Preliminary Analyses of Recruiting Centre for Mindfulness Research and Practice Elaine Weatherley-Jones & Mariel Jones Presentation for the ‘Mindfulness Now’ conference, Bangor, 10 th April, 2011

Research Aims To explore the benefits of two new psychological treatments for people who have been depressed and suicidal in the past: Mindfulness-Based Cognitive Therapy (MBCT) – a group- based treatment programme that combines training in mindfulness meditation and yoga with cognitive therapy Cognitive Psycho-Education (CPE) identical in content to MBCT, except there is no meditation component

Referral Flow Chart Aged between 18 and 70 inclusive? History of Major Depression: Three or more previous episodes? Inform patient that they may be eligible for participation in the study Are currently well or in remission? At least once in the last two years At least twice in the last five years Yes

Potential Barriers Identified Stigma attached to depression and suicidality Largely rural communities Welsh socio-cultural ethos Low population density Low SES area Large geographical area

Bangor site recruitment target/outcome figures 180 participants for each site (Bangor/Oxford) 771 contacted the trial in Bangor 519 screened 202 assessed 123 randomised

Strategy for Early Cohorts Encouraging direct referral by primary and secondary care professionals Encouraging self-referral using poster campaign, media and advertising

Strategy in later Cohorts Direct referral, change in emphasis to searches of patient databases (managed by NISCHR CRC ) Media, increasing focus on TV and radio coverage to include an advert on a local radio station and use of Web based advertising

Back to what we learned

Conclusions The high level of interest in this trial suggests that many people in North Wales are suffering with depression and experience a gap in service provision The feasibility of recruiting in a largely rural, bilingual, low SES area is promising despite the barriers to recruitment Posters campaigns and media coverage are the most effective means for generating self-referrals Radio advertising is recommended as being very effective in generating high levels of interest, however it requires careful orchestrating to avoid an influx of ineligible people as well as people who cannot be contacted back

Recruiting via direct referral from primary or secondary mental health services is poorly indicated for people who are currently well Data base searches and self-referrals have proven to be the most effective strategy for this population Collaborative working with NISCHR CRC plays a key role in facilitating Primary Care data searches Recruitment in culturally diverse areas such as North Wales requires a flexible recruitment strategy that is responsive Collaboration between (similarly oriented) research teams that concurrently liaise with GP surgeries and other health care professionals is indicated to reduce confusion and competition, as well as to share support and expertise

A pilot of feasibility and effectiveness Sholto Radford (CMRP)

MBCT within a Primary care setting WaMH in PC funding to deliver MBCT in GP surgery (Victoria Doc Caernarfon) Presentation to GP’s and information packs given GP’s referred patients for past depression, current mild to moderate depression, anxiety disorders and CFS. Interview with teacher to assess suitability

Methodology Single sample repeated measures design (pre/post & six month follow up) Primary outcomes - depression (HADS, PHQ-9) and anxiety (HADS) Secondary outcomes - rumination (RRS), self compassion (SCS) and well being (WBI-5). GP survey (posted to 52 GPs in Arfon and South Anglesey)

Fifteen of the twenty one participants in the MBCT group completed pre and post intervention questionnaires. Female = 10 male = 5 Age 33-60, mean 47 Past psychological treatment N=10 Current anti depressants N= Past depression (N=12) Chronic Fatigue Syndrome (N=5) Anxiety (N=5)

Appropriate referral Low drop out (two of the twenty one MBCT participant's) High attendance Positive feedback from participant's (high ratings of importance and positive comments) Survey revealed GP’s (N=10) Supported a shift to more preventative methods for dealing with mental health problems Felt that Primary care was the most suitable setting for MBCT Would regularly refer patients if it was routinely available (6-30 per year M= 14) Felt that counsellors would be the most suitable professional group to deliver MBCT in primary care Were not generally enthusiastic about receiving training in MBCT themselves Feasibility

Pre / post intervention outcomes ** Significant to p<.01

Depression – HADS

Depression – PHQ-9

Anxiety – HADS

Encouraging preliminary findings Appears to be effective for individuals with mild and moderate depression Leads to positive changes in Rumination, Self compassion and well being Six month follow up data will confirm if outcomes are maintained Limitations (sample size, absence of control group) Conclusions

Acknowledgements Eluned Gold Dr Gareth Owen Rebecca Crane Catrin Eames Stephanie Hopwood Sophie Podmore Katrina Drew Hannah Owen

Catrin Eames Centre for Mindfulness Research and Practice Presentation for the ‘Mindfulness Now’ conference, Bangor, 10 th April, 2011.

