As many of us are aware, mindfulness is one of the third-wave of cognitive therapies that are becoming increasingly popular, not just with therapists, but within the established healthcare arena too. There has been a welcome increase in the amount of research being carried out into its efficacy in treating a wide range of presenting conditions. Recently, one of these studies has indicated that mindfulness-based cognitive therapy (MBCT) may be as good as antidepressant medication at stopping people relapsing after recovering from major bouts of depression.
MBCT was developed by bringing CBT together with mindfulness techniques which, as I am sure we are all aware, encourage individuals to pay more attention to the present moment. In treating depression, MBCT teaches patients to recognise that negative thoughts and feelings will return (known as a relapse prediction), but that they can disengage from them, understand them and accept them, and therefore avoid being dragged down into a spiral leading back into depression.
Current best practice, endorsed by the National Institute for Health and Care Excellence (NICE) is to encourage people with a history of recurrent depression to remain on antidepressants for at least two years. As I am sure those of us who work with depression know, in reality this can be much longer. As may be expected, some patients are very reluctant to keep taking pills, while others find their depression comes back when they finally stop using the tablets.
The study in question was published in The Lancet, and involved a group of 424 adults taken from GP practices in the south-west of England, who were willing to try either antidepressants or MBCT. Half were randomly allocated to each group. Those assigned to mindfulness had eight group sessions of more than two hours plus daily home practice and the option of four follow-up sessions over a year. The course involved mindfulness training, group discussion and cognitive behaviour exercises. This cohort of patients gradually came off their medication. Those assigned to the other group stayed on the tablets for two years.
Interestingly, the relapse rates in the two groups were similar, with 44% in the mindfulness group and 47% for those on the pharmacotherapy. The researchers had thought the study might show that MBCT was more effective than medication, based on a 2008 pilot study where there was a suggestion that MBCT might do better than medication. However, the reality is very different.
What was established was that MBCT is equally as good as antidepressant therapy. This is encouraging as it potentially offers a new option for those who don’t want to be on medication for years. The study also indicated that MBCT might work better than antidepressants for those with very troubled histories and who are at the highest risk of relapse. It was found to have protected people with increased risk because of a background of childhood abuse. The researchers hypothesised that perhaps MBCT confers resilience in this group because these patients learn skills that address some of the underlying mechanisms of relapse.
It will be interesting to see what NICE makes of the study, and what recommendations may come from that in regard to the treatment of recurrent depression. As treating depression places an enormous financial burden on the already struggling global healthcare system, the results of this study are potentially significant. In comparison to medication, MBCT is relatively cheap to administer, the more so because it is generally carried out as group therapy.
Despite research, and the increased use of drugs, the long-term outcome of mood disorders has not improved in the 21st century. Having an alternative non-medication strategy to reduce relapse is an exciting and important means to help patients with depression.
And where does hypnotherapy come into all this? Well, it has been said that it is the intent with which you use mindful approaches that determines what you are doing: if the intent is to carry them out using meditation then it’s mindfulness. If, however, the intent is to do so using hypnotic trance, then it’s hypnotherapy. A little controversial, I know. So having lit that particular blue touch paper I will now stand back and let the mindfulness vs hypnotherapy debate take on a life of its own.
Peter Mabbutt FBSCH
For those who want to read the original research:
Kuyken W, Hayes R, Barrett B, Byng R, Dalgleish T, Kessler D, Lewis G, Watkins E, Brejcha C, Cardy J, Causley A, Cowderoy S, Evans A, Gradinger F, Kaur S, Lanham P, Morant, N, Richard J, Shah P, Sutton H, Vicary R, Weaver A, Wilks J, Williams M, Taylor RS and Byford S (2015) Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): a randomised controlled trial The Lancet 386(9988): 63-73