An open trial of mindfulness-based cognitive therapy for the prevention of perinatal depressive relapse/recurrence
- 2.1k Downloads
Pregnant women with histories of depression are at high risk of depressive relapse/recurrence during the perinatal period, and options for relapse/recurrence prevention are limited. Mindfulness-based cognitive therapy (MBCT) has strong evidence among general populations but has not been studied among at-risk pregnant women to prevent depression. We examined the feasibility, acceptability, and clinical outcomes of depression symptom severity and relapse/recurrence associated with MBCT adapted for perinatal women (MBCT-PD). Pregnant women with depression histories were recruited from obstetrics clinics in a large health maintenance organization at two sites and enrolled in MBCT-PD (N = 49). Self-reported depressive symptoms and interview-based assessments of depression relapse/recurrence status were measured at baseline, during MBCT-PD, and through 6-months postpartum. Pregnant women reported interest, engagement, and satisfaction with the program. Retention rates were high, as were rates of completion of daily homework practices. Intent to treat analyses indicated a significant improvement in depression symptom levels and an 18 % rate of relapse/recurrence through 6 months postpartum. MBCT-PD shows promise as an acceptable, feasible, and clinically beneficial brief psychosocial prevention option for pregnant women with histories of depression. Randomized controlled trials are needed to examine the efficacy of MBCT-PD for the prevention of depressive relapse/recurrence during pregnancy and postpartum.
KeywordsPregnancy Depression Prevention Mindfulness Cognitive behavioral therapy
We acknowledge funding by the National Institute of Mental Health (R34MH083866). The authors wish to thank all the study team members who contributed to the completion of this research including our key collaborators at KP (Thomas B. Landry, Deborah Hoerter, Fonda Mitchell, Carolee Nimmer), study therapists (Amy Brooks-DeWeese, Robbin Ryan, Joanne Whalen), research coordinators (Amanda Whittaker, Courtney Timms, Allen Mallory, Christina Metcalf, Abigail Lindemann, Abigail Lockhart), assessors (Debra Boeldt, Christopher Hawkey, Cara Lusby, Meaghan McCallum, Matthew Rouse, Courtney Stevens), and research assistants (Tess Atteberry, Kathryn Breazeale, Lucas Bermudez, Michaela Cuneo, Elizabeth Eustis, Anna Frye, Dhwani Kothari, Nicholas Webb, Jennalee Wooldridge, Nassim Zanganeh, and Capella Zhuang). We would like to express special appreciation for Sharon Salzberg who collaborated on the writing and recording of the meditation instructions, Nancy Bardacke who contributed consultation and the “Being with Baby” meditation practice, De West who recorded the yoga DVD, and Zindel Segal. We also express our gratitude to the members of our Data Safety and Monitoring Board who contributed time and expertise to the oversight of the study.
Conflicts of interest
The authors declare that they have no conflict of interest.
- APA (2000) Diagnostic and statistical manual of mental disorders: DSM-IV-TR. American Psychiatric Association, Washington, DCGoogle Scholar
- Bardacke N (2012) Mindful birthing: training the mind, body, and heart for childbirth and beyond. HarperCollins, New YorkGoogle Scholar
- Chiesa A, Mandelli L, Serretti A (2012) Mindfulness-based cognitive therapy versus psycho-education for patients with major depression who did not achieve remission following antidepressant treatment: a preliminary analysis. J Altern Complem Med 18:756–760. doi: 10.1089/Acm.2011.0407 CrossRefGoogle Scholar
- First MB, Gibbon M, Spitzer RL, Williams JBW, Benjamin LS (1997) Structured clinical interview for DSM-IV axis II personality disorders, (SCID-II). American Psychiatric Press, Inc., Washington, D.CGoogle Scholar
- First MB, Spitzer RL, Gibbon M, Williams JBW (2002) Structured clinical interview for DSM-IV-TR axis I disorders, Research Version, Patient Edition. (SCID-I/P) Biometrics Research, New York State Psychiatric Institute, New YorkGoogle Scholar
- Fox S (2011a) Health topics. Pew Internet & American LifeGoogle Scholar
- Fox S (2011b) Peer-to-peer healthcare. Pew Internet & American LifeGoogle Scholar
- Goodman SH, Rouse MH (2010) Perinatal depression and children: a developmental perspective. Centre of Excellence for Early Childhood Development. Accessed 11/04/13 2013Google Scholar
- Institute of Medicine (2009) Depression in parents, parenting, and children: opportunities to improve identification, treatment, and prevention. The National Academies Press, Washington, DCGoogle Scholar
- Lagan L, Sinclair M, Kernohan WG (2006) Pregnant women’s use of the internet: a review of published and unpublished evidence. Evid Based Midwifery 4:17–23Google Scholar
- Raudenbush SW, Bryk AS (2002) Hierarchical linear models: applications and data analysis methods. 2nd edn. Sage Publications, IncGoogle Scholar
- Segal ZV, Williams JM, Teasdale JD (2002b) Mindfulness-based cognitive therapy for depression: a new approach to preventing relapse. The Guilford Press, New YorkGoogle Scholar
- Thompson NJ, Walker ER, Obolensky N, Winning A, Barmon C, DiIorio C, Compton MT (2010) Distance delivery of mindfulness-based cognitive therapy for depression: project UPLIFT Epilepsy & Behavior 19:247–254 doi: 10.1016/j.yebeh.2010.07.031
- Van Aalderen JR, Donders ART, Giommi F, Spinhoven P, Barendregt HP, Speckens AEM (2012) The efficacy of mindfulness-based cognitive therapy in recurrent depressed patients with and without a current depressive episode: a randomized controlled trial. Psychol Med 42:989–1001PubMedCrossRefGoogle Scholar
- Webb CA, DeRubeis RJ, Dimidjian S, Hollon SD, Amsterdam JD, Shelton RC (2012) Predictors of patient cognitive therapy skills and symptom change in two randomized clinical trials: The role of therapist adherence and the therapeutic alliance. J Consult Clin Psychol 80:373–381. doi: 10.1037/a0027663 PubMedCentralPubMedCrossRefGoogle Scholar
- Yonkers KA, Lockwood CJ, Wisner K (2010) The management of depression during pregnancy: a report from the american psychiatric association and the american college of obstetricians and gynecologists reply obstetrics and gynecology 115:189–189Google Scholar