AUTHOR=Francis Sarah E. B. , Shawyer Frances , Cayoun Bruno , Enticott Joanne , Meadows Graham N. 

TITLE=Group Mindfulness-Integrated Cognitive Behavior Therapy (MiCBT) Reduces Depression and Anxiety and Improves Flourishing in a Transdiagnostic Primary Care Sample Compared to Treatment-as-Usual: A Randomized Controlled Trial

JOURNAL=Frontiers in Psychiatry

VOLUME=13

YEAR=2022

URL=https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2022.815170

DOI=10.3389/fpsyt.2022.815170

ISSN=1664-0640

ABSTRACT=<sec><title>Objectives</title><p>This study investigated the effectiveness of a group-based 8-week intervention, Mindfulness-integrated Cognitive Behavior Therapy (MiCBT), to decrease psychological distress and increase wellbeing in a heterogeneous population in primary health care. MiCBT focuses on the importance of interoception and its interaction with cognition in emotional experience. These interactions are represented in the co-emergence model of reinforcement, in which non-reactivity (equanimity) to interoceptive signals facilitates adaptive behavior.</p></sec><sec><title>Methods</title><p>Participants (<italic>n</italic> = 125, aged 20–72) were randomized to two groups (MiCBT), and treatment-as-usual (TAU). Outcomes were assessed at pre-, mid-, and post-intervention and at 6-month follow-up. The primary outcome was psychological distress, measured by the Depression, Anxiety and Stress Scale (DASS-21). Secondary outcome measures were the Kessler Psychological Distress Scale-10 (K10), Satisfaction with Life Scale (SWLS), and Flourishing Scale (FS). Mediator or process measures of interoceptive awareness, metacognitive awareness (decentering), equanimity, and social functioning were included to investigate putative mediators.</p></sec><sec><title>Results</title><p>The MiCBT intervention significantly reduced DASS-21 scores at mid and post-treatment and the gains were maintained at 6-month follow-up (<italic>p</italic> &lt; 0.0001, <italic>d</italic> = 0.38). Flourishing scores also showed significant improvement post-treatment and at 6-month follow-up (<italic>d</italic> = 0.24, <italic>p</italic> &lt; 0.0001). All measures selected showed a similar pattern of positive change, with the exception of the SWLS, which failed to reach significance. Mediation analysis suggested equanimity to be the most influential mediator of the primary outcome.</p></sec><sec><title>Conclusions</title><p>The results support the effectiveness of MiCBT in creating rapid and sustainable reduction of psychological distress and improvement in flourishing in a primary mental health care setting with heterogenous groups. These promising results support the scaled-up implementation of this intervention.</p></sec><sec><title>Clinical Trial Registration</title><p>This trial is registered with the Australian and New Zealand Clinical Trial Registry: <ext-link ext-link-type="uri" xlink:href="https://www.anzctr.org.au/ACTRN12617000061336" xmlns:xlink="http://www.w3.org/1999/xlink">https://www.anzctr.org.au/ACTRN12617000061336</ext-link>.</p></sec>