The efficacy of mindfulness-based cognitive therapy in the management of depression in adults: A systematic review of randomized controlled trials

Abstract

Background:Depression is a prevalent mental disorder affecting 5% of the global adult population. Despite numerous review studies supporting the efficacy of mindfulness-based cognitive Therapy (MBCT) for recurring depressive disorders, reviews on its efficacy in adults are remain absence.

Objective:This review examined the efficacy of the evidence-based mindfulness-based cognitive therapy for managing depressive symptoms in adults.

Methods:A systematic literature search was conducted in six electronic databases (PubMed, Web of Science, EBSCOhost, JSTOR, Scopus, and Science Direct) to identify randomized controlled trials (RCTs) evaluating the effectiveness of MBCT on adult depression up to May 13, 2024.

Results:The 1151 screened studies, 117 were eligible for full-text review, 18 studies met the criteria and were included in this review. All included studies utilized RCT or pre-post designs, with three comparing MBCT with other psychological interventions. The results support that MBCT effectively manages the symptoms of current depressive disorders and improves mental well-being compared to the control intervention.We appraised the methodological quality of the included studies using the Cochrane Risk-of-Bias 2.0 tool.

Conclusion:MBCT was more effective in managing depression and improving mental well-being in adults, particularly in reducing recurrent depression. However, further research is needed to assess its efficacy for specific depressive disorders.

Keywords: MBCT, Depression, Depressive Disorders, RCTs

The efficacy of mindfulness-based cognitive therapy in the management of depression in adults: A systematic Review of randomized controlled trials

Depression is the most prevalent mental disorder affecting the adult population (Moussavi et al., 2007), and a significant public health issue in most societies worldwide, leading to impaired functioning, decreased quality of life, and increased morbidity and mortality (Culpepper, 2011). Depression is characterized by feeling sad all the time, losing interest in activities, and experiencing several physical and mental distractions (Khune et al., 2023), and it affects more than 322 million people of all ages, making it one of the leading causes of disability worldwide (World Health Organization, 2017). Furthermore, the World Health Survey reported an annual prevalence rate of 3.2% for ICD-10 depressive episodes (Moussavi et al., 2007). According to the Adult Psychiatric Morbidity Survey (APMS), the prevalence rate of depression in adults was 3.8% in 2014. Further, 17 % of adults met the criteria for common mental disorders (CMDs) including depression (McManus et al.,2016, p.49). Moreover, the prevalence of depressive disorders has increased from 170.8 million people in 1990 to 279.8 million individuals in 2019 (GBD 2019 Mental Disorders Collaborators.,2022).

The successful treatment of depressive disorder is a significant challenge. Most often, pharmacotherapy is prescribed to help patients return to their baseline level of functioning, when they are experiencing the acute phase of a major depression, particularly selective serotonin reuptake inhibitors (SSRIs). In addition to that depression-focused psychotherapy, a combination of medications and psychotherapy, and somatic therapy, such as electroconvulsive therapy (ECT) are treatment options for the management of depression in acute phase (Karrouri et al., 2021).

Psychological interventions, such as mindfulness-based cognitive therapy (MBCT), cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT), and have shown the efficacy in the treatment of mild and moderate depressive disorders (Hofmann et al., 2012; Cuijpers et al., 2013). In severe cases of depression, supportive therapy (ST) and psychoeducational intervention (PEI) are used to augment pharmacological treatments (Karrouri et al., 2021). CBT, PEI, and MBCT are recommended to maintain remission and prevent the relapse of depression. However, psychological interventions might be continued to prevent relapse (Qaseem et al., 2016).

Mindfulness-based cognitive therapy (MBCT) is an evidence-based eight weeks psychological intervention developed to prevent depression (Zindel V. Segal et al.,2013, p.64.) It combines principles from cognitive behavioral therapy (CBT) and mindfulness-based stress reduction (MBSR) with mindfulness techniques rooted in Buddhist teachings to develop awareness of the present moment, acceptance and shift from thoughts and feelings without judgement (Sipe et al., 2012; Tseng et al.,2023).

