Restricted accessResearch articleFirst published online 2025
Evaluating the Efficacy of Mindfulness-Based Cognitive Therapy in Alleviating Depressive Symptoms,Reducing Rumination,and Preventing Relapse Among the Institutionalized Patients in Nigeria: A Randomized Controlled Trial
Depression is a serious issue in the world, affecting over 350 million people. Although it may present at any age, adolescence to early adulthood is the most common age of onset, and females are affected twice as much as males. Rumination is a specific known risk factor for the onset, severity, prolongation, and relapse of depression. Relapse prevention in recurrent depression is a significant public health problem, and antidepressants are the current first-line treatment approach.
Aim:
This study aims to evaluate the efficacy of mindfulness-based cognitive therapy in alleviating depressive symptoms, reducing rumination, and preventing relapse among depressive patients.
Method:
This randomized controlled trial was conducted with 101 population of 101 consisting of adult patients with three or more previous episodes. Participants were randomly assigned to Mindfulness-Based Cognitive Therapy (n = 50) and Control Group (n = 51) using randomized sampling. The Mindfulness-Based Cognitive Therapy group received 8-week group training sessions including meditation exercises, psycho-education and group discussions. The assessment was done at baseline, post-treatment, and 2-month follow-up. Analysis was done using SPSS software (V 22).
Result:
The results showed that there were no significant differences between the groups on depression relapse (χ2 = 0.002; p = 0.99). However, there is a statistically significant reduction in depressive symptoms mean score level in the MBCT group [F(2, 37) = 6.878, p = .003]. Moreover, there is a statistically significant reduction in rumination score in the MBCT group [F (2,37) = 36.021; p = 0.02].
Conclusion:
The findings showed that MBCT appears efficacious in reducing depressive symptoms and rumination. However, MBCT did not further reduce their risk for relapse/recurrence.
AdewuyaA. O.OlaB. A.AlobaO. O.DadaA. O.FasotoO. O. (2007). Prevalence and correlates of depression in late pregnancy among Nigerian women. Depression and Anxiety, 24(1), 15–21. https://doi.org/10.1002/da.20221
2.
AlmeidaS. S.ZizziF. B.CattaneoA.ComandiniA.Di DatoG.LubranoE.PellicanoC.SpalloneV.TongianiS.TortaR. (2020). Management and treatment of patients with major depressive disorder and chronic diseases: A multidisciplinary approach. Frontiers in Psychology, 11, Article 542444. https://doi.org/10.3389/fpsyg.2020.542444
3.
American Psychiatric Association. (1996). Diagnostic and statistical manual of mental disorders, (DSM-IV).
4.
American Psychiatric Association. (2010). Practice guideline for the treatment of patients with major depressive disorder. The American Journal of Psychiatry, 167, Article 1.
5.
BarnhoferT.CraneC.BrennanK.DugganD. S.CraneR. S.EamesC.RadfordS.SilvertonS.FennellM. J.WilliamsJ. M. (2015). Mindfulness-based cognitive therapy (MBCT) reduces the association between depressive symptoms and suicidal cognitions in patients with a history of suicidal depression. Journal of Consulting and Clinical Psychology, 83(6), 1013–1020. https://doi.org/10.1037/ccp0000027
6.
BatinkT.PeetersF.GeschwindN.van OsJ.WichersM. (2013). How does MBCT for depression work? Studying cognitive and affective mediation pathways. PLOS ONE, 8, Article e72778.
7.
BeckA. T.SteerR. A.BallR.RanieriW. F. (1996). Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients. Journal of Personality Assessment, 67(3), 588–597. https://doi.org/10.1207/s15327752jpa6703_13
8.
BielingP. J.HawleyL. L.BlochR. T.CorcoranK. M.LevitanR. D.YoungL. T.MacQueenG. M.Patelis-SiotisI.SegalZ. V. (2012). Treatment-specific changes in decentering following mindfulness-based cognitive therapy versus antidepressant medication or placebo for prevention of depressive relapse. Journal of Consulting and Clinical Psychology, 80(3), 365–372. https://doi.org/10.1037/a0027483
BurgessE. E.SelchenS.DiplockB. D.RectorN. A. (2021). A brief mindfulness-based cognitive therapy (MBCT) intervention as a population-level strategy for anxiety and depression. International Journal of Cognitive Therapy, 14, Article 380. https://doi.org/10.1007/s41811-021-00112-4
11.
