February 24, 2024

A self-guided, practitioner-supported form of mindfulness therapy was found to be more effective and more cost-effective than self-help cognitive behavioral therapy (CBT-SH), according to a head-to-head study.

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 treatment regimens are becoming increasingly popular as a way to expand access to mental health services and to address the shortage of mental health professionals.

Overall, mindfulness-based cognitive therapy aims to increase awareness of the maintenance cycle of depression while promoting a nonjudgmental attitude toward present-moment experiences, the researchers note.

Conversely, CBT aims to challenge the negative and unrealistic thought patterns that can perpetuate depression, by replacing them with more realistic and objective thoughts.

“Professional-supported MBCT-SH should be offered routinely as an intervention for mild to moderate depression along with practitioner-supported CBT-SH,” note the investigators.

The study was published online on March 22 JAMA Psychiatry.

Better recovery rates?

CBT-SH had traditionally been associated with high dropout rates, and alternative forms of self-help therapy are becoming increasingly necessary to fill this treatment gap, the researchers note. To compare the effectiveness and cost-effectiveness of both types of treatment, 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 provided with specific self-help manuals, 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 distresswhile those who received CBT-SH used Overcoming Depression and Depressed Mood, 3rd Edition: A Five Areas Approach.

The investigators asked all participants to walk themselves through six 30- to 45-minute sessions using information from the workbooks. Trained psychological well-being professionals supported participants as they moved through the workbooks during the six sessions.

Participants were assessed with the Patient Health Questionnaire9 (PHQ-9) at baseline and the Clinical Interview Schedule Revised at 16 and 24 weeks.

At 16 weeks after randomization, results showed that practitioner-supported MBCT-SH led to significantly greater reductions in depression symptom severity than practitioner-supported CBT-SH (mean [SD] PHQ-9 Score, 7.2 [4.8] points against 8.6 [5.5] points; difference between groups, -1.5 points; 95% CI, -2.6 to -0.4; P = .009).

The results also showed that, on average, the CBT-SH intervention cost $631 more per participant than the MBCT-SH intervention during the 42 weeks of follow-up.

The researchers explain that “a substantial portion of this additional cost was the additional face-to-face individual psychological therapy accessed by the CBT-SH participants outside of the study intervention.

“In conclusion, this study found that a new intervention, practitioner-supported MBCT-SH, was clinically superior in targeting postintervention depressive symptom severity and was cost-effective compared to the criterion standard of supported CBT-SH by the professional for adults with mild to moderate depression,” the investigators write.

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

Clinically significant?

Commenting on the study for Medscape Medical NewsLauren Bylsma, PhD, a professor of psychiatry and psychology at the University of Pittsburgh School of Medicine in Pennsylvania, questioned the ability of such a short process to bring about meaningful change.

Dr. Lauren Bylsma

He said the additional costs incurred by participants in the CBT-SH arm of the study are likely, as it’s “hard to do CBT on your own. You need an objective person to guide you as you practice.”

Bylsma noted that more real-world therapeutic studies are ultimately 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 comprehensive listing of the authors’ relevant financial relationships.

JAMA Psychiatry. Published online March 22, 2023. Full text

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