Contents lists available at ScienceDirect Journal of Affective Disorders journal homepage: www.elsevier.com/locate/jad Research paper Improvement of mindfulness skills during Mindfulness-Based Cognitive Therapy predicts long-term reductions of neuroticism in persons with recurrent depression in remission Philip Spinhoven a,b, ⁎ , Marloes J. Huijbers c , Johan Ormel d , Anne E.M. Speckens c a Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333AK Leiden, The Netherlands b Department of Psychiatry, Leiden University Medical Centre, Albinusdreef 2, 2333ZA Leiden, The Netherlands c Department of Psychiatry, Radboud University Medical Centre, Reinier Postlaan 10, 6525 GC Nijmegen, The Netherlands d Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands ARTICLE INFO Keywords: Mindfulness Big five personality traits Recurrent depression Mindfulness-Based Cognitive Therapy Remission ABSTRACT Background: This study examined whether changes in mindfulness skills following Mindfulness-based Cognitive Therapy (MBCT) are predictive of long-term changes in personality traits. Methods: Using data from the MOMENT study, we included 278 participants with recurrent depression in remission allocated to Mindfulness-Based Cognitive Therapy (MBCT). Mindfulness skills were measured with the FFMQ at baseline, after treatment and at 15-month follow-up and personality traits with the NEO-PI-R at baseline and follow-up. Results: For 138 participants, complete repeated assessments of mindfulness and personality traits were available. Following MBCT participants manifested significant improvement of mindfulness skills. Moreover, at 15-month follow-up participants showed significantly lower levels of neuroticism and higher levels of conscientiousness. Large improvements in mindfulness skills after treatment predicted the long-term changes in neuroticism but not in conscientiousness, while controlling for use of maintenance antidepressant medication, baseline depression severity and change in depression severity during follow-up (IDS-C). In particular improvements in the facets of acting with awareness predicted lower levels of neuroticism. Sensitivity analyses with multiple data imputation yielded similar results. Limitations: Uncontrolled clinical study with substantial attrition based on data of two randomized controlled trials. Conclusions: The design of the present study precludes to establish whether there is any causal association between changes in mindfulness and subsequent changes in neuroticism. MBCT could be a viable intervention to directly target one of the most important risk factors for onset and maintenance of recurrent depression and other mental disorders, i.e. neuroticism. 1. Introduction Mindfulness refers to nonjudgmental, present-moment awareness of internal and external stimuli (Kabat-Zinn, 2013). Kabat-Zinn (1982) developed a standardized format to teach mindfulness skills to patients with chronic pain and other somatic conditions. This program called Mindfulness-Based Stress Reduction (MBSR) was later converted to Mindfulness-Based Cognitive Therapy (MBCT) for the prevention of relapse in recurrent depression (Segal et al., 2002). Since then mind- fulness-based interventions have been applied to a growing number of mental and somatic health conditions. The rapidly expanding treat- ment literature summarized in various meta-analyses suggests that mindfulness-based interventions are helpful in preventing depressive relapses (Kuyken et al., 2016) and reducing emotional problems such as depression, anxiety and stress in adults (e.g., Khoury et al., 2013) and in children and adolescents (e.g., Kallapiran et al., 2015; Zoogman et al., 2015), in somatic diseases (e.g., Bawa et al., 2015; Zhang et al., 2015), in primary care (e.g., Demarzo et al., 2015) and also using an online format (Spijkerman et al., 2016). A recent meta-analysis of 23 meta-analyses summarizes evidence supporting the use of mindful- ness-based interventions to alleviate symptoms, both mental and physical, in the adjunct treatment of cancer, cardiovascular disease, http://dx.doi.org/10.1016/j.jad.2017.02.011 Received 21 September 2016; Received in revised form 4 January 2017; Accepted 12 February 2017 ⁎ Corresponding author at: Leiden University, Institute of Psychology, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands. E-mail address: Spinhoven@FSW.LeidenUniv.NL (P. Spinhoven). Journal of Affective Disorders 213 (2017) 112–117 Available online 13 February 2017 0165-0327/ © 2017 Published by Elsevier B.V. MARK