Objective: We compared mindfulness-based cognitive therapy (MBCT) with both cognitive psychological education (CPE) and treatment as usual (TAU) in preventing relapse to major depressive disorder (MDD) in people currently in remission following at least 3 previous episodes. Method: A randomized controlled trial in which 274 participants were allocated in the ratio 2:2:1 to MBCT plus TAU, CPE plus TAU, and TAU alone, and data were analyzed for the 255 (93%; MBCT = 99, CPE = 103, TAU = 53) retained to follow-up. MBCT was delivered in accordance with its published manual, modified to address suicidal cognitions; CPE was modeled on MBCT, but without training in meditation. Both treatments were delivered through 8 weekly classes. Results: Allocated treatment had no significant effect on risk of relapse to MDD over 12 months follow-up, hazard ratio for MBCT vs. CPE = 0.88, 95% CI [0.58, 1.35]; for MBCT vs. TAU = 0.69, 95% CI [0.42, 1.12]. However, severity of childhood trauma affected relapse, hazard ratio for increase of 1 standard deviation = 1.26 (95% CI [1.05, 1.50]), and significantly interacted with allocated treatment. Among participants above median severity, the hazard ratio was 0.61, 95% CI [0.34, 1.09], for MBCT vs. CPE, and 0.43, 95% CI [0.22, 0.87], for MBCT vs. TAU. For those below median severity, there were no such differences between treatment groups. Conclusion: MBCT provided significant protection against relapse for participants with increased vulnerability due to history of childhood trauma, but showed no significant advantage in comparison to an active control treatment and usual care over the whole group of patients with recurrent depression.

Although outcomes for mothers completing the intervention were improved relative to a waitlist control, high rates of drop out indicate that the online course has low completion rates for pregnant women in its current format.

ObjectivesFace-to-face mindfulness interventions have been shown to significantly decrease perceived stress, anxiety and depression and research is beginning to show similar benefits for such courses delivered via the internet. We investigated the feasibility and effectiveness of an online mindfulness course for perceived stress, anxiety and depression.DesignA follow-up investigation of an online mindfulness course. Previous research examining the change in perceived stress showed promising results. Measures of anxiety and depression were added to the online mindfulness course and these were investigated as well as perceived stress using a new, larger sample.ParticipantsParticipants (N=273) were self-referrals to the online course who completed the outcome measure immediately before the course, upon course completion and at 1 month follow-up.InterventionThe programme consists of 10 sessions, guided meditation videos and automated emails, with elements of Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy, completed at a pace to suit the individual (minimum length 4 weeks).Primary and secondary outcome measuresThe Perceived Stress Scale, the Generalised Anxiety Disorder Assessment-7 and the Patient Health Questionnaire-9 (for depression). Mindfulness practice was self-reported at automated time points upon login, once the exercises and sessions for each week were completed.ResultsPerceived stress, anxiety and depression significantly decreased at course completion and further decreased at 1 month follow-up, with effect sizes comparable to those found with face-to-face and other online mindfulness courses and to other types of intervention, such as cognitive behavioural therapy for stress. The amount of meditation practice reported did affect outcome when controlling for baseline severity.ConclusionsThe online mindfulness course appears to be an acceptable, accessible intervention which reduces stress, anxiety and depression. However, there is no control comparison and future research is required to assess the effects of the course for different samples.

ObjectivesStress has been shown to have a number of negative effects on health over time. Mindfulness interventions have been shown to decrease perceived stress but access to interventions is limited. Therefore, the effectiveness of an online mindfulness course for perceived stress was investigated.DesignA preliminary evaluation of an online mindfulness course.ParticipantsThis sample consisted of 100 self-referrals to the online course. The average age of participants was 48 years and 74% were women.InterventionsThe online programme consisted of modules taken from Mindfulness Based Stress Reduction and Mindfulness Based Cognitive Therapy and lasted for approximately 6 weeks.Primary and secondary outcome measuresParticipants completed the Perceived Stress Scale (PSS) before the course, after the course and at 1-month follow-up. Completion of formal (eg, body scan, mindful movement) and informal (eg, mindful meal, noticing) mindfulness activities was self-reported each week.ResultsParticipation in the online mindfulness course significantly reduced perceived stress upon completion and remained stable at follow-up. The pre-post effect size was equivalent to levels found in other class-based mindfulness programmes. Furthermore, people who had higher PSS scores before the course reported engaging in significantly more mindfulness practice, which was in turn associated with greater decreases in PSS.ConclusionsBecause perceived stress significantly decreased with such limited exposure to mindfulness, there are implications for the accessibility of mindfulness therapies online. Future research needs to evaluate other health outcomes for which face-to-face mindfulness therapies have been shown to help, such as anxiety and depressive symptoms.

For many participants in this study, the period that follows treatment for cancer did not represent a "teachable moment." A variety of complex and heterogeneous factors appeared to impact motivation and may limit cancer survivors from engaging with diet and PA changes.

This paper illustrates a rigorous approach to developing digital interventions using an evidence-, theory- and person-based approach. Intervention planning included a rapid scoping review that identified cancer survivors’ needs, including barriers and facilitators to intervention success. Review evidence ( N = 49 papers) informed the intervention’s Guiding Principles, theory-based behavioural analysis and logic model. The intervention was optimised based on feedback on a prototype intervention through interviews ( N = 96) with cancer survivors and focus groups with NHS staff and cancer charity workers ( N = 31). Interviews with cancer survivors highlighted barriers to engagement, such as concerns about physical activity worsening fatigue. Focus groups highlighted concerns about support appointment length and how to support distressed participants. Feedback informed intervention modifications, to maximise acceptability, feasibility and likelihood of behaviour change. Our systematic method for understanding user views enabled us to anticipate and address important barriers to engagement. This methodology may be useful to others developing digital interventions.

This research provides a clear rationale and justification for a large randomised control trial of this intervention within the NHS, which should include a more diverse population, across multiple centres and should explore both the potential health benefits for parents and infants/children as well as potential economic costs/benefits.

BackgroundHospital antimicrobial stewardship strategies, such as ‘Start Smart, Then Focus’ in the UK, balance the need for prompt, effective antibiotic treatment with the need to limit antibiotic overuse using ‘review and revise’. However, only a minority of review decisions are to stop antibiotics. Research suggests that this is due to both behavioural and organizational factors.ObjectivesTo develop and optimize the Antibiotic Review Kit (ARK) intervention. ARK is a complex digital, organizational and behavioural intervention that supports implementation of ‘review and revise’ to help healthcare professionals safely stop unnecessary antibiotics.MethodsA theory-, evidence- and person-based approach was used to develop and optimize ARK and its implementation. This was done through iterative stakeholder consultation and in-depth qualitative research with doctors, nurses and pharmacists in UK hospitals. Barriers to and facilitators of the intervention and its implementation, and ways to address them, were identified and then used to inform the intervention’s development.ResultsA key barrier to stopping antibiotics was reportedly a lack of information about the original prescriber’s rationale for and their degree of certainty about the need for antibiotics. An integral component of ARK was the development and optimization of a Decision Aid and its implementation to increase transparency around initial prescribing decisions.ConclusionsThe key output of this research is a digital and behavioural intervention targeting important barriers to stopping antibiotics at review (see http://bsac-vle.com/ark-the-antibiotic-review-kit/ and http://antibioticreviewkit.org.uk/). ARK will be evaluated in a feasibility study and, if successful, a stepped-wedge cluster-randomized controlled trial at acute hospitals across the NHS.