MENTAL HEALTH
Mindfulness, meditation and the NHS
Mindfulness is the awareness that emerges when we pay deliberate and open-hearted attention, in each moment, to the unfolding of the external and internal world. It has long been of central importance in the Buddhist tradition, and the methods of cultivating mindfulness through meditation have been in use within that tradition for two and a half thousand years, says Mark Williams
Mark Williams depressed, it tends to return.
The risk of recurrence for those in a first episode is 50% but after two or three episodes the risk goes up to 70-80%.
We thought that mindfulness training might have powerful effects in preventing depression in those at greatest risk or recurrence, even if taught when people were well.
M
indfulness-based approaches in healthcare began
in the USA with Kabat-Zinn’s pioneering research into Mindfulness-Based Stress Reduction (MBSR), an eight- session course that was shown to be effective for patients with physical problems such as chronic pain, hypertension, and heart disease, as well as for psychological problems such as anxiety and stress.
Using Kabat-Zinn’s work as a starting point, Mark Williams (then at Bangor, now at Oxford), with colleagues John Teasdale (Cambridge) and Zindel Segal (Toronto), combined MBSR with cognitive therapy, creating the eight week Mindfulness-Based Cognitive Therapy (MBCT) programme. Their aim was to find a way of helping people stay well after depression.
During the 1980s and early 90s many people were increasingly aware that depression can be very recurrent for many people. Much of the economic costs of depression to the NHS, and much of the burden to sufferers and their families comes from the fact that once you’ve been
36 nhe
Mindfulness teaches people to be less judgmental of themselves and increases their ability to detect the early warning signs of relapse and to take appropriate action so as to reduce the probability of a full-blown episode.
Is it effective?
Four trials have evaluated the efficacy of MBCT in preventing relapse in depression. The results are striking. In patients with three or more previous episodes of depression, MBCT reduces the recurrence rate over 12 months by 50% compared with usual care, and is as effective as maintenance antidepressants in preventing new episodes of depression. Since 2004, the National Institute for Health and Clinical Excellence has recommended MBCT as a primary treatment for preventing relapse in depression.
Training
The recent explosion of interest in mindfulness as a radically new approach to health and well-being has been helped by the Mental Health Foundation’s
Nov/Dec 10
Be Mindful Campaign (www.
bemindful.co.uk ).
Many organizations and their staff wish to be trained to teach the approach. But there is an important point to make. Mindfulness is a skill. Like playing a musical instrument, it requires that those who teach it to have been themselves been taught and continue to practise it.
There is training available at Oxford (
www.octc.co.uk/www.
mbct.co.uk), Bangor (www.
bangor.ac.uk/mindfulness) and Exeter (www.centres.exeter.
ac.uk/mood) and also non- university training schemes in closely related skills (such as the Breathworks programmes for living with pain and illness,
www.breathworks-mindfulness.
org.uk).
More are becoming available all the time and it is important that purchasers and patients are aware of who might be able to deliver mindfulness programmes competently (see box).
The wider application of mindfulness
The central principles of
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100