Mindfulness-Based Cognitive Therapy Delivered in Primary Care: a Naturalistic, Mixed-Methods Study of Participant Characteristics and Experiences (original) (raw)
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The Effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) in Real-World Healthcare Services
Mindfulness
Depression is common with a high risk of relapse/recurrence. There is evidence from multiple randomised controlled trials (RCTs) demonstrating the efficacy of mindfulness-based cognitive therapy (MBCT) for the prevention of depressive relapse/ recurrence, and it is included in several national clinical guidelines for this purpose. However, little is known about whether MBCT is being delivered safely and effectively in real-world healthcare settings. In the present study, five mental health services from a range of regions in the UK contributed data (n = 1554) to examine the impact of MBCT on depression outcomes. Less than half the sample (n = 726, 47%) entered with Patient Health Questionnaire (PHQ-9) scores in the non-depressed range, the group for whom MBCT was originally intended. Of this group, 96% sustained their recovery (remained in the non-depressed range) across the treatment period. There was also a significant reduction in residual symptoms, consistent with a reduced risk of depressive relapse. The rest of the sample (n = 828, 53%) entered treatment with PHQ-9 scores in the depressed range. For this group, 45% recovered (PHQ-9 score entered the non-depressed range), and overall, there was a significant reduction in depression severity from pre-treatment to post-treatment. For both subgroups, the rate of reliable deterioration (3%) was comparable to other psychotherapeutic interventions delivered in similar settings. We conclude that MBCT is being delivered effectively and safely in routine clinical settings, although its use has broadened from its original target population to include people experiencing current depression. Implications for implementation are discussed.
Mindfulness, 2021
Objectives Evidence suggests the efficacy of mindfulness-based cognitive therapy (MBCT) to prevent depression relapse and decrease depressive symptoms during the acute phase. However, the effectiveness of MBCT in real-world heterogeneous samples treated in clinical health settings, including primary care, has received little attention. This study had two aims: (1) to evaluate the effectiveness of MBCT delivered in primary care considering pre-treatment depression scores and (2) to explore the role of participants’ characteristics on symptom improvement. Methods Data were obtained from 433 individuals who received MBCT. Participants completed the Personality Inventory for ICD-11 (PiCD) pretreatment and the Beck Depression Inventory (BDI-II) pre- and post-treatment. Results Sixty percent presented moderate-to-severe depression according to scores on the BDI-II, 18.1% presented mild depression, and 21.7% were in the non-depressed range. The severity of pre-treatment depressive symptoms...
Participation in an Adapted Version of MBCT in Psychiatric Care
Mindfulness, 2012
Mindfulness-based cognitive therapy (MBCT) groups are challenged by high attrition particularly in early sessions. This leads to disturbances in the composition of the groups and potential dissatisfaction. In order to support patients in their decision about participation and to accommodate the program to psychiatric patients, an adapted version of MBCT was developed with nine instead of 8 weekly units, reduced duration of some exercises, and patients invited to make an active decision about continuing with the program or leaving the group after an introductory phase of the first three sessions. 120 participants joined the program, 35 % decided to leave the program before the advanced stage started, and 50.8 % completed it. In a multiple logistic regression model, neither the degree of depression and mindfulness at onset nor sociodemographic variables could predict if participants would complete the program. The only significant predictor was the number of sessions attended in the introductory phase. In bivariate analyses, having participated in group therapies earlier strongly predicted if a person would complete sessions 1 to 3. The therapist's assessment of the patient's motivation and her/his predictions if the patient would leave the group preterm and if the patient would finalize the program regularly were also related to attrition. The modified version of MBCT has proved to be feasible and useful to stabilize the participants' presence in the later sessions. Particular attention should be paid to patients who miss sessions in the introductory phase and for which the therapist recognizes low motivation or risk of dropping out.
Mental Health in Family Medicine, 2012
Background Mindfulness-based cognitive therapy (MBCT) is an intervention developed for the prevention of recurrent depression which is now being applied to widening numbers of clinical populations. Despite evidence for its effectiveness in preventing relapse in depression, less is known about its efficacy within routine clinical practice for groups of patients with more varied mental health problems, despite this being a potentially promising context for its application.Aims This pilot study aimed to investigate whether MBCT would be feasible and effective when delivered in a primary care context for patients who are vulnerable to recurrent depression and anxiety.Results Attrition from the programme was low and both attendance and engagement with home practices (during and after the intervention) were comparable with or higher than those observed in the existing literature. Improvements in self-reported depression, anxiety, rumination, self-compassion and well-being were evident over the 8-week programme and at 6-month post intervention follow-up.Conclusions Despite limitations in terms of sample size and the absence of a control group, the results demonstrate that the promising research results of MBCT for depression are transferable from a research to a practice setting, and demonstrate that it may be an effective and feasible intervention when delivered in a primary care setting for a range of mental health problems.