The National Institute for Health and Care Excellence (NICE) recommends MBCT as the preferred psychological intervention in the clinical management of depressive symptoms in adults (NICE, 2022). According to American Psychological Association guidelines, clinicians offer psychotherapy or second-generation antidepressants for the initial treatment of adult patients diagnosed with depression. The recommended psychotherapeutic options for depression are included behavioral therapy, cognitive therapy, cognitive-behavioral therapy, mindfulness-based cognitive therapy, interpersonal psychotherapy, psychodynamic therapies, and supportive therapy. Considering the combined treatment. The APA recommends cognitive-behavioral therapy or interpersonal psychotherapy with a second-generation antidepressant (American Psychological Association, 2019, p.10.).

In the past decades, there has been a substantial increase in the publication of RCTs and review studies evaluating the efficacy of MBCT for a range of depressive and anxiety disorders (McManus et al., 2012; Hofmann et al.,2017; Chan et al., 2020; Ninomiya et al., 2020;Jiang et al.,2022; Liu et al., 2021; Johannsen et al.,2022). More recent, systematic and meta-analysis review studies have shown the efficacy of MBCT in the management of depressive disorders compared to patients treated with TAU (McCartney et al.,2021; Nisa'Fiddaroini et al., 2020) and suggest that MBCT is an effective treatment option for depression among various populations (Tseng et al., 2023; Williams et al., 2022; Zhang et al., 2022; Zinzow et al., 2022). Additionally, MBCT has been shown to be effective in reducing depression and suicidal ideation in patients with major depressive disorder (MDD) (Strauss et al., 2023; Zhang et al., 2022). However, as par as our knowledge, there is a dearth of systematic reviews conducted exclusively on the efficacy of MBCT for depression in adult diagnosed as per DSM-IV TR or ICD-10 criteria. Therefore, this systematic review aimed to evaluates the efficacy of MBCT for depression in the adult population and to understand the research gap in future studies. The current systematic review hypothesized that MBCT would be effective in the management of depressive symptoms in the adult population.

2. Method

2.1. Protocol & registration

This systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO registration number: CRD42024548497). The review was conducted following the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines.

2.2 Eligibility Criteria

Inclusion Criteria

Studies were included in this review according to the following inclusion criteria. The review included only randomized controlled trials (RCTs) with treatment group (TG) and control group (CG), waitlist and treatment as usual (TAU). Participants eligible for inclusion were adults aged 18-65 who had been diagnosed with depression according to the diagnostic criteria of the DSM-IV TR or ICD-10. The treatment group received MBCT according to the protocol developed by Segal et al (2002; 2013). In terms of comparators, inactive controls (TAU or Waitlists), and active groups (antidepressants or other psychological interventions) are included.Table 1outlines the PICOS criteria used in the present study. Relevant studies should report the various symptomatic domains of depressive disorders. Additionally, all included studies should be published in English and involved face-to-face delivery of MBCT sessions.

Exclusion Criteria

The current review excluded non-randomized trials, such as controlled clinical trials, quasi-experimental designs, and case studies. Studies conducted on bipolar disorders, brain injury, schizophrenia, schizoaffective disorder, organic mental disorders, or neurocognitive disorders(NCDs) (e.g., dementia,Parkinson disease, Alzheimer's disease), and any form of cancer were also excluded. Furthermore, studies that focused exclusively on specific demographic groups such as children (under 18 years of age) or older adults (above 65 years of age), and studies conducted with participants of pregnant women or high-suicide risk patients were not eligible for this review. In addition, studies with participants with specific medical conditions or diseases other than depression and any trials of Mindfulness-Based Cognitive Therapy (MBCT) delivered via internet-based or video-based formats will be excluded. Studies with duplicate data, those lacking primary data, and pilot studies were excluded to ensure that the focus remained on more definitive evidence.

