SMAD, Rev. Eletrônica Saúde Mental Álcool Drog.

2020 May-June;16(3):55-63
DOI: 10.11606/issn.1806-6976.smad.2020.165509
www.revistas.usp.br/smad/
SMAD

Original Article

Mindfulness-Based Cognitive Therapy in

individual clinical care for depression*

Nazaré de Oliveira Almeida1,2

https://orcid.org/0000-0001-8610-3753

Marcelo Demarzo3 Objective: the aim of this multiple case study was to to
https://orcid.org/0000-0002-7447-1834 evaluate the applicability of the group protocol of an 8-week
Carmem Beatriz Neufeld1 Mindfulness-Based Cognitive Therapy program adapted for
https://orcid.org/0000-0003-1097-2973
the individual clinical care of patients with symptoms of
depression. Method: the method used was to study multiple
cases, in which 11 cases of patients with a diagnosis of
mild to moderate depression who underwent intervention
adapted from this protocol were evaluated in the results of
measures of depression, anxiety, stress and mindfulness.
Results: the results indicated a significant reduction in
these symptoms, as well as an increase in mindfulness in
everyday life. Conclusion: the benefits of the Mindfulness-
Based Cognitive Therapy intervention can be presented
both in the context of group clinical care, as well as in
*
This article refers to the call “Mindfulness and other the individual. In this study, all study participants had
contemplative practices”. significant improvement in the symptoms of depression,
1
Universidade de São Paulo, Faculdade de Filosofia Ciências
e Letras, Ribeirão Preto, SP, Brazil. as well as in the levels of anxiety and stress, consistent
2
Scholarship holder at the Coordenação de Aperfeiçoamento with the data presented in the literature. There is an urgent
de Pessoal de Nível Superior (CAPES), Brazil.
need for a greater number of studies of this nature. Future
3
Universidade Federal de São Paulo, Escola Paulista de
Medicina, São Paulo, SP, Brazil. research, especially those of an empirical nature, controlled
and randomized, will consolidate the external validity of the
results found by studies with nature such as this one.

Descriptors: Mindfulness; Meditation; Depression; Anxiety.

How to cite this article

Almeida NO, Demarzo M, Neufeld CB. Mindfulness-Based Cognitive Therapy in individual clinical
care for depression. SMAD, Rev Eletrônica Saúde Mental Álcool Drog. 2020;16(3):55-63.
doi: https://dx.doi.org/10.11606/issn.1806-6976.smad.2020.165509
2 SMAD, Rev. Eletrônica Saúde Mental Álcool Drog. 2020 May-June;16(3):55-63

Terapia cognitiva baseada em mindfulness no

atendimento clínico individual de depressão

Objetivo: estudo de casos múltiplos teve objetivo de avaliar a aplicabilidade do protocolo de

grupo de um programa de 8 semanas de Terapia Cognitiva Baseada em Mindfulness adaptado
para o atendimento clínico individual de pacientes com sintomas de depressão. Método: para o
estudo de casos múltiplos, no qual 11 casos de pacientes com diagnóstico de depressão leve à
moderada submetidos à intervenção adaptada desse protocolo foram avaliados nos resultados
de medidas de depressão, ansiedade, estresse e mindfulness. Resultados: indicaram redução
significativa destes sintomas, bem como aumento de mindfulness na vida cotidiana. Conclusão:
os benefícios da intervenção de Terapia Cognitiva Baseada em Mindfulness podem se apresentar
tanto no contexto de atendimento clínico grupal, bem como no individual. Neste estudo, Todos
os participantes do estudo tiveram melhora significativa dos sintomas de depressão, bem como
dos níveis de ansiedade e estresse, condizente com a os dados apresentados na literatura.
É premente a necessidade de maior número de estudos desta natureza. Pesquisas futuras,
especialmente as de natureza empírica, controlados e randomizados, consolidarão a validade
externa dos resultados encontrados por estudos com a natureza como o deste.

Descritores: Atenção Plena; Meditação; Depressão; Ansiedade.

