New research has found that a mindfulness-based psychological therapy that incorporates elements from cognitive behavioural therapy (CBT), may help to reduce symptoms in people with difficult-to-treat depression (DTD).
The paper, “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” was published recently in The Lancet Psychiatry.
Trial Manager and paper co-author, Dr Asha Ladwa, National Institute for Health and Care Research (NIHR) Mental Health Translational Research Collaboration (MH-TRC) Mission Postdoctoral Research Fellow and Research Psychologist at the University of Exeter’s Mood Disorders Centre shares insights into the importance of the study and its findings:
Why we are doing this work
Our research focuses on the innovation, adaptation, and evaluation of psychological therapies for DTD. Those with the condition may have received an evidence-based treatment, but their depression symptoms remain, alongside ongoing impairment in functioning and reduced quality of life.
For this patient group, there are few next-step psychological therapy options available in primary care mental health service, such as NHS Talking Therapies for anxiety and depression (NHS-TTad).
About the RESPOND Trial
I was the Trial Manger of an NIHR Research for Patient Benefit programme trial, called the RESPOND trial. The trial investigated whether mindfulness-based cognitive therapy (MBCT) could be a clinically and economically worthwhile next-step psychological treatment option for DTD patients who had previously received a psychological treatment in NHS-TTad services and had not responded.
MBCT is currently delivered in these services to support depression relapse prevention and consists of an eight-week group intervention, delivered through a weekly video call, that combines elements from CBT and mindfulness practice to help patients connect with the present moment.
It teaches patients to non-judgementally become aware of their thoughts and emotions, encouraging them to step back and observe these experiences as they arise, rather than becoming caught in patterns of negative thinking.
A total of 234 participants took part in the RESPOND trial. Of which, 118 were randomly allocated to receive MBCT in addition to treatment-as-usual and 116 were allocated to receive treatment-as-usual alone as a comparative control group. Within the MBCT group there was good engagement, with 86% of participants completing at least half of the therapy.
We found MBCT and treatment-as-usual was superior to treatment-as-usual alone at reducing depression symptoms, with improvements lasting for six-months post-treatment. Alongside depression improvements, we also saw MBCT and treatment-as-usual participants showed significant improvements in mental wellbeing and reductions in generalised anxiety compared to those in the treatment-as-usual alone group.
MBCT was cost-effective relative to treatment-as-usual alone and led to reductions in other health and social care costs even when considering the resources required to run MBCT groups.
Our next steps
As part of my MH-TRC Mission fellowship I am establishing the South West Gap Practice Research Network (SW MH Gap PRN) to bring together clinicians, researchers, and lived experience contributors to upskill and conduct research to support the missing middle in mental health care population.
One project I will lead through the SW MH Gap PRN will be to evaluate the practice-based implementation of MBCT for this client group in a local NHS-TTad service. Together with the trial findings, the learning from this local practice-based evaluation will support the future national implementation of MBCT for DTD in NHS-TTad services.
Visit our website to learn more about the MH-TRC Mission Mood Disorders workstream.
