Mindfulness-Based Compassionate Living for Recurrent Depression: Examining Experiential Avoidance, Fear of Self-Compassion, and Positive Affect as Mediators of Response in a Randomized Controlled Trial

Background: Compassion-based interventions (CBIs) such as Mindfulness-Based Compassionate Living (MBCL) are effective for treating depression, with improvements in self-compassion partly mediating the effects. The aim of this study is to investigate whether experiential avoidance, fear of self-compassion, and positive affect additionally mediate the effects of MBCL on depressive symptoms and quality of life in patients with recurrent depression. Methods: Data were collected in the context of an RCT on the efficacy of MBCL + treatment as usual (TAU) compared to TAU-only in recurrent depression (n = 122) and a subsequent uncontrolled cohort study. In a subsample of RCT participants (n = 68) who completed questionnaires on experiential avoidance, fear of self-compassion, positive affect at baseline and end-of-treatment/-control, univariate and multivariate mediation analyses were conducted. Consolidation and prediction analyses were conducted in the uncontrolled cohort sample, incorporating a six month follow-up measurement. Results: Experiential avoidance and fear of self-compassion reduced in the MBCL + TAU group compared to the TAU-only group, whereas positive affect did not differ between the two conditions. Univariate mediation analyses revealed only experiential avoidance as a mediator of MBCL’s effects. When these results were controlled for improvements in self-compassion using multivariate analyses, the mediating effect of experiential avoidance was no longer significant. In the uncontrolled cohort, reductions in experiential avoidance and fear of self-compassion were observed and maintained, along with improvements in the relaxed and safe & warmth positive affect subscales. Changes in experiential avoidance and relaxed positive affect during treatment predicted depressive symptoms at six month follow-up, whereas only changes in experiential avoidance predicted quality of life. Conclusions: MBCL reduces experiential avoidance and fear of self-compassion in recurrent depression. Reductions in experiential avoidance may contribute to MBCL’s efficacy, though increases in self-compassion appear to have a stronger mediating effect. Further research on experiential avoidance and its interplay with self-compassion during CBIs is recommended.