CLINICAL RESEARCH POSTER PRESENTATION ABSTRACTS
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Salons 10-12.
THURSDAY, 5:30-6:15 PM
Eisendrath S, McLane M.
Treatment resistant depression: a pilot study of mindfulness-based
cognitive therapy.
University of California San Francisco stuarte@lppi.ucsf.edu
PURPOSE: Mindfulness-Based Cognitive Therapy
(MBCT) for depression has been utilized as a treatment to prevent depression
relapse in remitted individuals. The present study is an extension of
MBCT to treat actively depressed individuals with treatment resistant
depression (TRD). The proposed study actually relates to a large clinical
problem, because only a minority of depressed individuals enters remission
with initial treatment. Most suffer from some form of treatment resistance,
defined here as an incomplete response to at least one antidepressant
trial of adequate duration and dosage or to a depression-specific psychotherapy
(interpersonal psychotherapy or cognitive behavior therapy).
METHODS: The study is a nonrandomized cohort
comparison study of two groups of subjects with TRD. One group consisted
of 26 TRD individuals who received MBCT in a group format based on the
manual developed by Segal, Williams, and Teasdale. Their Beck Depression
Inventory-II (BDI-II) scores were compared at the beginning and end
of the MBCT course. The other group of 30 individuals received treatment
as usual (TAU) in our Depression Center Clinic where BDI-II scores are
routinely obtained at 12-week intervals. This group consisted of individuals
who had received 12 weeks of treatment as usual but still had incomplete
responses and were classified as TRD. The scores after a subsequent
12 weeks of treatment were compared to their 12-week scores.
RESULTS: Within group comparisons indicated
a significant (p <. 05) decrease in BDI-II scores in the MBCT group
from a mean of 24 to 14. The treatment as usual group had a nonsignficant
decrease from 24 to22, despite a longer interval of treatment. The between
group comparison indicated a significant difference between the MBCT
and TAU groups of p<. 001.
CONCLUSIONS: MBCT appears to be efficacious
in reducing depression levels in this study. TRD is a significant mental
health problem and as our TAU data indicate, tends to be a persistent
one. MBCT appears to offer a way for individuals to learn skills that
allow them to "decenter" themselves from a depressive stream of cognitions
with significant decreases in symptoms. We discuss potential mediators
of MBCT effects. This study needs to be expanded to a randomized clinical
trial to more fully evaluate the efficacy of MBCT.
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