Mindfulness-based interventions enhance wellbeing: development and implementation

Description of impact

Whilst our research trials have focussed on depressive relapse as a primary outcome [3.1-3.4], we strategically address the wider transfer of the MBCT evidence base into practice settings regionally, nationally and internationally. The beneficiaries of MBCT delivery include patients; members of the general public; education and health professionals; and policy-makers [5.1-5.8]. Impact on the general public An on-going programme of delivery of 8-week MBCT courses reaches the general public in Bangor and London, and within the local NHS hospital cancer service for cancer patients and their carers. Between August 2008 and July 2013, 1173 general public participants participated in our courses, 514 of whom received financial support due to socioeconomic disadvantage. A further 228 service users participated in our conferences, which include experiential training. 300 cancer patients and their carers have participated in the charity-funded MBCT for Cancer programme, with evidence of benefits to wellbeing and adjustment.

To extend occupational and organisational impact, we also take MBCT into the workplace context. The Centre for Mindfulness Research and Practice has been contracted to offer eight ‘Mindfulness and Wellbeing Classes’ to Gwynedd County Council staff during 2013 and 2014 - evaluations of the benefits of this programme are underway. To support this, the Centre published a self-help guide for participants (Silverton, 2012), sales of which have exceeded 28,000 copies. Course materials have also recently been developed for Welsh speakers.

Impact on training others in MBCT delivery The Centre for Mindfulness Research and Practice is the largest and leading UK training organisation in this field. Developmental training for professionals who want to up-skill and gain understanding in delivering mindfulness-based interventions is offered at foundational through to advanced teacher training level over a range of residential formats (4-7 days) or through Master classes and training days. These have been taken up by approximately 1310 professionals (~10% international) since 2008. Since 2009, the clinical doctorate programme at Bangor has also worked with the Centre to provide trainees with teaching in the principles of MBCT [5.3-5.5].

To support implementation of mindfulness by professional and practitioner audiences, several books have been authored by Centre staff, on topics such as Mindfulness principles and practice (Crane, 2009, 2012, sales: 11000+); MBCT adapted specifically for those affected by cancer (Bartley, 2012, sales: more than 1200); and applying Mindfulness training in work place contexts (Chaskalson, 2011, sales: more than 2000).

Implementation of MBCT in the UK National Health Service [5.3-5.7] In line with MRC guidance on the development, evaluation and implementation of complex interventions to improve health, implementation remains a key challenge in developing MBCT. Crane has led this on a UK wide level, in collaborations with Kuyken (Exeter) and Williams (Oxford). A survey of MBCT stakeholders (e.g. health, education and social work practitioners) found that MBCT implementation is rarely strategic and that large inequities exist across the UK. In response, we developed a freely available online toolkit for stakeholders involved in MBCT implementation. Over 200 individuals in 73 NHS geographical areas working within the UK services have been supported in their MBCT implementation through training, supervision, consultation and mentoring provided by Centre staff. A National Institute for Health Research study led by Bangor (2013) will scope existing provision of MBCT across UK, examine the benefits/costs of embedding MBCT in mental health services, investigate facilitators and barriers to delivering MBCT, and identify the critical success factors for the routine use of MBCT as recommended by NICE.

Creating a professional context for mindfulness-based teachers across the UK Senior staff from the Centre for Mindfulness Research and Practice led the development of the UK Network for Mindfulness-Based Teaching Organisations. The Network has representation from all the main training organisations in the UK, and has developed consensus on good practice standards for mindfulness-based teachers and trainers. These have had a considerable impact on service delivery in the UK by providing structure and guidance to NHS managers, commissioners and clinicians as they set up MBCT services [5.3-5.5].

Benefits to the economy MBCT is a cost effective intervention for the NHS. When delivered in a group context, the ‘per participant’ rate is reduced in comparison to individual therapies or treatments. For every episode of depression prevented there is a saving of £30 per depression free day for total costs and £14 per day for health service costs.

