Online Mindfulness Therapy Helps Patients with Depression

Zindel V. Segal, PhD

Online mindfulness-based cognitive therapy could be a welcome addition to the usual care for patients suffering from depression.

A team led by Zindel V. Segal, PhD, examined whether web-based treatment of residual depressive symptoms can lead to incremental benefits for adults when it is added to usual care for depression.

Patients with residual depressive symptoms often face a gap in care due to very few resources available to manage the lingering effects of the disease.

In the randomized clinical trial, the investigators evaluated the effectiveness of treating residual depressive symptoms with Mindful Mood Balance (MMB), a web-based application that delivers mindfulness-based cognitive therapy along with the usual depression care compared with usual depression care only.

The trial, which involved 460 patients, was conducted in primary care and behavioral health clinics at Kaiser Permanente Colorado, Denver. A total of 230 patients received usual care, while 230 patients received MMB along with usual care. The MMB treatment included 8 online sessions for a 3-month interval along with minimal phone or email coaching support.

The investigators sought primary outcomes of a reduction in residual depressive symptom severity, which was assessed using the Patient Health Questionaire-9 (PHQ-9); rates of depressive relapse (PHQ-9 scores ≥15); and rates of remission (PHQ-9 scores <5).

They also sought secondary outcomes, which included depression-dree days, anxiety symptoms (General Anxiety Disorder—7 Item Scale), and functional status (12-Item Short Form Survey).

The investigators identified adults with residual depressive symptoms between March 2015 and November 2018. Outcomes were assessed for a 15-month period, comprising of a 3-month intervention interval and a 12-month follow-up period.

Those who received an online version of mindfulness-based cognitive therapy in addition to their usual care had greater reductions in depressive and anxiety symptoms, as well as higher rates of remission and higher levels of quality of life compared to patients who received usual care only for depression.

Patients in the MMB group had significantly greater reductions in residual depressive symptoms than did those receiving UDC only (mean [SE] PHQ-9 score, .95 [.39], P&thinsp;<.02).

The team also found a significantly greater proportion of patients achieved remission with the online therapy (PHQ-9 score, <5: β [SE], .38 [0.14], P&thinsp;=&thinsp;.008), while rates of depressive relapse were significantly lower (HR, .61; 95% CI, .39-.95; P&thinsp;<.03).

Compared with the UDC only group, the MMB group had decreased depression-free days (mean [SD], 281.14 [164.99] days vs 247.54 [158.32] days; difference, −33.60 [154.14] days; t&thinsp;=&thinsp;−2.33; P&thinsp;=&thinsp;.02), decreased anxiety (mean [SE] General Anxiety Disorder—7 Item Scale score, 1.21 [.42], P&thinsp;=&thinsp;.004), and improved mental functioning (mean [SE] 12-Item Short Form Survey score, −5.10 [1.37], P&thinsp;<&thinsp;.001).

However, there is no statistically significant differences in physical functioning between the groups.

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

The study, “Outcomes of Online Mindfulness-Based Cognitive Therapy for Patients With Residual Depressive Symptoms,” was published online in JAMA Psychiatry.