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Cited by 100Mindfulness and Compassion InterventionsPsychotherapy Techniques and ApplicationsAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

The Effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) in Real-World Healthcare Services

Open access
Tickell, Alice, Ball, Susan, Bernard, Paul, Kuyken, Willem, Marx, Robert, Pack, Stuart, Strauss, Clara, Sweeney, Tim +1 more·2020·Mindfulness
DOI 10.1007/s12671-018-1087-9PMC PMC6995449
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Abstract

Depression is common with a high risk of relapse/recurrence. There is evidence from multiple randomised controlled trials (RCTs) demonstrating the efficacy of mindfulness-based cognitive therapy (MBCT) for the prevention of depressive relapse/recurrence, and it is included in several national clinical guidelines for this purpose. However, little is known about whether MBCT is being delivered safely and effectively in real-world healthcare settings. In the present study, five mental health services from a range of regions in the UK contributed data ( n = 1554) to examine the impact of MBCT on depression outcomes. Less than half the sample ( n = 726, 47%) entered with Patient Health Questionnaire (PHQ-9) scores in the non-depressed range, the group for whom MBCT was originally intended. Of this group, 96% sustained their recovery (remained in the non-depressed range) across the treatment period. There was also a significant reduction in residual symptoms, consistent with a reduced risk of depressive relapse. The rest of the sample ( n = 828, 53%) entered treatment with PHQ-9 scores in the depressed range. For this group, 45% recovered (PHQ-9 score entered the non-depressed range), and overall, there was a significant reduction in depression severity from pre-treatment to post-treatment. For both subgroups, the rate of reliable deterioration (3%) was comparable to other psychotherapeutic interventions delivered in similar settings. We conclude that MBCT is being delivered effectively and safely in routine clinical settings, although its use has broadened from its original target population to include people experiencing current depression. Implications for implementation are discussed.

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Crossref · 10.1007/s12671-018-1087-9

Cites

62 of 62 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

0 of 59 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    In the non-depressed entry subgroup, residual depression symptoms significantly decreased from pre- to post-treatment.

    “There was also a significant reduction in residual symptoms, consistent with a reduced risk of depressive relapse.”
    Quote in the paperSubstantial claim
  • Findingown data

    In the depressed entry subgroup, depression severity significantly decreased from pre- to post-treatment.

    “overall, there was a significant reduction in depression severity from pre-treatment to post-treatment.”
    Quote in the paperSubstantial claim
  • Findingown data

    The reliable deterioration rate was 3% in both the non-depressed and depressed entry subgroups.

    “For both subgroups, the rate of reliable deterioration (3%) was comparable to other psychotherapeutic interventions delivered in similar settings.”
    Quote in the paperSubstantial claim
  • Findingown data

    In the study sample, 47% (n = 726) entered treatment with PHQ-9 scores in the non-depressed range.

    “Less than half the sample (n = 726, 47%) entered with Patient Health Questionnaire (PHQ-9) scores in the non-depressed range, the group for whom MBCT was originally intended.”
    • Also stated in: § Participants · plain
      “According to scores on the Patient Health Questionnaire (PHQ-9), before treatment, 53% of service users were currently depressed and 47% were not depressed.”
    Quote in the paperSubstantial claim
  • Findingown data

    Among service users who entered with depressed PHQ-9 scores, 45% recovered by moving into the non-depressed range.

    “For this group, 45% recovered (PHQ-9 score entered the non-depressed range)”
    Quote in the paperSubstantial claim
  • May combine two claims. 36
  • Classified as probably not a substantial claim. 18

  • May combine two claims.

    Findingown data

    Whilst findings were broadly consistent across services, there were also areas of divergence, and the services differed significantly from one another in clinical outcomes.

    “Whilst findings were broadly consistent across services, there were also areas of divergence, and the services differed significantly from one another clinical outcomes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Jackdaw, in contrast, had very high rates of missing data and showed reliable deterioration rates of 0.63%, reliable improvement rates of 17% and rates of sustained recovery of 99%.

