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Depression typically runs a relapsing and recurrent course.1 Without ongoing treatment people with recurrent depression have a very high risk of repeated depressive relapses throughout their life, even after successful acute treatment. Major inroads into the substantial health burden attributable to depression could be offset through interventions that prevent depressive relapse among people at high risk of recurrent episodes.2 If the factors that make people vulnerable to depressive relapse can be attenuated, the relapsing course of depression could potentially be broken. Currently, most depression is treated in primary care, and maintenance antidepressants are the mainstay approach to preventing relapse.3 The UK’s National Institute for Health and Clinical Excellence (NICE) recommends that to stay well, people with a history of recurrent depression should continue taking antidepressants for at least two years. However, many patients experience side effects, and some express a preference for psychosocial interventions, which provide long term protection against relapse.4 Mindfulness based cognitive therapy (MBCT)5 was developed as a psychosocial intervention for teaching people with a history of depression the skills to stay well in the long term (see box for a description of MBCT).
Importance Relapse prevention in recurrent depression is a significant public health problem, and antidepressants are the current first-line treatment approach. Identifying an equally efficacious nonpharmacological intervention would be an important development.Objective To conduct a meta-analysis on individual patient data to examine the efficacy of mindfulness-based cognitive therapy (MBCT) compared with usual care and other active treatments, including antidepressants, in treating those with recurrent depression.
Data Sources English-language studies published or accepted for publication in peer-reviewed journals identified from EMBASE, PubMed/Medline, PsycINFO, Web of Science, Scopus, and the Cochrane Controlled Trials Register from the first available year to November 22, 2014. Searches were conducted from November 2010 to November 2014.
Study Selection Randomized trials of manualized MBCT for relapse prevention in recurrent depression in full or partial remission that compared MBCT with at least 1 non-MBCT treatment, including usual care.
Data Extraction and Synthesis This was an update to a previous meta-analysis. We screened 2555 new records after removing duplicates. Abstracts were screened for full-text extraction (S.S.) and checked by another researcher (T.D.). There were no disagreements. Of the original 2555 studies, 766 were evaluated against full study inclusion criteria, and we acquired full text for 8. Of these, 4 studies were excluded, and the remaining 4 were combined with the 6 studies identified from the previous meta-analysis, yielding 10 studies for qualitative synthesis. Full patient data were not available for 1 of these studies, resulting in 9 studies with individual patient data, which were included in the quantitative synthesis.
Results Of the 1258 patients included, the mean (SD) age was 47.1 (11.9) years, and 944 (75.0%) were female. A 2-stage random effects approach showed that patients receiving MBCT had a reduced risk of depressive relapse within a 60-week follow-up period compared with those who did not receive MBCT (hazard ratio, 0.69; 95% CI, 0.58-0.82). Furthermore, comparisons with active treatments suggest a reduced risk of depressive relapse within a 60-week follow-up period (hazard ratio, 0.79; 95% CI, 0.64-0.97). Using a 1-stage approach, sociodemographic (ie, age, sex, education, and relationship status) and psychiatric (ie, age at onset and number of previous episodes of depression) variables showed no statistically significant interaction with MBCT treatment. However, there was some evidence to suggest that a greater severity of depressive symptoms prior to treatment was associated with a larger effect of MBCT compared with other treatments.
Conclusions and Relevance Mindfulness-based cognitive therapy appears efficacious as a treatment for relapse prevention for those with recurrent depression, particularly those with more pronounced residual symptoms. Recommendations are made concerning how future trials can address remaining uncertainties and improve the rigor of the field.
Over recent decades, there has been an exponential growth in mindfulness-based interventions (MBIs). To disseminate MBIs with fidelity, care needs to be taken with the training and supervision of MBI teachers. A wealth of literature exists describing the process and practice of supervision in a range of clinical approaches, but, as of yet, little consideration has been given to how this can best be applied to the supervision of MBI teachers. This paper articulates a framework for supervision of MBI teachers. It was informed by the following: the experience of eight experienced mindfulness-based supervisors, the literature and understandings from MBIs, and by the authors’ experience of training and supervision. It sets out the nature and distinctive features of mindfulness-based supervision (MBS), representing this complex, multilayered process through a series of circles that denote its essence, form, content and process. This paper aims to be a basis for further dialogue on MBS, providing a foundation to increase the availability of competent supervision so that MBIs can expand without compromising integrity and efficacy.