Terapia cognitiva basada en la atención plena en la

atención clínica individual para la depresión

Objetivo: el objetivo de este estudio de caso múltiple fue evaluar la aplicabilidad del protocolo
grupal de un programa de terapia cognitiva basada en la atención plena de 8 semanas adaptado
para la atención clínica individual de pacientes con síntomas de depresión. Método: el método
utilizado fue estudiar múltiples casos, en el que 11 casos de pacientes con un diagnóstico de
depresión leve a moderada que se sometieron a una intervención adaptada de este protocolo
fueron evaluados en los resultados de las medidas de depresión, ansiedad, estrés y atención
plena. Resultados: los beneficios de la intervención de Terapia Cognitiva Basada en Mindfulness
se pueden presentar tanto en el contexto de la atención clínica grupal, como en el individual.
En este estudio, todos los participantes del estudio tuvieron una mejoría significativa en los
síntomas de la depresión, así como en los niveles de ansiedad y estrés, consistente con los datos
presentados en la literatura. Existe una necesidad urgente de un mayor número de estudios de
esta naturaleza. Las investigaciones futuras, especialmente las de carácter empírico, controladas
y aleatorizadas, consolidarán la validez externa de los resultados encontrados por estudios de
naturaleza como este.

Descriptores: Atención Plena; Meditación; Depresión; Ansiedad.

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 Almeida NO, Demarzo M, Neufeld CB. 3

Introduction who are currently fine, but have had three or more
depression episodes.
Nowadays, depression is one of the biggest public A number of studies(2) on the results from using
health problems and risk of premature death , with an
(1)
Mindfulness in patients with a history of depression point
increase of 18.4% in the period between 2005 and 2015 out that the most important finding of their research
worldwide, raising it to the level of an alarming condition, was that, in the participants with three or more previous
with a 4.4% prevalence in the world. In percentage episodes of depression (which constituted more than
terms, Brazil has the highest index in Latin America and 75% of the studied patients), the MBCT decreased by
the fifth largest in the world, with a prevalence of 5.8%. practically 50% the relapse/recurrence rates during the
One of the biggest challenges of depression is its follow-up period compared to subjects who received
recurrence in more than one episode. Several guidelines, usual treatments. As the patients were treated in groups,
for example, from the American Psychiatric Association in terms of cost-effectiveness, this benefit is much
(APA), the Canadian Network for Mood and Anxiety greater when compared to patients treated individually,
Treatments (CANMAT), the Cochrane and The National
in the conventional individual cognitive therapy format
Institute for Health and Care Excellence (NICE), rely on
for depression. Indeed, the MBCT was able to assist up
research data from specific interventions for the first
to 12 patients almost in the same time as is necessary
episode and for recurrent depression, the treatment
to treat a single patient in a single conventional session
being, in the latter case, maintenance. One of these
of cognitive therapy for depression.
currently widely used and researched interventions is
MBCT programs have undergone meta-analysis
Mindfulness-Based Cognitive Therapy (MBCT), developed
studies (9-11) with an effect size comparable to
in 2002 for recurrent depression(2). It is based on the
interventions known to be recommended due to the
integration of the Cognitive-Behavioral Therapy (CBT)
level of evidence of effectiveness for this population, for
for depression(3) with the Mindfulness-Based Stress
example, CBT(12). They have shown significant results in
Reduction (MBSR) Program developed by Kabat-Zinn and
preventing relapses in depression, as well as reducing
colleagues(4). In this integration, many elements were
depressive symptoms in non-clinical populations(13).
maintained, but others were changed and added. In the
Group protocol studies already used in the
MBCT there is an emphasis on changing consciousness
individual context(14) conducted a first randomized
in relation to self and states of thought, emotion,
controlled clinical trial with diabetic patients (types 1
sensations and impulses, but no emphasis on altering
and 2) with depressive symptoms (N=12), obtaining
the content of thoughts(5).
results of significant intervention effectiveness for these
A fundamental MBCT assumption is that cultivating
symptoms, in addition to improvement in states of
a relationship with oneself decentralized from self-
anxiety, well-being, mindfulness and self-compassion.
deprecating mental states, functioning as prevention in
The study adapted the classic 8-week MBCT protocol(2)
times of potential relapse. In this sense, the main means
for an individual program for people with depression and
of developing this decentralization is by teaching people
diabetes. According to the authors, in this adaptation the
to become more aware of mental states and to relate
structure, basic contents and homework of the original
to them in a broader perspective, recognizing them
group program were maintained. In the following year,
as mental events only and not identifying with them
or recognizing them as necessarily real(2-5). The MBCT the same group of authors carried out another controlled

