Behavioral Activation in individual setting as adjunct to a meditation group programme for patients with chronic depression

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Chronic depression is a highly prevalent disorder, but despite high distress neglected in mental health care. The effectiveness and acceptance of pharmacological treatment is often limited. Thus, there is urgent need for psychological treatment options as an alternative. Besides positive results of interpersonal treatment approaches such as Cognitive Behavioral Analysis System of Psychotherapy, there is also preliminary evidence for the efficacy of mindfulness-based cognitive therapy. Based on this approach, we developed a group meditation program that combined mindfulness with metta meditation. The specific aim of metta is to enhance a positive attitude towards oneself and others. In two pilot studies, we observed preliminary positive effects on symptoms (Graser et al., 2016; Hofmann et al., 2015). The implementation of these interventions into daily life is complicated by intense withdrawal and avoidance. However, the positive outcome of a former RCT of Cognitive Therapy for recurrent depression (Stangier et al., 2013) as well as from unpublished cases indicate that behavioral activation in individual setting compensate for the shortcomings of the group mediation program and significantly contribute to the reduction of depression-prone behavior. In the present RCT, the efficacy of this combination will be examined more systematically than in preceding pilot studies, and controlled effect sizes will be established. 46 patients with chronic depression will be randomized to a) either a combination of 8 sessions group meditation and 8 individual sessions behavioral activation, or b) a wait-list control group. Symptoms of depression will be assessed at pre-, intermediate-, post-treatment and follow-up. Primary outcome measure is the independent and blind rating of depression, using the Quick Inventory of depressive symptoms. Self-report measures will be used to assess behavioral and cognitive avoidance, emotion regulation strategies, rumination and social adaptation, as well as a standardized Interview of emotion regulation. The study will be the first to provide evidence for the efficacy of the treatment and a basis for the calculation of controlled effect sizes. In case of positive outcome, further studies will have to test the efficacy in comparison with active treatments. The combination of group mediation and subsequent individual treatment may be a good treatment option for patients with chronic depression in mental health care.