Mindfulness-Based Cognitive Therapy and the Role of Psychiatry

Background: Mindfulness-based cognitive therapy (MBCT) now has established efficacy and effectiveness in reducing risk of major depression where people have had recurrent episodes. The evidence base for this includes multiple RCTs, with a multi-site pragmatic trial led by the authors reported in 2014 in the ANZJP. Something of a consensus position exists in the field about training requirements for practitioners, as set out in guidelines from the UK, where it has for some years been included in NICE guidelines. As primarily a group-based intervention, it can be challenging to implement in typical mental health care settings and existing MBS items are not well suited to delivery.

Objectives: To orient psychiatrists to MBCT, enabling consideration of how to select and prepare patients for possible participation and to inform regarding training requirements.

Methods: After briefly summarising the evidence base, including key results from the recent Australian study, consideration will be given to the pragmatics of MBCT in clinical practice including availability, applicability of MBS items and the development of an individual delivery model.

Findings: While the evidence base is strong, there is very variable availability of MBCT, and widely available funding streams are not well suited to supporting its delivery.

Conclusions: Psychiatrists in adult practice seeing patients with depression should be aware of MBCT as a technique, and should have capacity to prepare patients for it and support them through it. Among this profession delivery of MBCT is likely to remain a minority pursuit but there are possible system reforms that could encourage this.