The Effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) in Real-World Healthcare Services

Abstract

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.

The effectiveness of mindfulness-based cognitive therapy for major depressive disorder: evidence from routine outcome monitoring data

“…To compare this finding in further detail to previous RCTs, we collected within-group effect sizes of the change in BDI-II scores in the MBCT arms of relevant previous RCTs. 5 , 31 With regard to history of MDD, Tickell et al 30 demonstrated a moderate within-group effect (Cohen's d = 0.31) in patients with remitted, recurrent MDD with three or more episodes, whereas the effect size for remitted, recurrent MDD in our study was Cohen's d = 0.84. With regard to remission status of MDD, a study of patients with chronic MDD 28 found a moderate effect as well (Cohen's d = 0.48; our sample: current/recurrent Cohen's d = 0.76, current/single Cohen's d = 0.83), Van Aalderen et al 29 found moderate effects in both acute and remitted patients with MDD who suffered three or more previous episodes (Cohen's d = 0.71 and 0.45, respectively).…”

“…To compare this finding in further detail to previous RCTs, we collected within-group effect sizes of the change in BDI-II scores in the MBCT arms of relevant previous RCTs. 5,31 With regard to history of MDD, Tickell et al 30 That MBCT has comparable effects in patients with recurrent and single episodes of MDD in terms of depressive symptom reduction is in line with previous evidence suggesting that reduction of residual symptoms by MBCT is independent of number of previous episodes of MDD. 13 In terms of remission status, our results are also in accordance with evidence from a recent meta-analysis 5 indicating that MBCT was effective in the treatment of current depressive symptoms.…”

“…The current results are comparable with previous findings on the effectiveness of MBCT for depressive symptoms in real-world settings as conducted in the UK. 30 Forty per cent of the patients that entered this study with Patient Health Questionnaire (PHQ-9) scores in the depressed range (total n = 828; note that no formal psychiatric diagnoses was available in this study) showed reliable improvement, compared with 2% that showed reliable deterioration. These findings are remarkably similar to our findings in patients with an established diagnosis of MDD (40% reliable change, 3% reliable deterioration).…”

‘Mind the gaps’: the accessibility and implementation of an effective depression relapse prevention programme in UK NHS services: learning from mindfulness-based cognitive therapy through a mixed-methods study

“…While this supported implementation, its effects on effectiveness are unknown. A recent pragmatic study of MBCT’s effectiveness in NHS services sampled from some of our case study sites suggested that MBCT’s acceptability and outcomes were comparable when benchmarked against outcomes in randomised trials 34. Implementation literature35 36 suggests a dynamic interplay between an intervention, its implementation and context.…”

Implementation and Dissemination of Mindfulness-Based Interventions

“…The first two papers address the question of the effectiveness of MBCT in naturalistic real-world settings. Tickell et al (2019) investigated the effectiveness of MBCT in five mental health services in different regions in the UK. In a sample of 1554 service users, they examined the effect of MBCT on depressive outcomes.…”