Outline 21/08/2014. Rationale for MBCT The Challenge. Mindfulness-based Cognitive Therapy

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1 Mindfulness-based Cognitive Therapy Promising Approach to Preventing Depressive Relapse Willem Kuyken Welsh Psychiatric Society Friday 16 th May 2014 Outline Rationale for MBCT Does MBCT work? How does MBCT work? Opportunities & challenges for next ten years? Acknowledgements Collaborators Sarah Byford, Richard Burnett, Richard Byng, Rebecca Crane, Chris Cullen, Tim Dalgleish, Chris Dickens, Rob Dudley, Barney Dunn, Alison Evans, Christina Feldman, Tamsin Ford, Andy Gibson, Felicia Huppert, Anke Karl, Heather O Mahen, Obi Ukoumunne, Christine Padesky, Dave Richards, Jo Rycroft-Malone, Rod Taylor, Katherine Weare, Jenny Wilks & Mark Williams Research and therapy team Shadi Beshai, Aaron Causley, Rachel Hayes, Felix Gradinger, Jo MacKenzie, Pete Mason, Holly Sugg, & Rachael Vicary Exeter Mindfulness Network Associates Postgraduate students Current: Anna Abel, Emily Hammond, JJ Hill, Kat Legge, Hans Kirschner, Jo Mann, Selina Nath, Alice Weaver Past: Mark Allen, Chantal Baillie, Lisa Baxter, Andrew Bromley, Rachael Carrick, Colin Greaves, Emma Griffiths, Vivienne Hopkins, Emily Holden, Nicola Motton, Meyrem Musa & Dimitrious Tsivrikos Past research team Corinna Baum, Clare Bootle Jess Cardy, Suzanne Cowderoy, Claire Fothergill, Nora Goerg, Pooja Shah, Cara Simmance, Harry Sutton, Kat White & Matt Williams Past collaborators Aaron T. Beck, Chris Brewin, David Kessler, Tony Lavender, Glyn Lewis, John Teasdale, Ed Watkins, Nicola Wiles & the WHOQOL Group Rationale for MBCT The Challenge Mood Disorders: A public health, theoretical, clinical and health services challenge The vast majority of depression goes unrecognised and untreated Almost all presentation is in primary care, where treatment is typically antidepressant medication. Small minority of people who could benefit, receive evidence-based psychological treatments Rationale for MBCT Depression is a Prevalent, Disabling & Recurrent Disorder Mindfulness-based Cognitive Therapy 50 Relapse prevention Zindel Segal, University of Toronto Depression Severity 0 Premorbid Onset Depressive episode Relapse Onset Recurrent episode Recurrence Stage of disorder Sustained remission Mark Williams, University of Oxford John Teasdale, Formerly of the Medical Research Council Cognition and Brain Sciences Unit, Cambridge 1

2 Mindfulness What is Mindfulness? Mindfulness means paying attention in a particular way on purpose - in the present moment - non-judgementally Jon Kabat-Zinn Is MBCT Efficacious? Survival for MBCT vs. Usual Care over 60 weeks of Follow-up Proportion Well Teasdale et al., 2000; Ma & Teasdale, 2004, JCCP Does MBCT Work? 1.00 Sub-group analysis: 1 or 2 vs. 3 or more episodes Relapse rates MBCT: 37% 0.5 TAU: 66% Weeks MBCT vs. Controls Does MBCT Prevent Depressive Relapse? National Institutes for Clinical Excellence (NICE) Recommendation for Relapse Prevention (2009) Piet & Hougaard, 2011, Clinical Psychology Review 2

3 New Large MBCT Trials WK 13 m-adm, 39% MBCT-TS 33% Time, 0-24 months Is MBCT-TS an alternative to m-adm? N=424, 24 month follow-up Relapse rates m-adm, 49% MBCT-TS 44% MBCT Efficacy and Effectiveness Summary MBCT reduces depressive relapse compared with TAU. It is effective for a broad range of people It may be most effective for those at greatest risk of relapse There are important remaining uncertainties around MBCT s relative efficacy and mechanism Kuyken, Hayes, Barratt,. Taylor & Byford, in preparation How Does MBCT Work? Clare Pleasant Event Calendar There is nothing as practical as good [clinical] theory Kurt Lewin,

4 21/08/2014 How Can We Understand Depressive Relapse? Beliefs e.g., If I let my partner do all the difficult stuff, no one will figure out I am a bad mother A Wandering Mind is an Unhappy Mind Analysing, worrying, ruminating, proliferating Memories I am a bad mother Higher level meanings Triggers e.g., thought (Teasdale & Chaskalson, 2012, Mindfulness) Killingsworth & Gilbert, 2010, Science Summary: How does MBCT work? Reactivity Opportunities & challenges Implementation & dissemination Scientific evidence - Producing high quality evidence - Responsibly reporting evidence Implementation and dissemination Maintaining integrity of MBI s 4

5 MBCT Implementation Even if a psychosocial intervention has compelling aims, has been shown to work, has a clear theory-driven mechanism of action, is costeffective and is recommended by a government advisory body, its value is determined by how widely available it is in the health service. UK survey and 10 case studies Development of an Implementation Plan Felix Gradinger & Heledd Owen Jo Rycroft-Malone, Willem Kuyken, Rebecca Crane, Andy Gibson & Stewart Mercer Dissemination: Stepped care is like motherhood and apple pie Integrity in Teaching MBCT Teacher training and CPD Teaching competencies and their assessment Good practice standards Crane, R.S., Kuyken, W., Williams, J.M.G., Hastings, R.P., Cooper, L. & Fennell, M. (2012) Adjusted mean difference (MT-Control) Maintaining the Integrity of MBIs The Mindfulness in Schools Programme An Exemplar Post-intervention 3 month follow-up Well-being Depressive symptoms Summary MBCT is efficacious and probably cost-effective, but may be most indicated for particular groups MBCT (probably) works through its hypothesized mechanism of cultivating mindfulness/selfcompassion and breaking up reactivity The opportunities/challenges are in scientific evidence, dissemination and maintaining integrity in new developments -2.5 Kuyken, Weare, Ukoumunne, Vicary, Motton, Burnett, Cullen, Hennelly & Huppert, BJP,