RELAPSE PREVENTION IN DEPRESSION AND ANXIETY

Relapse is a common challenge for individuals who have recovered from depression and anxiety and advancing evidence-based interventions for relapse prevention is essential. To this end, Claudi is committed not only to promoting well-proven methods but also to exploring innovative approaches that can expand access to care. This includes promoting low-cost interventions, leveraging technology, and expanding non-specialist care in both high- and low-income countries. Below, you'll find a selection of initiatives and ongoing studies Claudi and her team have led to support these efforts.

PREVENTIVE COGNITIVE THERAPY

Developed by Claudi Bockting, Preventive Cognitive Therapy (PCT) is an extensively researched method for relapse prevention in depression. Throughout 8 sessions, clients and therapist develop a tailor-made plan to overcome depression relapse. PCT is cost effective, can be used alongside or as an alternative to anti-depressants and has been shown to provide significant protection against relapse over a period of 2 to 20 years. PCT is selected for dissemination via the Ministry of Health and MIND.

For more information, see here or download our brochure.

Evidence-based intervention against relapse in depression and anxiety

Books for Clients:

Between dip and dream: Break your patterns, dare to feel.
Authors: Claudi LH Bockting & Evelien van Valen
2013 | ISBN 9789000328857 | 1st edition
Spectrum € 10.00

No more depressed. 
Author: Claudi LH Bockting
2009 | ISBN 9789031374274 | 1st edition
Bohn Stafleu van Loghum € 23.95

Books for Clinicians:

Preventive Cognitive Therapy for Depression: An evidence based approach to reduce relapse risk.
Author: Claudi LH Bockting
2025 | ISBN 9781462558445
Guilford Press €40,00 - Order 15% off

Preventieve cognitieve training bij terugkerende depressie. 
Auteur: Claudi L. H. Bockting
2009 | ISBN 9789031353071 | 1e druk
Bohn Stafleu van Loghum € 47,95

Terapia cognitiva preventiva para la depresión recurrente.
Auteur: Claudi L. H. Bockting (adaptado y traducido por Cristian J. Garay & Cristina Tenreyro)
2020 | ISBN 978-98-9875704350 | 1e druk
Liberia Akadia Editorial, € 17,99

Interested in taking part in a PCT workshop or would you like to have access to our training videos?

Then please send us a message via our contact form.

  • van Tol, M.-J., van Kleef, R., Eike, R., van Valen, E., Marsman, J.-B., Renken, R., Aleman, A., & Bockting, C. L. (in press). Neurocognitive mechanisms of Preventive Cognitive Therapy as relapse prevention in remitted major depressive disorder: a randomized controlled trial. Biological Psychiatry: Global Open Science.  https://doi.org/10.1016/j.bpsgos.2026.100781

    Angeles-Valdez, D., van Kleef, R., van Valen, E., Garza-Villarreal, E. A., Bockting, C. L., & van Tol, M. J. (2026). The role of cognitive and affective changes in preventing depressive relapse: A network analysis approach to understanding the mechanisms of preventive cognitive therapy. Journal of  Affective Disorders, 406, 121705. https://doi.org/10.1016/j.jad.2026.121705

    Gülpen, J., Breedvelt, J. J.F., van Dis, E. A.M., Geurtsen, G. J., Warren, F. C., van Heeringen, C., Hitchcock, C., Holländare, F., Huijbers, M. J., Jarrett, R. B., Jermann, F., de Jonge, M., Klein, D. N., Klein, N. S., Ma, S.H., Moore, M. T., Denys, D. A.J.P., Williams, J.M. G., Kuyken, W., & Bockting, C. L. (2025). Psychological interventions for preventing relapse in individuals with partial remission of depression: A systematic review and individual participant data meta-analysis. Psychological Medicine, 55, 1–11. https://doi.org/10.1017/S0033291725000157

