Thank you for your patience in waiting for information about the results of the Staying Well after
Depression Randomised Controlled Trial. Although the final participant data was collected in early
2012, because the trial was large and involved two sites (Oxford and Bangor) it has taken us a long time to process and analyse the data. The main trial paper is now available (see http://www.bangor.ac.uk/mindfulness/publications.php.en
). Here we provide a brief summary of the results of the trial.
Background
The aim of the Staying Well Trial was to examine the effectiveness of Mindfulness Based Cognitive
Therapy (MBCT), as compared to a second treatment, Cognitive Psychoeducation (CPE) - which contained most of the same elements as MBCT but did not require participants to meditate - and treatment as usual (TAU). Many people, experiencing a range of physical and mental health conditions, report benefits from mindfulness practices. This trial looked at one specific group of people, who had had three or more episodes of clinical depression, and investigated who the MBCT approach is most beneficial for. We were interested to see who benefited most from the full MBCT treatment, as compared to a treatment which contained all the main bits of MBCT, but which did not require people to meditate (i.e. CPE). Although research shows that MBCT has a range of benefits such as increasing wellbeing and quality of life, the main thing we were looking at in this trial was prevention of
depression. Therefore the main results are based on whether or not people experienced another episode of clinical depression during the year after the trial had finished. The results we will describe apply only to a specific group of people (people with three or more episodes of depression when they receive treatment), and are only averages. In any group some people will benefit more than others and in fact this was one of the things we were trying to understand in this project.
Who took part?
In total 274 people took part in the trial across our two sites. Seventy-five percent of participants were women and the average age of participants was 43 years (with people from 18-70 taking part).
110 people were allocated to MBCT, 110 to CPE and 56 to treatment as usual. We got some followup information from 99 people who had MBCT, 103 who had CPE, and 53 who had TAU. These rates of follow-up are fantastic and we would like to extend our thanks to everyone who got in touch with us and chose to participate.
In both the MBCT and CPE groups, people attended an average of seven out of the eight treatment sessions with 90% of MBCT participants and 94% of CPE participants completing four or more sessions.
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The rates of attendance at the treatment sessions are very high for a study of this type and we are
very grateful to everyone involved for their commitment. Having such high rates of attendance at
treatment and follow-up assessments means we can be more confident in the results of the study.
At the end of treatment both groups rated their treatment highly.
Main Results
Over the follow-up period 46% of people in the
MBCT group, 50% of participants in the CPE group and 53% of participants in the TAU group experienced at least one further episode of depression. Although relapse rates were somewhat lower in the MBCT group than the other two groups these differences between the groups were not statistically significant. In all three groups the rates of recurrence of depression were somewhat lower than in previous similar studies. This means that across the sample as a whole, although many participants found the treatment groups beneficial, there was no statistically significant difference in the risk of having another episode of depression between the two treatment groups, or between the treatment groups and those receiving usual care. However, what about those people who were more vulnerable?
How do differences between people influence the effectiveness of treatment?
Next we looked to see whether the differences between the three treatment groups were more obvious when we took symptoms of depression and history of childhood trauma into account. It tuned out that if a person experienced trauma during childhood they were particularly likely to become depressed again in the year after they joined the trial if they did not have either of the treatments.
And when we looked at the results for those who had trauma during childhood, the differences between the three treatments became more obvious. People with more history of trauma relapsed more if they received CPE or TAU than if they received MBCT, whereas for people with less history of trauma rates of relapse were not affected by treatment received. For those with higher levels of childhood trauma, if they only received treatment as usual (TAU) two-thirds become depressed
(65%). CPE took the risk down to 54%, but MBCT took the risk down even further - to 41%.
These results suggest that MBCT is particularly beneficial in preventing recurrences of clinical depression for people with recurrent depression who have experienced a difficult childhood and adolescence. This is a novel and important findin0g that will pave the way for future work in this area. It is only with large studies of this type that it is possible to explore to get a better of understanding of which treatments work for which people.
This study cannot tell us exactly why it is that MBCT is more beneficial than other treatments for people with a history of childhood trauma. It may be that people with a history of childhood trauma need more direct practice in relating differently to difficult thoughts, feelings, and memories, which meditation provides, rather than just discussing these issues, whereas for people without a history of trauma this is not so necessary. It is important to
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note that these results reflect averages. They do not mean that only people with a history of childhood trauma will benefit from MBCT or that people who have experienced such trauma will
always benefit.
They just suggest that MBCT is more likely to be beneficial in preventing relapse to depression than the other two treatment arms, for people with a history of recurrent depression who experienced trauma during childhood. Our future work will examine this question further by trying to understand more about why we have found this result.
In the future we plan to carry out more analyses to understand whether the different treatments have different effects on the chances that a person will experience suicidal thoughts in the future, particularly if they become depressed again. There are many potential benefits of receiving a psychological treatment, and we hope to explore some of these in our subsequent work.
It takes quite some time for research papers to go through the peer review process and to be published. All publications arising from this trial will ultimately be open access. This means that they will be freely available online for anyone to download from the internet and read. This open access is funded by the
Wellcome Trust who supported this study. As papers from this trial emerge we will post links to them from the Oxford Mindfulness Centre website www.oxfordmindfulness.org
and the Centre for Mindfulness Research and Practice website http://www.bangor.ac.uk/mindfulness .
We would be very interested to hear your feedback about the trial. If you would like to share your thoughts with us please email us at: omcadmin.ox.ac.uk
(Oxford) or mindfulness@bangor.ac.uk
(Bangor) or write to us at:
Oxford Mindfulness Centre
University of Oxford Department of Psychiatry
Prince of Wales International Centre
Warneford Hospital
Oxford
OX3 7JX
Centre for Mindfulness Research and Practice,
School of Psychology,
Centre for Mindfulness Research and Practice
Dean St Building
Bangor University
Bangor LL57 1UT
Thank you once again for your involvement in this study. Without your efforts this work could not have been conducted and we are very grateful for your involvement and support. We hope you have found this information interesting. Please do not hesitate to get in touch with us if you have any questions,
With best wishes,
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