{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T04:16:04Z","timestamp":1788840964537,"version":"build-2803163510"},"reference-count":101,"publisher":"BMJ","issue":"10","funder":[{"name":"Instituto de Investigaci\u00f3n Sanitaria Arag\u00f3n","award":["G-99426132"],"award-info":[{"award-number":["G-99426132"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,8,30]]},"published-print":{"date-parts":[[2019,10]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Depressive, anxiety and adjustment disorders are highly prevalent among mental health outpatients. The lack of funding for mental health problems produces inefficient results and a high burden of disease. New cost-effective group interventions aimed at treating these symptoms might be an appropriate solution to reduce the healthcare burden in mental health units. Mindfulness-based interventions (MBIs) have shown significant reductions in anxious, depressive and adjustment symptomatology. Recent research highlights the influence of compassion as a key mechanism of change. However, MBIs only address compassion implicitly, whereas compassion-based protocols consider it a core aspect of psychotherapy. In this randomised controlled trial, we hypothesise that the provision of attachment-based compassion therapy (ABCT), which is a compassion-based protocol, will be more effective than mindfulness-based stress reduction (MBSR), which is a conventional MBI programme, for the treatment of depressive, anxious and adaptive symptoms in patients in mental health settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>Approximately 90 patients suffering from depressive, anxious or adjustment disorders recruited from Spanish mental health settings will be randomised to receive 8 weekly 2\u2009hours group sessions of ABCT, 8 weekly 2.5\u2009hours group sessions of adapted MBSR (with no full-day silent retreat) or treatment as usual (TAU), with a 1:1:1 allocation rate. Patients in the ABCT and adapted MBSR groups will also receive TAU. The main outcome will be general affective distress measured by means of the \u2018Depression Anxiety Stress Scales-21\u2019 at post-test as primary endpoint. Other outcomes will be quality of life, mindfulness, self-compassion and the use of healthcare services. There will be a 6-month follow-up assessment. Intention-to-treat analysis will be conducted using linear mixed models. Per-protocol and secondary outcome analyses will be performed. A data monitoring committee comprising the trial manager, the ABCT and MBSR teachers and an independent clinical psychologist will monitor for possible negative side effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Approval was obtained from the Ethics Committee of the General University Hospital of Castell\u00f3n, Spain. The results will be submitted to peer-reviewed specialised journals, and brief reports will be sent to participants on request.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT03425487\">NCT03425487<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-029909","type":"journal-article","created":{"date-parts":[[2019,10,9]],"date-time":"2019-10-09T06:45:24Z","timestamp":1570603524000},"page":"e029909","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Attachment-based compassion therapy and adapted mindfulness-based stress reduction for the treatment of depressive, anxious and adjustment disorders in mental health settings: a randomised controlled clinical trial protocol"],"prefix":"10.1136","volume":"9","clinical-trial-number":[{"clinical-trial-number":"nct03425487","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Jesus","family":"Montero-Marin","sequence":"first","affiliation":[{"name":"Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Collado-Navarro","sequence":"additional","affiliation":[{"name":"La Plana University Hospital, Castell\u00f3n, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mayte","family":"Navarro-Gil","sequence":"additional","affiliation":[{"name":"Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alba","family":"Lopez-Montoyo","sequence":"additional","affiliation":[{"name":"Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcelo","family":"Demarzo","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, Mente Aberta \u2013 Brazilian Center for Mindfulness and Health Promotion, Universidade Federal de S\u00e3o Paulo, UNIFESP, S\u00e3o Paulo, Brazil"},{"name":"Hospital Israelita Albert Einstein, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Herrera-Mercadal","sequence":"additional","affiliation":[{"name":"Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Barcelo-Soler","sequence":"additional","affiliation":[{"name":"Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain"},{"name":"Institute of Health Research of Aragon (IIS), Zaragoza, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Garcia-Campayo","sequence":"additional","affiliation":[{"name":"Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain"},{"name":"Institute of Health Research of Aragon (IIS), Zaragoza, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,10,8]]},"reference":[{"key":"2025101810505431000_9.10.e029909.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2011.07.004"},{"key":"2025101810505431000_9.10.e029909.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31678-6"},{"key":"2025101810505431000_9.10.e029909.3","unstructured":"World Health Organization . 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