The role of mindfulness training in reducing rumination in recurrent depression

INTERVENTION: Mindfulness‐based Cognitive Therapy with waiting list control. Standard randomization, stratified for gender. Blinded assessment pre‐ and post intervention. Mindfulness Based Cognitive Therapy (MBCT) is a manualized eight‐week group program aimed at raising awareness of rumination thought processes in patients with recurrent depression. The basis is that relapses occur due to automatic negative self‐generative thought processes hindering flexible cognitive and emotional functioning. In MBCT, mindfulness practices (i.e., meditation techniques) in combination with psychoeducation are used to break the vicious circle of rumination fueling depressive moods. The patients learn to become aware of and experience negative thoughts and feelings with an attitude of acceptance. Experiencing difficult thoughts and feelings with a non‐judgmental attitude is thought to increase the individual’s ability to tolerate these without automatically starting a ruminative cycle of emotional stress. The goal of increasing patients’ emotional tolerance will lead to them learning to take control over their self‐generative thought processes. The experimental group will receive the MBCT intervention a short time after pre‐measurements. There will be eight weekly 2 hour sessions, and in addition, one longer session lasting for six hours between session 6 and 7. Each MBCT group will consist of 8‐12 participants. The theme of the first session is “Beyond Automatic Pilotâ€?. The main focus is to discover how fast attention wanders and how bringing attention to something specific affects how we perceive that object. The participants get introduced to a structured mindfulness exercise focusing on physical sensations. Each exercise is followed by an inquiry where the participants get to share what they discovered during the exercise and how they experienced it. They also get a sound recording of this exercise to practice 45 min every day at home betwee CONDITION: Recurrent major depressive disorder ; Mental and Behavioural Disorders ; Recurrent depressive disorder PRIMARY OUTCOME: ; Attention regulation processes will be the primary outcome measures. Intra‐individual variability in reaction times and default mode activity during cognitive control processing will be used as measures of attentional lapses. Attentional lapses and cognitive control will be measured with performance based test measures. In a subsample brain activation will be measured using functional Magnetic Resonance Imaging (fMRI). Further, self‐reported questionnaire data will be applied to measure the degree of ruminative thought (RRQ), and the correlation between intra‐individual variance of reaction times, Default Mode activity and ruminative thought processes. Heart Rate Variability (HRV) will be used as a psychophysiological measure of cognitive control.; ; All the outcome measures are administered at baseline and at 8 weeks following post treatment. The primary outcome of level of rumination (RRQ) is also measured after 6 months, 1, and 2 years.; SECONDARY OUTCOME: ; 1. Facets of mindfulness, emotion regulation, self‐compassion, attachment, childhood trauma, personality traits, depression and anxiety symptoms, and early attention processing; 2. Emotion regulation and self‐compassion measured with self‐report, qualitative interviews, emotion recognition task, and with HRV; 3. Early attachment with significant others, traumatic childhood experiences, and personality traits measured with self‐reports, and outcome of MBCT measured with change scores in depressive symptoms and in mindfulness facets from pre‐ to post‐intervention; 4. Early attention processing measured with cue conditions during cognitive control processing (the Attention Network Test Revised Version); 5. Basic abilities such as intelligence (assessed with Wechler Abbreviated Scale of Intelligence) and processing speed (assessed with trail making test); ; All the outcome measures are administered at baseline and at 8 weeks following post treatment. After 6 months, 1, and 2 years, selected outcome measures are administered. This includes the primary outcome of level of rumination (RRQ) together with relapse of depressive episodes. Further, the participants also fill out the following self‐report questionnaires:; 1. Depressive symptoms, measured with Beck Depression Inventory (BDI); 2. Anxiety, measured with Beck Anxiety Inventory (BAI); 3. Difficulties with emotion regulation, measured with Difficulties in Emotion Regulation Scale (DERS); 4. Self‐compassion, measured with Self‐Compassion Scale (SCS); 5. Mindfulness, measured with the Five Facet Mindfulness Questionnaire (FFMQ); INCLUSION CRITERIA: Clinical group: 1. Age: 18 ‐ 70 years old 2. Both genders 3. At least three previous depressive episodes, and to currently fulfill the diagnostic criteria for recurrent depression, and in full/partial remission from depression 4. Patients may continue on antidepressant while participating in the study. It is, however, important that they do not discontinue or change dosage of medication while receiving the interventions of MBCT 5. No current neurological, cardiac or hormonal diseases 6. Borderline Personality Disorder (as assessed by SCID‐II) Healthy control group: 1. Age: 18‐70 years old 2. No current or prior psychiatric illness (as indicated by M.I.N.I.) 3. No current neurological, cardiac or hormonal diseases