Harnessing meditation techniques on the NHS

As it's recommended by NICE, it is now available on the NHS.

We talk to Dr Florian Ruths, a consultant psychiatrist and a cognitive therapist about his experience of putting the research on MBCT into a practical eight week NHS outpatient skill training course.  It is now offered from the Maudsley hospital in South London and is available free to many Londoners.  




FIH: What is your medical background and how did you get interested in meditation?




FR: I first trained as a physician in oncology and haematology before switching to psychiatry.  While doing a postgraduate diploma in CBT at King's College I came across a randomised controlled trial by Mark Williams and John Teasdale which tested mindfulness-based Cognitive therapy on people with depression. 



I thought 'this is a truly amazing study' because it was as effective to treat people with Mindfulness based CT in groups as it is to treat people singly with CBT alone.  The relevance of these findings had not sunk in at that stage - it was just a journal article.  I started to buy a few meditation CDs and got interested in the work of Jon Kabat-Zinn who first brought meditation as Mindfulness Based Stress Reduction  to US hospitals in the 80s.



Back then meditation and yoga were still seen as hippy and odd.  Kabat-Zinn wanted to take “the Buddhism out of meditation”, so that people of others faiths or none would feel at ease with doing this simple practice.  He used it in hospital settings for thousands of patients who were distressed by often serious chronic illness not responding to biomedical treatment.  The conditions he treated ranged from general physical illness to chronic pain and anxiety.



In 2003 I went to see Jon Kabat-Zinn after I had practised meditation for a year or so myself.  Then I was keen to try MBCT on my patients but didn't want to harm anyone!  So for my first attempts at facilitating an MBCT course the 'patients' were 20 colleagues, all mental health professionals and psychologists.  I also got a great deal of support from Mark Williams who had co-authored the paper that started it all off.

Together we ran a small Mindfulness Based CT research trial.




FIH: When did you start working with patients and how did they respond?




FR: In 2004/5 I felt confident that we could apply these ideas without doing harm, and started to use MBCT with patients. These days of course, yoga and meditation are everywhere so patients were very open to it.   Though there's some evidence for the use of this therapy for general anxiety, panic attacks and bipolar disorder, the strong RCT evidence is for those with three or more recurrences of depression.  So that's our main patient group, and it's now NICE recommended for people in this category.




 

FIH: How has the perception of depression changed in the last few decades and how has that affected treatment?




FR: A few years ago, depression was seen as an acute disease like pneumonia - you catch it, you get very ill, there's a crisis and then you recover.  Now we understand it much more as a chronic vulnerability to disease like high blood pressure or diabetes.  Everyone has different vulnerabilities - just as I have to take exercise and watch my lifestyle so I don't get a recurrence of back injury, others will be vulnerable to depression.  With good self-knowledge, a susceptible person can spot the signs and in many cases head off spiraling into serious depression.




 

FIH: Can you talk us through a typical session?




FR: A  course of MBCT consists of  eight weekly two-hour sessions. Each session deals with a different kind of meditation - for instance meditating on the body, stretching or yoga meditation, three minute breathing space, mindful eating - mindfulness while having a  shower even.  The important thing is to bring the mind to where the body is now, rather than being constantly distracted. Meditation is combined with skills used in generic CBT for depression.

 

FIH: Who is the course for?



FR: It's not for people who are currently depressed, but rather people who have had two or three episodes before, are currently recovered and want to find a way to protect themselves against further episodes.  We haven't really advertised our MBCT group London-wide yet, but it's available to many Londoners  - in most cases it's just a question of going to your GP and asking - if your particular PCT is signed up for our service your doctor can refer you.  It does help for attendees to have had a psychological assessment before - it tends to speed up the inclusion process. 

Our sessions run in the early evening, so people who are working can still attend.

But really anyone who isn't in the middle of a depressive episode can get some tapes and try out meditation at home by themselves.  There's a book called 'The Mindful way through depression', by Mark Williams which is a great starting point.




 

FIH: How unique are you? Are there other services doing this?




FR: Even though we were one of the first NHS services to offer MBCT in London, we're not the only one. WE are regularly evaluating the outcomes of our MBCT program delivery, so that we offer a high quality service – MBCT is increasingly available through other psychotherapy services.  But it's patchy, and I'm not sure where they all are.




 

FIH: What kinds of effects can people typically expect from your course?




FR; Overall, it reduces the risk of relapsing back into depression by about 50%.  Someone who has had three bouts of depression has a 80 - 90% chance of it happening again - Mindfulness based CT brings that down to about 40%.  And even those MBCT participants who still do get some depression often report that they deal with their emotional upsets in a different, less distressing way. 

The sorts of skills it teaches are first of all kindness to yourself - many people with or without depression don't like to look after their own needs very much, so it helps to allow to direct kindness towards that person that looks after others, e.g. through supporting children or holding down jobs.

It helps with awareness of how the depressed mind works - many people find themselves ruminating about the same issues over and over again.  MBCT can help to become aware of the ways of the mind and make choices how to deal with it in a different way.

It also helps to create a lighter hearted relationship with our thinking.  The views of reality our brain comes to are a series of hypotheses about the world around us, which may or may not reflect reality.  MBCT helps people not to take the most negative construction their minds can apply to events as a cast iron truth.  We are bigger than our thoughts tell us, and the course can allow people to step back and see wider perspective on life and realities.