BusariA. O. (2015). Mindfulness-based cognitive therapy; impact on depressed outpatients of the State Hospital Oyo State Ibadan, Nigeria. American Journal of Medicine and Medical Sciences, 5(5), 191–200. https://doi.org/10.5923/j.ajmms.20150505.01
12.
ChiesaA.SerrettiA. (2011). Mindfulness based cognitive therapy for psychiatric disorders: A systematic review and meta-analysis. Psychiatry Research, 187, 441–453.
CohenZ. D.DeRubeisR. J.HayesR.WatkinsE. R.LewisG.ByngR.ByfordS.CraneC.KuykenW.DalgleishT.SchweizerS. (2023). The development and internal evaluation of a predictive model to identify for whom mindfulness-based cognitive therapy offers superior relapse prevention for recurrent depression versus maintenance antidepressant medication. Clinical Psychological Science, 11(1), 59–76.
15.
CooperC.BebbingtonP.KingM.BrughaT.MeltzerH.BhugraD.JenkinsR. (2007). Why people do not take their psychotropic drugs as prescribed: Results of the 2000 National Psychiatric Morbidity Survey. Acta Psychiatrica Scandinavica, 116(1), 47–53.
16.
CosgroveL.BrhlikovaP.LyusR.HerrawiF.D’AmbrozioG.Abi-JaoudeE.ShaughnessyA. F. (2024). Global burden disease estimates for major depressive disorders (MDD): A review of diagnostic instruments used in studies of prevalence. Community Mental Health Journal, 60(8), 1493–1503. https://doi.org/10.1007/s10597-024-01245-5
17.
CraneR. S.EamesC.KuykenW.HastingsR. P.WilliamsJ. M. G.BartleyT.EvansA.DunnC.GoldE.SilvertonS.SoulsbyJ. G.SurawyC. (2013). Development and validation of the Mindfulness-Based Interventions–Teaching Assessment Criteria (MBI:TAC). Assessment, 20(6), 681–688. https://doi.org/10.1177/1073191113490790
18.
de Klerk-SluisJ. M.HuijbersM. J.LöckeS.SpijkerJ.SpinhovenP.SpeckensA. E.RuheH. G. (2022). Factors associated with relapse and recurrence of major depressive disorder in patients starting mindfulness-based cognitive therapy. Depression and Anxiety, 39(2), 113–122.
19.
DunlopB. W.BinderE. B.CubellsJ. F.GoodmanM. M.KelleyM. E.KinkeadB.NemeroffC. B.CraigheadW. E.MaybergH. S. (2012). Predictors of remission in depression to individual and combined treatments (PReDICT): Study protocol for a randomized controlled trial. Trials, 13, Article 106. https://doi.org/10.1186/1745-6215-13-106
20.
EisendrathS. J.DelucchiK.BitnerR.FenimoreP.SmitM.McLaneM. (2008). Mindfulness- based cognitive therapy for treatment-resistant depression: A pilot study. Psychotherapy and Psychosomatics, 77, 319–320.
21.
FirstM. B.GibbonM.SpitzerR. L.BenjaminL. S.WilliamsJ. B. (1997). Structured clinical interview for DSM-IV® axis ii personality disorders SCID-II. American Psychiatric Publishing.
22.
FrancisS. E. B.ShawyerF.CayounB. A.GrabovacA.MeadowsG. (2024). Differentiating mindfulness-integrated cognitive behavior therapy and mindfulness-based cognitive therapy clinically: The why, how, and what of evidence-based practice. Frontiers in Psychology, 15, Article 1342592. https://doi.org/10.3389/fpsyg.2024.1342592
23.
FrostadottirA. D.DorjeeD. (2019). Effects of mindfulness based cognitive therapy (MBCT) and compassion focused therapy (CFT) on symptom change, mindfulness, self-compassion, and rumination in clients with depression, anxiety, and stress. Frontiers in Psychology, 10, Article 1099.
24.
GeschwindN.PeetersF.HuibersM.van OsJ.WichersM. (2012). Efficacy of mindfulness-based cognitive therapy in relation to prior history of depression: Randomised controlled trial. The British Journal of Psychiatry, 201, 320–325.
25.
GossK.AllanS. (2014). The development and application of compassion-focused therapy for eating disorders (CFT-E). British Journal of Clinical Psychology, 53(1), 62–77.
26.
GoyalM.SinghS.SibingaE.M.S.NedaF.G.Rowland-SeymourA.SharmaR.BergerZ. (2014). Meditation programs for psychological stress and well-being. a systematic review and meta-analysis. JAMA Internal Medicine, 174, 357–368.