BMC Psychiatry
Background: Depressive symptoms are quite prevalent in Primary Care (PC) settings. The treatment as usual (TAU) in PC is pharmacotherapy, despite the high relapse rates it produces. Many patients would prefer psychotherapy, but specialized services are overloaded. Studies that apply Mindfulness-Based Interventions (MBIs) for the treatment of depression have obtained significant improvements. Brief low-intensity approaches delivered from PC could be a promising approach. This study aims to compare a low-intensity mindfulness intervention for the treatment of depression in PC using different intervention formatsa face-to-face MBI delivered in a group and the same MBI individually applied on the Internetto a control group that will receive PC medical treatment as usual. Methods: A randomized controlled clinical trial will be conducted in PC, with about 120 depressed patients allocated (1:1:1) to three groups: "face-to-face MBI + TAU", "Internet-delivered MBI + TAU", and "TAU alone". The MBI programs will be composed of four modules. The primary outcome will be depressive symptoms, measured through the Beck Depression Inventory, assessed at pre-and post-treatment and 6-and 12-month follow-ups. Other outcomes will be mindfulness, happiness, affectivity, quality of life, and the use of healthcare services. Intention-to-treat analysis using linear mixed models adjusted for baseline scores and routine sociodemographic analysis that could show baseline differences will be conducted. Per-protocol secondary outcome analyses will also be performed. Discussion: This is the first Spanish RCT to apply a low-intensity face-to-face MBI (plus TAU) to treat depression in PC settings compared to TAU (alone). Moreover, this study will also make it possible to evaluate the same MBI program (plus TAU), but Internet-delivered, considering their cost-effectiveness. Positive results from this RCT might have an important impact on mental health settings, helping to decrease the overload of the system and offering treatment alternatives beyond antidepressant medication through high-quality, flexible PC interventions. Trial registration: Clinical Trials.gov NCT03034343. Trial Registration date 24 January 2017, retrospectively registered.
Mindfulness based cognitive therapy for psychiatric disorders: A systematic review and meta-analysis
Psychiatry Research, 2011
Mindfulness-based Cognitive Therapy (MBCT) is a meditation program based on an integration of Cognitive behavioural therapy and Mindfulness-based stress reduction. The aim of the present work is to review and conduct a meta-analysis of the current findings about the efficacy of MBCT for psychiatric patients. A literature search was undertaken using five electronic databases and references of retrieved articles. Main findings included the following: 1) MBCT in adjunct to usual care was significantly better than usual care alone for reducing major depression (MD) relapses in patients with three or more prior depressive episodes (4 studies), 2) MBCT plus gradual discontinuation of maintenance ADs was associated to similar relapse rates at 1 year as compared with continuation of maintenance antidepressants (1 study), 3) the augmentation of MBCT could be useful for reducing residual depressive symptoms in patients with MD (2 studies) and for reducing anxiety symptoms in patients with bipolar disorder in remission (1 study) and in patients with some anxiety disorders (2 studies). However, several methodological shortcomings including small sample sizes, non-randomized design of some studies and the absence of studies comparing MBCT to control groups designed to distinguish specific from non-specific effects of such practice underscore the necessity for further research.
The Efficacy of Mindfulness-Based Interventions in Primary Care: A Meta-Analytic Review
PURPOSE Positive effects have been reported after mindfulness-based interventions (MBIs) in diverse clinical and nonclinical populations. Primary care is a key health care setting for addressing common chronic conditions, and an effective MBI designed for this setting could benefit countless people worldwide. Meta-analyses of MBIs have become popular, but little is known about their efficacy in primary care. Our aim was to investigate the application and efficacy of MBIs that address primary care patients. METHODS We performed a meta-analytic review of randomized controlled trials addressing the effect of MBIs in adult patients recruited from primary care settings. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and Cochrane guidelines were followed. Effect sizes were calculated with the Hedges g in random effects models. RESULTS The meta-analyses were based on 6 trials having a total of 553 patients. The overall effect size of MBI compared with a control condition for improving general health was moderate (g = 0.48; P = .002), with moderate het-erogeneity (I 2 = 59; P <.05). We found no indication of publication bias in the overall estimates. MBIs were efficacious for improving mental health (g = 0.56; P = .007), with a high heterogeneity (I 2 = 78; P <.01), and for improving quality of life (g = 0.29; P = .002), with a low heterogeneity (I 2 = 0; P >.05). CONCLUSIONS Although the number of randomized controlled trials applying MBIs in primary care is still limited, our results suggest that these interventions are promising for the mental health and quality of life of primary care patients. We discuss innovative approaches for implementing MBIs, such as complex intervention and stepped care.
