Mindfulness-Based Cognitive Therapy Eases Depression After Rehabilitation, Icelandic Study Finds

Eight weeks of mindfulness-based cognitive therapy delivered after a structured rehabilitation programme significantly reduced depression, anxiety, and hopelessness among patients who entered the course with moderate-to-severe depressive symptoms, according to a study published in BMC Psychology. The research, conducted at Reykjalundur Rehabilitation Centre in Mosfellsbær, Iceland, adds to a growing body of evidence that mindfulness training can serve as a powerful follow-up intervention for people recovering from depression and anxiety disorders. Yet the findings also carry a cautionary note: patients who began the therapy with only minimal depressive symptoms did not benefit in the same way, and some even reported a slight worsening of their mood by the end of the treatment.

The study enrolled 130 patients who had completed a six-week interdisciplinary rehabilitation programme for depression, anxiety disorders, or both. Interdisciplinary rehabilitation of this kind typically combines physical exercise, psychotherapy, occupational therapy, and educational components, all coordinated across a team of clinicians. Rather than discharging patients directly after this intensive phase, the researchers offered them an additional eight-week course of mindfulness-based cognitive therapy, a structured programme that blends meditation practices with elements of cognitive behavioural therapy. The design reflects a practical clinical question: what is the best way to consolidate gains after rehabilitation and reduce the risk of relapse once patients return to everyday life?

Mindfulness-based cognitive therapy, often abbreviated as MBCT, was originally developed to prevent relapse in recurrent depression, and it has strong empirical support for that purpose. The therapy teaches participants to observe their thoughts and feelings with detached awareness, recognising early warning signs of depressive spirals without being swept up in automatic negative thinking. Clinical guidelines, including those from the National Institute for Health and Care Excellence in the United Kingdom, have recognised the value of mindfulness-based approaches in relapse prevention. The Icelandic team wanted to know whether MBCT could deliver benefits not only for relapse prevention but also as an active treatment for people still carrying substantial depressive symptoms when the course begins.

To answer that question, the researchers measured three key symptom domains before and after the eight-week therapy. Depressive symptoms were assessed with the Beck Depression Inventory-II, a widely used self-report questionnaire in which higher scores indicate more severe depression. Anxiety symptoms were tracked with the Beck Anxiety Inventory, and hopelessness was measured with the Beck Hopelessness Scale, an instrument that captures pessimistic expectations about oneself and the future. Hopelessness matters clinically because it is closely linked to suicide risk, making any reduction in this domain particularly significant for patient safety.

The results were striking for one subgroup of patients. Among participants whose Beck Depression Inventory-II score was 20 or higher at the start of MBCT, indicating moderate-to-severe depressive symptoms, the therapy produced significant reductions across all three measures by the end of the eight weeks. The effect size for depression was 0.73, a medium-to-large treatment effect in psychological research terms. Anxiety symptoms fell with an effect size of 0.41, and hopelessness declined with an effect size of 0.48. Effect sizes of this magnitude suggest changes that are not only statistically reliable but also clinically meaningful, particularly for a follow-up intervention added after an already intensive rehabilitation programme.

The picture was very different for patients who entered the course with minimal depressive symptoms, defined as a Beck Depression Inventory-II score of 13 or lower. In this group, depressive symptoms actually increased slightly over the eight weeks, with an effect size of minus 0.44, while changes in anxiety and hopelessness were not statistically significant. Participants with mild depressive symptoms at baseline were not included in the subgroup analyses, leaving a gap between the two well-defined extremes. The finding that low-symptom patients may derive little benefit, and possibly some discomfort, from an additional mindfulness course challenges the assumption that preventive interventions are universally helpful regardless of symptom status.

Several explanations for this divergent pattern are worth considering. Patients with minimal symptoms may already have developed effective coping strategies during their rehabilitation programme, leaving little room for improvement on symptom questionnaires. A ceiling effect of this kind would mask any genuine benefits of mindfulness training, such as enhanced resilience or relapse prevention, which may only become visible over longer follow-up periods. Alternatively, the demands of an eight-week course, including regular meditation practice and group attendance, may impose a burden on patients who are functioning well, and the slight increase in depressive symptoms could reflect fatigue, overextension, or heightened self-focus rather than harm from the therapy itself. The study was not designed to distinguish among these possibilities, and the authors describe MBCT as a follow-up intervention that may provide additional benefits, particularly for patients with moderate-to-severe symptoms at the start of treatment.

The technical details of the analysis reinforce the credibility of the findings. The researchers used statistical software to compare symptom scores from baseline to the end of treatment, and they applied a last-observation-carried-forward approach to handle missing data, a conservative method that retains the most recent available measurement for participants who dropped out. Effect sizes were calculated to express the magnitude of change in standardised units, allowing comparison across different outcome measures. The study received full approval from the Icelandic National Bioethics Committee and was conducted in accordance with the Declaration of Helsinki. Participation was voluntary, written informed consent was obtained from all patients, treatment was provided at no cost, and participants received no remuneration. The authors declare no competing interests.

For clinicians, the study offers a practical template for sequencing care. Rather than treating rehabilitation and mindfulness training as competing alternatives, the findings support a staged model in which intensive interdisciplinary rehabilitation lays the groundwork and MBCT consolidates the gains, especially for patients still struggling with significant symptoms. This sequencing may be particularly relevant in health systems where waiting lists for psychotherapy are long, since MBCT is a group-based intervention that can be delivered efficiently to multiple patients at once. The subgroup findings also underscore the importance of symptom assessment before enrolment, so that patients with minimal symptoms can be directed toward other forms of support or monitored without an additional course of treatment.

For researchers, the study raises questions that future trials must address. The absence of a randomised control group means that natural recovery, regression to the mean, and the passage of time cannot be ruled out as contributors to the observed improvements. Longer follow-up periods would reveal whether the benefits persist and whether relapse rates differ between symptom subgroups. The slight worsening among low-symptom patients deserves dedicated investigation, including qualitative interviews that explore how these participants experienced the course. As mindfulness-based interventions continue to spread across clinical settings worldwide, this Icelandic study provides a sober, evidence-based reminder that the same therapy can be a substantial benefit for some patients and a questionable addition for others, and that matching the intervention to the patient’s current symptom profile is essential for realising its full potential.

Subject of Research: Effects of mindfulness-based cognitive therapy on depression, anxiety, and hopelessness after interdisciplinary rehabilitation

Article Title: Mindfulness-based cognitive therapy in an interdisciplinary rehabilitation setting: effects on depression, anxiety, and hopelessness

Article References: Jónsdóttir, I. H., Þorsteinsdóttir, A. K., Steingrímsdóttir, J. K., & Kristbergsdóttir, H. (2026). Mindfulness-based cognitive therapy in an interdisciplinary rehabilitation setting: effects on depression, anxiety, and hopelessness. BMC Psychology. https://doi.org/10.1186/s40359-026-05651-7

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05651-7

Keywords: mindfulness-based cognitive therapy, depression, anxiety, hopelessness, interdisciplinary rehabilitation, relapse prevention, Beck Depression Inventory, Beck Anxiety Inventory, Beck Hopelessness Scale, cognitive behavioural therapy, mental health, clinical psychology