includes a variety of mindfulness practices that aim and randomized study(15), comparing the effects of

to observe and accept bodily sensations, perceptions, individual CBT and MBCT interventions with a waiting

cognitions and emotions without judgment or reaction. list in a large sample of patients with the same profile

These states are seen as the very nature of the mind. (N=91). The results showed the quality and effectiveness

The use of Mindfulness is associated with a 44% of both interventions in the reduction of depressive

reduction in the risk of relapse in patients with a history symptoms. Then, the authors(14-16) carried out a new
of three or more relapses of depressive symptoms(6). controlled and randomized study from the previous
The MBCT can be used to reduce residual symptoms study, with the objective of evaluating long-term effects
of depression regardless of the amount of depressive of a sample extracted from the same previous sample,
episodes in the patient, with effects comparable to in this case, of patients who maintained depressive
staying on a maintenance dose of antidepressants(7). symptoms. The results in the reduction of depressive
For people looking for a psychosocial approach to symptoms showed effectiveness of the intervention in
staying healthy, Mindfulness appears as an accessible, the long term (9 months).
acceptable and low-cost alternative. Based on this Most people with depression prefer psychological
evidence, the National Institute for Health and Clinical treatment to medication(17). In addition, some prefer
Excellence(8) began to recommend Mindfulness to people individual interventions over group interventions(18-19).

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4 SMAD, Rev. Eletrônica Saúde Mental Álcool Drog. 2020 May-June;16(3):55-63

However, the literature on the MBCT for the individual not initially considered, thus offering data to compare
context is very scarce. It is probable that there are discrepancies that force the researcher to clarify the
advantages and disadvantages in both approaches. It concepts and confirm the limits established for choosing
seems that sharing experiences and encouragement the sample. Thus, following the criteria of the population
are the main advantages in groups, while privacy and benefited by the program, the patients were at least in
personalization in the individual approach. In addition, the third depression episode and out of crisis.
there may be cases in which, for the profile of each The selection was performed by means of a clinical
person, one or the other alternative is indicated, so that interview based on DSM-5(23) and the use of the DASS-
if the person submits to one less indicated, they may 21 instrument, and by the psychotherapist himself who
suffer less or even have no expected beneficial effect. conducted psychotherapy adapted from the intervention
However, these conditions have not been widely verified, of the 8-week MBCT(2). The other research authors
which makes studies like this pertinent. participated in the subsequent stages.
The present study aims to study the applicability of The participants who completed the intervention
the group protocol of an 8-week program of Mindfulness- and evaluation of this study are 6 females and 5 males,
Based Cognitive Therapy, adapted from the original with ages ranging from 19 to 57 years old, all Brazilian
model developed for groups(2) for the individual clinical and with completed or ongoing higher education
care of patients with depression symptoms. The initial level, with no previous experience in meditation. One
hypothesis is that such an intervention can promote participant left the group due to time unavailability, as
the reduction of symptoms of depression, anxiety and he changed his working hours.
stress, as well as an increase in mindfulness in everyday Both for the inclusion and exclusion of participants
life. In addition, it is expected that the group protocol in this study and for the assessment of improvement
can be adapted to the context of individual clinical care. in symptoms of depression, anxiety and stress, the
Depression Anxiety and Stress Scale - DASS-21
Method
was used, an instrument consisting of a set of three
subscales, each one containing 7 Likert type 4-point
Regarding the research design, this is a multiple
self-responding items. Each subscale is designed to
case study. Unlike a single case study, it is more
assess emotional states of depression, anxiety and
concerned with establishing the similarities between
stress. The respondents must indicate how much
situations, establishing a basis for generalization, which
each item applied to them during the last week. The
often justifies generalization from one case to another,
items on the Likert scale refer to severity or frequency
much more than for a population of cases(20-21). The
and are organized on a scale from 0 to 3 points, the
study was carried out in a private practice office of one
of the authors, in the city of Foz do Iguaçu. result being obtained by the sum of the answers to