27.
HaritonE.LocascioJ. J. (2018). Randomised controlled trials—The gold standard for effectiveness research. BJOG: An International Journal of Obstetrics & Gynaecology, 125(13), Article 1716. https://doi.org/10.1111/1471-0528.15199
28.
HayesA. M.AndrewsL. A. (2020). A complex systems approach to the study of change in psychotherapy. BMC Medicine, 18, Article 197. https://doi.org/10.1186/s12916-020-01656-2
29.
KaymazN.Van OsJ.LoonenA. J. M.NolenW. A. (2008). Evidence that patients with single versus recurrent depressive episodes are differentially sensitive to treatment discontinuation: A meta-analysis of placebo-controlled randomized trials. Journal of Clinical Psychiatry, i69(9), 1423–1436.
30.
KearneyA.Rosala-HallasA.BaconN.DaykinA.ShawA. R. G.LaneA. J.BlazebyJ. M.ClarkeM.WilliamsonP. R.GambleC. (2018). Reducing attrition within clinical trials: The communication of retention and withdrawal within patient information leaflets. PLOS ONE, 13(11), Article e0204886. https://doi.org/10.1371/journal.pone.0204886
31.
KennyM. A.WilliamsJ. M. G. (2007). Treatment-resistant depressed patients show a good response to mindfulness based cognitive therapy. Behavior and Research Therapy, 45, 617–625.
32.
KrainesM. A.PetersonS. K.TremontG. N.BeardC.BrewerJ. A.UebelackerL. A. (2022). Mindfulness-based stress reduction and mindfulness-based cognitive therapy for depression: A systematic review of cognitive outcomes. Mindfulness, 13(5), 1126–1135.
33.
KuykenW.ByfordS.TaylorR. S.WatkinsE.HoldenE.WhiteK.BarrettB.ByngR.EvansA.MullanE.TeasdaleJ. D. (2008). Mindfulness-based cognitive therapy to prevent relapse in recurrent depression. Journal of Consulting and Clinical Psychology, 76(6), 966–978. https://doi.org/10.1037/a0013786.
34.
KuykenW.HayesR.BarrettB.ByngR.DalgleishT.KesslerD.LewisG.WatkinsE.BrejchaC.CardyJ.CausleyA.CowderoyS.EvansA.GradingerF.KaurS.LanhamP.MorantN.RichardsJ.ShahP.SuttonH.VicaryR.WeaverA.WilksJ.WilliamsM.TaylorR. S.ByfordS. (2015). Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): A randomised controlled trial. The Lancet, 386(9988), 63–73. https://doi.org/10.1016/S0140-6736(14)62222-4
35.
KuykenW.WarrenF. C.TaylorR. S.WhalleyB.CraneC.BondolfiG.HayesR.HuijbersM.MaH.SchweizerS.SegalZ.SpeckensA.TeasdaleJ. D.Van HeeringenK.WilliamsM.ByfordS.ByngR.DalgleishT. (2016). Efficacy of mindfulness-based cognitive therapy in prevention of depressive relapse: An individual patient data meta-analysis from randomized trials. JAMA Psychiatry, 73(6), 565–574. https://doi.org/10.1001/jamapsychiatry.2016.0076
36.
LiZ.RuanM.ChenJ.FangY. (2021). Major depressive disorder: Advances in neuroscience research and translational applications. Neuroscience Bulletin, 37(6), 863–880.
37.
MaS. H.TeasdaleJ. D. (2004). Mindfulness-based cognitive therapy for depression: Replication and exploration of differential relapse prevention effects. Journal of Consulting and Clinical Psychology, 72(1), Article 31.
38.
MainaG.AdamiM.AscioneG.BondiE.De BerardisD.DelmonteD.MaffezzoliS.MartinottiG.NivoliA.FagioliniA. (2023). Nationwide consensus on the clinical management of treatment-resistant depression in Italy: A Delphi panel. Annals of General Psychiatry, 22(1), Article 48.
39.
ManicavasgarV.ParkerG.PerichT. (2011). Mindfulness-based cognitive therapy vs cognitive behaviour therapy as a treatment for non-melancholic depression. Journal of Affective Disorders, 130, 138–144.
40.
MarxW.PenninxB. W. J. H.SolmiM.FurukawaT. A.FirthJ.CarvalhoA. F.BerkM.TeasdaleJ. D. (2023). Major depressive disorder. Nature Reviews Disease Primers, 9(1), Article 44. https://doi.org/10.1038/s41572-023-00454-1
41.
