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Gradually Getting Better: Trajectories of Change in Rumination and Anxious Worry in Mindfulness-Based Cognitive Therapy for Prevention of Relapse to Recurrent Depression

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Increased tendencies towards ruminative responses to negative mood and anxious worry are important vulnerability factors for relapse to depression. In this study, we investigated the trajectories of change in rumination and anxious worry over the course of an eight-week programme of mindfulness-based cognitive therapy (MBCT) for relapse prevention in patients with a history of recurrent depression. One hundred and four participants from the MBCT-arm of a randomized-controlled trial provided weekly ratings. Mixed linear models indicated that changes in rumination and worry over the course of the programme followed a general linear trend, with considerable variation around this trend as indicated by significant increases in model fit following inclusion of random slopes. Exploration of individual trajectories showed that, despite considerable fluctuation, there is little evidence to suggest that sudden gains are a common occurrence. The findings are in line with the general notion that, in MBCT, reductions in vulnerability are driven mainly through regular and consistent practice, and that sudden cognitive insights alone are unlikely to lead into lasting effects.

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Analyses of the current study were based on data from the Staying Well after Depression trial. We gratefully acknowledge the contribution of the people and institutions involved in conducting this trial: the administrative teams in Bangor and Oxford, and the staff of the North Wales Organisation for Randomised Trials in Health (NWORTH) for their assistance with recruitment, administration and data management; the general practice and mental health professionals who referred patients to the study; the National Institute for Health Research Mental Health Research Network, the Clinical Research Centre of the (Wales) National Institute for Social Care and Health Research, the Thames Valley Primary Care Research Network, Gwynedd & Mon Local Health Boards and Gwynedd County Council (North Wales), who supported fieldwork; and the independent psychiatrists who rated clinical interviews. Most importantly, we thank our participants for giving time to take part in this trial. This research was funded by Wellcome Trust Grant GR067797, awarded to J. Mark G. Williams and Ian T. Russell (Trial Registration Number: ISRCTN97185214). The funders had no role in study design; in the collection, analysis and interpretation of data; in the writing of the report and in the decision to submit the article for. All authors declare financial support for the submitted work from the Wellcome Trust; J. Mark G. Williams, Melanie J.V. Fennell, Ann Hackmann, and Thorsten Barnhofer and/or their institutions have received honoraria or fees for lectures, workshops, courses, and/or educational presentations on mindfulness or mindfulness-based cognitive therapy (MBCT); J. Mark G. Williams has received royalties for books on mindfulness, including the MBCT manual.

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Correspondence to Thorsten Barnhofer.

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Ietsugu, T., Crane, C., Hackmann, A. et al. Gradually Getting Better: Trajectories of Change in Rumination and Anxious Worry in Mindfulness-Based Cognitive Therapy for Prevention of Relapse to Recurrent Depression. Mindfulness 6, 1088–1094 (2015).

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