More locally, the Centre for Mindfulness Research and Practice has grown from employing 0.5FTE staff in 2001 to now employing 7+ staff on contracts within the University. A further 26 teachers/trainers work freelance for the Centre and are based across the UK. Several graduates from Centre training programmes have gone on to set up successful social enterprises delivering Mindfulness-based teaching and training. These include LivingMindfully, who work with Jobcentreplus among others, and Mindfulness-Works, who work in organisational settings including with KPMG, the Home Office, the Cabinet Office, and the Prudential.

Impact Summary for the General Public

There is strong evidence that Mindfulness-Based Cognitive Therapy (MBCT) plays a major role not
only in preventing the recurrence of depression, but also in enhancing well-being more broadly.
Much of this research was carried out at Bangor University’s Centre for Mindfulness Research and
Practice, with a focus on non-academic impact from the outset. Between 2008-2013, the Centre
has delivered MBCT courses to over 1500 members of the public. We have also trained over 1300
professionals to deliver MBCT within the NHS and other contexts, leading to several successful
spin-off businesses. Finally, Centre researchers lead in the creation of UK good practice
standards.

Description of the underpinning research

Mindfulness-Based Cognitive Therapy (MBCT) integrates Mindfulness-Based Stress Reductionwith aspects of Cognitive Behavioural Therapy. It was (and continues to be) developed at BangorUniversity through translational research on the mechanisms of depressive relapse/recurrencefollowing a three-centre randomised controlled trial (1995-8) funded by the Welsh Office ofResearch & Development and the National Institute of Mental Health (USA). This project was ledby Professor Mark Williams of Bangor University (1991-2002) in collaboration with Teasdale(Cambridge) and Segal (Toronto). This research demonstrated that MBCT halves the expectedrate of depression recurrence in those who have experienced three or more episodes [3.1,3.2].Following replication of this result, the approach was recommended in 2004 by the NationalInstitute for Health and Care Excellence (NICE) as an effective depression prevention programme.A body of subsequent trials suggests that it significantly and consistently reduces depressiverelapse rates compared with usual care.These research findings generated widespread interest in MBCT. Recognising this, and in order tostrategically focus our strengths in this area, in 2001 Bangor University founded the Centre forMindfulness Research and Practice. Since then, the Centre has played a leading role in thedevelopment and evaluation of MBCT.An important implication of our MBCT research is that it offers a model that clinicians andresearchers working with other populations can translate to their context through the integration ofcognitive science with a mindfulness-based orientation. Specifically: 1) the central processes onwhich MBCT is thought to have its effects (rumination and experiential avoidance) are transdiagnostic;2) the skills that MBCT trains (attentional focus, self-awareness and self-compassion)have wide applicability; 3) The MBCT manual that was published in 2002 made the programmeform and its rationale explicit and accessible.As a result, MBCT is now adapted, researched and applied across a range of populations includingthose with chronic fatigue, residual depression, bi-polar disorder, anxiety, and chronic physicalconditions; and for children (in clinical and educational contexts) and parents. In Bangorspecifically, we are conducting research to evaluate MBCT adaptations for those affected bycancer; for parents; for children and teachers in school contexts; and for people with learningdisability.We continue to conduct research on depression prevention through an on-going collaboration withProfessor Williams (now at Oxford University). A Wellcome Trust funded randomized control trial,‘Staying Well After Depression’ (2009-2013) investigates the effect of MBCT on cognitivevulnerability to recurrent suicidality [3.3]. A recent British Medical Journal editorial analysedimportant directions for the next phase of depression related MBCT research [3.4], determiningthat one of the areas that requires systematic focus is the implementation of MBCT in the UK health service. Even though it is nearly 10 years since NICE first recommended MBCT, andalthough the 2009 NICE update identified the approach as a key priority for implementation, asubstantial evidence gap remains between the efficacy research and implementation in routinesettings. Bangor has recently secured National Institute for Health Research funding in order tosystematically research the process of implementation of MBCT in the NHS.Finally, we have been at the forefront of responding to the demand for suitable evidence-basedtraining for clinicians, and for leadership on issues of professional practice and implementation. Tothis end, we have led a collaboration with colleagues at Oxford and Exeter to develop amethodology for assessing mindfulness-based teacher competence [3.5, 3.6].

Impact status	Ongoing
Category of impact	Health/Quality of life
Impact level	Benefit