McClellandG. H.JuddC. M. (1993). Statistical difficulties of detecting interactions and moderator effects. Psychological Bulletin, 114(2), Article 376.
42.
MehtaN. N.TalwarG. (2022). Recognizing roots and not just leaves: The use of integrative mindfulness in education, research, and practice. Psychology from the Margins, 4(1), Article 6.
43.
MusaZ. A.SohK. L.FirdausB. M.SohK. Y.TajudeenO. O.SohK. G. (2020). Effectiveness of mindfulness-based cognitive therapy on the management of depressive disorder: Systematic review. International Journal of Africa Nursing Sciences, 12, Article 100200. https://doi.org/10.1016/j.ijans.2020.100200
44.
MusaZ. A.SohK. L.MukhtarF.SohK. Y.OladeleT. O.SohK. G. (2021). Effectiveness of mindfulness-based cognitive therapy among depressed individuals with disabilities in Nigeria: A randomized controlled trial. Psychiatry Research, 296, Article 113680.
45.
National Institute of Health and Clinical Excellence. (2009). Depression: The treatment and management of depression in adults (update).
46.
Nolen-HoeksemaS.MorrowJ. (1991). A prospective study of depression and posttraumatic stress symptoms after a natural disaster: The 1989 Loma Prieta earthquake. Journal of Personality and Social Psychology, 61(1), 115–121. https://doi.org/10.1037/0022-3514.61.1.115
47.
OlfsonM.MarcusS. C.TedeschiM.WanG. J. (2006). Continuity of antidepressant treatment for adults with depression in the United States. American Journal of Psychiatry, 163, 101–108.
48.
OmidiA.MohammadkhaniP.MohammadiA.ZargarF. (2013). Comparing mindfulness based cognitive therapy and traditional cognitive behavior therapy with treatments as usual on reduction of major depressive disorder symptoms. Iranian Red Crescent Medical Journal, 15, 142–146.
49.
PanY.LiF.LiangH.ShenX.BingZ.ChengL.DongY.SatouT. (2024). Effectiveness of mindfulness-based stress reduction on mental health and psychological quality of life among university students: A GRADE-assessed systematic review. Evidence-Based Complementary and Alternative Medicine, 2024, Article 8872685. https://doi.org/10.1155/2024/8872685
50.
PedersenB.SaltinB. (2015). Exercise as medicine—Evidence for prescribing exercise as therapy in 26 different chronic diseases. Scandinavian Journal of Medicine & Science in Sports, 25, 1–72. https://doi.org/10.1111/sms.12581
51.
RichardsD. (2011). Prevalence and clinical course of depression: A review. Clinical Psychology Review, 31(7), 1117–1125.
52.
SalmonP.LooJ. L. (2023). Mindfulness-based cognitive therapy. In TasmanA.KayJ.LiebermanJ. A.FirstM. B.MajM. (Eds.), Tasman’s psychiatry (pp. 1–19). Springer. https://doi.org/10.1007/978-3-030-42825-9_123-1
53.
SegalZ. V.BielingP.YoungT.MacQueenG.CookeR.MartinL.BlochR. T.LevitanR. D. (2010). Antidepressant monotherapy vs sequential pharmacotherapy and mindfulness-based cognitive therapy, or placebo, for relapse prophylaxis in recurrent depression. Archives of General Psychiatry, 67(12), 1256–1264. https://doi.org/10.1001/archgenpsychiatry.2010.168
54.
SegalZ. V.TeasdaleJ. D.WilliamsJ. M.GemarM. C. (2002). The Mindfulness-Based Cognitive Therapy Adherence Scale: Inter-rater reliability, adherence to protocol and treatment distinctiveness. Clinical Psychology & Psychotherapy, 9, 131–138.
55.
SegalZ. V.WilliamsJ. M. G.TeasdaleJ. D. (2013). Mindfulness-Based Cognitive Therapy for Depression (2nd ed.). New York: The Guilford Press.
56.
ShallcrossA. J.GrossJ. J.VisvanathanP. D.KumarN.PalfreyA.FordB. Q.DimidjianS.ShirkS.Holm-DenomaJ.GoodeK. M.MaussI. B. (2015). Relapse prevention in major depressive disorder: Mindfulness-based cognitive therapy versus an active control condition. Journal of Consulting and Clinical Psychology, 83(5), 964.
57.
