Evidence map›Paper›PMID 42438894›Full record

Trial reportPsychological medicine2026

Mechanisms of mindfulness-based cognitive therapy in difficult-to-treat depression: moderation and mediation analyses from the RESPOND trial.

Thorsten Barnhofer, Barnaby D Dunn, Clara Strauss, Florian A Ruths, Mary Ryan, Asha Ladwa, Frances Stafford, Roberta Fichera, Isabella Metcalfe, Allan H Young and 1 more

Abstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Psychological medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Thorsten BarnhoferSchool of Psychology, https://ror.org/00ks66431University of Surrey, Guildford, UK.ORCID 0000-0003-2984-8454
Barnaby D DunnMood Disorders Centre, https://ror.org/03yghzc09University of Exeter, Exeter, UK.ORCID 0000-0002-0299-0920
Clara Strausshttps://ror.org/05fmrjg27Sussex Partnership NHS Foundation Trust, Hove, UK.ORCID 0000-0002-0303-763X
Florian A Ruthshttps://ror.org/015803449South London and Maudsley NHS Foundation Trust, London, UK.
Mary Ryanhttps://ror.org/04xy18872Royal College of Psychiatrists, London, UK.
Asha LadwaSchool of Psychology, https://ror.org/00ks66431University of Surrey, Guildford, UK.ORCID 0000-0002-4195-6135
Frances Staffordhttps://ror.org/05fmrjg27Sussex Partnership NHS Foundation Trust, Hove, UK.ORCID 0009-0007-2994-6034
Roberta Ficherahttps://ror.org/015803449South London and Maudsley NHS Foundation Trust, London, UK.ORCID 0009-0009-5115-584X
Isabella Metcalfehttps://ror.org/015803449South London and Maudsley NHS Foundation Trust, London, UK.ORCID 0009-0007-5403-1127
Allan H YoungDivision of Psychiatry, https://ror.org/041kmwe10Imperial College London, London, UK.
Kimberley GoldsmithInstitute of Psychiatry, Psychology and Neuroscience, https://ror.org/0220mzb33King's College London, London, UK.ORCID 0000-0002-0620-7868

Funding

Research for Patient Benefit Programme NIHR200750
6 · The paper itself

Abstract

backgroundMindfulness-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.

methodsSecondary moderation, mediation, and moderated mediation analyses were conducted using data from the RESPOND randomized trial (

resultsHigher 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.

conclusionsConcerns 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.

Indexed as

Cognitive Behavioral TherapyDepressionDepressive Disorder, Treatment-ResistantMindfulnessAdultFemaleHumansMaleMediation AnalysisMiddle AgedSeverity of Illness IndexTreatment Effect HeterogeneityTreatment Outcomedecenteringdepressiondifficult-to-treatmechanismsmediationmindfulness-based cognitive therapymoderated mediationmoderationsymptom severity

Identifiers

PMID42438894
PMCPMC13370192

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.