MBCT for Depression on the NHS

A recent study – the largest ever analysis of research on the subject – demonstrated that Mindfulness Based Cognitive Therapy (MBCT) helps people just as much as commonly prescribed anti-depressant drugs… and yet there was no evidence of any harmful effects.

The study showed that people suffering from depression who received MBCT were 31 per cent less likely to suffer a relapse during the next 60 weeks – it was reported in a paper in the JAMA Psychiatry journal.

Lead author, Professor Willem Kuyken, said: “This new evidence for mindfulness-based cognitive therapy … is very heartening. While MBCT is not a panacea, it does clearly offer those with a substantial history of depression a new approach to learning skills to stay well in the long-term.”

For once the UK is “on it”. The NICE guidance for the treatment of depression recommends the use of MBCT – and indeed the NHS runs its own MBCT courses. Here.

I have written before about the journalist Sarah Vine who said that while antidepressants medicines worked well for her, she had found it very difficult to come of the drugs: https://carinasciences.com/2019/05/30/the-drugs-do-work-but-are-hard-to-give-up/.  MBCT has no such addiction legacy – other than the positive benefits of mindfulness.

An article on the website stylist.co.uk related the experience of journalist Alice Purkiss who was advised to try an NHS MBCT course: “During the course, I’ve realised just how much my brain has held me hostage in the past… I am so very, very grateful that my local NHS psychological service has offered me this incredible opportunity to tune back in with my life and take control of the way my brain has terrorised me in the past. https://www.stylist.co.uk/health/mental-health/depression-treatment-mindful-cognitive-behavioural-therapy-nhs-course-health/182010

The benefits of MBCT for those with either anxiety and depression are very well researched: For example, this paper from the Journal Consulting and Clinical Psychology (April 2010) “The Effect of Mindfulness-Based Therapy on Anxiety and Depression: A Meta-Analytic Review” (by Stefan G. Hofmann, Alice T. Sawyer, Ashley A. Witt, and Diana Oh).

This review of many MBCT trials showed that improvements on depression scores and anxiety scores were robust (repeatable and consistent) and significant; both for those with the conditions and for those without these conditions. – i.e. Even for those who were not suffering from depression or anxiety their mood was raised and worry was lowered – it’s not about a return to the normal – it is an elevation in mood and ability to avoid worry.  The researchers said that “[MBCT] improves symptoms of anxiety and depression across a relatively wide range of severity.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2848393/

Our Rezl app uses this same Mindfulness Based Cognitive Therapy (MBCT) to build resilience… and more.

We chose to work with MBCT for two big reasons: –

  1. It is a formalised programme – an eight-step programme – as we knew that many people using mindfulness apps find them a little open-ended and so while these apps are relaxing… they can lack a sense of progress.
  2. The impacts of MBCT have been extremely well researched over the last 25 years.  It was clear that the benefits were very significant.

In summary, from the user’s perspective, then working with Rezl’s MBCT programme will:

  • increase your resilience – the signs that your resilience may be getting low include difficulty sleeping, irritability and mood swings, poor levels of concentration and restlessness
  • improve ability deal with stress, pressure, challenges and uncertainty.
  • make you more empathetic open to the views of others
  • increase positivity and self-esteem – increase self confidence
  • teams with mindful team-members are more effective and more likely to collaborate towards achieving team goals.
  • increase job satisfaction and life satisfaction
  • reduce absenteeism and staff turnover
  • US special forces use mindfulness to help them to improve their decision making in high pressure situations
  • boost your performance at work or in sport, increase your focus, your engagement and your ‘flow’.
  • enable you to develop the skills to manage in challenging and disruptive business environments and to attain the objectivity, focus and emotional stability that are required.

There are a lot of benefits there – but it is important to stress that Rezl isn’t just about helping those with mental wellbeing issues – Rezl can help all of us to achieve more in our lives. It’s for everyone!

Can I Have Your Attention Please?

The ability to focus and to avoid distractions –  i.e. to “pay attention” – is key for us. We constantly receive so much stimulation and information from our environment that without an ability to focus we would never be able to think clearly and to be effective.

Further, we also have our internal thoughts and emotions competing for our attention; not only do we ruminate about the past – going over previous events and re-experiencing the emotions and thoughts around those events – our brains are also able to “travel forward in time”-  imagining possible futures  or catastrophising –  and even to “mind travel” so that we imagine what others are thinking.

So, without being able to “pay attention” we would never be able to get anything done or to make considered decisions. Plus, in any emergency situation, is it is vital that we remain focused on making the right decisions and taking the actions that are required – panicking, becoming overwhelmed or distracted will not help us!

This week I came across this podcast from the Oxford Mindfulness Centre in which Professor Amishi Jha talks about the brain’s ability to “pay attention”. Amishi Jha is an associate professor of psychology at the University of Miami. Her research on attention, working memory and mindfulness has investigated the neural bases of executive functioning and mental training using various cognitive neuroscience techniques. Here.

Professor Jha suggests that our “attention” is our ability to select information for consideration in pursuit of some current purpose or goal – that’s our ability to select from the available external information, our knowledge and our internal thoughts.  Interestingly, she suggests that our ability to pay attention develops late… and is only fully developed in our mid 20s (- note to self: cut the kids more slack).

The podcast explains the key cognitive subsystems that are involved in our ability to pay attention:

  • Orientation System – like a flashlight that we shine on the information on which we wish to focus – and so to diminish the attention we pay to the other stuff.
  • Alerting System – an ability to remain broadly vigilant for any “flashing light” that may require our attention or our caution.
  • Executive Function – our management system to direct our thinking and attention – while also taking care to respond to any incoming or ongoing issues (“a juggler”).
  • Working Memory – our short term memory – like a whiteboard that fades – that we use to keep track to the current issues that we are focusing on.

So, what can go wrong?  Well research shows that attention is diminished by  stress, threat and mood.  It seems reasonable that threats can grab our attention, and of course mood and negativity can be a distracting ( – this is where mindfulness techniques like self-compassion and choosing to “live in this moment” can be so helpful). But how does stress impact our attention?

Well, stress can cause our flashlight to become preoccupied by negative thoughts (of failure and it’s implications; or also of our perceived inability to get things done… to be “good enough”);  it can cause our alerting system to become hypervigilant – distracting us with issues that are not urgent or helpful to us; and stress may cause our executive function to become diminished so that we are distracted and fail to focus on critical issues.

Besides stress, we also face a significant challenge from the brain’s ability to “mind wander” – thinking “off task thoughts” during some ongoing activity.

Mind-wandering may be due to ruminations about the past, anxiety about the future, negative thoughts or even “mind travel”.  Studies show that Mind-wandering can lead to performance errors, variable” speed of response” to incoming stimuli, perceptual decoupling (we fail to notice the thing that we should) and low mood (negative thoughts).

The good news is that Professor Jha explains that her research shows that Mindfulness is reliable and exclusively effective to bolster our performance.  It is the practice of reducing distractions and mind-wandering which enables us to improve our attention skills… to set aside unhelpful distractions, thoughts and emotions.  Studies upon those who are stressed or in high-pressure environments – e.g. business professionals, students, athletes and elite soldiers –  have demonstrated the impact of Mindfulness training such a MBCT and MBSR to improve attention and to facilitate better decision-making in pressured or chaotic situations.

Maybe we all need to pay more attention to our attention.