Mindfulness-based cognitive therapy improves depressive symptoms through decentering mediation in adultsMindfulness therapy helps people with severe depression symptoms

Psychological medicine Published July 13, 2026 Study authors: Barnhofer Thorsten, Dunn Barnaby D, Strauss Clara, Ruths Florian A, Ryan Mary, Ladwa Asha, Stafford … PubMed ↗ DOI ↗ Editorial oversight: Dr. Ji-eun Park, MD · Brain, Mind & Pain

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Key Takeaway

Note that MBCT may be particularly effective for patients with high baseline depressive symptom severity.

This secondary analysis of a randomized controlled trial evaluated 234 adults who were not remitted after high-intensity psychological therapy. The study compared Mindfulness-based cognitive therapy (MBCT) to Treatment as usual (TAU) over a follow-up period of 34 weeks.

Primary outcomes focused on depressive symptoms measured by the PHQ-9. Results indicated that higher baseline severity predicted greater symptom improvement across both groups. Furthermore, treatment-related increases in decentering partially mediated the effect of MBCT on depressive symptoms at the 34-week follow-up.

Analysis of moderation effects showed that while baseline severity did not moderate the acquisition of decentering skills, it did moderate the indirect effect; specifically, decentering was more strongly associated with symptom reduction among those with higher baseline depression. Safety and tolerability data were not reported.

Limitations include the fact that this is a secondary analysis of the RESPOND trial. The findings suggest MBCT is effective for individuals with high symptom burden and that its mechanism of action via decentering remains operative regardless of baseline severity.

How this fits prior evidence

How this fits prior evidence: This finding addresses a gap in non-pharmacological interventions for depression, complementing existing evidence where moderate-intensity exercise was ranked best for reducing depression and anxiety, and Tai Chi significantly reduced depression symptoms among college students with an SMD of -0.67.

Living with severe depression is incredibly hard, especially when standard intensive therapies do not provide the relief a person needs. A study of 234 adults looked at how mindfulness-based cognitive therapy (MBCT) compares to usual treatment for those who still have significant symptoms.

The researchers found that people starting with more severe symptoms saw greater improvements overall. Specifically, they looked at a skill called decentering. Decentering means learning to step back and view your thoughts as just passing events rather than facts about yourself. This mental shift helped reduce depressive symptoms over a 34-week period.

While the study shows that MBCT is effective for those with high symptom burdens, it is important to remember these results come from a secondary analysis of an existing trial. The data suggests that practicing decentering helps people distance themselves from their distress, making it a promising path for those seeking new ways to manage severe depression.

What this means for you:

Mindfulness-based therapy can help people with severe depression by teaching them to view their thoughts more objectively.

Common questions

What is mindfulness-based cognitive therapy?

Mindfulness-based cognitive therapy (MBCT) combines traditional cognitive therapy with mindfulness practices. It helps people learn to be present and observe their thoughts without judgment. In this study, it was compared to standard treatment for adults who did not find relief through high-intensity psychological therapy.

How does the concept of decentering help with depression?

Decentering is a skill where you learn to see your thoughts as just mental events rather than facts. The study found that this ability helped reduce depressive symptoms over 34 weeks. It was especially helpful for those who started with more severe symptoms, helping them distance themselves from their distress.

Who specifically can benefit from this type of therapy?

The study focused on adults who were not remitted after high-intensity psychological therapy. The results suggest that mindfulness-based cognitive therapy is particularly effective for individuals with a high symptom burden, meaning those experiencing more severe symptoms at the start of treatment.

Study Details

Study typeRct

EvidenceLevel 2

PublishedJul 2026

PMID42438894

View Original Abstract ↓

BACKGROUND: Mindfulness-based cognitive therapy (MBCT) was developed for relapse prevention in people with remitted depression but is increasingly used for those with difficult-to-treat depression (DTD). A key question regarding this broader application is whether ongoing depressive symptoms constrain therapeutic responsiveness or disrupt MBCT's proposed mechanism, decentering. We explored whether baseline depressive severity moderates clinical outcomes, whether changes in decentering mediate treatment effects, and whether this mediation varies by baseline severity. METHODS: Secondary moderation, mediation, and moderated mediation analyses were conducted using data from the RESPOND randomized trial ( = 234), comparing MBCT plus treatment as usual (TAU) with TAU alone in adults not remitted after high-intensity psychological therapy. Depressive symptoms (PHQ-9) and decentering (Experiences Questionnaire) were assessed at baseline, post-treatment (10 weeks), and follow-up (34 weeks). Analyses were conducted using structural equation modelling. RESULTS: Higher baseline severity predicted greater symptom improvement across both groups. Treatment-related increases in decentering partially mediated the effect of MBCT on depressive symptoms at follow-up. Although baseline severity did not moderate the treatment effect, it moderated the indirect effect, with decentering more strongly associated with symptom reduction among those with higher baseline depression. Severity did not moderate the acquisition of decentering skills. CONCLUSIONS: Concerns that more severe depressive symptoms limit the effectiveness of MBCT were not supported. MBCT's core mechanism remained operative under substantial symptom burden, with clinical impact amplified at higher severity. These findings reduce key uncertainties regarding the application of MBCT in DTD and support its use across a broad range of symptom severity.

Mindfulness-based cognitive therapy improves depressive symptoms through decentering mediation in adultsMindfulness therapy helps people with severe depression symptoms

How this fits prior evidence

Common questions

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Mindfulness-based cognitive therapy improves depressive symptoms through decentering mediation in adultsMindfulness therapy helps people with severe depression symptoms

How this fits prior evidence

Common questions

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PETRUSHKA decision-support tool reduced treatment discontinuation and improved symptoms in major depressive disorder

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