    “Jackdaw, in contrast, had very high rates of missing data (and hence baseline data carried forward) and showed reliable deterioration rates of 0.63%, reliable improvement rates of 17% and rates of sustained recovery of 99%.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Neither age nor gender was associated with the degree of reduction in depressive symptoms during treatment, indicating that outcomes do not seem to be influenced by these sociodemographic variables.

    “Consistent with Kuyken et al. (2016), neither age nor gender was associated with the degree of reduction in depressive symptoms during treatment, indicating that outcomes do not seem to be influenced by these sociodemographic variables.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Kuyken et al. (2016) source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Robin, the largest unique sample with negligible missing data, had relatively low rates of reliable deterioration (4.7%), high rates of reliable improvement (34%) and high rates of sustained recovery (94%).

    “Robin, the largest unique sample, with negligible missing data, had relatively low rates of reliable deterioration (4.7%), high rates of reliable improvement (34%) and high rates of sustained recovery (94%)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In the pooled sample, mean PHQ-9 score decreased from 10.75 (SD = 6.18) pre-treatment to 7.81 (SD = 6.08) post-treatment, a statistically significant change with a small-to-medium effect size (d = 0.48).

    “mean PHQ-9 score was M = 10.75 (SD = 6.18) at pre-treatment, and reduced to M = 7.81 (SD = 6.08) at post-treatment, resulting in a statistically significant change with a small to medium effect size, t(1553) = 22.46, p < 0.001, d = 0.48.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Service users in the present study most commonly took part in MBCT as a second-line treatment after another form of psychological therapy (typically CBT) and had lower PHQ-9 scores at intake than the IAPT samples mentioned above.

    “Service users in the present study most commonly took part in MBCT as a second-line treatment after another form of psychological therapy (typically CBT) and had lower PHQ-9 scores at intake than the IAPT samples mentioned above.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In this subgroup, there were very high rates of sustained recovery, low rates of sustained deterioration, and a small and statistically significant effect on residual symptoms, which are consistently shown to be the best predictor of depressive relapse.

    “Encouragingly, in this subgroup, there were very high rates of sustained recovery, low rates of sustained deterioration a small and statistically significant effect on residual symptoms, which are consistently shown to be the best predictor of depressive relapse (Bockting et al. 2015).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Bockting et al. 2015 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    MBCT is recommended in national clinical guidelines for relapse prevention in several countries and has been endorsed by the American Psychiatric Association.

    “As such, MBCT is included in the clinical guidelines as a recommended option for relapse prevention in a number of different countries, including the UK, Netherlands, Canada, Australia and New Zealand (Malhi et al. 2015; NICE 2009; Parikh et al. 2016), and has been endorsed by the American Psychiatric Association (Lu 2015).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Malhi et al. 2015 source

      Not checked in the free run.

    • cites NICE 2009

      Not checked in the free run.

    • cites Parikh et al. 2016 source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    MBCT was developed as a relapse prevention programme for people at high risk of depressive relapse/recurrence.

    “Mindfulness-based cognitive therapy (MBCT) was developed as a relapse prevention programme, to help people who are at high risk of depressive relapse/recurrence to learn the skills to stay well in the long term (Segal et al. 2002).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Segal et al. 2002

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The effects of MBCT appear maintained at follow-up and robust to publication bias, study quality, and sensitivity analysis.

    “These effects appear to be maintained at follow-up, and robust when accounting for publication bias, study quality features and sensitivity analysis (Goldberg et al. 2018).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Goldberg et al. 2018 source

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    The MBCT evidence base consists of relatively few studies, mostly clinical trials conducted in research settings.

    “However, this evidence base reflects a relatively small number of studies, the majority of which are clinical trials in research settings.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    People with a history of depression have a high and increasing risk of relapse/recurrence, with likelihood at least 40% after a first episode, 60% after a second, and up to 90% after a third.