2.3 Literature Sources and Search Strategy

Electronic data bases (PubMed, PubMed, Web of Science, EBSCOhost, JSTOR, Scopus, Science Direct) were searched from 13^thMarch 2024 to 21^stApril 2024 (Figure 1). In accordance with PRESS guidelines (McGowan et al.,2016), the following search string was developed and the same search thread was used in each database: (MBCT OR "Mindfulness-Based Cognitive Therapy") AND (Depression OR "Depressive Disorder" OR "Major Depression" OR "Clinical Depression") AND ("randomized controlled trial" OR RCT OR trial). The filter option of each database was used to obtain relevant search results. In addition, an extensive manual review of the review articles was conducted to identify eligible publications.

2.4 Study Selection

Duplicates from the identified literature were removed using automated web-based software, and all duplicates were manually double-checked by the first author. The authors screened all titles and abstracts and selected eligible studies for full paper selection following the inclusion and exclusion criteria. Studies with doubts regarding eligibility were included in the full paper review process. Two authors independently completed the full-text screening process, and disagreements were discussed to reach a consensus.

2.5 Data extraction

Data extraction from the studies included in this systematic review was performed using several elements, including the PICO framework. Data extraction included variables related to (i) population characteristics (e.g. age, sex, sample size, and clinical conditions), (ii) intervention characteristics (e.g., type of therapy, number of sessions) (iii) comparator characteristics (e.g., active control group, inactive control group), (iv) outcome characteristics (e.g., used tools, results, findings), and (v) study characteristics (e.g., authors, publication year).

2.6 Risk of Bias Assessment

The risk of bias in each study included was evaluated using version 2 of the revised Cochrane risk of bias tool for randomized trials (RoB 2) (Sterne et al.2019). The tool examined the following five domains: (i) bias arising from the randomization process (e.g., allocation sequence, and sequence concealed); (ii) bias due to deviations from intended interventions (e.g., assigned intervention, intended intervention); (iii) bias due to missing outcome data (e.g., outcome availability, predicted direction); (iv) bias in the measurement of the outcome (e.g., measuring the outcome, ascertainment of the outcome); and (v) bias in the selection of the reported result (e.g., prespecified analysis, outcome measurements). The assessment was conducted by the first reviewer and disagreements were resolved by consensus with the second reviewer.

3. Result
   
   

3.1 Study selection

A total of 1581 studies were found from five electronic databases and after removing duplicate studies, 1151 studies were retrieved for the title and abstract screening process. After reviewing the titles and abstracts 1034 studies which did not meet the inclusion criteria were removed, and 117 studies were eligible for full-text review. In the review process, 98 studies were excluded for the following reasons: seven studies were reviews or theoretical; eight studies were not full form of MBCT; nine studies were not RCTs; nine studies were children or older adults; one study was conducted with pregnant women; thirteen studies were conducted with participants who had specific medical conditions; eleven studies were pilot studies; fourteen studies were internet-based or video based delivered MBCT; seven studies were duplicate or insufficient data; nine studies were excluded population; two studies were conducted with suicidal ideation patients; and nine studies were specific mental disorder. Finally, 18 studies were included in this systematic review. The flow of information for identification, screening and inclusion is shown inFigure 1using the PRISMA flow diagram (Haddaway et al., 2022)

3.2 Characteristics of Included Studies

Table 1presents an overview of the characteristics of the included studies, including their design, interventions, comparators, and outcome measures. In terms of study location, most studies were conducted in European countries (Netherlands, k=7; United Kingdom, k=2). The remaining studies were conducted in the United States (k=2). The others were Iran (k=2), Nigeria (k=1), Australia (k=1), Italy (k=1), Belgium (k=1), and Norway (k=1). Most of the studies (n=14) were published before 2018. Only one study was conducted in 2023, whereas the other studies were conducted between 2018-2022 (k=5). All the studies were published in peer-reviewed journals between 2004 and 2023.

All included studies had randomized controlled trial (RCT) designs, and the primary intervention was MBCT. Among them, 12 studies compared the efficacy of MBCT with TAU, including pharmacotherapy, active Control Condition, and four studies compared with wait-list control group. The remaining studies (k=4) compared with another intervention or combined with TAU. Two of these studies, specifically compared MBCT with individual interventions (CBT and psycho-education). Four studies compared MBCT with other interventions or combined with TAU. In terms of outcome measures of the study, Beck Depression Inventory (BDI), Hamilton Rating Scale for Depression (HAMD), and Five Facet Mindfulness Questionnaire (FFMQ) were most common. Rigorous designs and diverse measures ensured a comprehensive assessment of the efficacy of MBCT for depression and mental well-being outcomes across different settings and populations.