    Breedvelt, J. J. F., Karyotaki, E., Warren, F. C., Brouwer, M. E., Jermann, F., Hollandare, F., Klein, N., de Jonge, M., Klein, D. N., Farb, N., Segal, Z., Biesheuvel Leliefeld, K. E. M., Jarrett, R., Vittengl, J., Thase, M., Ma, H., Kuyken, W., Shallcross, A. J., van Heeringen, C., … Bockting, C. L. (2024). An individual participant data meta-analysis of psychological interventions for preventing depression relapse. Nature Mental Health, 2(2), 154–163. https://doi.org/10.1038/s44220-023-00178-x

    Legemaat, A. M., Burger, H., Geurtsen, G. J., Brouwer, M., Spinhoven, P., Denys, D., Bockting, C. L. (2023). Effects up to 20-year follow-up of Preventive Cognitive Therapy in adults remitted from recurrent depression: the DELTA study. Psychotherapy and Psychosomatics, 92(1), 55-64. https://doi.org/10.1159/000527906

    Bockting, C. L., Legemaat, A. M., van der Stappen, J., Geurtsen, G. J., Semkovska, M., Burger, H., Bergfeld, I. O., Lous, N., Denys, D., & Brouwer, M. (2022). Augmenting neurocognitive remediation therapy to Preventive Cognitive Therapy for partially remitted depressed patients: Protocol of a pragmatic multicentre randomized controlled trial. BMJ open, 12(6), e063407. https://doi.org/10.1136/bmjopen-2022-063407

    Van Tol, M.-J., Kleef, R. S. van, Eike, R., Valen, E. van, Marsman, J.-B., Renken, R., Aleman, A., & Bockting, C. L. (2021). Neurocognitive mechanisms of change following Preventive Cognitive Therapy for preventing relapse in depression: A randomized controlled trial. PsyArXiv.https://doi.org/10.31234/osf.io/n8tvx

    Breedvelt, J., Brouwer, M. E., Harrer, M., Semkovska, M., Ebert, D. D., Cuijpers, P., & Bockting, C. L. (2021). Psychological interventions as an alternative and add-on to antidepressant medication to prevent depressive relapse: Systematic review and meta-analysis. The British Journal of Psychiatry: The Journal of Mental Science, 219(4), 538–545. https://doi.org/10.1192/bjp.2020.198

    Breedvelt, J., Warren, F. C., Segal, Z., Kuyken, W., & Bockting, C. L. (2021). Continuation of antidepressants vs sequential psychological interventions to prevent relapse in depression: An individual participant data meta-analysis. JAMA Psychiatry, 78(8), 868–875. https://doi.org/10.1001/jamapsychiatry.2021.0823

    Breedvelt, J. J. F., Warren, F. C., Brouwer, M. E., Karyotaki, E., Kuyken, W., Cuijpers, P., van Oppen, P., Gilbody., S. &  Bockting, C. L. (2020). Individual participant data (IPD) meta-analysis of psychological relapse prevention interventions versus control for patients in remission from depression: A protocol. BMJ Open, 10(2), e034158. https://doi.org/10.1136/bmjopen-2019-034158

    Brouwer, M. E., Molenaar, N. M., Burger, H., Williams, A. D., Albers, C., Lambregtse-van den Berg, M., & Bockting, C. L. (2020). Tapering antidepressants while receiving digital Preventive Cognitive Therapy during pregnancy: An experience sampling methodology trial. Frontiers in Psychiatry, 11, 574357. https://doi.org/10.3389/fpsyt.2020.574357

    Kamperman, A. M., Bergink, V., Hoogendijk, W. J. G., Williams, A., Bockting, C. L., & Lambregtse-van den Berg, M. P. (2020). Preventive cognitive therapy with antidepressant discontinuation during pregnancy: Results from a randomized controlled trial. Journal of Clinical Psychiatry, 81(4). https://doi.org/10.4088/JCP.19l13099