    “However, even when acute treatment is successful, people with a history of depression have a high risk of relapse/recurrence that increases with each successive episode: the likelihood is at least 40% after a first episode, 60% after a second, and as high as 90% after a third (Eaton et al. 2008; Moffitt et al. 2010; Solomon et al. 2000).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Eaton et al. 2008 source

      Not checked in the free run.

    • cites Moffitt et al. 2010 source

      Not checked in the free run.

    • cites Solomon et al. 2000 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    MBCT is delivered effectively and safely in routine clinical practice.

    “We conclude that MBCT is being delivered effectively and safely in routine clinical settings”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The observed 3% reliable deterioration rate is comparable to rates seen in other psychotherapeutic interventions in similar settings.
    • Rests on an assumption: The five participating NHS services are representative of routine clinical settings for MBCT.

  • May combine two claims.

    Premisecitation

    MBCT reduces depressive relapse risk when added to usual care and has comparable efficacy to maintenance antidepressant medication, based on at least nine clinical trials with 1258 participants.

    “There is evidence from at least nine clinical trials (n = 1258) that MBCT reduces the risk of relapse to depression when added to usual care, and demonstrates comparable efficacy to maintenance antidepressant medication (Kuyken et al. 2016).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Kuyken et al. 2016 source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    This study drew existing data from real-world clinical services, providing a naturalistic picture of the effectiveness of MBCT as delivered in healthcare settings, without experimental interference or control.

    “This study drew existing data from real-world clinical services. This is a strength of the work as it provides a naturalistic picture of the effectiveness of MBCT as it is delivered in healthcare settings, without any experimental interference or control.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Existing clinical trials of MBCT for relapse prevention in depression have also focussed largely on Caucasian samples and/or have not reported information on the ethnicity of participants.

    “Existing clinical trials of MBCT for relapse prevention in depression have also focussed largely on Caucasian samples and/or have not reported information on the ethnicity of participants (e.g. Goldberg et al. 2018; Kuyken et al. 2016).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Goldberg et al. 2018 source

      Not checked in the free run.

    • cites Kuyken et al. 2016 source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Although the LOCF method for missing data may have inflated the sustained recovery proportion, the rate at Robin (94%) where there was no missing data suggests any such effect is unlikely to be marked.

    “Although the LOCF method of dealing with missing data may have inflated this proportion, the rate of sustained recovery at Robin, where there was no missing data, was 94%, suggesting that any such effect is unlikely to be marked.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The PHQ-9 has been validated in different patient groups and in the general population.

    “It has been validated in different patient groups and the general population (Kroenke et al. 2001; Martin et al. 2006; Spitzer et al. 1999; Spitzer et al. 2000).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Kroenke et al. 2001 source

      Not checked in the free run.

    • cites Martin et al. 2006 source

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    • cites Spitzer et al. 1999 source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    We did not have access to information on the groupings of individuals receiving MBCT, so in our analysis we were unable to correct for the intragroup correlations between participants.

    “Similarly, we did not have access to information on the groupings of individuals receiving MBCT, so in our analysis, we were unable to correct for the intragroup correlations between participants.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The PHQ-9 has high internal reliability, with Cronbach's alpha from 0.86 to 0.89, and high test-retest reliability of 0.84.

    “The PHQ-9 has demonstrated high internal reliability with Cronbach’s α ranging from 0.86 to 0.89 and high test–retest reliability (0.84; Kroenke et al. 2001).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Kroenke et al. 2001 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Many studies have demonstrated the clinical importance of reducing residual depression symptoms because they have a large impact on long-term depression outcomes.

    “Many studies have demonstrated the clinical importance of reducing residual depression symptoms, as they have a large impact on long-term depression outcomes (Rottenberg et al. 2018).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Rottenberg et al. 2018 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    England is among the countries that have progressed furthest in formally implementing MBCT within an integrated NHS, and its providers routinely monitor clinical outcomes before and after treatment.