SiwikC. J.AdlerS. R.MoranP. J.KuykenW.SegalZ.FelderJ.EisendrathS.HechtF. M. (2023). Preventing depression relapse: A qualitative study on the need for additional structured support following mindfulness-based cognitive therapy. Global Advances in Integrative Medicine and Health, 12. https://doi.org/10.1177/27536130221144247
58.
SpitzerR. L.WilliamsJ. B.GibbonM.FirstM. B. (1992). The structured clinical interview for DSM-III-R (SCID): I: History, rationale, and description. Archives of General Psychiatry, 49(8), 624–629. https://doi.org/10.1001/archpsyc.1992.01820080032005
59.
SteidtmannD.ManberR.ArnowB. A.KleinD. N.MarkowitzJ. C.RothbaumB. O.ThaseM. E.KocsisJ. H. (2012). Patient treatment preference as a predictor of response and attrition in treatment for chronic depression. Depression and Anxiety, 29(10), 896–905.
60.
StraussC.CavanaghK.OliverA.PettmanD. (2014). Mindfulness-based interventions for people diagnosed with a current episode of an anxiety or depressive disorder: A meta-analysis of randomised controlled trials. PLOS ONE, 9(4), Article e96110.
61.
TeasdaleJ. D.SegalZ. V.WilliamsJ. M.RidgewayV. A.SoulsbyJ. M.LauM. A. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 68(4), 615–623. https://doi.org/10.1037//0022-006x.68.4.615
62.
ThaseM. E. (2014). Combining cognitive therapy and pharmacotherapy for depressive disorders: A review of recent developments. International Journal of Cognitive Therapy, 7(2), 108–121. https://doi.org/10.1521/ijct.2014.7.2.108
63.
van AalderenJ. R.DondersA. R.GiommiF.SpinhovenP.BarendregtH. P.SpeckensA. E. (2012). The efficacy of mindfulness-based cognitive therapy in recurrent depressed patients with and without a current depressive episode: A randomized controlled trial. Psychological Medicine, 42(5), 989–1001. https://doi.org/10.1017/S0033291711002054
64.
van SchaikD. J. F.KleinA. F. J.van HoutH. P. J.van MarwijkH. W. J.BeekmanA. T. F.de HaanM.Van DyckR. (2004). Patients’ preferences in the treatment of depressive disorder in primary care. Psychiatry and Primary Care, 26, 184–189.
65.
WeissmanM. M.BlandR. C.CaninoG. J.FaravelliC.GreenwaldS.HwuH. G.JoyceP.R.KaramE.G.LeeC.K.LellouchJ.LépineJ. P. (1996). Cross-national epidemiology of major depression and bipolar disorder. Jama, 276(4), 293–299.
66.
WidemanT. H.AsmundsonG. G. J.SmeetsR. J. E. M.ZautraA. J.SimmondsM. J.SullivanM. J. L.HaythornthwaiteJ. A.EdwardsR. R. (2013). Rethinking the fear avoidance model: Toward a multidimensional framework of pain-related disability. Pain, 154(11), 2262–2265. https://doi.org/10.1016/j.pain.2013.06.005
67.
WilliamsJ. M.CraneC.BarnhoferT.BrennanK.DugganD. S.FennellM. J.HackmannA.KruscheA.MuseK.Von RohrI. R.ShahD.CraneR. S.EamesC.JonesM.RadfordS.SilvertonS.SunY.Weatherley-JonesE.WhitakerC. J.RussellD.… RussellI. T. (2014). Mindfulness-based cognitive therapy for preventing relapse in recurrent depression: A randomized dismantling trial. Journal of Consulting and Clinical Psychology, 82(2), 275–286. https://doi.org/10.1037/a0035036
68.
World Health Organization. (2017). Depression and other common mental health disorders: Global health estimates.
69.
ZhangB.FuW.GuoY.ChenY.JiangC.LiX.ZhangY.ZhangL. (2022). Effectiveness of mindfulness-based cognitive therapy against suicidal ideation in patients with depression: A systematic review and meta-analysis. Journal of Affective Disorders, 319, 655–662. https://doi.org/10.1016/j.jad.2022.09.065
70.
ZhangX.YangH.ZhangJ.YangM.YuanN.LiuJ. (2021). Prevalence of and risk factors for depressive and anxiety symptoms in a large sample of Chinese adolescents in the post-COVID-19 era. Child and Adolescent Psychiatry and Mental Health, 15(1), 80. https://doi.org/10.1186/s13034-021-00429-8
