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Mindful Mood Balance Effective for Treating Residual Depressive Symptoms and Suicidal Ideation

Research Highlight

Although many people with depression see improvement in their symptoms after taking antidepressant medication or participating in psychotherapy, some still experience lingering symptoms. While these low- to moderate-level symptoms may continue to have a negative impact on people’s lives, many are not provided with resources to help them manage these residual symptoms of depression, suggesting a need for new interventions.

Researchers supported by the National Institute of Mental Health (NIMH) have been working to meet this need by testing whether an online mindfulness-based cognitive behavioral therapy—called Mindful Mood Balance (MMB)—is effective at reducing residual depressive symptoms and at reducing suicidal ideation in those who experience these lingering symptoms.

The MMB intervention consists of eight online self-administered sessions that teach people how to disengage from automatic, problematic cognitive patterns (such as ruminative thoughts). People using the MMB intervention also have limited access (average 2–3 hours total) to a coach who provides motivation and technical support over the phone.

NIMH has supported several studies testing the effectiveness of MMB for treating residual depressive symptoms (RDS) and preventing depression relapse, and for testing the effectiveness of this intervention for those with RDS who also experience suicidal ideation. Ongoing research is currently expanding the use of this intervention, testing to see if it is effective at treating women with perinatal depression.

Treating Residual Depressive Symptoms

In 2020, researchers led by Zindel Segal, Ph.D. , of the University of Toronto Scarborough, published the results of a study  that tested the effectiveness of MMB for treating people with residual depressive symptoms. Participants in the study included 460 Kaiser Permanente Colorado patients who were 18 or older who had experienced at least one episode of major depressive disorder and were currently experiencing residual depressive symptoms. Participants were randomly assigned to receive usual depression care and online MMB intervention or usual depression care alone.

The researchers found that patients randomly assigned to receive MMB in addition to usual depression care experienced greater reductions in residual depressive symptoms and anxiety and improved mental functioning than patients receiving usual depression care alone. Patients receiving MMB were also more likely to experience depression remission and had lower rates of depression relapse than those receiving usual care alone.

The findings suggested MMB is an effective way to increase access to mindfulness-based cognitive therapy for patients with RDS.

Treating Suicidal Ideation

In a recent follow-up analysis  led by Sona Dimidjian, Ph.D. , of the University of Colorado, Boulder, the researchers sought to expand their original findings by working to understand the impact of MMB paired with usual depression care on suicidal ideation in people with residual depressive symptoms. In this new analysis, researchers analyzed data from 109 of the original study participants who had a self-reported history of attempted suicide or current suicidal ideation.

The researchers found that patients receiving MMB had significantly greater reductions in suicidal ideation compared with patients receiving usual depression care alone. Similar to the original study, the subsample of patients receiving MMB experienced a greater reduction in residual depressive symptoms than those receiving usual depression care alone.

The researchers noted that the original study investigating MMB was not designed to specifically evaluate the impact of MMB on suicidal ideation and that future studies that focus on participants at risk of suicidal ideation and behavior are needed. Despite these limitations, this follow-up study suggests MMB is an effective therapy for people with residual depressive symptoms who are at risk for suicidal ideation and behavior.

Expanding the Use of Mindful Mood Balance

Dr. Dimidjian is now conducting a study (MH117251 ; MH117253 ) with her colleague, Lee Cohen, M.D. , of Massachusetts General Hospital, that further extends this line of research by investigating the effectiveness of MMB for pregnant women with recurrent depression who are being treated with maintenance antidepressants. In this national study, women are randomly assigned to receive MMB or usual depression care. The goal of this study is to understand changes in depressive symptoms and the risk of depression relapse in women receiving MMB or usual care who have or have not discontinued their antidepressant medications.

While recruiting for this current study, the researchers found that many women (28%) were reporting suicidal ideation at the time of their initial screening. The researchers are also working  to characterize suicidal ideation and behavior among pregnant and postpartum women in their participant group and include these women in their ongoing trial of MMB.

Further, Arne Beck, Ph.D. , of the Institute for Health Research at Kaiser Permanente Colorado, is studying MMB’s effectiveness for treating perinatal depression. In Dr. Beck’s study, which is taking place at four Mental Health Research Network  sites located across the U.S., the researchers are testing the effectiveness of MMB for reducing residual depressive symptoms when supported by coaching over the phone provided by either mental health professionals or trained peers with lived experience of perinatal depression. They are also investigating the cost-effectiveness of MMB supported by mental health professionals versus trained peer coaches and evaluating the health care system’s implementation of MMB.


Dimidjian, S., Kaufman, J., Coleman, N., Levy, J., Beck, A., Gallop, R., & Segal, Z. V. (2022). Impact of online mindfulness-based cognitive therapy on suicidal ideation: A secondary analysis of a randomized trial of mindful mood balance. Journal of affective disorders301, 472–477. 

Segal, Z. V., Dimidjian, S., Beck, A., Boggs, J. M., Vanderkruik, R., Metcalf, C. A., Gallop, R., Felder, J. N., & Levy, J. (2020). Outcomes of online mindfulness-based cognitive therapy for patients with residual depressive symptoms: A randomized clinical trial. JAMA psychiatry77(6), 563–573. 


MH102229 , MH117251-04 , MH117251-02S1 , MH117253 , MH1217383