Breathing Space London

mindfulness for health

Mindfulness Based Cognitive Therapy

Mindfulness Based Cognitive Therapy (MBCT) is a clinically tested treatment for preventing relapse into depression. Through a combination of meditation and Cognitive Behavioural Therapy (CBT), it helps people break the link between negative moods and negative thinking. This can help you stay free from depression without needing to keep taking antidepressants. MBCT is recommended by the National Institute for Health and Clinical Excellence (NICE).

The need for MBCT - tackling the depression epidemic 

How relapse into depression happens

How MBCT was developed

How MBCT prevents relapse into depression

Clinical research into MBCT

The need for MBCT - tackling the depression epidemic

Depression - a debilitating illness

  • Around 1 in 5 people experience depression at some point in their lives.
  • Up to 1 in 10 adults experienced clinical depression in the last year in the UK.
  • 25% of women are likely to suffer clinical depression in their lifetime.
  • 10% of men are likely to suffer clinical depression in their lifetime.
  • 50% of people are likely to suffer a recurrence after a first episode.
  • 80% of people are likely to suffer a recurrence after two or more episodes.
  • 15% of people who have been hospitalised for depression will eventually die by suicide.
  • By 2020 depression will become the second leading cause of 'disMBCTease burden' worldwide.

According to a large population-based study by the World Health Organisation in September 2007 (from more than 245,000 people in 60 countries), depression can do more physical damage to a person's health than angina, arthritis, asthma, and diabetes. The study showed that depression was the fourth leading cause of 'disease burden' in 2000, a measure of the number of years of full health lost due to an illness. Projections by scientists at the Harvard School of public health suggest that, by 2020, depression will rise to become second only to heart disease in terms of disease burden.

Impact on society

Depression and anxiety prevent many people from working, which results in a loss of output and income. It is estimated that the total loss of output due to depression and chronic anxiety is some £12 billion a year - 1% of our total national income. Work is in fact a powerful aid to recovery, but so many people are in a vicious circle where the loss of work adds to depression which makes the return to work even more difficult - unless help is provided.

 "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 now have a million people on Incapacity Benefits because of mental illness - more than the total number of unemployed people receiving unemployment benefits. Some 40% of all disability...is due to mental illness. Similarly, roughly 40% of people on Incapacity Benefits are there because of mental illness... Likewise at the surgery one third of those who appear each year have mental health problems, and they take up at least a third of GP time."  'The Depression Report - A New Deal for Depression and Anxiety Disorders', London School of Economics, 2006

Health services struggling to cope

  • Only one in four of those currently suffering from depression are receiving any kind of treatment.
  • Depression has a high relapse rate - after the first 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, these conventional treatments are falling drastically short in helping tackle this epidemic. There is a considerable risk of relapse after coming off antidepressants and many people don't want to take them long term. There is a shortage of trained therapists for CBT and IPT; while as it is usually provided individually it is resource intensive.

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How relapse into depression happens

  • When people are no longer depressed, dysfunctional attitudes are no different from those who have never been depressed. i.e. persistent dysfunctional attitudes do not cause relapse.
  • Each recurrence is less likely to be triggered by a major life event, suggesting the process becomes more and more autonomous.
  • Low mood reactivates negative thinking and dysfunctional attitudes.
  • In the face of a difficulty, people prone to depression are more likely use rumination (e.g. analyse recent events and try to work our why you are depressed) than distraction (e.g. try to find something positive in the situation or something you learned, or do something you enjoy). Rumination prolongs the low mood and impairs problem solving, while creating the sense that you are trying to solve the difficulty.
  • Driving the rumination is a 'discrepancy monitor'. This continually monitors the current state and compares it with a model or standard of what is desired, required, expected or feared - which creates more negative thinking.
  • Relapse occurs due to small changes in mood that reactivate negative thinking plus rumination that prolongs the lowered mood. The symptoms of depression re-constellate as the mind follows well-worn mental grooves.

