Clinical Effectiveness and Cost-Effectiveness of Supported Mindfulness-Based Cognitive Therapy Self-help Compared With Supported CBT.. 2023 Strauss

Full title:
Clinical Effectiveness and Cost-Effectiveness of Supported Mindfulness-Based Cognitive Therapy Self-help Compared With Supported Cognitive Behavioral Therapy Self-help for Adults Experiencing Depression

The Low-Intensity Guided Help Through Mindfulness (LIGHTMind) Randomized Clinical Trial

Key Points

Question Is practitioner-supported mindfulness-based cognitive therapy self-help (MBCT-SH) clinically effective and cost-effective compared with practitioner-supported cognitive behavioral therapy self-help (CBT-SH) for adults experiencing mild to moderate depression?

Findings In this randomized clinical trial of 410 participants with mild to moderate depression, practitioner-supported MBCT-SH led to significantly greater reductions in depressive symptom severity at 16 weeks postrandomization compared with practitioner-supported CBT-SH. The probability of MBCT-SH being cost-effective compared with CBT-SH exceeded 95%.

Meaning Practitioner-supported MBCT-SH for mild to moderate depression was clinically effective and cost-effective compared with currently recommended practitioner-supported CBT-SH and should be made routinely available to adults experiencing mild to moderate depression.


Abstract
Importance Depression is prevalent. Treatment guidelines recommend practitioner-supported cognitive behavioral therapy self-help (CBT-SH) for mild to moderate depression in adults; however, dropout rates are high. Alternative approaches are required.

Objective To determine if practitioner-supported mindfulness-based cognitive therapy self-help (MBCT-SH) is superior to practitioner-supported CBT-SH at reducing depressive symptom severity at 16 weeks postrandomization among patients with mild to moderate depression and secondarily to examine if practitioner-supported MBCT-SH is cost-effective compared with practitioner-supported CBT-SH.

Design, Setting, and Participants This was an assessor- and participant-blinded superiority randomized clinical trial with 1:1 automated online allocation stratified by center and depression severity comparing practitioner-supported MBCT-SH with practitioner-supported CBT-SH for adults experiencing mild to moderate depression. Recruitment took place between November 24, 2017, and January 31, 2020. The study took place in 10 publicly funded psychological therapy services in England (Improving Access to Psychological Therapies [IAPT]). A total of 600 clients attending IAPT services were assessed for eligibility, and 410 were enrolled. Participants met diagnostic criteria for mild to moderate depression. Data were analyzed from January to October 2021.

Interventions Participants received a copy of either an MBCT-SH or CBT-SH workbook and were offered 6 support sessions with a trained practitioner.

Main Outcomes and Measures The preregistered primary outcome was Patient Health Questionnaire (PHQ-9) score at 16 weeks postrandomization. The primary analysis was intention-to-treat with treatment arms masked.

Results Of 410 randomized participants, 255 (62.2%) were female, and the median (IQR) age was 32 (25-45) years. At 16 weeks postrandomization, practitioner-supported MBCT-SH (n = 204; mean [SD] PHQ-9 score, 7.2 [4.8]) led to significantly greater reductions in depression symptom severity compared with practitioner-supported CBT-SH (n = 206; mean [SD] PHQ-9 score, 8.6 [5.5]), with a between-group difference of −1.5 PHQ-9 points (95% CI, −2.6 to −0.4; P = .009; d = −0.36). The probability of MBCT-SH being cost-effective compared with CBT-SH exceeded 95%. However, although between-group effects on secondary outcomes were in the hypothesized direction, they were mostly nonsignificant. Three serious adverse events were reported, all deemed not study related.

Conclusions and Relevance In this randomized clinical trial, practitioner-supported MBCT-SH was superior to standard recommended treatment (ie, practitioner-supported CBT-SH) for mild to moderate depression in terms of both clinical effectiveness and cost-effectiveness. Findings suggest that MBCT-SH for mild to moderate depression should be routinely offered to adults in primary care services.

Open access, https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2802550

 

Mindfulness better than CBT for treating depression, study finds

"Practising mindfulness is much better than taking part in talking therapies at helping people recover from depression, a British study has found.

People who used a mindfulness self-help book for eight weeks and had six sessions with a counsellor experienced a 17.5% greater improvement in recovery from depressive symptoms than those who underwent cognitive behavioural therapy (CBT) while being supported by a mental health practitioner.

The study’s authors say their findings have shown supported mindfulness-based cognitive therapy (MBCT) is “clinically superior” to CBT, which is the treatment the NHS usually offers people with mild or moderate depression. Half a million people a year are referred to NHS talking therapy services in England, in which CBT is the commonest form of treatment.

MBCT is “significantly” more effective than CBT, and cheaper for the NHS to offer, they concluded. Their results have been published in JAMA Psychiatry, an American medical journal."

https://www.theguardian.com/society...-than-cbt-for-treating-depression-study-finds

 

Sniffing other people's sweat can help treat social anxiety, study suggests
Using mindfulness as an anxiety therapy could be more effective if participants sniff sweat at the same time, a new study suggests.

Sniffing other people's sweat can help treat social anxiety, study suggests | World News | Sky News

 

I assume they will welcome it. Constant rebranding of the same stuff is integral to the business model. The labels change but the substance is always the same hot air. There's as much significant difference here as between one homeopathic remedy and another.

I was curious about how they evaluate cost-effectiveness. And it turns out they don't, they simply imagine it based on perceived efficacy from their biased questionnaires:

So basically they say this similar intervention appears slightly better on questionnaires, and that improvement on questionnaires is then turned into economic value. Which is basically as valid as doing the same with a psychic service and attributing economic value to communicating with dead family. Or whatever.

But also because:

Not sure why those don't apply to the other stuff. But when you look at the amounts involved, all this stuff is very expensive. Especially as it's sold as self-help.

They mention in the paper that this therapy is already widely used in IAPT. So they were already using it, zero chance they would find it's not good. They're testing products after they started spending a lot of money on them.

Imaginary savings out of imaginary benefits. This is the BPS way. What a giant scam.

 

1.5 point on the PHQ-9 scale does not seem to be a minimal clinically important difference, at least for moderate depression: https://www.cambridge.org/core/jour...primary-care/74A6FC27FCCD5CD48DAA943E3A007E46