Preventing relapse into Depression

• ‘Crippling depression and chronic anxiety are the biggest causes of misery in Britain today’.

• ‘One family in three is affected’

• ‘Only one in four of those who suffer from depression or chronic anxiety is receiving any kind of treatment’

• ‘We have a million people on Incapacity Benefits because of mental illness – more than the total number of unemployed people receiving unemployment benefits.’

‘The Depression Report – A New Deal for Depression and Anxiety Disorders’, London School of Economics 2006

The Depression Report goes on to recommend Cognitive Behavioural Therapy (CBT) as an evidence-based solution. It costs £750 to treat someone with CBT for 7 weeks. The report says, ‘Someone on Incapacity Benefit costs us £750 a month in extra benefits and lost taxes. If the person works just a month more as a result of the treatment, the treatment pays for itself.’ However, we do not have enough therapists, and in most areas ‘waiting lists for therapy are over nine months long’.

The Development of Mindfulness-Based Cognitive Therapy (MBCT)

MBCT was developed by three clinical physiologists (Teasdale, Williams and Segal) to provide a means of preventing relapse into depression, including for those who were initially treated with antidepressants. It was designed to be provided in a group format to be more cost effective.

Helping people stay well and not relapse into depression

• Depression has a high relapse rate – after the 1st episode, 50% are likely to have another; after two or more episodes, 80% are likely to have further depression.

• Treatment for depression includes antidepressants and psychological therapies such as cognitive-behavioural therapy (CBT) and interpersonal therapy (IPT). However, there is a considerable risk of relapse after stopping taking antidepressants and many people do not wish to take them long term.

• There is a shortage of trained therapists for CBT and IPT and because it is usually provided individually it is resource intensive.

Research into MBCT

The results of research conducted in Toronto, Cambridge and Bangor, showed that Mindfulness-Based Cognitive Therapy (MBCT) was of greatest benefit to those who had suffered the most number of previous episodes of depression.

• It substantially reduced the risk of relapse in those who had three or more previous episodes of depression (from 66% to 37%).

• These findings were replicated in a study in Cambridge. It found the same pattern of results, with MBCT reducing the rate of relapse from 78% in those with three episodes or more, to 36%.

• The Centre for Suicide Research at the University of Oxford is currently piloting the use of MBCT with people who have had a suicidal crisis, and now recovered, with the aim of reducing the risk of further self-harm.

• MBCT is recommended by the National Institute of Clinical Excellence (NICE) guidelines for depression alongside CBT.

Mindfulness-Based Cognitive Therapy at Breathing Space

• We have been running courses of MBCT at the LBC since 2004.

• These have been initiated and supervised by Dr Paramabandhu Groves who is a consultant psychiatrist.

• The courses last for 8 weeks plus a follow-up morning and back-up materials.

Who attends MBCT at Breathing Space?

We recently trialled a questionnaire at the beginning of the Meditation to Prevent Relapse into Depression Course. 35 participants (77%) took part. Amongst the findings were:

• 91% had had more than one relapse and of these 51% had had more than 3.

• 91% had tried other ways of preventing relapse in the past

• 91% had consulted their GP for advice.

• 72% of participants had taken anti-depressant medication at some time; 56% had tried CBT; 88% had tried counselling or other talking therapies; and 72% had tried all three methods.

• 75% of participants had tried other solutions ranging from ECT through alternative therapies.

• When asked why they had chosen to come on the course the most frequent response was a desire to cope with depression without medication

Evaluation of MBCT

• Feedback was sought from the 54 people who attended the last session of the first two courses (69% of all the participants).

• 84% rated the course as 7 out of 9 (i.e. very important) or greater.

• Common comments included: “I now have an invaluable set of tools to which I can always refer” “I feel I have been given … a new set of tools that I can reach for both in times of crises and in daily routine”

• Ella Sherlock, a trainee clinical psychologist at the University of East London, is doing qualitative research interviewing people who attend our MBCT courses at the Breathing Space. She is exploring what people with self-defined depression experience in attending an MBCT course at the Breathing Space. The aim is to learn what implications this might have for the practice and provision of MBCT in the NHS.

• A report in October 2007 by the Mental Health Foundation (a leading UK charity working in mental health) on ‘spirituality and recovery from mental health problems’ includes an appendix on Breathing Space. This provides a good overview of MBCT and the Breathing Space programme. It states that “the LBC, through its Breathing Space programme, promotes best practice in the teaching and understanding of the approaches based on mindfulness meditation as the central part of the clinical treatments to increase physical and mental and wellbeing.” Downlaod the full report, ‘Keeping the faith’.