The sample in this study was for convenience and the items that make up each of the three subscales. It

consisted of 11 patients who sought psychotherapeutic was adapted to the Brazilian context in 2014(24), which

care at the clinic of the first author during 2018 and verified a good internal consistency: Cronbach’s alpha

met the inclusion and exclusion criteria of the study. The values were 0.90 for depression, 0.86 for anxiety, 0.88

mean patient flow at this clinic is 57 per year. for stress and 0.95 for the total of the three subscales,

The inclusion criteria for the participants in this respectively.

study were the following: (a) Age over 18 years old; The Mindful Attention Awareness Scale - MAAS,

(b) availability to participate in at least 10 therapy which consists of 15 items, was also used in this

sessions at the specified time and place; (c) depression study, with the objective of assessing attention to the
symptoms greater than normal and this requires, awareness of the present moment and the attention
at least, a score of 78 percentile on the DASS-21 aspect of mindfulness. The authors conceptualize
instrument. The following exclusion criteria were mindfulness as an attribute of consciousness related
adopted: (a) severe or extremely severe depression to well-being, composed of two factors, consciousness
symptoms, that is, a score greater than the percentile and attention, although they unifactorially operationalize
over the 95 percentile on the DASS-21 instrument; the construct: mindfulness attention. The respondents
(b) previous routine meditation practice. must indicate how much they have experienced what
According to specialists in qualitative analysis(22), is described in each statement, using a six-point scale,
essential care must be taken in the criterion for choosing which ranges from one (almost always) to six (almost
the cases, which is to avoid narrowing the universe never). High scores reflect greater mindfulness capacity.
for choice, when cases that are on the frontier of the The scale was developed by Brown and Ryan in 2003
phenomenon to be analyzed are not analyzed. For the and validated by Barros et al.(25), who found an internal
authors, the borderline cases can show aspects that were consistency of Cronbach’s alpha = 0.83.

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 Almeida NO, Demarzo M, Neufeld CB. 5