3.3 Risk of Bias in the Studies

Two studies were found to have some concerns regarding the risk of bias (Cladder?Micus et al.,2018; Hamidian et al.,2013). Further, four studies were determined to have some concerns in domain of bias due to missing outcome data (van Aalderen et al.,2012; Manicavasgar et al.,2011; Shallcross et al., 2015; Barnhofer et al., 2009). The main concern regarding bias in several studies was related to the measurement of outcomes with a high drop rate. Overall, the included studies had a low risk of bias. Figure 2 shows the quality assessment, and Figure 3 provides a summary of the appraised studies.

3.4 Post-Treatment Efficacy of MBCT

Most studies have indicated that MBCT significantly reduces depressive symptoms and risk of relapse in patients with recurrent depression. Van Aalderen et al. (2011) found that MBCT combined with Treatment-As-Usual (TAU) effectively reduced depressive symptoms, worry, and rumination in patients with recurrent depression, regardless of their current depressive state (van Aalderen et al., 2011). Similarly, Ma and Teasdale (2004) reported that MBCT significantly reduced relapse rates in patients with three or more episodes of depression (Ma & Teasdale, 2004). Extending these findings, Musa et al. (2020) observed significant improvements in depressive symptoms at a two-month follow-up in patients with major depressive disorder, suggesting delayed yet enduring benefits of MBCT. Cladder-Micus et al. (2018) demonstrated that MBCT plus TAU not only improved remission rates but also enhanced mindfulness skills and quality of life among patients with chronic treatment-resistant depression. Chiesa et al. (2012) found that MBCT is superior to psycho-educational control in reducing symptoms and improving the quality of life in patients who did not achieve remission with antidepressant treatments. Schanche et al. (2020) highlighted significant reductions in depressive relapse risk factors and improvements in protective factors such as self-compassion. Furthermore, Pots et al. (2014) showed that MBCT effectively reduced depressive symptoms and anxiety, and maintained these improvements at a three-month follow-up. Dunn et al. (2023) revealed that MBCT is superior to maintenance antidepressants for enhancing positive affect in individuals with residual symptoms. Finally, Geschwind et al. (2012) reported that MBCT significantly reduced residual depressive symptoms compared to a wait-list control, with sustained effects over six to twelve months. Collectively, these studies affirm the post-treatment efficacy of MBCT across various forms of depression, highlighting its significant impact in improving long-term mental health outcomes.

In contrast, Shallcross et al. (2015) reported that MBCT is no more effective in reducing depression relapse rates and depressive symptoms than an active control condition (ACC) based on the Health Enhancement Program (HEP), suggesting that the unique efficacy of MBCT may not always result in superior outcomes compared to other well-structured interventions. Additionally, while Cladder-Micus et al. (2018) showed that MBCT combined with treatment-as-usual (TAU) led to higher remission rates, the initial post-treatment effects were not significantly different from those of TAU alone, indicating that MBCT's immediate impact on MBCT might be less pronounced in some cases.

3.6 MBCT Efficacy and other treatments

The efficacy of MBCT in treating major depressive disorder (MDD) and treatment-resistant depression has shown varying results. Chiesa et al. (2012) demonstrated significant improvements in depressive symptoms and quality of life, whereas Huijbers et al. (2017) found no significant differences compared to controls, underscoring the inconsistent outcomes of MBCT. For treatment-resistant depression, Cladder-Micus et al. (2018) observed improved remission rates with MBCT plus treatment-as-usual, in contrast to Eisendrath et al. (2016), who reported mixed results, particularly for sustained remission. Comparative studies such as Manicavasgar et al. (2011) and Omidi et al. (2013), show MBCT as equally effective as CBT and active control conditions, suggesting its potential as a viable alternative therapy. Additionally, MBCT combined with pharmacotherapy has been beneficial for dysthymia, significantly reducing symptoms and enhancing mindfulness skills (Hamidian et al., 2013). These findings highlight the need for further research to delineate the which specific conditions under which MBCT is most effective.