    “We used England as an exemplar, as it is currently one of the countries which has progressed furthest in terms of the formal implementation of MBCT in an integrated National Health Service (NHS), and providers routinely monitor the clinical outcomes of patients before and after treatment (Clark 2018).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Clark 2018 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    This pattern of results suggests that the approach of carrying forward baseline data where outcome data were missing may be suppressing rates of both reliable improvement and deterioration, and exaggerating rates of sustained recovery.

    “This pattern of results suggests that the approach we adopted of carrying forward baseline data where outcome data were missing data may be suppressing rates of both reliable improvement and deterioration, and exaggerating rates of sustained recovery.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Service users with PHQ-9 scores of 10 or above were classified as currently depressed, and those below 10 as without current depression.

    “those scoring above the clinical cutoff (PHQ-9 ≥ 10) were classed as currently depressed, and those below (PHQ-9 < 10) were classed as without current depression (National Collaborating Centre for Mental Health 2018).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites National Collaborating Centre for Mental Health 2018

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The PHQ-9 is a screening tool designed to establish a diagnosis of major depression and grade symptom severity.

    “The PHQ-9 was the primary outcome measure. It is a screening tool designed to establish a diagnosis of major depression and grade symptom severity (Kroenke et al. 2001).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Kroenke et al. 2001 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Therefore, one might expect a smaller effect size in this group compared to the IAPT sample that also included those who took part in CBT as a first-line treatment.

    “Therefore, one might expect a smaller effect size in this group compared to the IAPT sample that also included those who took part in CBT as a first-line treatment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Outlier analysis identified only six cases across four services, and omitting them did not change the pattern of results.

    “Only six cases, distributed across four services, were identified as outliers. Omission of these values did not alter the pattern of results in any way.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The fact that rates of reliable deterioration are below 5% for the total sample and for subgroups entering above and below clinical cutoff for depression suggests that MBCT is generally safe and that reliable deteriorations occur no more frequently after MBCT than with other psychotherapies.

    “The fact that rates of reliable deterioration are below 5% for the total sample and for subgroups entering above and below clinical cutoff for depression, suggests that MBCT is a treatment option which is generally safe, and that reliable deteriorations occur no more frequently after treatment with MBCT than with other psychotherapies.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    A measure of relapse beyond the end of treatment would have been a more appropriate outcome measure for the below-cutoff subgroup, but this information was not available from clinical services.

    “Although a measure of relapse beyond the end of treatment would have been a more appropriate outcome measure for this subgroup, this information was not available from clinical services.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Last observation carried forward is the most conservative approach for missing data when assessing symptom reduction because it assumes no change over time.

    “This provides the most conservative way of dealing with missing data in relation to the question of symptom reduction, the primary focus of this study, as it assumes no change over time.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Missing post-treatment PHQ-9 values would not have changed over time.

  • May combine two claims.

    Study design and conductown data

    There were high rates of missing data in some services, which may have influenced both estimates of positive and negative treatment effects.

    “In particular, there were high rates of missing data in some services, which, as discussed above, may have influenced both estimates of positive and negative treatment effects.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Previous studies of MBCT have not found significant intragroup dependency, and re-analysis of datasets using hierarchical linear modelling has been found to reinforce original findings.

    “Previous studies of MBCT have not found significant intragroup dependency, and re-analysis of datasets using hierarchical linear modelling has been found to reinforce original findings (Williams et al. 2008).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Williams et al. 2008 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Diminishing effect sizes may not be inevitable, and some adaptations may reflect positive infidelity that better fits the intervention to the population.

    “However, it seems that diminishing effect sizes may not be inevitable. Some adaptations may be the result of 'positive infidelity': the introduction of well-informed modifications to an intervention’s delivery to ensure that it best meets the needs of the population to which it is being applied.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    Rates of session attendance were generally high and dropout rates relatively low, very similar to those observed in RCTs of MBCT for relapse prevention in recurrent depression.

    “Rates of session attendance were generally high and rates of drop out from treatment were relatively low and very similar to those observed in RCTs of MBCT for relapse prevention in recurrent depression (e.g. Kuyken et al. 2015; Ma and Teasdale 2004; Teasdale et al. 2000; Williams et al. 2014).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Kuyken et al. 2015 source

      Not checked in the free run.

