Impact case study database

The Cambridge University research has had a significant and far-reaching impact on the lives of patients with depression worldwide. Beneficiaries include patients, health service providers, mental health workers, and the wider society through the economic benefits of reduced welfare costs and increased employment and productivity. The impact of MBCT nationally and internationally now extends beyond depression to other psychiatric and physical health conditions, and beyond the healthcare domain to education, the workplace, and the criminal justice system.

Inclusion of MBCT in professional guidelines worldwideThe weight of evidence in favour of MBCT as a psychosocial preventive intervention for depression and as an alternative to maintenance medication has led to its inclusion in UK National Institute of Health and Care Excellence (NICE) guidance since 2004. In 2017, the NICE updated consultation document extended the recommendations around MBCT, based on Cambridge University research (citing [1,3,4]), to advocate MBCT as a relapse prevention alternative for those who want to come off of medication: “ Offer group CBT[cognitive behavioural therapy] (or MBCT for those who have had 3 or more previous episodes of depression) for preventing relapse to people who are assessed as being at higher risk of relapse and who recovered with medication but who want to stop taking it” [A]).

MBCT is also included as a frontline prevention for depressive relapse in other international guidelines referencing Cambridge University research, e.g. Belgium (2016), Canada, Australia and New Zealand and the USA [B]. Clinical practice guidelines for mood disorders from the Royal Australian and New Zealand College of Psychiatrists (2015) recommend that “ MBCT or CBT should be offered as a relapse prevention intervention, particularly amongst patients with recurrent depressive episodes”. Guidelines for the management of adults with major depressive disorder from the Canadian Network for Mood and Anxiety Treatments (2016)[B-iii] recommend MBCT “ as sequential first-line treatment after a course of antidepressants, and as a secondline alternative to long-term maintenance antidepressant treatment”. Guidance from the American Psychological Association Guideline for the Treatment of Depression (2019) [B-v] recommends MBCT as a first line adult treatment as one of several evidence-based approaches.

Impact on the UK health service

In November 2013, the Mindfulness Initiative was founded to support British politicians in forming the All-Party Parliamentary Group on Mindfulness (MAPPG). In their Mindful Nation UK 2015 report, the MAPPG recommended national roll-out of MBCT across the UK NHS for the 580,000 sufferers of recurrent depression each year in need of treatment, stating that “ Mindfulness-Based interventions (MBIs) have a unique role to play in addressing the health challenges facing the country” [C].

Following these recommendations, in 2017, Health Education England (HEE) commissioned training to make MBCT more accessible within the NHS [D]. This led to the first UK-wide training programme for MBCT therapists in the national NHS Improving Access to Psychological Therapies (IAPT) Programme. It was led by Sussex Mindfulness Centre (SMC), in partnership with the Nottingham Centre for Mindfulness, the University of Exeter, Tees, Esk and Wear Valleys NHS Foundation Trust and the Oxford Mindfulness Centre [D]. Since 2018 the regional providers have completed MBCT training for a total of 615 people, including 165 IAPT professsionals[E]. The inclusion of MBCT nationwide as a frontline intervention within the NHS IAPT programme alone between 2015 and 2020 has seen more than 10,000 patients benefit from MBCT[Dii].

Courses to train clinicians in MBCT techniques are now available internationally, including in Hong Kong, the USA, Canada, Europe, and China [F] with an internationally agreed set of training criteria outlined in a report referencing the underpinning research [G]. As of December 2020, there are now 200 clinics in North America that deliver MBCT face-to-face for the prevention of depression, reaching around 6000 patients a year[F].

Economic impact

Depression is estimated to cost the UK GBP9.19 billion a year in lost earnings, and is forecast to cost the NHS GBP2.96 billion in the next decade. The NICE 2017 Consultation Document to update the 2009 guidelines concluded that MBCT is the most cost-effective option for severely affected patients. “In people at high risk of relapse who have remitted following acute psychological treatment and who are expected to experience more severe depression if they relapse, clinical management appears to be the most cost-effective option ..In sensitivity analysis that included group CT and MBCT, MBCT became the most cost-effective option”[A]. Similar evidence of the cost-effectiveness for MBCT has been gathered internationally [Fii].

Broader health impact of MBCT beyond depression

Since August 2013, good supporting evidence has emerged from randomised controlled trials supporting MBCT’s or adapted-MBCT’s therapeutic benefits for other psychiatric conditions including Obsessive Compulsive Disorder, and Bipolar Disorder [H].Trial evidence also supports MBCT’s efficacy in alleviating psychological and physical symptoms for a number of physical health conditions including Chronic Obstructive Pulmonary Disease (COPD), and irritable bowel syndrome [H]. Evidence also now supports extension of MBCT as a healthcare intervention to an online delivery format [H].

Impact beyond the healthcare system

The MAPPG also recommended an evaluation of MBCT-derived interventions for adults in non-clinical settings such as the workplace, the criminal justice system and education [C].

In 2016 the Mindfulness Initiative published ‘Building the case for Mindfulness in the Workplace’ [I-i] which reported that programmes based on MBCT have an increasing impact within work and other adult non-clinical settings. Emerging data, including a systematic review and meta-analysis led from Cambridge involving Professor Jones and Dr Dalgleish, supports MBCT’s beneficial effects on critical work indicators such as reduced risk of drop out, as well as the expected reductions in stress and associated mental health problems [I-ii].

MBCT was introduced into the UK prison service in 2017, initially at HMP Pentonville but now extended to eight other prisons nationally. The prison programmes have three elements: (i) to reduce staff stress,(ii) as a mental health intervention for inmates, and (iii) to provide staff training as MBCT practioners [I-iii]. In Autumn 2016, 21 staff members (including occupational therapists, clinical psychologists and mental health nurses) undertook the 8 week training programme, of whom 17 continued to undertake full MBCT training. As a result one prison now offers six MBCT groups with an average of six men in each group. A pilot project with prisoners was found to be effective – the average participant rated the course as 8.8/10. From one prisoner “ ‘It has helped me in steadying myself when things are rushing in my head- concentrating on me now rather than could be or has been.’

Within the education domain, Cambridge University research [6] showing that an MBCT-based programme confers resilience to exam stress in students at Cambridge has led to approximately 2,100 Cambridge students (14 courses for 30 students run/year) going through the programme since 2015, which has also been disseminated and trialled internationally at institutions in France and Finland, with further interest from Chile and the United States [I-iv].

Finally, popular self-help guides and workbooks on MBCT for depression have emerged from the underpinning research: The Mindful Way through Depression; Williams et al., 2007; The Mindful Way Workbook; Teasdale et al., 2014; and Mindfulness: A Practical Guide to Finding Peace in a Frantic World; Williams & Penman, 2011), that have variously been translated into over a dozen languages. Combined they have sold over 1,280,000 copies worldwide [J].