Easing the Lingering Symptoms of Depression

Despite our best efforts, most patients who experience depression are left with residual symptoms that linger beyond the completion of treatment. Whether it be low motivation, low mood, self-criticism, guilt or worry, residual symptoms of depression are not only disabling, they place patients at greater risk of relapse and future depressive episodes if they remain untreated. Given depression is often a chronic and recurrent condition, we need new ways to help reduce residual symptoms to achieve better long-term outcomes for our patients.

A newly published study has shown that online mindfulness based cognitive therapy can help reduce these lingering effects of depression.

What was the study?

The study , conducted in the USA and published in JAMA Psychiatry, provides exciting evidence of a new online approach to reduce residual symptoms and prevent relapse in people experiencing residual depressive symptoms. The authors recruited a large sample of 460 participants who had mild scores of 5-9 on the PHQ-9 (self-report measure for depression), and randomly allocated them to receive either 12 weeks of coach-supported online mindfulness-based cognitive therapy (MBCT) or continue receiving usual care for depression. They followed participants up at 3 and 12-months after the intervention period to compare outcomes in both groups.

What was the intervention?

The intervention – called ‘Mindful Mood Balance’ consisted of 8 online modules that included the core content and components of the face-to-face MBCT intervention online. This included mindfulness instruction, videos and practical exercises. It taught patients how to disengage with maladaptive, habitual and automatic habits of thinking, such as ruminative thinking that is common in depression. The participants also received telephone coaching and motivational emails from a coach throughout the 12-week treatment period.

What did the study find?

The group who received the online MBCT intervention had significantly lower self-reported depression and anxiety severity, lower rates of relapse (defined as having their PHQ-9 score deteriorating to >15) and better mental health outcomes over the study period, relative to the control group. There were no differences in physical health outcomes.

Why are these findings important?

Although we have known for a long time that MBCT can achieve powerful effects in preventing relapse of depression, relative to usual care and maintenance antidepressants, it has typically been out of reach of most patients, due to the high cost and lack of trained practitioners. These findings are important in showing that delivering MBCT via the internet can be just as successful in helping improve outcomes for patients with depression, and it may be more accessible than face-to-face therapy.

What are the limitations of the study?

The sample was primarily white (90%), female (76%), and receiving concurrent treatment (78% on medications and 50% receiving concurrent psychotherapy), which means we cannot necessarily generalise the effects of this intervention to other samples. The results were mostly based on self-report outcomes too – they didn’t examine diagnostic outcomes using interview. And the study was run by world experts in mindfulness (e.g., Zindel Segal) and the developers of the intervention so replication is needed.

Is it available in Australia?

Although Mindful Mood Balance isn’t available in Australia, the good news is that there are similar web-based mindfulness-based programs available for immediate use to clinicians in Australia. The closest program is the mindfulness-based CBT program on THIS WAY UP, which combines the best of mindfulness strategies and CBT skills, and costs $59 for 12 weeks access. Clinicians can register with THIS WAY UP for free and prescribe the program to their patients.

Keep in mind that coaching appears to be important, so if you’re choosing to try this program with your own patient experiencing residual symptoms, regular follow-up (weekly to fortnightly phone calls) will be important.

www.thiswayup.org.au