Abstract

Depression is the leading cause of disability globally and has serious consequences for the individual, their family and for society. Effective, accessible and affordable treatments are urgently needed. In-person group-based mindfulness-based interventions are an effective treatment for depression, but are not widely available and can be costly. Clinician supported use of mindfulness self-help resources such as mindfulness smartphone applications could widen access at a reduced cost, but there are key feasibility questions that need answering. This is a mixed-methods feasibility study of a blended intervention involving the mindfulness smartphone app Headspace alongside six clinician support sessions with mental health treatment seeking adults experiencing moderate to moderately severe symptoms of depression. In line with recommendations for feasibility studies, we examine whether: (1) it is possible to recruit participants to this novel intervention, (2) participants engage with the intervention, (3) participants and clinicians find the intervention acceptable, and (4) pre-post outcomes on measures of depression (primary outcome), anxiety, wellbeing, mindfulness, self-compassion, rumination and worry indicate effectiveness. Findings show that recruitment is feasible with 54 participants enrolled in the intervention within a 6-month window. In terms of engagement, 44.4% completed at least 80% of recommended Headspace sessions and 72.2% of participants attended at least three clinician support sessions. Clinician-supported Headspace was deemed acceptable by participants and clinicians. Pre-post effect sizes were statistically significant and in the small-medium or medium-large range on all outcomes, with an effect size of d = 0.69 (95% CI: 0.34–1.04) for the primary outcome of depression symptom severity. The number of Headspace sessions engaged with was associated with greater reduction in depression symptom severity. Findings suggest that a blended intervention combining Headspace with clinician support has potential as a first-line treatment for moderate/moderately severe depression, but findings are too preliminary to recommend the intervention outside of a research trial. Important caveats are noted including the need for future research to examine predictors of engagement with Headspace sessions so that engagement can be enhanced, to measure the longer term effects of such interventions and to better understand the potential for lasting negative effects of the intervention so that these can be minimised.

Highlights

  • Depression is the leading cause of disability globally and has serious consequences for the individual, their family and for society

  • Self-help cognitive behaviour therapy (CBT) resources supported by a mental health practitioner are recommended in the UK as an afford­ able first line treatment for depression (National Institue of Health and Care Excellence [NICE], 2011) and are offered in the National Health Service (NHS) in England through its Improving Access to Psychological Therapies (IAPT) service

  • Meta-analyses of Randomised Controlled Trials (RCTs) show that self-help Mindfulness-Based Interventions (MBIs) are effective at improving depressive symptoms in comparison to control conditions (Cavanagh et al, 2014; Spijkerman et al, 2016), most studies are in non-clinical populations meaning that the effectiveness of selfhelp MBIs in treating depression in mental health treatment seeking populations is not well understood

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Summary

Introduction

Depression is the leading cause of disability globally and has serious consequences for the individual, their family and for society. Clinician supported use of mindfulness self-help resources such as mindfulness smartphone applica­ tions could widen access at a reduced cost, but there are key feasibility questions that need answering This is a mixed-methods feasibility study of a blended intervention involving the mindfulness smartphone app Headspace alongside six clinician support sessions with mental health treatment seeking adults experiencing moderate to moderately severe symptoms of depression. Meta-analyses of RCTs show that self-help MBIs are effective at improving depressive symptoms in comparison to control conditions (Cavanagh et al, 2014; Spijkerman et al, 2016), most studies are in non-clinical populations meaning that the effectiveness of selfhelp MBIs in treating depression in mental health treatment seeking populations is not well understood It is unclear if self-help MBIs would be of interest to and an acceptable treatment for people experiencing depression and if a blended approach, integrating self-help MBIs with clinician support, may be warranted. A randomised controlled trial of internetdelivered MBI for depression with coaching support found significant effects on depression symptom severity in comparison to treatment as usual and a systematic review comparing guided with unguided internet-based (non-mindfulness) interventions found that guided in­ terventions were more effective and had higher rates of engagement

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