A self-led, practitioner-supported form of mindfulness therapy was more effective and more cost-effective than self-help cognitive-behavioral therapy (CBT-SH), results from a head-to-head study show.
Self-help mindfulness-based cognitive therapy (MBCT-SH) produced better outcomes for participants with depression and was more cost-effective than CBT-SH.
Practitioner-supported self-help therapy regimens are growing in popularity as a way to expand access to mental health services and to address the shortage of mental health professionals.
Generally, mindfulness-based cognitive therapy aims to increase awareness of the depression maintenance cycle while fostering a nonjudgmental attitude toward present-moment experiences, the investigators note.
In contrast, CBT aims to challenge negative and unrealistic thought patterns that may perpetuate depression, replacing them with more realistic and objective thoughts.
"Practitioner-supported MBCT-SH should be routinely offered as an intervention for mild to moderate depression alongside practitioner-supported CBT-SH," the investigators note.
The study was published online March 22 in JAMA Psychiatry.
Better Recovery Rates?
CBT-SH traditionally had been associated with high attrition rates, and alternative forms of self-help therapy are becoming increasingly necessary to fill this treatment gap, the researchers note. To compare the efficacy and cost-effectiveness of both treatment types, the researchers recruited 410 participants with mild to moderate depression at 10 sites in the UK. Participants were randomly assigned to receive either MBCT-SH or CBT-SH between November 2017 and January 2020. A total of 204 participants received MBCT-SH, and 206 received CBT-SH.
All participants were given specific self-help workbooks, depending on the study group to which they were assigned. Those who received MBCT-SH used The Mindful Way Workbook: An 8-Week Program to Free Yourself From Depression and Emotional Distress, while those who received CBT-SH used Overcoming Depression and Low Mood, 3rd Edition: A Five Areas Approach.
Investigators asked all participants to guide themselves through six 30- to 45-minute sessions, using the information in the workbooks. Trained psychological well-being practitioners supported participants as they moved through the workbooks during the six sessions.
Participants were assessed at baseline with the Patient Health Questionnaire–9 (PHQ-9) and the Clinical Interview Schedule–Revised at 16 weeks and 24 weeks.
At 16 weeks post randomization, results showed that practitioner-supported MBCT-SH led to significantly greater reductions in depression symptom severity compared to practitioner-supported CBT-SH (mean [SD] PHQ-9 score, 7.2 [4.8] points vs 8.6 [5.5] points; between-group difference, -1.5 points; 95% CI, -2.6 to -0.4; P = .009).
Results also showed that on average, the CBT-SH intervention cost $631 more per participant than the MBCT-SH intervention over the 42-week follow-up.
The investigators explain that "a substantial proportion of this additional cost was accounted for by additional face-to-face individual psychological therapy accessed by CBT-SH participants outside of the study intervention.
"In conclusion, this study found that a novel intervention, practitioner-supported MBCT-SH, was clinically superior in targeting depressive symptom severity at postintervention and cost-effective compared with the criterion standard of practitioner-supported CBT-SH for adults experiencing mild-to-moderate depression," the investigators write.
"If study findings are translated into routine practice, this would see many more people recovering from depression while costing health services less money," they add.
Clinically Meaningful?
Commenting on the study for Medscape Medical News, Lauren Bylsma, PhD, professor of psychiatry and psychology at the University of Pittsburgh School of Medicine in Pennsylvania, cast doubt on the ability of such a short trial to determine meaningful change.
Dr Lauren Bylsma
She said that the extra costs incurred by participants in the CBT-SH arm of the study are likely, since it is "difficult to do CBT alone ― you need an objective person to guide you as you practice."
Bylsma noted that ultimately, more real-world studies of therapy are needed, given the great need for mental health.
The study was funded by the National Institute for Health and Care Research. The original article contains a full list of the authors' relevant financial relationships.
JAMA Psychiatry. Published online March 22, 2023. Full text
For more Medscape Psychiatry news, join us on Facebook and Twitter.
Credits:
Lead image: Prostockstudio | Dreamstime.com
Image 1: University of Pittsburgh Department of Psychiatry
Medscape Medical News © 2023
Cite this: Will a Mindfulness Approach to Depression Boost Recovery Rates, Reduce Costs? - Medscape - May 17, 2023.
Comments