The tendency towards repeated relapse into depression - and the over-reliance on antidepressants - is backed up by our own findings at Breathing Space. Among participants on our MBCT courses:

  • 86% had had more than one relapse - of these 53% had had more than 3
  • 89% had tried other methods to prevent relapse
  • 84% had consulted their GP for advice
  • 63% had taken anti-depressant medication
  • 64% had had counselling or talking therapies

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How MBCT was developed

Mindfulness Based Cognitive Therapy (MBCT) was developed through clinical research to help people who have suffered from depression to remain well. Three clinical psychologists - Williams, Teasdale and Segal - were tasked with finding a way of delivering Cognitive Behavioural Therapy (CBT) in a group format; thereby making it more cost effective and helping to resolve the national shortage of trained CBT therapists. In developing their work they made use of 'mindfulness meditation', an approach to health and wellbeing developed by Dr Jon Kabat-Zinn in his stress reduction programme at the University of Massachusetts Medical Centre. The resulting MBCT course is predominantly mindfulness with some Cognitive Therapy.

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How MBCT prevents relapse into depression

Research has shown that a major characteristic of depression is that it can feed on itself; you get depressed and then get more depressed about being depressed. Negative thoughts start to become automatic. MBCT can help challenge this negative thinking by teaching you how to become more 'mindful', or aware, of what is going on in your mind and body. Here's the ABC of MBCT:

A. We start by developing awareness of what is happening in our experience. We do this through mindful exercises, meditation, and being mindful of other activities during the day such as walking or eating.

B. Next, we learn to be with our experience. Instead of pushing away unwanted thoughts, emotions or other experience, we try to cultivate an attitude of acceptance. Pushing away our experience can make it worse. Acceptance gives us an opportunity to really find out what's going on and choose how best to respond. It also allows us to savour pleasant experiences.

C. Finally, we can choose how best to respond to our experience. Sometimes the most helpful thing is to be with our experience as best as we can, perhaps noting thoughts as just thoughts (not facts) or noting familiar unhelpful thinking patterns. Sometimes it can be best to take some practical action by dealing with the issue or engaging in some pleasurable or satisfying activity.

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Clinical research into MBCT

There is strong evidence to suggest that MBCT is a highly effective in preventing relapse into depression. In early clinical trials only half the people who completed the course relapsed, compared to the 80% relapse rate for people coming off antidepressants. MBCT is recommended by the National Institute of Health and Clinical Excellence (NICE) guidelines for treatment of recurrent depression. MBCT is not suitable whilst people are currently significantly depressed.

The results of research conducted in Toronto, Cambridge and Bangor, showed that 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.

The results of a major study into MBCT were published in November 2008. The study had been funded by the Medical Research Council and led by Professor Willem Kuyken at the Mood Disorders Centre, School of Psychology, University of Exeter, in collaboration with colleagues at the Centre for Economics of Mental Health at the Institute of Psychiatry, King's College London, Peninsula Medical School, Devon Primary Care Trust and the Medical Research Council Cognition and Brain Sciences Unit. The study showed that MBCT proved as effective as maintenance anti-depressants in preventing a relapse and more effective in enhancing peoples' quality of life. The study also showed MBCT to be as cost-effective as prescription drugs in helping people with a history of depression stay well in the longer-term. The randomised control trial involved 123 people from urban and rural locations who had suffered repeat depressions and were referred to the trial by their GPs. The participants were split randomly into two groups. Half continued their on-going anti-depressant drug treatment and the rest participated in an MBCT course and were given the option of coming off anti-depressants. Over the 15 months after the trial, 47% of the group following the MBCT course experienced a relapse compared with 60% of those continuing their normal treatment, including anti-depressant drugs. In addition, the group on the MBCT programme reported a higher quality of life, in terms of their overall enjoyment of daily living and physical well-being.

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