As for the procedures, in the first session, the In the second session of the protocol, with the
protocol for patients is proposed and the assessment theme of “Another Way of Knowledge”, the “breathing
and FICF instruments are filled out, as well as the MBCT practice in a seated position” and the inquiry are
psychoeducation, with an emphasis on mental ways conducted in session. As activities of the week, the
for doing and being. In this session, the importance protocol proposes “body scan” and “brief breathing
of daily practices at home is clarified, without which exercise”, bringing awareness to routine activities and
the effectiveness of the intervention is compromised. the calendar of pleasant experiences. Among other
During a minimum of 8 sessions and, in the case of 11 issues, it addresses the power of thoughts and feelings,
participants, a maximum of 18 sessions, the 8 sessions the notion that thoughts are not facts: they are mental
adapted from the protocol of the therapist manual events and how mood affects the interpretation of the
Mindfulness-based cognitive therapy for depression: A facts and that interpretation affects mood. The protocol
new approach to preventing relapse, 2nd ed.(2) and in the suggests the following regarding home practice: “body
patient manual The Mindful Way Workbook An 8-Week scan”, bringing awareness to routine activities and an
Program to Free Yourself from Depression and Emotional agenda of pleasant experiences.
Distress (ibid., 2014) were conducted. The adaptation In the third session of the protocol, with the theme
referred to the number of practices performed in session of “Returning to the Present – Reuniting the Scattered
or the type and quantity of elements of psychoeducation Mind”, the practices of “stretching” and “3-minute
in each session, depending on the patient’s need. After breathing space” are proposed, followed by the inquiry.
the last adapted session of the protocol, the post- The protocol suggests, while at home, four activities for
intervention evaluation was carried out. the week: combined practice of stretching and breathing
The intervention consists of adapting the original interspersed with the practice of conscious movement,
group program to the individual context and presented a 3-minute breathing space and agenda of unpleasant
some distinctions, which refer mainly to the needs experiences, with the aim of helping the individual to
and personal characteristics of each patient and to calm and reorganize the restless and dispersed mind.
the duration of the session. The sessions lasted 1 In the fourth session of the protocol, with the
hour, while in the group program they last 2 hours. theme of “Recognizing Aversion”, the “breathing in a
In this way, the adaptation was made by reducing the seated position”, “additional 3-minute breathing space”
duration of the practices in session, but maintaining and “conscious walking” practices are performed in the
the number of practices and inquiry. In addition, the session, followed by the inquiry, One of the main topics
personal characteristics and needs led to a variation in covered is learning to see negative feelings with less
the distribution of the time for each activity in session. aversion, by understanding that bad feelings and the
Another aspect that differentiated the individual changes felt are symptoms of depression, and not a sign
sessions of this study referred to psychoeducation, of personal failure or inadequacy. The protocol submits
which contemplated different aspects of the theme the following practices for the week: “sitting breathing”,
of depression, anxiety and stress, depending on the “3-minute breathing space”, “additional 3-minute
presence of other clinical aspects such as comorbidities breathing space” and “conscious walking”.
or other health problems, severity of the symptoms, In the fifth session of the protocol, with the theme
characteristics and personal needs, socio-cultural level, of “Let Things Be As They Are”, the “breathing in a sitting
personal interests and lifestyle. It is worth mentioning position: working through difficulties” and “responsive
that the home practices remained faithful to what was 3-minute breathing space” practices are performed,
proposed in the original group program. followed by the inquiry. The main assumption is that,
As for the basic contents, structure of the sessions when changing the attitude towards the experience
and homework, the adaptation kept the same ones of “not wanting” to “being open”, there is a break in
proposed by the original program for groups. They are the automatic reactions. For the week, the protocol
presented below, session by session. proposes the “breathing in a sitting position: working
In the first session of the protocol, whose theme with difficulties”, “regular 3-minute breathing space”,
is “Beyond the Autopilot”, the “raisin practice”, “body and “responsive 3-minute breathing space” practices
scan” and, immediately after, the inquiry, an approach with additional instructions.
technique of the MBCT instructor, performed immediately In the sixth session of the protocol, with the theme
after the practices, aiming to stimulate the patient’s of “See Thoughts as Thoughts”, the focus is the idea that
awareness about their present experiences. The protocol thoughts are not facts. In the session, the exercise of
proposes the practice of three exercises during the the “Three ways to practice the perception of practicing
first week: “body scan”, bringing awareness to routine thoughts as mental events” is performed. The protocol
activities and “conscious eating”. proposes practically the same activities as in the

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6 SMAD, Rev. Eletrônica Saúde Mental Álcool Drog. 2020 May-June;16(3):55-63

previous week, complemented with “Setting up an Early Table 2 - Pre-/Post-evaluations of the research participants,
Warning System”. Foz do Iguaçu, PR, Brazil, 2018
In the seventh session of the protocol, with Pre-intervention Post-intervention Anova* Pre/Post
 
the theme of “Kindness in Action”, a practice of M† SD‡ M† SD‡ F§ p||
“3-minute breathing space” is carried out, followed
DASS-21 ¶
           
by the inquiry. The protocol works with the same
Depression 86.75 0.92 62.67 14.64 29.72 0.0003
three activities as in the sixth week, adding an Action
Anxiety 83.25 8.82 68.58 9.68 18.71 0.0015
Plan. One of the topics of the week is the relationship
Stress 82.17 7.81 36.17 14.90 199.15 6.27
between actions and feelings, and that it is possible
MAAS** 1.83 0.63 4.00 0.81 58.78 0.000017
to change what is felt by changing the actions. As
requested during the session, the patient builds an Practices     78.17 16.79    

action plan for the moments when they realize they *ANOVA (Double factor without repetition); M = Arithmetic Mean;
†

