May 14, 2025

expert reaction to trial of treating depression with mindfulness-based cognitive therapy in those who haven’t improved after NHS Talking Therapies

A trial published in Lancet Psychiatry looks at mindfulness-based cognitive therapy for depression in those who haven’t improved after NHS Talking Therapies. 

Dr Elena Makovac, Senior Lecturer in Clinical Psychology, Brunel University of London, said:

“Treatment-resistant or difficult-to-treat depression poses a significant challenge for the NHS system, with its impact on healthcare costs being substantial and possibly underestimated. This is due to the multifaceted nature of depression, which often includes various somatic symptoms. This study addresses a critical question: what additional treatment options can be offered to patients who have exhausted first-line interventions, including a full course of Talking Therapies—typically 12 or more sessions? Patients with treatment-resistant depression not only continue to suffer, but the knowledge that no further treatment options are available exacerbates feelings of hopelessness, leading to further deterioration of their mental health.

“A key limitation of the study is that, by comparing MCBT (Mindfulness-Based Cognitive Therapy) plus treatment-as-usual with the treatment-as-usual group, we cannot definitively determine whether the observed improvements were specifically due to the MCBT, or if they resulted from the fact that the MCBT group received more treatment overall compared to the control group. This improvement could potentially have been achieved with an extension of the originally delivered Talking Therapies.

“While research into additional treatments for difficult-to-treat depression is essential, it is even more important to offer interventions grounded in well-understood mechanisms. This process begins with a crucial first step: answering the question of why some patients do not respond to Talking Therapies.”

From our colleagues at SMC Spain

Maria Serra-Blasco, Principal investigator, Digital Health Programme ICOnnecta’t, and member of the Group of Psycho-oncology and Digital Health at IDIBELL, said:

“This study provides very strong evidence for the value of Mindfulness-Based Cognitive Therapy (MBCT) as a treatment option for people with depression who have not improved after receiving intensive psychological treatments within the NHS. Compared to treatment as usual, adding MBCT – delivered in a group and by video call – achieved a greater reduction in depressive symptoms, with benefits sustained up to six months later. Improvements in participants’ work and social functioning were also observed.

“A particularly relevant finding is that this intervention, validated in a group and online format, proves to be effective even in people with complex clinical conditions: many of the participants had a history of depression from an early age, several relapses, comorbidities and were on medication. The fact that MBCT works in this context suggests that it can be an effective and safe alternative in cases of difficult-to-treat depression, and not only as an add-on, but also as a possible next step when other approaches have failed.

“Validating this approach in an online and group format is an important step forward, as it considerably improves its scalability: it allows it to be offered to more people, at lower cost and without the need for travel, which is key to broadening access to evidence-based psychological treatments.

“Furthermore, from a health perspective, MBCT showed good cost-effectiveness: not only was it clinically more effective, but it also reduced costs in health and social services, even considering the resources needed for its implementation. This evidence, together with previous studies, supports its inclusion in clinical guidelines as a second- or third-line treatment.

“In Spain, MBCT has also been shown to be feasible and safe in primary care (Elices et al., 2022). Although it does not replace conventional treatments, it represents a promising, accessible and scalable tool that can expand therapeutic options in the public health system.”

Jesús Montero-Marín, Miguel Servet Senior Researcher at the Teaching, Research and Innovation Unit of the Parc Sanitari Sant Joan de Déu, member of the Department of Psychiatry at Warneford Hospital-University of Oxford (UK) and member of Spain’s Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), said:

“The study published in The Lancet Psychiatry represents a major advance in the treatment of resistant depression. Mindfulness-based cognitive therapy (MBCT) showed higher effectiveness compared to treatment as usual, even in patients who had not remitted after previous intensive interventions. The study methodology is robust, with a randomised, controlled design and 34-week follow-up, which supports the robustness of its conclusions.

“This work provides conclusive evidence that MBCT can be an effective and cost-effective second-line treatment option in structured clinical settings. Although direct extrapolation to other health systems, such as the Spanish one, should be done with caution and requires further research, the model is scalable and compatible with primary mental health care. Its implementation could lead to a substantial improvement in the continuity of care for cases of difficult-to-treat depression.”

‘Mindfulness-based cognitive therapy versus treatment as usual after non-remission with NHS Talking Therapies high intensity psychological therapy for depression: a UK-based clinical effectiveness and cost-effectiveness randomised, controlled, superiority trial’ by Thorsten Barnhofer et al. was published in Lancet Psychiatry at 23:30 UK time on Wednesday 14^th May. 

Declared interests

Maria Serra-Blasco:She declares that she has no conflicts of interest.

Jesús Montero-Marín:“I am a member of the Oxford Mindfulness Centre and collaborate regularly with some of the papers’ authors.”

For all other experts, no reply to our request for DOIs was received.