Mindfulness: an effective mental health treatment but not a panacea

Kate Bermingham  14 May The Guardian

It may be an ancient Buddhist practice, co-opted and misrepresented by celebrity practitioners, but scientists and health practitioners have found that mindfulness has specific benefits for mental health patients. The medical profession, too, is beginning to take it seriously. 

Consultant psychiatrist Dr Florian Ruths explains why: “MBCT [mindfulness based cognitive therapy] is a powerful intervention –it isn’t fluffy or alternative. The MBCT course is based on solid scientific research, and Nice [the National Institute for Health and Care Excellence] has recommended it since 2005 for keeping patients with recurrent depressive vulnerability depression-free.”

Last month, research found that MBCT may be as effective as medication for treating recurrent depression, and may work even better than medication for patients with a history of childhood abuse.

The Oxford Mindfulness Centre, part of the University of Oxford’s department of psychiatry, has found that the MBCT course reduces the risk of relapse into depression by 44%. There is emerging evidence to suggest MBCT is also effective for treating generalised anxiety disorder, stress and other mental health conditions. Cancer patients have also benefitted from it.

But despite these findings, mindfulness isn’t appropriate for some patient groups as Dr Christina Surawy, a clinical psychologist, warns: “MBCT isn’t suitable for patients who are in the grip of a drug or alcohol dependency, as they won’t be able to fully engage with the therapy. Also, patients who are recently bereaved may find MBCT too overwhelming.” Ruths echoes these concerns, adding that it is not useful for patients during an episode of severe depression. These patients should wait until they recover to a mild or moderate state before engaging with MBCT.

Ruths adds that unlike some drug treatments, side effects are very rare with MBCT, though “minor side effects, such as a temporary drop in mood before an improvement in mood, are more common but manageable”. He emphasises that it is important for MBCT therapists to be properly trained to deal with any side effects and support their patients appropriately.

The shortage of properly qualified MBCT teachers, and the need to widen access to mindfulness-based interventions for people with long-term conditions, was noted in this year’s mindfulness all-party parliamentary group’s interim report, Mindful Nation UK. The report described mindfulness as “an effective, low-cost intervention with a wide range of benefits”. 

Amid the rush to train enough MBCT teachers to meet rising demand, efforts are being made to avoid any decline in quality of practice. The UK Network for Mindfulness-Based Teachers has produced good practice guidelines that all MBCT teachers should abide by.

Dr Clara Strauss, research lead at Sussex Mindfulness Centre, emphasises that MBCT teachers in training learn to have an attitude of acceptance: “Mindfulness is not about getting rid of negative thoughts, it’s about learning to sit with and tolerate all of our experiences, including difficult experiences, with kindness and compassion towards ourselves.

“An inexperienced teacher may respond to a person’s struggle with difficult experiences with inadvertent judgment, encouraging the person to try to avoid or change these, and so it is crucial that MBCT training is thorough and that the good practice guidelines are followed. A cornerstone of the good practice guidelines is that MBCT teachers have an established personal mindfulness practice and appreciate the common nature of human suffering, rather than teaching from a purely intellectual stance.”

Professor Willem Kuyken, director of the Oxford Mindfulness Centre, leads the Aspire Project, a study set up in 2013 to investigate patients’ access to MBCT across the UK. He says access to MBCT throughout the NHS is patchy and “effectively a postcode lottery”.

“To improve access to MBCT we need a combination of top-down action, such as getting commissioners and senior managers on board, and bottom-up action ... pro-active mindfulness teachers and trainers setting up high quality local services and encouraging GPs to refer patients who would benefit from MBCT treatment,” he says. But Kuyken acknowledges the tough financial climate means mental health trusts often can’t make MBCT a priority: “Their core business is treatment of serious illness rather than prevention of relapse, which can mean that therapies like MBCT get sidelined.”

Despite pressure on resources, there are successful NHS examples of mindfulness-based service delivery, including the Nottingham Centre for Mindfulness. Set up in 2010, the service has trained approximately 100 MBCT teachers (mainly nurses, doctors and psychologists) and treated more than 1,000 patients.

Tim Sweeney, MBCT clinical lead at the centre, described its progress: “The patient population has welcomed MBCT. Verbal and written feedback from patients has been largely very positive and measures of depression and anxiety on average show a significant reduction following the course.

“In the face of budget cuts, it’s been relatively straightforward to integrate MBCT into our trust. It’s a no-brainer: the arguments in favour stack up for both patients and staff. It’s effective, and can be made readily available to large numbers of people as a group intervention … It’s rare for patients to find it unhelpful, and research has found that the results are comparable to ongoing anti-depressant drug treatment.”