Self-guided, online Mindfulness-Based Cognitive Therapy tool reduces depression symptoms, CU Boulder researchers find

The introduction of medications for depression in 1986 revolutionized treatment. But most patients who respond to treatment with antidepressants still experience residual depressive symptoms, including problems with appetite, sleep, mood and even suicidal ideation, which can result in significant impairment. These symptoms can also increase patients’ risk of relapse to another episode of depression.

Hoping to reduce relapse among those with major depressive illness, a team of psychologists in the 1990s created mindfulness-based cognitive therapy (or MBCT), a blend of mindfulness practices and cognitive behavioral therapy techniques.

It worked. According to a 2016 analysis of more than a thousand patients who have participated in trials of MBCT, patients who participated in MBCT were more likely to stay well and prevent depression in the future than patients who tried other treatment approaches. For example, MBCT was found to reduce the risk of relapse to depression even more than continued antidepressant medication.

Sona Dimidjian, professor of psychology and neuroscience and director of the Renée Crown Wellness Institute at the University of Colorado Boulder, has been studying the role of mindfulness and other contemplative practices to support mental health and wellness for more than 15 years, including her collaboration with one of the co-developers of MBCT, Zindel Segal, Distinguished Professor of psychology at the University of Toronto Scarborough.

In their early work, they provided MBCT training for clinicians in the format of in-person workshops and retreats. But they soon saw limitations in this approach.

“It became immediately clear that there would never be a way to fully provide access to this approach to the general population of people in need by relying only on in-person formats,” Dimidjian says.

With that in mind, they created Mindful Mood Balance, an eight-session, self-administered online platform designed to teach participants how to “disengage from habitual, automatic, dysfunctional cognitive patterns” to reduce vulnerability to relapse.

It worked well. In a randomized clinical trial of 460 participants, Dimidjian and several other researchers, including Segal, CU Boulder graduate psychology students Joseph Levy, Rachel Vanderkruik, Christina A. Metcalf and Jennifer N. Felder, found that use of MMB in conjunction with “usual depression care” reduced the risk of relapse to depression by 40%. They also found that MMB reduced suicidal ideation by more than half, compared to a reduction of less than 9% among participants who did not use MMB.

“Use of MMB plus UDC resulted in significant improvement in depression and functional outcomes compared with UDC only,” the authors wrote in a 2021 paper published in the Journal of the American Medical Association. “The MMB web-based treatment may offer a scalable approach for the management of residual depressive symptoms.”

MMB gives patients self-guided tools to become more aware of their thought patterns to reduce reactivity.

“These are skills to strengthen attention and awareness so people can watch thoughts arise and pass without getting caught up in them or engaging in elaboration,” Levy says.

But MMB uses mindfulness practices to help those with depression to better understand their own relapse “signature” and offers strategies to become familiar with how one’s daily experiences, habits and patterns may influence their mood.

“The idea is (to) strengthen the capacity to bring this level of awareness and self-kindness, increasing over the eight-session program,” Dimidjian says. MMB is also “an opportunity to engage an asynchronous community of learners in a process of guided inquiry and people sharing their first-hand experiences.”

Dimidjian and her collaborators are also working on MMB for Moms, a parallel platform that focuses on depression among new and expectant mothers, and they are continuing to investigate why MMB works.

“One of the clear challenges this work is addressing will not be fully solved in my lifetime,” Dimidjian says. “That means a big part of it is working with students who have the same passion that Joey (Levy) articulates. … The work he and other students are doing now and envision doing in the future, is critical to realizing the vision of making science accessible to people in daily life and providing science-based skills that people can learn and apply, in this case, to severe, and unfortunately sometimes lethal, experiences and struggles.”