Psychology, 2015
The concept of mindfulness has attracted a growing body of research within behavioural medicine over the last decade. Mindfulness-based cognitive therapy (MBCT) has been developed to prevent relapse among people who suffer recurrent depression. Studies show impressive results, with a decrease in the risk of relapse of up to 50%. However, primary care patients' own experiences and MBCT's effectiveness as a relapse program and aid to their ability to deal with everyday life remain relatively unexplored. The aim of the study, therefore, was to examine how primary care patients with recurrent depression perceive the usefulness of MBCT in preventing relapse. Nineteen patients who had participated in a MBCT program for recurrent depression within a primary care setting were interviewed 12 months after treatment. Qualitative thematic analysis was used to identify, analyse, and report patterns in the interviews. Analysis suggests two overarching themes, "Strategies for remission" and "Personal development". This study brings new information about what participants in MBCT classes describe as the most useful interventions for relapse prevention. The formal and informal meditation exercises focused on the body and the breath were described as the most important strategies for remission and the mindfulness practice gave the participants an enhanced self-knowledge that helped them to better deal with everyday stress and interpersonal functioning. The findings also indicate that traditional cognitive behavioural interventions, such as behaviour activation and establishing a maintenance plan, might not be as essential to relapse prevention as formerly thought.
• Background: Major Depression represents a pressing challenge for health care. In England, Increasing Access to Psychological Therapies (IAPT) services provide evidence-based psychological therapies in a stepped care approach to patients with depression. While introduction of these services has successfully increased access to therapy, estimates suggest that about 50 percent of depressed patients who have come to the end of the IAPT pathway still show signi cant levels of symptoms. This study will investigate whether Mindfulness-Based Cognitive Therapy (MBCT), a group intervention combining training in mindfulness meditation and elements from cognitive therapy, can have bene cial effects in depressed patients who have not responded to high-intensity therapy in IAPT. It will seek to establish the effectiveness and cost-effectiveness of MBCT as compared to the treatment these patients would usually receive. • Methods: In a 2-arm randomised controlled trial, patients who currently meet criteria for Major Depressive Disorder and who have not su ciently responded to at least 12 sessions of IAPT highintensity therapy will be allocated, at a ratio of 1:1, to receive either MBCT (in addition to treatment as usual [TAU]) or continue with TAU only. Assessments will take place at baseline, 10-weeks and 34-weeks post-randomisation. The primary outcome will be reduction in depression symptomatology 34 weeks post-randomisation as assessed using the Public Health Questionnaire-9 (PHQ-9). Secondary outcomes will include depressive symptomatology at 10-weeks post-randomisation and other clinical outcomes measured at 10-week and 34-week follow-up, along with a series of binarized outcomes to indicate clinically signi cant and reliable change. Evaluations of cost-effectiveness will be based on assessments of service use costs collected using the Adult Service Use Schedule and health utilities derived from the EQ-5D. • Discussion: This trial will add to the evidence-base for the use of MBCT in depressed treatment nonresponders. It will constitute the rst trial to test MBCT following non-response to psychological therapy, with results providing a direct estimate of e cacy within the IAPT pathway. As such, its results will offer an important basis for decisions regarding the adoption of MBCT for non-responders within IAPT.
Mindfulness-based therapy: A comprehensive meta-analysis
• We conducted a meta-analysis to provide a review of mindfulness-based therapy. • It includes 209 studies enrolling 12,145 participants with a variety of disorders. • We obtained Hedge's g=.53 in waitlist controlled studies, .55 in pre-post studies. • When compared with other treatments, we obtained a smaller effect (Hedge's g=.33). • The results obtained are robust and are maintained at follow-up. a b s t r a c t Background: Mindfulness-based therapy (MBT) has become a popular form of intervention. However, the existing reviews report inconsistent findings. Objective: To clarify these inconsistencies in the literature, we conducted a comprehensive effect-size analysis to evaluate the efficacy of MBT. Data sources: A systematic review of studies published in journals or in dissertations in PubMED or PsycINFO from the first available date until May 10, 2013. Review methods: A total of 209 studies (n = 12,145) were included. Results: Effect-size estimates suggested that MBT is moderately effective in pre-post comparisons (n = 72; Hedge's g = .55), in comparisons with waitlist controls (n = 67; Hedge's g = .53), and when compared with other active treatments (n = 68; Hedge's g = .33), including other psychological treatments (n = 35; Hedge's g = .22). MBT did not differ from traditional CBT or behavioral therapies (n = 9; Hedge's g = −.07) or pharmacological treatments (n = 3; Hedge's g = .13). Conclusion: MBT is an effective treatment for a variety of psychological problems, and is especially effective for reducing anxiety, depression, and stress.