‡
SD = Standard Deviation; F = Calculated F;
§ ||
p-value; ¶
DASS-
are losing control. First, they describe the signs that 21 = Depression, Anxiety and Stress Scale; **MAAS = Mindful Attention
precede the disorder: pessimistic thoughts, insecurity, Awareness Scale

and irritation and then includes mindfulness practices

and pleasurable activities. The results demonstrate that the 11 participants
The eighth session of the protocol, with the theme showed a significant reduction in the depression
of “What now?”, works on identifying the benefits symptoms, as well as in the levels of anxiety and
perceived during the process and how to continue it after stress, consistent with the data presented in the
the end of the meetings. literature(6,14,25,27). This fact can be observed in the
data of the depression subscale pre- and post-
Results intervention: F (4.96) = 29.72 and p = 0.0003; in the
data of the anxiety subscale pre- and post-intervention:
Table 1 shows the sociodemographic data of the F (4.96) = 18.70 and p = 0.0015; and in the data
participants. of the stress subscale pre- and post-intervention:
F (4.96) = 29.72 and p = 0.0003 in Table 2.
Table 1 - Sociodemographic data of the participants, Foz The rates of greatest remission for symptoms of
do Iguaçu, PR, Brazil, 2018 depression, anxiety and stress are among participants 1,
Total Complete Withdrawal 2, 3, 4 and 11. These were also the patients who
N 12 11 1 performed the most practices outside the session.
Mean age (years old) 36.09 31 25 Scholars(14) stress out that, in adapting the original(2)
Standard Deviation (SD) (11.81) (12.10) - 8-week protocol, it will probably be necessary to
Gender maintain the emphasis on carrying out the home tasks
Female 6 5 1 and meditative practices. A number of studies indicate
Male 6 6 0 that practices at home are more important than the

Schooling program format itself, for example, if performed in 4 or

Incomplete Higher Education 8 7 1 8 weeks(28).

Complete Higher Education 3 3 -

Discussion
Smokes 2 2 -

Baby 6 5 1
Regarding the results of the MAAS Scale, in the pre-
Using medication 5 3 2
intervention evaluation, all the participants presented
Using psychiatric medication 4 3 1 scores between 1 and 3, which indicates a low level of
Psychiatric monitoring 2 2 - attention at the present time, also indicating possible
Undergoes psychological treatment 1 1 - frequent distractions, involvement with concerns about
Performs physical activity 4 3 1 the future, and ruminations about the past. In the
post-intervention evaluation, most of the participants
The comparison between the results of the measures increased their attention to level 4 or 5 of the scale.
before and after the intervention and the percentage There was a significant effect on the mindfulness state
of dedication to the practices in session and at home between the pre- and post-intervention, expressed in
are presented in Table 2. This last comparison item the data of F(4.96) = 58.78 and p = 0.000017 in Table 2.
was established considering the number of studies that The group of researchers of the MBCT in individual
demonstrate that the benefits of any mindfulness-based format(6,13,14-16-26,29-30) found in their studies data similar
program are directly proportional to the participant’s to the increase in attention at the present time. From
dedication to daily practices outside the session. level 4 of the scale, the respondents have good attention

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 Almeida NO, Demarzo M, Neufeld CB. 7

at the moment, in which most of the activities they to the context of individual clinical care proved feasible,
perform receive a good degree of their concentration considering different factors. First, due to the reduction
and reflect on affective, social and professional life. At of symptoms, observed in the results of the interventions
level 5 of the scale, attention to simple and complex in the cases of this study, similar to that presented in the
activities is very high and the relationship with mental literature for the classic group protocol(2,5,9-10,13). Second,
events such as frequent distractions, involvement with due to increased adherence to the treatment since, in
concerns about the future, and ruminations about the an individual context, the dispersion of contact with
past are much less frequent, which promotes a state the instructor decreases and the bond increases. The
of well-being most of the time. It is worth mentioning patients may feel cared for with greater attention, being
again that the participants who stayed below 4 points treated in a personalized way, conferring with what the
on the MAAS Scale (participants 9 and 10) were also literature proposes(18-19). Third, due to the personalization
the ones who least dedicated themselves to practices of the intervention, considering the particular aspects of
outside the session. each patient. This advantage is also pointed out in the
A data related to the dedication to the practices literature(18-19).

