Predicting which intervention works better for whom: Moderators of treatment effect of Mindfulness-Based Cognitive Therapy and Positive Psychology Intervention in patients with bipolar disorder

Imke Hanssen*, Peter ten Klooster, Jannis Kraiss, Marloes Huijbers, Eline Regeer, Ralph Kupka, Ernst Bohlmeijer, Anne Speckens

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Background This study aimed to identify moderators of treatment effect (i.e. depressive symptoms and well-being) of Mindfulness-Based Cognitive Therapy (MBCT) and Positive Psychology Intervention (PPI) in patients with bipolar disorder. Methods Data were drawn from two multicenter randomized controlled trials investigating effectiveness of MBCT vs treatment as usual (TAU; n = 144) and PPI vs TAU (n = 97) in bipolar disorder. Outcomes were assessed at baseline, posttreatment, and 12 months after baseline. Data were analyzed using separate linear regression models, comparing the pooled MBCT or PPI outcomes to TAU, and comparing MBCT to PPI. Results The exploratory analyses not corrected for multiple comparisons showed a number of variables that were associated with stronger response to the interventions, including higher baseline anxiety, lower well-being, and lower levels of self-focused positive rumination, well-being, and self-compassion, and variables associated with a stronger response to either MBCT (higher levels of depression and anxiety and being married) or PPI (being male). After correcting for multiple testing, depressive symptoms appeared to be the most robust variable associated with better response to MBCT than PPI. Limitations The RCTs handled slightly different enrollment criteria and outcome measures. Conclusions The most robust finding is that patients with more severe symptomatology seem to benefit more from MBCT than PPI. Clinical implications This is a first step to improve personalized assignment of third-wave CBT interventions for patients with bipolar disorder. However, before definite treatment assignment criteria can be formulated and implemented in clinical practice, these findings should be replicated.
Original languageEnglish
Pages (from-to)79-87
Number of pages9
JournalJournal of Affective Disorders
Volume360
Early online date22 May 2024
DOIs
Publication statusE-pub ahead of print/First online - 22 May 2024

Keywords

  • Effect
  • Mindfulness based cognitive therapy
  • Moderators
  • Positive psychology
  • Bipolar disorder

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