Online MBCT to improve lingering depression

Researchers have found that online mindfulness-based cognitive therapy (MBCT) can improve lingering depressive symptoms.

A team of researchers has found that online MBCT can improve a range of lingering depressive symptoms in people who have already received treatment for depression.

The findings, which feature in the journal JAMA Psychiatry, are significant for both reinforcing the effectiveness of MBCT and potentially expanding patient access to the treatment.

Mindfulness

Emerging from Asian Buddhist cultures, mindfulness and meditation practices focus on cultivating an embodied awareness of the present moment. Over the last 20 years, these practices have played an increasingly significant role as a component of the healthcare system.

One prominent area of research is MBCT, which combines mindfulness practices with cognitive behavioral therapy (CBT).

MBCT gives people the skills to improve how they regulate their emotions, enabling them to observe their thoughts, sensations, or feelings rather than immediately reacting to them.

A meta-analysis in the journal Clinical Psychology Review found MBCT to be as effective as antidepressant medication in some cases. This treatment also proved effective in reducing depression relapse in people who had previously experienced this several times.

However, while MBCT is effective in preventing relapses in depression, a significant number of people can still experience lingering depressive symptoms after their treatment has finished.

According to the lead author of the study, Prof. Zindel Segal of the University of Toronto Scarborough, Canada, “Treatments work well for many [living with] depression, but there remains a considerable group who continue to struggle with lingering symptoms, such as sleep, energy, or worry.”

Prof. Segal believes that these people are at an increased risk of relapsing into more severe depression. “Patients with these residual symptoms face a gap in care,” he notes, “since they are not depressed enough to warrant re-treatment but receive few resources for managing the symptom burden they still carry.”

Access an issue

This gap in care exists not only due to the relative lack of severity of lingering symptoms but also because access to MBCT is extremely difficult for those living outside of cities.

It is for this reason that Prof. Segal developed an online version of MBCT named Mindful Mood Balance (MMB).

“What drove us to develop MMB is to improve access to this treatment. The online version uses the same content as the in-person sessions, except people can now avoid the barriers of cost, travel, or wait times, and they can get the care they need efficiently and conveniently,” Prof. Segal says.

In 2015, Prof. Segal and his colleagues Dr. Arne Beck, from Kaiser Permanente Institute for Health Research in Denver, Colorado, and Prof. Sona Dimidjian, from the University of Colorado Boulder, received a grant from the National Institutes of Health (NIH) to set up MMB.

To test the program, they conducted a randomized clinical trial involving 460 participants, all of whom were receiving usual depression care (UDC) in clinics at Kaiser Permanente Colorado.

They found that those who also completed the MMB had reduced anxiety and depression symptoms, higher rates of remission, and improved quality of life compared with those receiving just UDC.

“An online version of MBCT, when added with usual care, could be a real game changer because it can be offered to a wider group of patients for little cost.”

– Prof. Zindel Segal

While the results are promising for the possibility of expanding MBCT and helping people whose symptoms are not severe enough for them to receive treatment, there are still issues with online programs that need resolving.

For example, online programs typically have higher dropout rates than face-to-face treatments.

However, Prof. Segal notes that “[t]he higher rates of dropout are somewhat offset by [the] fact that you can reach many more people with online treatment.”

“But,” he continues, “there’s still room for improvement, and we will be looking at our user metrics and outcomes for ways to make MMB more engaging and durable.”

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