Mindfulness-Based Cognitive Therapy for Perinatal Women with Depression or Bipolar Spectrum Disorder
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The perinatal period is a high-risk time for mood deterioration among women vulnerable to depression. This study examined feasibility, acceptability, and improvement associated with mindfulness-based cognitive therapy (MBCT) in perinatal women with major depressive disorder (MDD) or bipolar spectrum disorder (BSD). Following a diagnostic evaluation, 39 perinatal women with a lifetime history of MDD (n = 27) or BSD (n = 12) enrolled in an 8-week program of MBCT classes (2 h each) that incorporated meditation, yoga, and mood regulation strategies. Participants were pregnant (n = 12), planning pregnancy (n = 11), or up to 1-year postpartum (n = 16). Participants were self-referred and most had subthreshold mood symptoms. Assessments of depression, (hypo)mania, and anxiety were obtained by interview and self-report at baseline, post-treatment and at 1- and 6-month post-treatment. Women with a history of MDD were more likely to complete the classes than women with BSD. Of 32 women who completed the classes, 7 (21.9 %) had a major depressive episode during the 6-month post-treatment follow-up. On average, participants with MDD reported improvements in depression from pre- to post-treatment. Mood improvement was not observed in the BSD group. In the full sample, improvements in depression symptoms across time points were associated with increasing mindful tendency scores. This study was limited by its uncontrolled design, heterogeneous sample, and questionnaire-based assessment of mindfulness skills. MBCT may be an important component of care for perinatal women with histories of major depression. Its applicability to perinatal women with BSD is unclear.
KeywordsMeditation Pregnancy Postpartum Feasibility Acceptability Mania Depression
Conflict of Interest
This study was supported by grants from the Danny H. Alberts Foundation and the Attias Family Foundation, and Grant R01-MH093676 from the National Institute of Mental Health (NIMH) (Miklowitz, PI). Author D. Miklowitz lists the following financial relationships: NIMH, Carl and Roberta Deutsch Foundation, Kayne Family Foundation, Knapp Foundation, Danny H. Alberts Foundation, and Attias Family Foundation; and book royalties from Guilford Press and John Wiley and Sons. Author S. Dimidjian receives research funding from the NIMH and book royalties from Guilford Press. Authors R. Semple, D. Elkun, and M. Weintraub have no financial or other relationships that would create a conflict of interest regarding this manuscript.
All procedures performed in studies involving human participants were in accordance with the ethical standards of each institution’s research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Written informed consent was obtained from all participants after they received a full explanation of the study procedures. The protocol was reviewed and approved by the Human Subject Review Boards of the University of Colorado and the UCLA School of Medicine.
No animals studies were carried out by the authors for this paper.
- American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, (text revision) (DSM-IV-TR) (4th ed.). Washington, DC: American Psychiatric Press.Google Scholar
- Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck Depression Inventory-II. San Antonio, TX: The Psychological Corporation.Google Scholar
- Deckersbach, T., Hölzel, B. K., Eisner, L. R., Stange, J. P., Peckham, A. D., Dougherty, D. D., et al. (2012). Mindfulness-based cognitive therapy for nonremitted patients with bipolar disorder. CNS Neuroscience & Therapeutics, 18(2), 133–141. doi: 10.1111/j.1755-5949.2011.00236.x.CrossRefGoogle Scholar
- Dimidjian, S., Goodman, S. H., Felder, J. N., Gallop, R., Brown, A. P., & Beck, A. (2014). An open trial of mindfulness-based cognitive therapy for the prevention of perinatal depressive relapse/recurrence. Archives of Women’s Mental Health, 18(1), 85–94. doi: 10.1007/s00737-014-0468-x.CrossRefPubMedGoogle Scholar