of the participants which is also important is that those A study of this type has some limitations. First,

who were more dedicated obtained better levels of in terms of external validity, since it included separate

improvement of the symptoms of depression, anxiety experiments and with a sample of only eleven cases,

and stress, as well as attention to the present time, which hinders generalizations. In addition, the

requiring fewer sessions to advance in the program. participants were selected non-randomly, which also

This reinforces the already pointed out fact that home weakens external validity. The external validity of

practices represent, if not the largest responsible, one studies with this design can be reinforced with their

of the main sources of the benefits of the program(28). replication several times, strengthening possibilities of

They are participants 1, 2, 3, 4, 5 and 11. Participant 10 generalizations.

also required fewer sessions, but it is worth mentioning

Conclusion
that this participant had limited time for the program,
since he was scheduled to travel abroad, which made
A growing number of therapists have been using
him dedicate himself to the sessions more hard, even
Mindfulness-Based Cognitive Therapy adapting the group
if not to the home practices. This participant works
protocol to the clinical context of the individuals. This
traveling and this was not a factor that could influence
study suggests that it is possible to maintain the efficacy
positively or negatively, since this type of trip was part
potential of this intervention present in the scientific
of his daily life.
evidence, but it requires adaptations. In addition, it
As for comorbidities, it is worth mentioning that reinforces the literature supporting the effectiveness of
participants 1, 2, 3 and 7 met obsessive-compulsive the Mindfulness-Based Cognitive Therapy for depression,
personality disorder criteria and were also submitted anxiety and stress.
to specific evaluations for this disorder, showing All the study participants presented a significant
significant improvement in the symptoms. In their improvement in the depression symptoms, as well
turn, participants 4, 5 and 10 met generalized anxiety as in the anxiety and stress levels, a finding which is
disorder criteria and were also submitted to specific consistent with the data presented in the literature.
evaluations for this disorder, with participants 4 and 10 An important fact is that 6 of the 11 participants
presenting a significant improvement of the symptoms who had higher rates of remission of symptoms of
and participant 5 with complete remission of the depression, anxiety and stress were also the patients
symptoms; while participant 11 met nervous anorexia who performed the most practices outside the session.
criteria and was also submitted to specific evaluations The literature points out the essential character of home
for this disorder, showing complete remission of the practices.
symptoms. The group of researchers of the MBCT in Studies on the MBCT applied to the individual clinical
individual format(6,13-16,26,30) also mention comorbidities in context are scarce in the literature. Only 04 studies on
the studied samples, which deserve further deepening in the theme were found in the search for the writing of
new research studies. the present study; however, there are no review studies
Taken together, the results suggest that that evidence the expressiveness of these studies in the
the Mindfulness-Based Cognitive Therapy can be scientific literature. Thus, there is a pressing need for a
used in the treatment of patients with recurrent greater number of studies of this nature.
episodes of depression, but also for anxiety and Future research studies, especially those of an
stress, corresponding to what is pointed out in the empirical nature, controlled and randomized, will
literature(2,6,13,27). The adaptation of the group protocol consolidate the external validity of the results found by

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8 SMAD, Rev. Eletrônica Saúde Mental Álcool Drog. 2020 May-June;16(3):55-63

studies with a nature similar to that of this research. The randomized controlled trials. Acta Psychiatr Scand.
increase in this type of studies will allow for statistical [Internet]. 2011; 124(2):102–19. Available from:
analyses that build evidence of the effectiveness of the https://www.ncbi.nlm.nih.gov/pubmed/21534932.
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in terms of its use in the individual clinical context. mindfulness-based therapy on anxiety and depression: a
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Received: May 1st 2020

Accepted: Aug 11th 2020

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