    • cites Ma and Teasdale 2004 source

      Not checked in the free run.

    • cites Teasdale et al. 2000 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    It is well established that people from Black, Asian and minority ethnic backgrounds in the UK face barriers to accessing mental health services.

    “It is well established that people from Black, Asian and minority ethnic backgrounds in the UK face barriers to accessing mental health services (e.g. Sashidharan 2003; Memon et al. 2016).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Sashidharan 2003 source

      Not checked in the free run.

    • cites Memon et al. 2016 source

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  • Classified as probably not a substantial claim.

    Premisecitation

    A PHQ-9 score of 10 or above indicates clinically significant depression symptoms, or caseness.

    “A cutoff score of 10 or above indicates clinically significant depression symptoms, or ‘caseness’ (Kroenke et al. 2001).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Kroenke et al. 2001 source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductcitation

    Not correcting for pre-post correlation when computing effect sizes would have artificially inflated correlations and produced less conservative effect size estimates.

    “When computing effect sizes, we did not correct for the correlation between the pre- and post-treatment means despite the within-subjects design (Morris and DeShon 2002); given that we used the LOCF method to deal with missing data, this would have artificially inflated the pre- to post-treatment mean correlations leading to less conservative estimates of effect size.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Morris and DeShon 2002 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Because session attendance patterns were unavailable, the interval between first and last data collection could not be calculated.

    “There was no information on pattern of session attendance available, so it was not possible to calculate the length of the interval between first and last data collection point.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationown data

    The current data suggest that whilst MBCT can be safely and effectively delivered to individuals who are both in remission and symptomatic, it may be best conceptualised as a second-line treatment.

    “Therefore, the current data suggest that whilst MBCT can be safely and effectively delivered to individuals who are both in remission and symptomatic, we would suggest it may be best conceptualised as a second-line treatment.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Depression is typically a lifelong, recurrent disorder.
    • Rests on an assumption: Many services have chosen to offer MBCT as a second-line treatment.

  • May combine two claims.

    Interpretationcitation

    53% of our sample entered MBCT with acute depressive symptoms, and the effect size for outcomes (d = 0.86), whilst large, is smaller than for IAPT depression services as a whole.

    “However, 53% of our sample entered MBCT with acute depressive symptoms, and whilst acceptability and effectiveness were again encouraging, the effect size for outcomes, d = 0.86, whilst large, is smaller than for IAPT depression services as a whole (Clark 2018).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Clark 2018 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    In summary, our findings suggest that MBCT in real-world settings is acceptable and effective.

    “In summary, our findings suggest that MBCT in real-world settings is acceptable and effective.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In line with other recent work, services are offering MBCT to a broader population.

    “In line with other recent work (Rycroft-Malone et al. 2017), services are offering MBCT to a broader population.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Rycroft-Malone et al. 2017 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    Models of delivery in other countries are likely to differ from that of England, and so it is unclear whether the outcomes of this study would translate to other forms of MBCT delivery taking place internationally.

    “Models of delivery in other countries are likely to differ from that of England, and so, it is unclear whether the outcomes of this study would translate to other forms of MBCT delivery taking place internationally.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    This study recruited services from NHS England, and so the findings only reflect this country's model of service provision.

    “Another limitation was that this study recruited services from NHS England, and so the findings only reflect this country’s model of service provision.”
    Quote in the paperNot a substantial claim
44 of 44

  • The authors state this as an assumption.

    The treatment target differed between the non-depressed and depressed entry groups.

    “It can be reasonably assumed that the target of treatment was different for each of these groups, and therefore, we examined separate outcomes for each.”

  • The paper relies on this without support.

    The observed 3% reliable deterioration rate is comparable to rates seen in other psychotherapeutic interventions in similar settings.

    “For both subgroups, the rate of reliable deterioration (3%) was comparable to other psychotherapeutic interventions delivered in similar settings.”

