Effectiveness of mindfulness‐based stress reduction and attachment‐based compassion therapy for the treatment of depressive, anxious, and adjustment disorders in mental health settings: A randomized controlled trial

• Published in: Depression and anxiety Vol. 38; no. 11; pp. 1138 - 1151
• Main Authors: Collado‐Navarro, Carlos, Navarro‐Gil, Mayte, Pérez‐Aranda, Adrián, López‐del‐Hoyo, Yolanda, Garcia‐Campayo, Javier, Montero‐Marin, Jesus
• Format: Journal Article
• Language: English
• Published: United States Hindawi Limited 01.11.2021
• Subjects: adjustment disorder; Adjustment Disorders; Anxiety; Anxiety - psychology; Anxiety - therapy; Attachment; attachment‐based compassion therapy; Clinical trials; Compassion; depression; Empathy; Humans; mediation analysis; Mental depression; Mental Health; Mindfulness; mindfulness‐based stress reduction; Patients; randomized controlled trial; Self compassion; Stress; Stress, Psychological - psychology; Stress, Psychological - therapy; attachment-based compassion therapy; anxiety; mediation analysis; mindfulness-based stress reduction; adjustment disorder; depression; randomized controlled trial
• ISSN: 1091-4269; 1520-6394
• DOI: 10.1002/da.23198

Objectives To study the effectiveness of attachment‐based compassion therapy (ABCT) for reducing affective distress in a sample of outpatients with depressive, anxiety, or adjustment disorders, and to explore its mechanisms of action. Methods This randomized controlled trial involved the assessment time points of pretreatment, posttreatment and 6‐month follow‐up. A total of 90 patients from three mental health units in Castellón, Spain, were recruited and randomly assigned to “ABCT + treatment as usual (TAU),” “Mindfulness‐based stress reduction (MBSR) + TAU” or “TAU” alone. Affective distress, as measured by the “Depression, Anxiety and Stress Scales” (DASS‐21) was the main outcome; self‐compassion and mindfulness were also assessed. Multilevel mixed‐effects models were used to estimate the effectiveness of the program, and path analyses were conducted to study the potential mechanistic role of mindfulness and self‐compassion. Results ABCT was not superior to MBSR in any outcome or at any assessment point. ABCT was superior to TAU alone both posttreatment (B = −13.20; 95% confidence interval [CI]: −19.57, −6.84) and at 6‐month follow‐up (B = −7.20; 95% CI: −13.63, −0.76) for reducing DASS‐21, and MBSR was superior to TAU alone both posttreatment (B = −11.51; 95% CI: −17.97, −5.05) and at 6‐month follow‐up (B = −8.59; 95% CI: −15.09, −2.10), with large effects (d ≥ 0.90). Changes produced by ABCT in DASS‐21 were mediated by self‐compassion, whereas changes produced by MBSR were mediated by both mindfulness and self‐compassion. Conclusion ABCT is effective for reducing affective distress in patients with anxiety, depressive and adjustment disorders, although its effect is not superior to that offered by MBSR. Self‐compassion seems to be a significant mediator of the effects of ABCT.