Collaboration for Academic Primary Care (APEx) Blog
Collaboration for Academic Primary Care (APEx) Blog
Posted by ma403
27 May 2025We know that around 40-50% of adults who receive evidence-based psychological therapies for depression in primary care mental health services (NHS Talking Therapies, for anxiety and depression; NHS-TTad) do not respond to treatment. Unfortunately, there are limited next-step psychological treatment options available – creating a significant gap in mental health care provision.
One promising candidate for a next-step treatment option is mindfulness-based cognitive therapy (MBCT). MBCT is an eight-week group intervention that combines elements from cognitive behavioural therapy and mindfulness practice. It teaches clients to non-judgementally become aware of their thoughts and emotions, encouraging them to step back and observe these experiences as they arise, rather than becoming caught in patterns of negative thinking. MBCT is currently delivered within NHS-TTad to support depression relapse prevention, but could it help people who have not benefitted from previous therapy? This is what we set out to answer in the ‘RESPOND’ trial, which investigated whether MBCT could be clinically and cost-effective for clients who had not responded to high-intensity NHS-TTad treatment, compared to treatment-as-usual (TAU).
The RESPOND trial funded by the NIHR Research for Patient Benefit programme was led by Professor Thorsten Barnhofer (University of Surrey) and recruited participants from NHS-TTad services in Devon, London, and Sussex. In Devon, the co-lead was Professor Barney Dunn (co-lead of the APEx Primary Care Mental Health theme and AccEPT clinic, University of Exeter), and I supported the trial first as a Research Assistant and later as the Trial Manager at Devon Partnership NHS Trust. Lived experience input was critical in shaping the trial and its research questions. A dedicated lived experience advisory group led by a lived experience team member, Mary Ryan, provided ongoing support throughout the trial.
From NHS-TTad services across England we recruited individuals who had not responded to high-intensity therapy. A total of 234 participants took part in the study; 118 were randomly allocated to received MBCT+TAU and 116 to TAU alone.
Engagement with MBCT was strong – 86% of participants completed at least half the therapy sessions. We found MBCT+TAU was superior to TAU alone in reducing depressive symptoms, and improvements lasted six months post-treatment. MBCT+TAU participants also experienced significant improvements in mental wellbeing and reductions in generalised anxiety, compared to TAU alone.
What’s more, MBCT was more cost effective than TAU, cutting health and social care costs even when accounting for the additional resources required to run the MBCT groups.
The trial results suggest that MBCT is a viable next-step treatment option for people who have not responded to initial NHS-TTad treatments. Our next step is to explore client and therapist views on the acceptability of MBCT within the trial and broader implementation in NHS-TTad services. Since MBCT is already delivered within NHS-TTad services for depression relapse prevention, we will be working closely with Devon NHS-TTad services to train and support the running of MBCT groups for depression non-responders and evaluate both client and therapist experiences. This practice-based insight will help us to understand how to best support wider implementation of MBCT for non-responders across NHS-TTad services in the near future. You can read the full RESPOND trial paper published in Lancet Psychiatry here: https://tinyurl.com/55kkr8ts and see our lived experience team member and co-author Mary Ryan’s thoughts on the trial here: https://tinyurl.com/43j3wtyh
Dr Asha Ladwa is currently a Postdoctoral Research Fellow at the Mood Disorders Centre, University of Exeter funded by the National Institute for Health and Care Research (NIHR) Mental Health Translational Research Collaboration (MH-TRC) Mission. She is setting up the ‘South West Mental Health Gap Practice Research Network’ (https://tinyurl.com/2hu57396) to bring together clinicians, researchers, and lived experience contributors to innovate and conduct research to support clients who fall into the treatment gap between primary and secondary care mental health services.