as "your feelings being easily hurt," are ranked on a 5-point scale ranging from 0 (not at all) to 4 (extremely). Higher scores represent higher intensity of distress during the past week. Baseline, 8 weeks (post-intervention for experimental group), 16 weeks (follow-up for experimental group, post-intervention for control group)
Secondary Change in Perceived stress Perceived stress will be assessed with the Perceived Stress Scale-4 (Warting et al., 2013). The questions in this scale ask you about your feelings and thoughts related to stress during the last month, with 0 representing "seldom" and 4 representing "very often." Higher scores are correlated to more stress. Baseline, 8 weeks (post-intervention for experimental group), 16 weeks (follow-up for experimental group, post-intervention for control group)
Secondary Change in Posttraumatic stress The PTSD CheckList - Civilian Version (PCL-C) will be used to assess PTSD symptoms (Ruggiero et al., 2003). The PCL is a self-report scale for PTSD comprising 17 items that correspond to the key symptoms of PTSD. Respondents indicate how much they have been bothered by a symptom over the past month using a 5-point (1-5) scale, with high scores characterize higher intensity of PTSD. Baseline, 8 weeks (post-intervention for experimental group), 16 weeks (follow-up for experimental group, post-intervention for control group)
Secondary Change in Adherence to Medication Assisted Treatment (MAT) Adherence to other medical treatments not given as part of this study will be assessed with the Adherence to Refills and Medications Scale (ARMS; Kripalani et al., 2009). The ARMS scale is a 12 item scale that measures adherence to medications. Baseline, 8 weeks (post-intervention for experimental group), 16 weeks (follow-up for experimental group, post-intervention for control group)
Secondary Change in Mindfulness skills FFMQ-15: 15-item Five-Facet Mindfulness Questionnaire https://www.sussexpartnership.nhs.uk/sites/default/files/documents/jenny_gus_short_ffmq-15_june_16.pdf. The FFMQ-15 measures 5 subscales of mindfulness: Observing, Describing, Acting with Awareness, Non-judgement, Non-reactivity; Scores range from 15 to 75, with higher scores indicating higher levels of mindfulness skills. Baseline, 8 weeks (post-intervention for experimental group), 16 weeks (follow-up for experimental group, post-intervention for control group)
Secondary Change in Perceived Quality of Life (health, well-being) Quality of life will be assessed with the World Health Organization Quality of Life (WHOQOL-BREF; World Health Organization, 2004). The 26-item scale assesses quality of life, health, and other areas of wellbeing. Items are measured on a five-point scale. Higher scores represent higher quality of life. Baseline, 8 weeks (post-intervention for experimental group), 16 weeks (follow-up for experimental group, post-intervention for control group)
Secondary Change in Extent of mindfulness self-practice Participants will be asked the following questions: "Besides the sessions you may have attended as part of this study, on your own, 'Did you engage in mindfulness meditation or other mindfulness practices in the past two months (8 weeks)?', 'How many days per week did you engage in mindfulness meditation or other mindfulness practices?', 'How long in minutes did you meditate per session of mindfulness meditation?', 'Describe your practice of mindfulness (what exercises/activities/techniques did you practice?).'" For quantitative analyses, we will use the variable representing number of days of mindfulness practice per week. We will also assess the number of sessions attended, number of non-completers, and reasons for dropout. Baseline, 8 weeks (post-intervention for experimental group), 16 weeks (follow-up for experimental group, post-intervention for control group)
Secondary Change in Frequency of major depressive disorder relapse episodes The number of Major depressive relapse episodes will be identified using the ICD-10 codes for MDD in the DSM-5 (First, 2014). Baseline, 8 weeks (post-intervention for experimental group), 16 weeks (follow-up for experimental group, post-intervention for control group)
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