Sustained Attention as Mediator in Mindfulness-Based Cognitive Therapy for Depression

点击翻译按钮获取中文摘要

Mindfulness-based cognitive therapy (MBCT) effectively prevents relapse/recurrence in major depression. The ability to deploy and maintain attention on a particular focus is considered a prerequisite for 'mindful', 'metacognitive' awareness, and hence crucial for therapy success. Accordingly, sustained concentration, is the skill most extensively taught in MBCT. In a previous DFG-funded study, we tested whether this ability increases after MBCT as assumed. The late contingent negative variation (LCNV), an event-related brain potential (ERP), known to reflect the allocation of attentional resources in real-time, was used as a measure of concentration ability. The LCNV was significantly increased after MBCT compared to both pre-therapy baseline and no-treatment control group. Since our 'mindfulness LCNV task' included sad mood induction and rumination challenge, we interpreted this result as reflecting the patients' improved ability to shift their attention toward current moment experience and away from potentially depressogenic thinking or rumination during mild dysphoric states (a known risk factor for depressive relapse/recurrence). However, the clinical and discriminating relevance of the LCNV effect and, consequently, of the measured concentration ability still remains unclear, which is the reason for the present grant proposal. We intend to validate further the LCNV as a measure of sustained mindful attention by comparing the LCNV in a group treated with MBCT with the LCNV in a group treated with cognitive therapy (CT) without mindfulness, and also by investigating the relationship between LCNV and a newly developed self-report measure of sustained mindful attention. The ultimate goal of the proposed project, however, is to investigate the relationship between LCNV and the presence and severity of symptoms and/or relapse/recurrence of depression during a one-year follow-up period after treatment. We intend to recruit 160 recurrently depressed patients in remission and to assign them randomly to MBCT or CT. Patients' LCNV will be measured immediately before, immediately after, and one year after treatment. Presence and severity of depressive symptoms and/or relapse/recurrence will be assessed retrospectively for the year preceding the treatment and both retrospectively and continuously (via internet-assisted self-report) for the follow-up year. To the best of our knowledge, this will be the first study to test the hypothesis that increased mindful concentration ability predicts reduction in frequency and severity of symptoms and/or relapse/recurrence of major depression.