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Jan Scott
Cognitive–behavioural therapy for severe mental disorders: back to the future?
The British Journal of Psychiatry 2008; 192: 401-403 [Abstract] [Full text] [PDF]
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[Read eLetter] Mindfulness Based Cognitive Behavioural Therapy (MBCT) and awareness in basic requirements for Evide
Alain Braillon, Philippe Nicot   (31 July 2008)

Mindfulness Based Cognitive Behavioural Therapy (MBCT) and awareness in basic requirements for Evide 31 July 2008
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Alain Braillon,
MD
University hospitals, 80054 Amiens,
Philippe Nicot

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Re: Mindfulness Based Cognitive Behavioural Therapy (MBCT) and awareness in basic requirements for Evide

braillon.alain{at}chu-amiens.fr Alain Braillon, et al.

We do not share Scott’s statement that efficacy trials for BCT were positive.1 A guideline on depression from NICE concludes: “Mindfulness … may significantly reduce the likelihood of future relapse (grade B)”.2 This recommendation is based on two trials from the same group, the second trial being published after the end of NICE bibliographical search (2003).3,4 Looking at the published data we observed an error in the sum for the “meta-analysis” performed by NICE. The two groups are not 94 and 124 as presented but 150 and 51 respectively (we noticed several patients without data allowing classification)! Moreover, methodological validity is also a serious concern due to a per-protocol analysis with a post hoc stratification and confusion between “no statistical difference” and “equivalence”. Lastly, patients in the mindfulness group consulted more their GP, had more psychotherapy and take more an antidepressant medication than the control group, indicating numerous confounding factors. Accordingly, we conclude “evaluation process for mindfulness: rejected (lack of rational, two poorly designed studies by the same group, limited number of patients, inappropriate statistical methods, alternative available).” Very recently, Williams & al’s tried to clarify evidence for MBCT.5 In fact, they demonstrated major difficulties with elementary calculation concerning the number of patients. In table 1: 28 + 27 = 55 not 155 and 83 + 77 = 160 not 260. Nevertheless, they used for their pledge a Cox model which necessitates complex calculations, rigor and no methodological flaws for its application.

1. Scott J. Cognitive–behavioural therapy for severe mental disorders: back to the future? The British Journal of Psychiatry (2008) 192: 401-403

2. NICE (2004). Management of depression in primary and secondary care. National Clinical Practice Guideline number 23. December 2004. Retrieved July 23, 2008, from www.nice.org.uk/download.aspx?o=236667.

3.. Teasdale, J., Segal, Z.,& Williams, J. Prevention of Repase/Reccurence in Major Depression by Mindfulness-Based Cognitive Therapy. The Journal of Consulting and Clinical Psychology (2000) 68:615- 623.

4. Ma, S.H., & Teasdale, J. Mindfulness-Based Cognitive Therapy for Depression: Replication and Exploration of Differential Relapse Prevention Effects. The Journal of Consulting and Clinical Psychology (2004) 72: 31-40.

5. Williams, J.M.G., Russell I., & Russell R. Mindfulness-Based Cognitive Therapy: Further issues in current evidence and future research. Journal of Consulting and Clinical Psychology (2008) 763: 524–529