Over recent decades, there has been an exponential growth in mindfulness-based interventions (MBIs). To disseminate MBIs with fidelity, care needs to be taken with the training and supervision of MBI teachers. A wealth of literature exists describing the process and practice of supervision in a range of clinical approaches, but, as of yet, little consideration has been given to how this can best be applied to the supervision of MBI teachers. This paper articulates a framework for supervision of MBI teachers. It was informed by the following: the experience of eight experienced mindfulness-based supervisors, the literature and understandings from MBIs, and by the authors’ experience of training and supervision. It sets out the nature and distinctive features of mindfulness-based supervision (MBS), representing this complex, multilayered process through a series of circles that denote its essence, form, content and process. This paper aims to be a basis for further dialogue on MBS, providing a foundation to increase the availability of competent supervision so that MBIs can expand without compromising integrity and efficacy.
This paper examined the facilitators and barriers to implementation of mindfulness training (MT) across seven secondary/high schools using a qualitative case study design. Schools varied in level of implementation. Within schools, head teachers, members of school senior leadership teams, and staff members involved in the implementation of MT were interviewed individually. In addition, focus groups were conducted with other members of school staff to capture a broad range of views and perspectives. Across the case studies, several key themes emerged, which suggested four cornerstones to successful implementation of MT in schools. These were: people, specifically the need for committed individuals to champion the approach within their schools, with the support of members of the senior leadership teams; resources, both time and financial resources required for training and delivery of MT; journey, reflecting the fact that implementation takes time, and may be a non-linear process with stops and starts; and finally perceptions, highlighting the importance of members of the school community sharing an understanding what MT is and why it is being introduced in each school context. Similarities and differences between the current findings and those of research on implementation of other forms of school mental health promotion programs, and implementation of MT in healthcare settings, are discussed.
Teacher stress is a serious and endemic concern. Mindfulness-based interventions show promise in reducing stress and increasing well-being by cultivating mindfulness and self-compassion. This feasibility trial evaluated a mindfulness-based programme customised for teachers. A sample of 89 secondary school teachers and staff were recruited and self-selected into the intervention (n = 49) or comparison (n = 40) conditions. Participants were asked to complete self-reports which measured stress (PSS), well-being (WEMWBS), mindfulness (FFMQ), and self-compassion (SCS; Kindness and Self-Judgement) at baseline and after the completion of the intervention. Results revealed that individuals in the intervention condition reported significant reductions in stress, and significant increases in well-being post-intervention in comparison to their counterparts in the comparison group. There was an observed large effect (ηp2 >.14) for the intervention on all outcome measures, an effect that was maintained when controlling for baseline differences between the intervention and comparison groups. Furthermore, the majority (95 %) of teachers who attended the course found it to be acceptable. These results indicate that a customised mindfulness-based programme for teachers is a promising approach to reducing stress and increasing well-being, mindfulness, and self-compassion among secondary school teachers. However, the results of the current study are preliminary and the next phase of work will involve extending to a larger scale randomised controlled trial.
Teacher stress is a serious and endemic concern. Mindfulness-based interventions show promise in reducing stress and increasing well-being by cultivating mindfulness and self-compassion. This feasibility trial evaluated a mindfulness-based programme customised for teachers. A sample of 89 secondary school teachers and staff were recruited and self-selected into the intervention (n = 49) or comparison (n = 40) conditions. Participants were asked to complete self-reports which measured stress (PSS), well-being (WEMWBS), mindfulness (FFMQ), and self-compassion (SCS; Kindness and Self-Judgement) at baseline and after the completion of the intervention. Results revealed that individuals in the intervention condition reported significant reductions in stress, and significant increases in well-being post-intervention in comparison to their counterparts in the comparison group. There was an observed large effect (ηp2 >.14) for the intervention on all outcome measures, an effect that was maintained when controlling for baseline differences between the intervention and comparison groups. Furthermore, the majority (95 %) of teachers who attended the course found it to be acceptable. These results indicate that a customised mindfulness-based programme for teachers is a promising approach to reducing stress and increasing well-being, mindfulness, and self-compassion among secondary school teachers. However, the results of the current study are preliminary and the next phase of work will involve extending to a larger scale randomised controlled trial.
