11-12-2024 | Original Article
Mindfulness-Based Compassionate Living for Recurrent Depression: Examining Experiential Avoidance, Fear of Self-Compassion, and Positive Affect as Mediators of Response in a Randomized Controlled Trial
Gepubliceerd in: Cognitive Therapy and Research | Uitgave 1/2025
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Background
Compassion-based interventions (CBIs) such as Mindfulness-Based Compassionate Living (MBCL) are effective for treating depression, with improvements in self-compassion partly mediating the effects. The aim of this study is to investigate whether experiential avoidance, fear of self-compassion, and positive affect additionally mediate the effects of MBCL on depressive symptoms and quality of life in patients with recurrent depression.
Methods
Data were collected in the context of an RCT on the efficacy of MBCL + treatment as usual (TAU) compared to TAU-only in recurrent depression (n = 122) and a subsequent uncontrolled cohort study. In a subsample of RCT participants (n = 68) who completed questionnaires on experiential avoidance, fear of self-compassion, positive affect at baseline and end-of-treatment/-control, univariate and multivariate mediation analyses were conducted. Consolidation and prediction analyses were conducted in the uncontrolled cohort sample, incorporating a six month follow-up measurement.
Results
Experiential avoidance and fear of self-compassion reduced in the MBCL + TAU group compared to the TAU-only group, whereas positive affect did not differ between the two conditions. Univariate mediation analyses revealed only experiential avoidance as a mediator of MBCL’s effects. When these results were controlled for improvements in self-compassion using multivariate analyses, the mediating effect of experiential avoidance was no longer significant.
In the uncontrolled cohort, reductions in experiential avoidance and fear of self-compassion were observed and maintained, along with improvements in the relaxed and safe & warmth positive affect subscales. Changes in experiential avoidance and relaxed positive affect during treatment predicted depressive symptoms at six month follow-up, whereas only changes in experiential avoidance predicted quality of life.
Conclusions
MBCL reduces experiential avoidance and fear of self-compassion in recurrent depression. Reductions in experiential avoidance may contribute to MBCL’s efficacy, though increases in self-compassion appear to have a stronger mediating effect. Further research on experiential avoidance and its interplay with self-compassion during CBIs is recommended.