Lesson 1 – The Road to MBCT

This video sets the MBCT programme in context – what it set out to address, why, and how.


The long shadow of depression

• From a survey of 14,000 people from six European countries, 17% of the population experienced depression within the past six months1

• GPs see at least one patient with depression each day

• US data: 18-22% of women, 7-11% of men suffer from depression during their lifetime2

• 15% chance that patients suffering from recurrent depression will die by suicide3

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1.Lepine JP, Gastpar M, Mendlewicz J, Tylee A. Depression in the community: the first pan-European study DEPRES. International Clinical Psychopharmacology 1997; 12:19-29.

2.Hasin DS, Goodwin RD, Stinson FS, Grant BF. Epidemiology of major depressive disorder: results from the National Epidemiology Survey on Alcoholism and Related Conditions. Archives of General Psychiatry 2005; 62:1097-1106.

3.Keller MB, Lavori PW, Mueller TI, Coryell W, Hirschfeld RMA, Shea MT. Time to recovery, chronicity and levels of psychopathology in major depression. Archives of General Psychiatry 1990; 47:519-526.


What makes depression so prevalent…

• … is that it’s a relapsing condition.

• At least 50% of patients who recover from one episode of depression will experience one further episode1

• Patients with two or more episodes have a 70-80% chance of recurrence2

• “Unipolar depression is a chronic, lifelong illness, the risk for repeated episodes exceeds 80%, patients will experience an average of 4 lifetime major depressive episodes of 20 weeks’ duration each.”3

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1. Kessler RC, Demler O, Frank RG, Olfson M, Pincus HA, Walters EE, Wang P, Wells KB, Zaslavsky AM. Prevalence and treatment of mental disorders, 1990 to 2003. New England Journal of Medicine 2005; 352:2515-2523.

2. Keller MB, Lavori PW, Mueller TI, Coryell W, Hirschfeld RMA, Shea MT. Time to recovery, chronicity and levels of psychopathology in major depression. Archives of General Psychiatry 1990; 47:519-526.

3. Judd LL. The clinical course of unipolar major depressive disorders. Archives of General Psychiatry 1997; 54:989-991


The journey towards a cure

• 1950s: antidepressants first employed

• 1980s: antidepressants prescribed prophylactically, as prevention of future episodes

• However, antidepressants suppress symptoms, they don’t target the causes

• Psychological approaches such as Interpersonal Therapy (IPT) were successful

• Could a ‘maintenance’ form of cognitive therapy be developed?


Therapy without a therapist

• Cognitive therapy proved very effective in preventing relapse

• But not enough therapists available!

• A ‘maintenance’ version of therapy could be delivered to groups

• Jon Kabat-Zinn set up his MBSR programme in 1979, teaching people a different mode of mind, which was helpful in difficult experiences.

• The mindful attitude to experience was more than just a set of techniques: could it be applied to patients with depression?


The mindful way

• Non-judgemental attention to experience

• Understanding the nature of thoughts and observing how we relate to them

• Accepting and allowing

• Gentle, compassionate interest towards our experience


The MBCT programme

• Created by Zindel Segal, John Teasdale and Mark Williams and first trialled in 2000

• Eight-session programme closely modelled on MBSR, with elements of cognitive therapy aimed at preventing depression

• Participants were much less likely to become depressed again in the next 12 months1

• The ‘chronic’ patients benefitted the most: the risk of relapse was reduced by nearly 50%1

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1. Teasdale JD, Segal ZV, Williams JMG, Ridgeway V, Soulsby J, Lau M. Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology 2000; 68:615-623.