- First, M. B., Spitzer, R. L., Miriam, G., & Williams, J. B. W. (2002). Structured Clinical Interview for DSM-IV-TR Axis I disorders, research version, patient edition with psychotic screen (SCID-I/P W/PSY SCREEN). New York: Biometrics Department, New York State Psychiatric Institute.Google Scholar
- Gaynes, B. N., Gavin, N., Meltzer-Brody, S. Lohr, K. N., Swinson, T., Gartlehner, G., et al. (2005). Perinatal depression: prevalence, screening accuracy, and screening outcomes. Evidence Report/Technology Assessment No. 119. (Prepared by the RTI-University of North Carolina Evidence-based Practice Center, under Contract No. 290-02-0016.) AHRQ Publication No. 05-E006-2. Rockville, MD: Agency for Healthcare Research and Quality.Google Scholar
- Grossman, P., et al. (2011). Defining mindfulness by how poorly I think I pay attention during everyday awareness and other intractable problems for psychology’s (re)invention of mindfulness: Comment on Brown et al. (2011). Psychological Assessment, 23, 1034–1040. doi: 10.1037/a0022713.CrossRefPubMedGoogle Scholar
- Hauser, M., Miklowitz, D. J., & Dimidjian, S. (2008). Treatment manual for mindfulness-based cognitive therapy for bipolar disorder. Unpublished. University of Colorado, Boulder, CO.Google Scholar
- Ives-Deliperi, V. L., Howells, F., Stein, D. J., Meintjes, E. M., & Horn, N. (2013). The effects of mindfulness-based cognitive therapy in patients with bipolar disorder: A controlled functional MRI investigation. Journal of Affective Disorders, 150(3), 1152–1157. doi: 10.1016/j.jad.2013.05.074.CrossRefPubMedGoogle Scholar
- Judd, L. L., Schettler, P. J., Akiskal, H. S., Coryell, W., Leon, A. C., Maser, J. D., et al. (2008). Residual symptom recovery from major affective episodes in bipolar disorders and rapid episode relapse/recurrence. Archives of General Psychiatry, 65(4), 386–394. doi: 10.1001/archpsyc.65.4.386.CrossRefPubMedGoogle Scholar
- Keller, M. B., Lavori, P. W., Friedman, B., Nielsen, E., Endicott, J., McDonald-Scott, P., et al. (1987). The longitudinal interval follow-up evaluation: A comprehensive method for assessing outcome in prospective longitudinal studies. Archives of General Psychiatry, 44, 540–548.CrossRefPubMedGoogle Scholar
- Segal, Z. V., Bieling, P., Young, T., Macqueen, G., Cooke, R., Martin, L., et al. (2010). Antidepressant monotherapy vs sequential pharmacotherapy and mindfulness-based cognitive therapy, or placebo, for relapse prophylaxis in recurrent depression. Archives of General Psychiatry, 67, 1256–1264. doi: 10.1001/archgenpsychiatry.2010.168.PubMedCentralCrossRefPubMedGoogle Scholar
- Segal, Z. V., Williams, J. M. G., Teasdale, J. D., & Kabat-Zin, J. (2012). Mindfulness-based cognitive therapy for depression (2nd ed.). New York: Guilford Press.Google Scholar
- Spielberger, C. D., Gorsuch, R. L., Lushene, P. R., Vagg, P. R., & Jacobs, A. G. (1983). Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press.Google Scholar
- Viguera, A. C., Whitfield, T., Baldessarini, R. J., Newport, D. J., Stowe, Z., Reminick, A., et al. (2007). Risk of recurrence in women with bipolar disorder during pregnancy: Prospective study of mood stabilizer discontinuation. American Journal of Psychiatry, 164(12), 1817–1824.CrossRefPubMedGoogle Scholar
- Williams, J. M., Alatiq, Y., Crane, C., Barnhofer, T., Fennell, M. J., Duggan, D. S., et al. (2008). Mindfulness-based Cognitive Therapy (MBCT) in bipolar disorder: Preliminary evaluation of immediate effects on between-episode functioning. Journal of Affective Disorders, 107(1–3), 275–279. doi: 10.1016/j.jad.2007.08.022.PubMedCentralCrossRefPubMedGoogle Scholar
- Williams, M., Teasdale, J., Segal, Z., & Kabat-Zinn, J. (2007). The mindful way through depression: Freeing yourself from chronic unhappiness. New York: The Guilford Press.Google Scholar