Impact on Treatment-resistant Depression: Cladder-Micus et al. (2018) found that MBCT was effective in treatment-resistant populations, whereas Eisendrath et al. (2016) reported mixed results, particularly in remission. This shows that MBCT may work differently, depending on the severity and history of depression.

Several studies included in this review compared MBCT to other forms of treatment options, and interventions reported no significant difference between MBCT and CBT, MBCT or ACC, suggesting that both could be effective in the management of depression (Manicavasgar et al.,2011; Omidi et al.,2013). Moreover, MBCT shows promise as an adjunct treatment for dysthymia. A study conducted by Hamidian et al. (2013) showed significant reductions in depressive symptoms and improvements in mindfulness skills in MBCT + Pharmacotherapy group.

3.7 Long-term Efficacy of MBCT

The long-term efficacy of MBCT has been assessed in several studies, with follow-up periods of up to 52 weeks. Eisendrath et al. (2016) found that MBCT offered significant improvements in depression severity and response rates compared to a health enhancement program (HEP) at the post-intervention (8-weeks) for individuals with treatment-resistant depression. Over a 52-week follow-up period, both interventions showed sustained improvement from baseline to the end of the follow up period. Ma and Teasdale (2004) reported that MBCT significantly lowered relapse rates in patients with three or more episodes of depression over a 12-month follow-up period. This finding is critical, because it suggests that MBCT helps build resilience against future depressive episodes. Similarly, van Aalderen et al. (2011) demonstrated that MBCT, combined with treatment-as-usual, not only reduced depressive symptoms but also maintained these benefits across a 12-month period, highlighting its sustained efficacy. This shows that, while MBCT has significant short-term advantages, its long-term superiority might require continued intervention to maintain its initial effectiveness (Eisendrath et al. 2016).

3.8 Variability in Long-term Outcomes

Despite the overall positive outcomes, the long-term efficacy of MBCT is not uniform across all studies and patient demographics. Shallcross et al. (2015) reported no significant differences in depression relapse rates between MBCT and an active control condition over a 60-week follow-up period, indicating that MBCT might not always offer superior long-term benefits compared to other structured interventions. This variability underscores the importance of considering individual differences in treatment responses and the potential need for tailored booster sessions to maintain the gains achieved through MBCT.

4. Discussion

The review findings suggest that MBCT is an effective psychological intervention for treating depressive disorders, including chronic, recurrent, and treatment resistant depression, compared to other treatment options such as control groups, medication-assisted depressive management (mADM), active control conditions (ACC), psycho-education, health enhancement programs (HEP), and waitlist controls (WLC). Additionally, MBCT has shown positive results in reducing the symptoms of major depressive disorder (MDD), managing future episodes of MDD, and improving psychological well-being across different populations and settings. Furthermore, MBCT showed a significant efficacy in reducing rumination, and improving cognitive function, mindfulness skills, positive thoughts, and quality of life.

In contrast, the findings of this review identified specific areas in which efficacy may be limited. In the treatment of chronic treatment-resistant depression, there was not significant reduction in depression symptoms when compared to TAU alone in the intention-to-treat analysis (Cladder-Micus et al., 2018) and Manicavasgar et al. (2011) found that CBT was more beneficial in treating non-melancholic depression. Furthermore, two studies found that MBCT was as effective as CBT and ACC based on HEP in treating major depressive disorder and preventing of depressive relapse, respectively.

First, the reduction of depressive symptoms and the enhancement of mindfulness skills have been demonstrated in several studies involving MBCT. Musa et al. (2020) found that while there was no significant immediate improvement, the MBCT group showed significant symptom reduction at a two-month follow-up, supporting the long-term efficacy of MBCT (Musa et al., 2020). Similarly, Cladder-Micus et al. (2018) reported higher remission rates, lower rumination, and increased mindfulness skills in the MBCT + Treatment-As-Usual (TAU) group than in the TAU group, especially in treatment-resistant depression (Cladder-Micus et al., 2018). Furthermore, significant improvements in rumination, emotion regulation, and depression have been found in participants who completed MBCT, reinforcing its efficacy in managing recurrent depression (Schanche et al., 2020). Pots et al. (2014) also observed significant reductions in depressive symptoms and experiential avoidance, with these benefits sustained over a three-month follow-up period (Pots et al., 2014).

