Mindfulness-Based Therapy Shown to Help When Talk Therapy Falls Short

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Mindfulness-based cognitive therapy (MBCT) can help people with depression who haven’t gotten better after completing talk therapy, according to new research published in The Lancet.

Many people with major depressive disorder (MDD) seek help through psychological therapy, such as cognitive behavioral therapy (CBT). However, approximately half of patients don’t experience full relief from their symptoms, even after completing a full course of high-intensity therapy. For these individuals, there are few clearly defined next steps.

Investigators wanted to find out whether MBCT could help people whose depression had not improved enough after traditional talk therapy. They also wanted to know whether the added cost of MBCT would be worth it.

MBCT combines traditional elements of cognitive therapy with mindfulness practices, such as focused breathing, meditation and body awareness. The goal is to help people become more aware of their thoughts and emotions so they can better manage them — especially negative thought patterns that can lead to or worsen depression.

The trial included 234 adults with MDD whose symptoms were still significant, as indicated by a Patient Health Questionnaire-9 (PHQ-9) score of 10 or more, after completing at least 12 sessions of U.K. National Health Service (NHS) high-intensity therapy.

Most participants were women (71%), the average age was 42.5 years, and most were White (86%). They were recruited from three regions across the U.K.

Participants were randomly assigned to two groups: One group received MBCT in addition to usual care, such as ongoing medication or doctor visits, and the other group continued with treatment as usual only.

MBCT was delivered online via videoconference, making it accessible for people regardless of their location. It included an orientation session followed by eight weekly group sessions.

After 34 weeks, people who received MBCT plus usual care had significantly greater reductions in depression symptoms compared with those who received usual care alone. The difference was statistically significant and clinically meaningful, showing a real improvement in people’s well-being. Additionally, no serious side effects were reported related to the MBCT sessions.

In terms of cost, MBCT was likely to be cost-effective, having an estimated 99% chance of being a worthwhile investment when using standard NHS thresholds for cost per quality-adjusted life year (QALY), a measure used to evaluate health outcomes and cost-effectiveness.

Clara Strauss, PGDip, professor of clinical psychology at the University of Sussex and member of the research team, explains that MBCT “helps people to recognize negative, self-critical thoughts as thoughts, rather than as facts and so helps to lessen their emotional impact” while also supporting them to be “more accepting of their difficult experiences and to be kinder to themselves.”

Investigators noted the short follow-up period and potential issues with generalizability (as most participants women and White) limited the study.

However, combined with past research on people who didn’t improve with medication, findings suggest MBCT is a strong next-step treatment. Because it works well in group settings and can be offered online, investigators recommend making it more widely available in routine care programs and beyond.

Kevin Munro, Ph.D., director of NIHR’s Research for Patient Benefit Programme, says the results are “a great example of practical research that could quickly help improve people’s quality of life.”