Accessibility and implementation in the UK NHS services of an effective depression relapse prevention programme: learning from mindfulness-based cognitive therapy through a mixed-methods study

Rycroft-Malone, Joanne; Gradinger, Felix; Griffiths, Heledd Owen; Crane, Rebecca; Gibson, Andy; Mercer, Stewart W; Anderson, Rob; Kuyken, Willem

doi:10.3310/hsdr05140

Cited by 22 publications

(31 citation statements)

References 65 publications

(82 reference statements)

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“…This has been a barrier to the implementation of MBCT in its original form, as people in remission are less likely to access services than those who are experiencing current problems. Some services have responded by adapting MBCT to fit their service delivery models (Crane and Kuyken 2013;Rycroft-Malone et al 2017). For instance, there has been a move to widen the reach of MBCT to include people experiencing current depression (Strauss et al 2014).…”

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The Effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) in Real-World Healthcare Services

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Depression is common with a high risk of relapse/recurrence. There is evidence from multiple randomised controlled trials (RCTs) demonstrating the efficacy of mindfulness-based cognitive therapy (MBCT) for the prevention of depressive relapse/ recurrence, and it is included in several national clinical guidelines for this purpose. However, little is known about whether MBCT is being delivered safely and effectively in real-world healthcare settings. In the present study, five mental health services from a range of regions in the UK contributed data (n = 1554) to examine the impact of MBCT on depression outcomes. Less than half the sample (n = 726, 47%) entered with Patient Health Questionnaire (PHQ-9) scores in the non-depressed range, the group for whom MBCT was originally intended. Of this group, 96% sustained their recovery (remained in the non-depressed range) across the treatment period. There was also a significant reduction in residual symptoms, consistent with a reduced risk of depressive relapse. The rest of the sample (n = 828, 53%) entered treatment with PHQ-9 scores in the depressed range. For this group, 45% recovered (PHQ-9 score entered the non-depressed range), and overall, there was a significant reduction in depression severity from pre-treatment to post-treatment. For both subgroups, the rate of reliable deterioration (3%) was comparable to other psychotherapeutic interventions delivered in similar settings. We conclude that MBCT is being delivered effectively and safely in routine clinical settings, although its use has broadened from its original target population to include people experiencing current depression. Implications for implementation are discussed.

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The Effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) in Real-World Healthcare Services

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“…However, in addition to this type of 'top-down' dissemination, the growing interest in mindfulness in the psychotherapy community also has the quality of a grassroots movement carried forward by the practitioners in the field (e.g., Rycroft-Malone et al 2017). Inspired by the accumulating evidence on the therapeutic potential of mindfulness-based interventions and often grounded in personal experience with practicing meditation and mindfulness, many therapists have started to experiment with different forms of integration of mindfulness into their therapeutic work (for a discussion of possible reasons for the strong interest in mindfulness within the Western health system see Michalak and Heidenreich 2018).…”

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Principles for a Responsible Integration of Mindfulness in Individual Therapy

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Objectives Mindfulness-based interventions (MBIs) like mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) teach mindfulness in a group-based format. Empirical research has shown that many therapists working in individual therapy integrate mindfulness practices (e.g., body scan, sitting meditation) into their treatments. However, research on this topic is in its infancy. The purpose of this paper is to present recommendations for a responsible use of mindfulness in individual therapy. Methods Informed by a literature review, an expert group developed guidelines for a responsible use of mindfulness in individual therapy. Results Recommendations for the following issues were developed: (a) different types of integration; (b) diagnoses/clinical problems for which integration of mindfulness in individual therapy could be useful; (c) qualification of therapists; (d) case formulation; (e) the inquiry process; (f) types and optimal duration of mindfulness practices in individual therapy; (g) managing difficult experiences; (h) integration of mindfulness into individual therapy training programs. Finally, we formulate important topics for research on the integration of mindfulness into individual therapy. Conclusions By formulating recommendations for the most important issues of the integration of mindfulness into individual therapy, we want to stimulate the discussion on a responsible use of mindfulness in this setting. Since research on this topic is scarce, our recommendations can only be tentative.

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“…The study protocol has been previously published23 and the methods, including the interview schedules described fully in the final report 19…”

Section: Methodsmentioning

confidence: 99%

“…A case study is particularly appropriate for when ‘a how or why question is being asked about a contemporary set of events over which the investigator has little or no control’ 25. Ten cases were purposively sampled to ensure UK’s four countries' representation and the level of embeddedness of MBCT provision (four fully embedded, four partially embedded and two scarce/no implementation) 19 23. The level of embeddedness was determined based on a set of criteria derived from national guidance and best practice about the features that should be in place to deliver an appropriate MBCT service.…”

Section: Methodsmentioning

confidence: 99%

“…Stakeholders, patient groups and an All Party Parliamentary Group in the UK have called for it to be made more readily available in the National Health Service 18. Our literature review and feasibility work suggest that while there are exemplars of effective, sustainable MBCT implementation, access is inequitably distributed 19. A 2015 workforce census suggests that the majority of National Health Service (NHS) Trusts in England have no one who is trained to deliver MBCT 20.…”

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‘Mind the gaps’: the accessibility and implementation of an effective depression relapse prevention programme in UK NHS services: learning from mindfulness-based cognitive therapy through a mixed-methods study

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ObjectivesMindfulness-based cognitive therapy (MBCT) is an evidence-based approach for people at risk of depressive relapse to support their long-term recovery. However, despite its inclusion in guidelines, there is an ‘implementation cliff’. The study objective was to develop a better explanation of what facilitates MBCT implementation.SettingUK primary and secondary care mental health services.Design, participants and methodsA national two-phase, multi-method qualitative study was conducted, which was conceptually underpinned by the Promoting Action on Research Implementation in Health Services framework. Phase I involved interviews with stakeholders from 40 service providers about current provision of MBCT. Phase II involved 10 purposively sampled case studies to obtain a more detailed understanding of MBCT implementation. Data were analysed using adapted framework analysis, refined through stakeholder consultation.ResultsAccess to MBCT is variable across the UK services. Where available, services have adapted MBCT to fit their context by integrating it into their care pathways. Evidence was often important to implementation but took different forms: the NICE depression guideline, audits, evaluations, first person accounts, experiential taster sessions and pilots. These were used to build a platform from which to develop MBCT services. The most important aspect of facilitation was the central role of the MBCT implementers. These were generally self-designated individuals who ‘championed’ grass-roots implementation. Our explanatory framework mapped out a prototypical implementation journey, often over many years with a balance of bottom-up and top-down factors influencing the fit of MBCT into service pathways. ‘Pivot points’ in the implementation journey provided windows of either challenge or opportunity.ConclusionsThis is one of the largest systematic studies of the implementation of a psychological therapy. While access to MBCT across the UK is improving, it remains patchy. The resultant explanatory framework about MBCT implementation provides a heuristic that informed an implementation resource.

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Accessibility and implementation in the UK NHS services of an effective depression relapse prevention programme: learning from mindfulness-based cognitive therapy through a mixed-methods study

Cited by 22 publications

References 65 publications

The Effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) in Real-World Healthcare Services

The Effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) in Real-World Healthcare Services

Principles for a Responsible Integration of Mindfulness in Individual Therapy

‘Mind the gaps’: the accessibility and implementation of an effective depression relapse prevention programme in UK NHS services: learning from mindfulness-based cognitive therapy through a mixed-methods study

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