Depression in parents impairs parenting and increases the risk of psychopathology among their children. Prevention and intervention could be informed by knowledge of the mechanisms that break the inter-generational transmission of psychopathology and build resilience in both parents and their children. We used data from two independent studies to examine whether higher levels of self-compassion were associated with better parenting and fewer emotional and behavioral problems in children of parents with a history of depression. Study 1 was a pilot trial of mindfulness-based cognitive therapy that included 38 parents with recurrent depression. Study 2 was a longitudinal study that consisted of 160 families, including 50 mothers and 40 fathers who had a history of depression. Families were followed up approximately 16 months after the first assessment (time 2; n = 106 families). In both studies, self-compassion was assessed with the Self-Compassion Scale. Parents reporting higher levels of self-compassion were more likely to attribute the cause of their children’s behavior to external factors, were less critical, and used fewer distressed reactions to cope with their children’s emotions. Parents’ self-compassion was longitudinally associated with children’s internalizing and externalizing problems, but these associations became nonsignificant after controlling for child gender, parent education, and depressive symptoms. Future larger scale and experimental designs need to examine whether interventions intended to increase self-compassion might reduce the use of negative parenting strategies and thereby the inter-generational transmission of psychopathology.
Several randomised controlled trials suggest that mindfulness-based approaches are helpful in preventing depressive relapse and recurrence, and the UK Government’s National Institute for Health and Clinical Excellence has recommended these interventions for use in the National Health Service. There are good grounds to suggest that mindfulness-based approaches are also helpful with anxiety disorders and a range of chronic physical health problems, and there is much clinical and research interest in applying mindfulness approaches to other populations and problems such as people with personality disorders, substance abuse, and eating disorders. We review the UK context for developments in mindfulness-based approaches and set out criteria for mindfulness teacher competence and training steps, as well as some of the challenges and future directions that can be anticipated in ensuring that evidence-based mindfulness approaches are available in health care and other settings.
Several randomised controlled trials suggest that mindfulness-based approaches are helpful in preventing depressive relapse and recurrence, and the UK Government’s National Institute for Health and Clinical Excellence has recommended these interventions for use in the National Health Service. There are good grounds to suggest that mindfulness-based approaches are also helpful with anxiety disorders and a range of chronic physical health problems, and there is much clinical and research interest in applying mindfulness approaches to other populations and problems such as people with personality disorders, substance abuse, and eating disorders. We review the UK context for developments in mindfulness-based approaches and set out criteria for mindfulness teacher competence and training steps, as well as some of the challenges and future directions that can be anticipated in ensuring that evidence-based mindfulness approaches are available in health care and other settings.
There has been an explosion of interest in mindfulness-based programs (MBPs) such as Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy. This is demonstrated in increased research, implementation of MBPs in healthcare, educational, criminal justice and workplace settings, and in mainstream interest. For the sustainable development of the field there is a need to articulate a definition of what an MBP is and what it is not. This paper provides a framework to define the essential characteristics of the family of MBPs originating from the parent program MBSR, and the processes which inform adaptations of MBPs for different populations or contexts. The framework addresses the essential characteristics of the program and of teacher. MBPs: are informed by theories and practices that draw from a confluence of contemplative traditions, science, and the major disciplines of medicine, psychology and education; underpinned by a model of human experience which addresses the causes of human distress and the pathways to relieving it; develop a new relationship with experience characterized by present moment focus, decentering and an approach orientation; catalyze the development of qualities such as joy, compassion, wisdom, equanimity and greater attentional, emotional and behavioral self-regulation, and engage participants in a sustained intensive training in mindfulness meditation practice, in an experiential inquiry-based learning process and in exercises to develop understanding. The paper's aim is to support clarity, which will in turn support the systematic development of MBP research, and the integrity of the field during the process of implementation in the mainstream.