    Molenaar, N. M., Brouwer, M. E., Burger, H., Kamperman, A. M., Bergink, V., Hoogendijk, W., Williams, A. D., Bockting, C. L., & Lambregtse-van den Berg, M. P. (2020). Preventive Cognitive Therapy with antidepressant discontinuation during pregnancy: Results from a randomized controlled trial. Frontiers in Psychiatry, 11(4), 19l13099. http://doi.org/doi.org/10.4088/JCP.19l13099

    de Jonge, M., Bockting, C. L., Kikkert, M. J., van Dijk, M. K., van Schaik, D. J. F., Peen, J., Hollon, S., & Dekker, J. J. M. (2019). Preventive cognitive therapy versus care as usual in cognitive behavioral therapy responders: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 87(6), 521-529. https://doi.org/10.1037/ccp0000395

    Klein, N. S., Wijnen, B. F. M., Lokkerbol, J., Buskens, E., Elgersma, H. J., van Rijsbergen, G. D., Slofstra, C., Ormel, J., Dekker, J., de Jong, P., & Bockting, C. L. (2019). Cost-effectiveness, cost-utility and the budget impact of antidepressants versus Preventive Cognitive Therapy with or without tapering of antidepressants. BJPsych Open, 5(1), e12. https://doi.org/10.1192/bjo.2018.81

    Bockting, C. L., Klein, N. S., Elgersma, H. J., van Rijsbergen, G. D., Slofstra, C., Ormel, J., Buskens, E., Dekker, J., de Jong, P. J., Nolen, W. A., Schene, A. H., Hollon, S. D., Burger, H. (2018). The effectiveness of Preventive Cognitive Therapy while tapering antidepressants compared with maintenance antidepressant treatment and their combination in the prevention of depressive relapse or recurrence (DRD study): A three-arm randomised controlled trial. Lancet Psychiatry, 5(5), 401-410. https://doi.org/10.1016/S2215-0366(18)30100-7

    Klein, N. S., Kok, G. D., Burger, H., van Valen, E., Riper, H., Cuijpers, P., Dekker, J., Smit, F., van der Heiden, C., & Bockting, C. L. (2018). No sustainable effects of an internet-based relapse prevention program over 24 months in recurrent depression: Primary outcomes of a randomized controlled trial. Psychotherapy and Psychosomatics, 87(1), 55-57. https://doi.org/10.1159/000485039

    Biesheuvel-Leliefeld, K. E. M., Dijkstra-Kersten, S.M.A. , van Schaik, D.J.F., van Marwijk, H. W. J., Smit, F., van der Horst, H.E., Bockting, C. L. (2017). Effectiveness of supported self-help in recurrent depression: A randomised controlled trial in primary care. Psychotherapy and Psychosomatics, 86(4), 220-230, https://doi.org/10.1159/000472260

    Molenaar, N. M., Brouwer, M. E., Bockting, C. L., Bonsel, G. J., van der Veere, C. N., Torij, H.  W., Hoogendijk, W. J., Duvekot, J. J., Burger, H. & Lambregtse-van den Berg, M. P. (2016). Stop or go? Preventive Cognitive Therapy with guided tapering of antidepressants during pregnancy: Study protocol of a pragmatic multicentre noninferiority randomized controlled trial. BMC Psychiatry, 16(1), 1. https://doi.org/10.1186/s12888016-0752-6

    Bockting, C. L., Smid, N. H., Koeter, M. W., Spinhoven, P., Beck, A. T., & Schene, A. H. (2015). Enduring effects of Preventive Cognitive Therapy in adults remitted from recurrent depression: A 10 year follow-up of a randomized controlled trial. Journal of Affective Disorders, 185, 188–194. https://doi.org/10.1016/j.jad.2015.06.048

    De Jonge, M., Bockting, C. L., Kikkert, M. J., Bosmans, J. E., & Dekker, J. J. (2015). Preventive Cognitive Therapy versus Treatment as Usual in preventing recurrence of depression: Protocol of a multi-centered randomized controlled trial. BMC Psychiatry, 15(1), 139. https://doi.org/10.1186/s12888-015-0508-8