Numerous studies have reported a positive relationship between MBCT and depressive symptoms, decreased of rumination, and negative thoughts. A longitudinal study conducted over two years with 41 participants demonstrated that MBCT is effective in reducing of rumination and increasing positive thoughts. This emphasizes the importance of the non-judgmental aspect mindfulness in reducing depressive symptoms over time (Petrocchi & Ottaviani, 2016). Schroevers and Brandsma (2010) found decreases in negative affect and increases in positive affect following an 8-week MBCT intervention, and there is significance correlation mindfulness and psychological well-being. (Schroevers, M. J., & Brandsma, R., 2010). Further supporting these findings, Shapero et al. (2018) reported that MBCT effectively reduces the risk of depressive relapse and treats active depression symptoms. MBCT has been shown comparable efficacy to maintenance antidepressant medications, especially for individuals with a history of multiple depressive episodes. Moreover, MBCT has demonstrated initial efficacy for treating current major depressive disorder and other psychiatric conditions such as anxiety disorders, bipolar disorder, and substance use disorders (Shapero et al., 2018). Barnhofer et al. (2015) found that MBCT weakened the association between depressive symptoms and suicidal cognition in patients with a history of suicidal depression, highlighting its efficacy in reducing vulnerability to relapse (Barnhofer et al., 2015).

Second, several studies have compared MBCT to other therapeutic interventions. In this review, MBCT was found to be more effective than treatment-as-usual (TAU) in reducing depressive symptoms, as well as reducing relapse rates and the time spent seeking psychotherapy. (Cladder-Micus et al., 2018; van Aalderen et al., 2011; Barnhofer et al., 2009; Eisendrath et al.,2016; Dunn et al.,2023). Piet and Hougaard (2011) conducted a meta-analysis on MBCT to prevent depressive relapse. They found that MBCT significantly reduced the risk of relapse in patients with recurrent depression compared to the control group, which supports our observation of reduced relapse rates with MBCT (Piet & Hougaard, 2011). Moreover, Segal et al. (2010) found that MBCT was as effective as maintenance antidepressant monotherapy (mADM)(Segal et al.,2010) This results consistence with the result of Kuyken et al. (2015). Both studies suggest that MBCT may be an acceptable substitute for long-term pharmacotherapy in the treatment of major depressive disorders. MBCT was shown to significantly reduce depressive symptoms and improve mindfulness skills in a clinical population with depression (Strauss et al., 2014). This is consistent with the findings that MBCT improves mindfulness skills and quality of life, as observe in studies by Cladder-Micus et al. (2018) and van Aalderen et al. (2011). Furthermore, MBCT significantly reduced depressive symptoms and improved mindfulness skills in a clinical population with depression (Strauss et al., 2014). Additionally, Godfrin and van Heeringen (2010) conducted a study with 106 depressed participants comparing MBCT and TAU, which showed a significant decrease in relapse rates and time, as well as improvements in depressive mood (Godfrin & van Heeringen, 2010). These findings underscore the efficacy of MBCT in managing depression and preventing relapse, and demonstrate its advantages over other therapeutic interventions.

