April 4, 2023 -- Depressed adults who were given a self-directed workbook focusing on mindfulness practices plus cognitive therapy saw greater improvement in their depression (at less cost) than peers who were given a self-help book focusing solely on cognitive therapy in a large study from the United Kingdom.
The cognitive behavior therapy, or CBT, self-help program used in the study is recommended in U.K. national treatment guidelines for mild to moderate depression. But some people don’t respond to it and many drop out.
Adopting mindfulness CBT for depression would improve outcomes and save money compared with standard CBT, say the researchers, led by Clara Strauss, DPhil, with the University of Sussex School of Psychology.
The “LIGHTMind” study recruited 410 adults with mild to moderate depression. They were given one of two established self-help workbooks.
One was The Mindful Way Workbook: An 8-Week Program to Free Yourself from Depression and Emotional Distress. Written by the pioneers of mindfulness-based CBT, the program helps people overcome depression, anxiety, and stress by simply learning new ways to respond to thoughts and feelings. It comes with guided audio meditations.
The other was Overcoming Depression and Low Mood, 3rd Edition: A Five Areas Approach, a CBT program widely used in England that helps people self-assess and manage their depression.
Both groups had support from a trained “psychological well-being” provider.
After about 4 months, the mindfulness group had significantly greater reductions in the severity of their depression symptoms and anxiety compared with the CBT group. The mindfulness self-help program also cost less then the CBT program.
If translated into routine practice, the mindfulness program “would see many more people recovering from depression while costing health services less money,” the study team says.
Zindel Segal, PhD, who wasn’t involved in the study, noted that mindfulness didn’t “drastically” outperform cognitive therapy.
“But cognitive therapy is a robust treatment in its own right, and so doing a little bit better is significant," he said.
Segal is a professor of psychology at the University of Toronto in Scarborough and an author on the mindfulness workbook used in the study.
Segal also noted that the study appropriately recruited adults who were moderately depressed and not acutely ill.
“That's one of the rationales for self-help compared to providing patients with a more resource-intensive group treatment," he said.
“If you look at the needs of people with moderate depression, what you find is that for cognitive therapy to work, negative thoughts and feelings need to be pervasive in order to make use of the techniques,” Segal explained. “With mindfulness, you don't need any to have constant negative thoughts or feelings. Anything that arises in your experience serves as grist for mill in terms of concentration and focus."
He also noted that mindfulness is “more optimized” for people who are finding themselves in a period of some measure of recovery or remission.
“It's well suited for that as it trends towards the wellness spectrum," he said.
Segal said the findings of the U.K. study are relevant to treatment of adults with mild to moderate depression in the United States.
“The self-help books that are used are widely available and the support that people were offered, either in person, telephone or email, could be easily delivered. This would be a very useful model,” Segal said.