Mindfulness-Based Cognitive Therapy Outperforms Standard CBT in Self-Help Trial

Practitioner-supported mindfulness-based cognitive therapy (MBCT) self-help was more clinically effective and cost-effective for mild to moderate depression than standard supported cognitive behavioral therapy (CBT) self-help, the randomized LIGHTMind trial showed.

At 16 weeks, MBCT led to significantly greater reductions in depression symptom severity compared with standard CBT, with a between-group difference of -1.5 points in Patient Health Questionnaire (PHQ-9) score (95% CI -2.6 to -0.4, P=0.009, d = -0.36), reported Clara Strauss, PhD, DClinPsy, of the Sussex Partnership NHS Foundation Trust in England, and co-authors.

The probability of MBCT being cost-effective compared with CBT exceeded 95%, they noted in JAMA Psychiatry.

While the mean intervention costs were similar, the costs of other health and social care were significantly lower for the MBCT group compared with the CBT group, with a mean cost per participant of $923 versus $1,684 (P=0.007).

Strauss and team attributed this difference in costs to the higher use of “individual psychological therapies received outside of the trial, outpatient contacts for mental health, general practitioner contacts, and psychotropic medication.”

“Our findings suggest that offering practitioner-supported MBCT-SH [self-help] as an intervention for mild to moderate depression would improve outcomes and save money compared with practitioner-supported CBT-SH,” they wrote. “Therefore, practitioner-supported MBCT-SH should be routinely offered as an intervention for mild to moderate depression alongside practitioner-supported CBT-SH.”

Making MBCT more widely available would “increase patient choice, as currently only CBT-SH is typically recommended in treatment guidelines for depression,” they added.

Secondary outcomes — generalized anxiety, well-being, functioning, and mindfulness — were not significantly different between groups, although they were in the “hypothesized direction,” Strauss’s group noted.

They also pointed out that practitioners in the study were trained and supervised to support MBCT, so adherence to the training and supervision processes would be crucial for any efforts to implement this therapy in clinical practice.

“If study findings are translated into routine practice, this would see many more people recovering from depression while costing health services less money,” they concluded.

“Future research should examine factors enabling successful implementation of practitioner-supported MBCT-SH to expedite the pathway to patient benefit and to ensure fidelity to the approach,” they wrote.

For this study, Strauss and colleagues included 410 participants from 10 publicly funded psychological therapy services in England, with recruitment taking place from November 2017 through January 2020. Median age was 32, 62.2% were women, and 85.6% were white.

Participants in both groups had similar baseline PHQ-9 scores, with a mean score of 7.2 in the MBCT group and 8.6 in the CBT group.

Participants received six sessions with a trained practitioner in addition to a self-help workbook based on their randomly assigned group. The practitioner-support sessions lasted between 30 to 45 minutes and were offered by phone or face-to-face based on the location and preference of the participants.

The participants were given either The Mindful Way Workbook: An 8-Week Program to Free Yourself from Depression and Emotional Distress (MBCT group; n=204) or Overcoming Depression and Low Mood, 3rd Edition: A Five Areas Approach (CBT group; n=206) for their self-help workbook.

Strauss and team noted that the high dropout rate was a limitation of their study, but said that this concern might be at least partially mitigated by the similar rates of dropout in the two groups.