  • The authors state this as an assumption.

    Missing post-treatment PHQ-9 values would not have changed over time.

    “as it assumes no change over time.”

  • The paper relies on this without support.

    The five participating NHS services are representative of routine clinical settings for MBCT.

    “five were eligible to participate, which covered four geographical regions in England and included a range of different types of service.”

  • The authors state this as an assumption.

    The treatment targets for the below-cutoff and above-cutoff groups are different.

    “We examined the outcomes of these two groups separately, on the premise that their treatment targets would be different.”

  • The paper relies on this without support.

    MBCT was originally designed as a relapse prevention treatment for individuals at high risk of depressive relapse to learn skills while well.

    “MBCT was first designed as a relapse prevention treatment for individuals at high risk of depressive relapse to learn skills whilst well”

  • The paper relies on this without support.

    Depression is typically a lifelong, recurrent disorder.

    “depression is typically a lifelong, recurrent disorder”

  • The paper relies on this without support.

    Many services have chosen to offer MBCT as a second-line treatment.

    “Indeed, many services have chosen to offer MBCT in this way.”
8 of 8

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Consistentt(1553) = 22.46reported p < .001 · recomputed p < .001

    “t(1553) = 22.46, p < .001”

  • Consistentt(725) = 8.21reported p < .001 · recomputed p < .001

    “t(725) = 8.21, p < .001”

  • Consistentt(827) = 22.78reported p < .001 · recomputed p < .001

    “t(827) = 22.78, p < .001”

  • ConsistentF(4, 1553) = 13.8reported p < .001 · recomputed p < .001

    “F(4,1553) = 13.80, p < .001”

4 of 4

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Robin is described as having no missing data despite a reported missing-data rate

    Minor

    The discussion says Robin had no missing data, but the methods report that 0.79% of its post-treatment data were missing.

1 of 1

Cites

Flagged first, then by citations

4 of the 66 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. Lu, S. (2015). Mindfulness holds promise for treating depression. Monitor on Psychology, 46(3), 50.
  2. World Health Organization. (2008). The global burden of disease: 2004 update. Geneva: WHO.

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Related

Authors
Tickell, A., Ball, S., Bernard, P., Kuyken, W., Marx, R., Pack, S., Strauss, C., Sweeney, T., & Crane, C.
Affiliations
  • University of Oxford (GB)
  • University of Exeter (GB)
  • Tees, Esk and Wear Valleys NHS Foundation Trust (GB)
  • Sussex Partnership NHS Foundation Trust (GB)
  • Oxleas NHS Foundation Trust (GB)
  • University of Sussex (GB)
  • Nottinghamshire Healthcare NHS Foundation Trust (GB)
Corresponding author
Crane, Catherine
ORCID
Venue
Mindfulness
Publisher
Springer Science and Business Media LLC
Published
2019-01-12
Volume
11
Issue
2
Pages
279-290
ISSN
  • 1868-8527 (ISSN-L)
  • 1868-8535
DOI
10.1007/s12671-018-1087-9
PMC
PMC6995449
OpenAlex
W2908787009
Semantic Scholar
0eac399cf3fe5470262a1d792b0751693bab7778
Cited by
99
References
66
Citations by year
2026: 10 · 2025: 22 · 2024: 16 · 2023: 10 · 2022: 19 · 2021: 14 · 2020: 6 · 2019: 2
FWCI
11.97
Type
journal article
Language
en
Open access
Licence
Locations
  • Mindfulness (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Open Research Exeter (University of Exeter) (acceptedVersion, cc-by)
  • Figshare (submittedVersion)
Funders
Wellcome Trust (104908/Z/14/Z & 107496/Z/15/Z)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
mindfulness-based cognitive therapy, depression, depressive relapse prevention, routine clinical practice, treatment effectiveness, residual depressive symptoms, treatment safety, implementation, PHQ-9, mental health services

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read under definition version 3 (extract-v3) on 2026-09-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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