Prof. Richard Bentall, Filippo Varese, Alisa Udachina Dr. Val Morrison, Polly Barr Judith Soulsby, Anne Douglas, Rebecca Crane, Sholto Radford

Increasing evaluations of mindfulness in clinical settings CMRP deliver 3 eight-week courses annually Increasing interest (and waiting lists!) but no formal evaluation of the CMRP courses Systematic evaluation of courses delivered to general population groups assessing the psychological factors believed to be influenced by mindfulness training Routine assessment of response to mindfulness training

Pre- (T0) and post- (T1) intervention, 6 (T2) and 12 (T3) month follow-up Intervention and waiting-list control No exclusion criteria Measures Demographic questionnaire (T0) Hospital Anxiety Depression Questionnaire (HADS; Zigmond & Snaith, 1983) Perceived Stress Scale (Cohen, Kamarck & Mermelstein, 1983) Well-Being Index 5 (World Health Organization, 1996) Five Factor Mindfulness Questionnaire (Baer et al., 2006) Ruminative Responses Scale (Nolen-Hoeksema, 1991) Self Compassion Scale (Neff, 2003)

Intervention N= 23Control N = 6 Gender18 female 5 male6 female AgeM = (SD = 12.99) Range M = (SD = 12.95) Range Married/Never married 14 / 95 / 1 Living alone/ Living with others 7 / 161 / 5 Table 1: Baseline demographic data for T0 and T1 completers ¥ Note: Some participants did not provide this data. Figures derived from Intervention N = 15, Control N = 5

Intervention N= 23Control N = 6 Previous Medication (Yes/No) 15 / 82 / 4 Current Medication (Yes/No) 8 / 14¥ 1 / 5 Meditation Previously (Yes/No) 19 / 45 / 1 Meditation in last year (Yes/No) 12 / 115 / 1 Frequency of meditation in last year Daily N = Weekly N = Monthly N = 1 < Once Monthly N = Weekly N = 2 < Once Monthly N = 3 Table 2: Baseline medication and meditation history for T0 and T1 completers ¥ One participant did not provide this information

Figure 1: Psychological disorders history (percentages by group) N = 29

Figure 2: Reported reasons for wishing to attend course (percentage by group) N = 29

MeasureFd HADS Anxiety subscale11.83*.44 HADS Depression subscale9.83*.23 Perceived Stress26.01**1.1 RRS Brooding21.23**.67 RRS Reflection15.37*.05 Well-being43.26**.35 FFMQ Observe26.81**.70 FFMQ Describe91.83**.08 FFMQ Aware42.26**.41 FFMQ Non-Judgement58.54**.84 FFMQ Non-React11.53*.53 SCS Total Mean40.82**.87 Table 3: Complete sample Analysis of Covariance adjusted for T0 score and group N = 29 * p<.01, ** p<.001. NB. df (1, 26). d.2 = small,.5 = medium,.8 = large

MeasureFd HADS Anxiety subscale15.22**.08 HADS Depression subscale7.77*.50 Perceived Stress14.56**.79 RRS Brooding19.61***.33 RRS Reflection7.97*.81 Well-being36.96***1.3 FFMQ Observe18.31***.85 FFMQ Describe64.97***.77 FFMQ Aware25.65***1.2 FFMQ Non-Judgement35.66***.78 FFMQ Non-React7.62*.67 SCS Total Mean22.22***.82 Table 4: Intervention only Analysis of Covariance adjusted for T0 score and Current Meditation N = 23 * p<.05, ** p<.01. ***p<.001 NB. df (1,20). d.2 = small,.5 = medium,.8 = large

Global improvements for intervention vs control Improvements demonstrated when take into account existing meditation practice A feasible intervention for the general population to enhance well-being, reduce stress, anxiety, depression Follow-up data will indicate whether changes are maintained

Differing designs, differing barriers Referrals/ Accessibility Feasibility Transition into routine practice