According to the U.K. National Health Service (NHS), half of patients treated for depression continue to experience symptoms above clinical thresholds after completing a course of NHS-delivered individual psychotherapy. Standard treatment typically involves cognitive-behavioral therapy, with patients attending an average of eight sessions.

There is the question of what is the best and most cost-efficient way to treat patients whose symptoms fail to remit following standard treatment, which typically combines medication and short-term psychotherapy.

Mindfulness-Based Cognitive Therapy (MBCT), which integrates mindfulness training into cognitive therapy, may offer added value for patients who have not fully responded to conventional treatments. As a short-term, group-based intervention treatment, MBCT may also be less expensive than other adjunct options.

Barnhofer et al. [The Lancet Psychiatry] examined the clinical effect and cost-effectiveness of group-based MBCT for patients whose depressive symptoms remained unremitted after individual psychotherapy. They compared MBCT plus treatment-as-usual (TAU) to TAU alone.

The researchers recruited 234 adult patients (average age = 42 years; 71% female; 86% White) from 20 NHS clinics. Eligible participants either still had clinical levels of depressive symptoms  after receiving at least 12 sessions of psychotherapy or showed clinical levels of symptoms of depression six months post-treatment. On average, participants reported six prior depression episodes, and about two-thirds also had a comorbid anxiety disorder.

Patients were randomly assigned to MBCT plus TAU or TAU alone. MBCT involved eight weekly group sessions delivered via synchronous videoconferencing. All participants were permitted to continue any ongoing care and follow recommendations from their general practitioners. 

In the MBCT group, 69% of participants were taking medication, compared to 74% in the TAU group. Additionally, 27% of MBCT participants received outside psychological services (e.g., counseling), versus 40% in the control group. The primary outcome was self-reported depression.

Assessments were conducted at baseline, 10 weeks, and 34 weeks. Cost data were collected from NHS records, and quality-adjusted life years (QALYs) were calculated according to National Institute for Health and Care Excellence (NICE) guidelines.

Results showed that MBCT plus TAU was superior to TAU. At 34 weeks, the MBCT group had significantly greater reductions in depression scores (Cohen’s d=-0.41). Moreover, 27% of participants in the MBCT group met recovery criteria, compared to 15% in the control group.

MBCT also resulted in $331 lower per-participant costs over the study period. Cost analysis indicated MBCT was likely a cost-effective option.

The study demonstrates that adding MBCT can reduce residual depressive symptom scores above TAU for patients who have not responded fully to prior psychotherapy. The study is limited by the lack of long-term follow-up and the sample’s limited demographic diversity, with a predominance of White and female participants.  

Reference:

Barnhofer, T., Dunn, B. D., Strauss, C.,...Warren, F. C. (2025). 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. The Lancet Psychiatry. 

Link to study