Mindfulness course effective in people with difficult-to-treat depression

(Press-News.org) Mindfulness-based therapy can offer significant relief for individuals who are still depressed after receiving treatment, according to a new clinical trial.

Researchers hope their findings, published in Lancet Psychiatry, could provide a new treatment pathway for people with depression who have not benefitted from previous treatment. The study was led by a researcher from the University of Surrey, sponsored by the Sussex Partnership NHS Foundation Trust, and funded by the National Institute for Health and Care Research (NIHR).

Mindfulness-based cognitive therapy (MBCT) differs from other psychological therapies by using intensive training in mindfulness meditation to help people develop skills to respond more adaptively to negative mood and stress, in addition to Cognitive Behavioral Therapy (CBT) principles which seek to change negative thought patterns.

The new study found that MBCT significantly improved depression symptoms compared to continued treatment as usual. The average effect was in the small-to-moderate range and comparable to treatment with antidepressants. Crucially, the study also concludes that providing MBCT as an alternative to usual treatment was cost-effective, at less than £100 per person, and could save the National Health Service (NHS) money by changing the way people use services.

The UK NHS Talking Therapies programme is the world’s largest and most advanced publicly funded psychological therapies service, treating around 670,000 people each year, of which almost half have depression as their primary complaint. About 50 per cent of those individuals still have some degree of depression when their care ends. This rate is comparable to the wider picture in the treatment of depression, which for many patients is a recurring condition.

Among them is Mary Ryan, a patient adviser and co-author who has worked with the research team from the start. The retired GP and palliative care doctor has experienced many episodes of severe depression throughout her adult life, and was first in contact with mental health services when she was 17 years old. She said: “For most people with severe depression, it’s more than a condition – it’s a recurring part of their life story. Up to now, people have often been told that they’ve reached the end of the road for psychological treatment, that there are no other options for them. The findings of this trial are hugely important because we’re telling this group of people that they still matter – that there’s something else we can try that may work for them.”

The study involved more than 200 patients who had received NHS talking therapies, but still had depression. They were recruited across 20 NHS trial sites. The three lead sites were: Sussex Partnership Foundation Trust, Devon Partnership Foundation Trust and South London and Maudsley NHS Foundation Trust.

One group of participants received eight weekly group-based MBCT sessions delivered by videoconferences, aimed to develop mindfulness skills and guide participants on how to respond more effectively to difficult emotions. The other group received treatment as usual. Six months after treatment, patients who had received MBCT had larger improvements in depression symptom scores on average, than those who had received treatment as usual. 

 Study co-author Professor Barney Dunn, from the University of Exeter, said: “We know there’s a gap in services for people with depression who haven’t got better through NHS Talking Therapies. These people often don’t qualify for further specialist mental health care, and so are left with no further options. We’ve shown that offering MBCT to this group can be effective and cost-efficient to deliver, and we hope this will lead to it being implemented widely. We need investment in this and other areas where there are gaps in service, to ultimately save the NHS money.”

Study co-author Barbara Barret, Professor of Health Economics a King’s College London, who analysed cost-effectiveness in the trial, said: "We are highly encouraged by our findings, which reveal that MBCT treatment offers a powerful dual benefit for this group: superior patient outcomes coupled with notable cost savings for the NHS."

Clara Strauss, Professor of Clinical Psychology at the University of Sussex, said: “For vulnerable people with depression, MBCT is particularly helpful for a number of reasons. It helps people to recognise negative, self-critical thoughts as thoughts, rather than as facts and so helps to lessen their emotional impact. It helps people to be more accepting of their difficult experiences and to be kinder to themselves. MBCT also helps people to avoid getting stuck in unhelpful, repeated cycles of negative thinking. Encouragingly, our trial shows MBCT can even work for people where other forms of talking therapy have had little effect.”

Professor Kevin Munro, Director of NIHR's Research for Patient Benefit Programme, said: "This NIHR-funded study shows that mindfulness-based therapy has the potential to benefit patients with difficult-to-treat depression, as well as the NHS and the wider economy. It's a great example of practical research that could quickly help improve people's quality of life."

The study is titled ‘Mindfulness-based cognitive therapy versus treatment as usual after non-remission with NHS Talking Therapies high-intensity psychological therapy for depression: a UK-based clinical effectiveness and cost-effectiveness randomised, controlled, superiority trial’, and is published in Lancet Psychiatry. The research was led by Professor Thorsten Barnhofer from the University of Surrey and conducted in collaboration with Exeter Clinical Trials Unit at the University of Exeter.

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