Third, the findings on the long-term effectiveness of MBCT align with the study conducted by Kuyken et al. (2008). This study showed that MBCT not only reduced the relapse rate but also improved quality of life over a 14-month follow-up period (Kuyken et al., 2008).Bondolfi et al. (2010) conducted a study that demonstrated the long-term effectiveness of MBCT in preventing relapse in recurrent depression. They found that MBCT significantly reduced relapse rates compared with TAU over a 60-week follow-up period, further supporting the robustness of MBCT in long-term depression management (Bondolfi et al., 2010). Similarly, Kearns et al. (2016) highlighted the sustained benefits of MBCT in improving mental health outcomes over a 12-month period. Participants reported significant reductions in depressive symptoms and enhanced quality of life, which were maintained at follow-up assessments (Kearns et al., 2016). These findings underscore the long-term benefits of MBCT in managing depression and improving overall well-being. Shallcross et al. (2015) reported that MBCT was as effective as active control in preventing depression relapse, supporting the robustness of MBCT as a therapeutic intervention (Shallcross et al., 2015). This aligns with our findings that MBCT provides sustained benefits in reducing depressive symptoms and enhancing mindfulness skills. Similarly, Godfrin and van Heeringen (2010) found that MBCT significantly reduced relapse rates and depressive symptoms compared to TAU over a 56-week follow-up period, reinforcing the efficacy of MBCT in long-term depression management (Godfrin & van Heeringen, 2010). The consistent findings across multiple studies demonstrate that MBCT not only effectively reduces depressive symptoms and relapse rates in the short term but also provides significant long-term benefits. These studies collectively highlight the robustness and versatility of MBCT as a therapeutic intervention for managing depression and enhancing overall quality of life.

Forth,the review identified specific areas where the efficacy of Mindfulness-Based Cognitive Therapy (MBCT) may be limited. These findings consistent with other studies that have also reported limited efficacy of MBCT in certain contexts. Our review found that MBCT did not show a significant reduction in depression symptoms when compared to TAU alone in the intention-to-treat analysis. This is aligned with the findings of Williams et al. (2014), which conducted a study on patients with chronic treatment-resistant depression and found that MBCT did not significantly outperform TAU in reducing depressive symptoms (Williams et al., 2014). This suggests that MBCT may have limited effectiveness for individuals with treatment-resistant forms of depression.

This review revealed that Cognitive Behavioral Therapy (CBT) produced similar results to Mindfulness-Based Cognitive Therapy (MBCT) in improving the general symptoms of depression. For instance, a study comparing MBCT with CBT reported comparable outcomes in reducing depressive symptoms (Manicavasgar et al., 2011). Another study emphasized the significance of this combination, noting that MBCT fosters self-compassion and emphasizes the content of thoughts (Cladder-Micus et al., 2018).

This systematic review provides strong evidence supporting the effectiveness of MBCT in treating various forms of depressive disorders among adults. MBCT significantly reduces depressive symptoms, prevents relapse, and enhances mindfulness skills and the overall quality of life. The long-term benefits and mechanisms of action further underscore its potential as a sustainable intervention for depression management. However, further research is needed to establish its efficacy across different depressive conditions and explore its integration with other therapeutic approaches.

5.1. Limitations

This review aims to understand the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) in the management of depression. This study had several limitations. First, this review included only randomized controlled trials, excluding other study types such as non-randomized controlled trials and case studies which might provide a more comprehensive understanding of the effectiveness of MBCT. Second, this study primarily focused on adults with depression. Exploring the efficacy of MBCT in other groups, such as individuals with anxiety, substance abuse issues, or stress, could provide a broader perspective of its impact on various psychological conditions. Third, only published studies were selected, potentially introducing a publication bias into the findings. Finally, this review did not assess the reliability of MBCT or how it was implemented by the participants, which may affect the generalizability and practical application of the results.

Conclusion

This systematic review proposes that Mindfulness-Based Cognitive Therapy (MBCT) is a promising alternative treatment for depression in adults. The results revealed that MBCT alone was effective in treating the primary depressive symptoms. However, its efficacy is significantly enhanced when combined with other interventions such as Cognitive Behavioral Therapy (CBT), treatment-as-usual (TAU), or pharmacotherapy. For instance, studies have shown that MBCT, when combined with antidepressants, results in greater improvements in depressive symptoms and reduces the rate of relapse compared with standard treatments alone. These findings underscore the need to integrate MBCT with other therapeutic approaches to optimize treatment outcomes and reduce intervention costs. Future research should focus on determining the optimal timing and sequence of MBCT to maximize its therapeutic benefits. This approach will help tailor MBCT interventions to individual needs, thereby improving the overall mental health outcomes of individuals suffering from depression.

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