Mindfulness-based cognitive therapy (MBCT) for depression: what it involves and who it helps

Mindfulness-based cognitive therapy combines mindfulness practices with ideas from cognitive therapy. In NICE guideline NG222 on depression in adults, it appears under the heading group mindfulness and meditation: a group intervention that uses a programme such as MBCT, specifically designed for people with depression.

NICE describes the focus as concentrating on the present, observing and sitting with thoughts, feelings and bodily sensations, and breathing exercises. The aim is to increase awareness and recognition of thoughts and feelings rather than to change them. That separates it from standard CBT, which works to challenge and change unhelpful thinking.

Because it is delivered to a group, it also offers a chance of peer support from others having similar experiences, which NICE lists as a feature, along with the fact that it avoids the potential side effects of medication.

According to NICE the course usually consists of 8 regular sessions, with 8 to 15 participants in the group, and is delivered preferably by 2 practitioners, at least one of whom has therapy-specific training and competence.

Between sessions, participants are expected to practise at home. NICE says the person needs to be willing to complete homework assignments, including using mindfulness recordings in between sessions, so it needs a regular time commitment beyond the group itself.

When used for relapse prevention, NICE says group CBT or MBCT should have an explicit focus on developing relapse prevention skills and what is needed to stay well, usually 8 sessions over 2 to 3 months with the option of additional sessions in the next 12 months. Components may include reviewing what was learnt, making plans to keep progress going and identifying stressful circumstances, triggers and early warning signs such as anxiety or poor sleep, or unhelpful behaviours such as avoidance or rumination.

NICE lists group mindfulness and meditation among the treatment options in its table for people with a new episode of less severe depression, alongside guided self-help, group CBT, behavioural activation, exercise and others, and says all the options in that table can be used as first-line treatments. The NHS lists a wide range of talking therapies for depression and says a GP can refer you, or you can refer yourself directly to an NHS talking therapies service.

NICE says MBCT may be helpful for people who want to develop a different perspective on negative thoughts, feelings or bodily sensations, and that it may allow peer support. It cautions that it may be difficult for people experiencing intense or highly distressing thoughts, or who find focusing on the body difficult, and that it does not directly help with relationship, employment or other stressors that may contribute to depression.

It involves attending a group and practising at home, which can be hard when depression is severe. If you are very low, struggling to concentrate, or unable to attend groups, speak to the clinician who offers it about whether another option or timing would suit you better.

NICE gives risk factors that make a relapse more likely: a history of recurrent episodes, particularly if they have happened frequently or within the last 2 years; an incomplete response to previous treatment, including residual symptoms; unhelpful coping styles such as avoidance and rumination; a history of severe depression; and other chronic physical or mental health problems.

For people who have recovered on antidepressants alone but are assessed as being at higher risk of relapse, NICE says to consider continuing the medication, or a course of psychological therapy (group CBT or MBCT) for people who do not wish to continue on antidepressants, or both. It is a shared decision, and NICE says people should be told how to stop antidepressants safely and to seek help as soon as possible if symptoms return.

The NHS says that antidepressants should usually continue for at least 4 to 6 months after symptoms ease and that people who have had depression before may need to take them longer term, with regular reviews. MBCT is one of the non-drug routes that can sit alongside or in place of that.

The NHS says to see a GP if you have symptoms of depression for most of the day, every day, for more than 2 weeks. It lists psychological symptoms such as continuous low mood, hopelessness, loss of interest and feeling anxious, physical symptoms such as disturbed sleep and loss of energy, and social symptoms such as withdrawing from friends.

The NHS lists having suicidal thoughts or thoughts of harming yourself among the symptoms, and says to contact a GP straight away if hopelessness or suicidal thoughts start or get worse after starting antidepressants. If you are in immediate danger or have harmed yourself, call 999 or go to A&E.

Mindfulness courses are not an emergency treatment. They are not suitable as the only support during a crisis, and the group leader or your GP can advise on timing.

NICE guidance recommends the approach, but how it is offered on the NHS, and how long you wait, varies by area, so ask your GP or local talking therapies service. The NHS says waiting times for talking therapies can be several weeks or months and that a GP can say what to do if your condition gets worse in the meantime.

Some people use private courses or therapists. NICE says the group should preferably be led by practitioners with therapy-specific training and competence, so it is reasonable to ask about the leader training and whether the course follows an MBCT programme designed for depression.