    Bockting, C. L., Spinhoven, P., Wouters, L. F., Koeter, M. W. J, Schene, A. H., & the DELTA study group (2009). Long term effects of Preventive Cognitive Therapy in recurrent depression: A 5.5 years follow-up. Journal of Clinical Psychiatry, 70, 1621-1628. https://doi.org/10.4088/JCP.08m04784

    Bockting, C. L., ten Doesschate, M. C., Spijker, J., Spinhoven, P., Koeter, M. W. J., Schene, A. H. & the DELTA study group (2008). Continuation and maintenance use of antidepressants in recurrent depression. Psychotherapy and Psychosomatics, 77, 17-26. https://doi.org/10.1159/000110056

    Bockting, C. L., Spinhoven, Ph., Koeter, M. W. J., Wouters, L. F., Schene, A. H., & the DELTA study group. (2006). Prediction of recurrence in recurrent depression and the influence of consecutive episodes on vulnerability: A 2-year prospective study. Journal of Clinical Psychiatry, 67, 747-755. https://doi.org/10.4088/JCP.v67n0508

    Bockting, C. L., Spinhoven, P., Koeter, M. W. J., Wouters, L. F., Visser, I., Schene, A. H., & the  DELTA study group. (2006). Differential predictors of response to Preventive Cognitive Therapy in recurrent depression: A 2-year prospective study. Psychotherapy and Psychosomatics, 75, 229-236. https://doi.org/10.1159/000092893

    Bockting, C. L., Schene, A. H., Spinhoven, P., Koeter, M. W. J., Wouters, L. F., Huyser, J., & Kamphuis, J. H. (2005). Preventing relapse/recurrence in recurrent depression using Cognitive Therapy. Journal of Consulting and Clinical Psychology, 73, 647-657. https://doi.org/10.1037/0022-006X.73.4.647

ITFRA CONSORTIUM

ITFRA (International TaskForce for Relapse Prevention of Depression and Anxiety) is a research taskforce co-ordinated by Josefien Breedvelt and Claudi Bockting, that aims to improve our understanding of the prevention of relapse in depression, harmonize outcome and moderator measurement, and advocate for improved outcomes for people who have experienced depression. The current projects are largely focused on individual participant data meta-analysis and meta-analyses aiming to identify what works for whom and evaluate treatment approaches such as the role of psychological interventions and antidepressants in preventing relapse or recurrence.

  • Gülpen, J., Breedvelt, J. J.F., van Dis, E. A.M., Geurtsen, G. J., Warren, F. C., van Heeringen, C., Hitchcock, C., Holländare, F., Huijbers, M. J., Jarrett, R. B., Jermann, F., de Jonge, M., Klein, D. N., Klein, N. S., Ma, S.H., Moore, M. T., Denys, D. A.J.P., Williams, J.M. G., Kuyken, W., & Bockting, C. L. (2025). Psychological interventions for preventing relapse in individuals with partial remission of depression: a systematic review and individual participant data meta-analysis. Psychological Medicine, 55, 1–11. https://doi.org/10.1017/S0033291725000157

    Breedvelt, J. J. F., Karyotaki, E., Warren, F. C., Brouwer, M. E., Jermann, F., Hollandare, F., Klein, N., de Jonge, M., Klein, D. N., Farb, N., Segal, Z., Biesheuvel Leliefeld, K. E. M., Jarrett, R., Vittengl, J., Thase, M., Ma, H., Kuyken, W., Shallcross, A. J., van Heeringen, C., … Bockting, C. L. (2024). An individual participant data meta-analysis of psychological interventions for preventing depression relapse. Nature Mental Health, 2(2), 154–163. https://doi.org/10.1038/s44220-023-00178-x

