Mindfulness-Based Cognitive Therapy for People with Depression and Cardiovascular Disorders: The Heart and Living Mindfully (HeLM) project.

Abstract

Clinical depression is a chronic and comorbid condition with cardiovascular disorders (CVDs), with its presence leading to worse medical outcomes, higher rates of mortality, poor quality of life, poor adherence to treatment, and high health care costs. Psychological factors, such as higher rumination and health related worry and lower self-efficacy and self-care have been found to be associated with both conditions. As a result, it has been suggested that any psychological intervention aiming to treat co-morbid depression in CVDs needs to target these factors. Mindfulness-based cognitive therapy (MBCT) is a mind-body treatment that has shown promising effects in a wide range of physical conditions, with small to medium effect sizes. However, whether MBCT can help manage comorbid depression in CVD populations remains unclear. Therefore, the Heart and Living Mindfully (HeLM) project was developed to explore this issue. We developed a bespoke MBCT for people with comorbid depression and CVD through three phases. The first phase involved establishing the evidence base for developing the manual through conducting a systematic review and secondary analysis. The second phase pertained to conducting a pilot group for modifying the manual and checking its acceptability. The third and last phase was a feasibility randomised controlled trial (RCT) to uncover uncertainties around the MBCT-HeLM before proceeding with a definitive trial. Overall, the three phases were successful and achieved their goals. The feasibility RCT provided useful information for future studies in terms of using a 3-arm design, recruitment, attrition and retention. The key learning point was that it was challenging to recruit a sufficient number of people into the trial, suggesting future research will need to develop alternative recruitment procedures to be feasible.