    Breedvelt, J., Warren, F. C., Segal, Z., Kuyken, W., & Bockting, C. L. (2021). Continuation of antidepressants vs sequential psychological interventions to prevent relapse in depression: An individual participant data meta-analysis. JAMA Psychiatry, 78(8), 868–875. https://doi.org/10.1001/jamapsychiatry.2021.0823

    Breedvelt, J. J. F., Warren, F. C., Brouwer, M. E., Karyotaki, E., Kuyken, W., Cuijpers, P., van Oppen, P., Gilbody., S. &  Bockting, C. L. (2020). Individual participant data (IPD) meta-analysis of psychological relapse prevention interventions versus control for patients in remission from depression: A protocol. BMJ Open, 10(2), e034158. https://doi.org/10.1136/bmjopen-2019-034158

    Breedvelt, J. J. F., Zamperoni, V., South, E., Uphoff, E. P., Gilbody, S., Bockting, C. L., Churchill, R., & Kousoulis, A. A. (2020). A systematic review of mental health measurement scales for evaluating the effects of mental health prevention interventions. European Journal of Public Health, 30(3), 510-516. https://doi.org/10.1093/eurpub/ckz233

ONGOING STUDIES

STAYFINE-App: Relapse prevention in Adolescents

More than one in five adolescents has to deal with anxiety or a depressive disorder before the age of 21. Even after recovery, the prevalence of relapse is especially high in this age group. To investigate whether it is possible to prevent relapse through ongoing monitoring and momentary app-based interventions, we are conducting a randomized controlled trial evaluating the effectiveness of personalized combination of app-based interventions with guidance of loved experience experts. This project is conducted with funding from ZonMw.

  • ‍Verstegen, N. A., Kooiman, B., Robberegt, S. J., Vuuregge, A. H., Bockting, C. L., Nauta, M. H., & Stikkelbroek, Y. A. J. (2026). Current well-being in youth remitted from depression and anxiety: Associations with prior suicidality and current behavioral activity. Journal of  Affective Disorders, 406, 121706. https://doi.org/10.1016/j.jad.2026.121706

    Kooiman, B. E., Robberegt, S. J., Albers, C. J., Bockting, C. L., Stikkelbroek, Y. A., & Nauta, M. H. (2023). Congruency of multimodal data-driven personalization with shared decision-making for StayFine: individualized app-based relapse prevention for anxiety and depression in young people. Frontiers in psychiatry, 14, 1229713. https://doi.org/10.3389/fpsyt.2023.1229713

    Robberegt, S. J., Kooiman, B. E. A. M., Albers, C. J., Nauta, M. H., Bockting, C. L., & Stikkelbroek, Y. (2023). Personalised app-based relapse prevention of depressive and anxiety disorders in remitted adolescents and young adults: a protocol of the StayFine RCT. BMJ Open 2022; 12:e058560. https://doi.org10.1136/bmjopen-2021-058560

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MINDCOG: Understanding mechanisms of depression prevention

MINDCOG is a randomized cross-over trial to investigate mechanisms of mindfulness and positive fantasizing (ingredient of PCT) as intervention techniques for reducing perseverative cognition (PC) in remitted depressed individuals. The current study aims to 1) test whether momentary psychological and psychophysiological indices of PC are differentially affected by positive fantasizing versus mindfulness-based interventions, 2) test whether the mechanisms of change by which fantasizing and mindfulness affect PC differ between remitted Major Depressive Disorder versus never-depressed individuals, and 3) explore potential moderators of the main effects of the two interventions (i.e., what works for whom).

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Patients partially remitted from depression are at increased risk of relapse. In the HERSTEL-study (eng. RECOVERY), we aim to further reduce depressive symptoms and the risk of relapse using multilevel interventions. To attain this goal, we compare the efficacy of Preventive Cognitive Therapy combined with a serious computer game intervention that targets cognitive functioning to Preventive Cognitive Therapy alone. This project is conducted with funding from the Hersenstichting

HERSTEL: Innovative depression treatment for lasting recovery