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Research transforming care

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Research transforming care
How has research improved care at CAMH, ​and elsewhere? Read about studies on different approaches to care for people with depression and schizophrenia, which have had an impact on patients' lives.


​​Research shows mindfulness benefits people with depression

A modified approach leads to better results for people with schizophrenia

Woman practising mindfulness

 

Reminder sign

Woman practising mindfulness

​“Mindfulness” is a word that tends to pop up at yoga studios – but did you know it has also been proven to be helpful in caring for people with depression?

Dr. Zindel Segal helped create Mindfulness-based Cognitive Therapy (MBCT) through his research at CAMH. This therapy helps people with depression keep their symptoms away, without needing medication. This is important because many people are unable or unwilling to take medication for a long time to prevent their symptoms from returning. 

“Patients need treatment options for preventing depression from returning to their lives,” says Dr. Segal, who is currently based at the University of Toronto.

MBCT combines the practice of mindfulness with more traditional cognitive therapy. Mindfulness involves being present in the moment. It is a kind of meditation that helps relax the mind. Cognitive therapy gives people the practical skills to stop destructive thought patterns. 

Combining these two practices is what makes MBCT so effective for people with depression. MBCT teaches people how to have control over their emotions. It helps people recognize their own triggers for depression. It also gives individuals the tools they need to make lifestyle changes to help maintain mood balance. 

CAMH did a study of the MBCT approach, and the results were published in 2010​The people who joined the study had all been diagnosed with major depression, but they didn’t have any symptoms of depression at the time of the study. These people were randomly split into three groups. 

The first group continued to use medication for their depression. The second group tried MBCT. The third used a placebo medication. The results were very interesting. The study showed that MBCT helped prevent people from having another episode of depression just as well as the medication did. (You can find out more about the study in the article in Archives of General Psychiatry.)

These results give health care professionals the confidence to recommend different treatment options to patients to prevent their depressive symptoms from returning – and give patients a say in which alternative they would prefer.
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A modified approach leads to better results for people with ​schizophrenia

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Can we offer better care for our patients?

This simple question often drives research at CAMH, as health-care providers are motivated to find ways to improve upon existing treatments. One example is a treatment for schizophrenia called cognitive adaptation training (CAT). Initially developed at the University of Texas, CAT has been shown to improve the lives of people with schizophrenia. 

The CAT model addresses the aspects of schizophrenia that typically are not well addressed with standard treatments, including difficulties with memory and attention, keeping up momentum or staying organized.

The treatment involves a CAT clinician and a person with schizophrenia meeting at the client’s home or in a community setting for an hour or more every week for nine months. The two work toward goals set out by the client, which could range from finding volunteer or paid work opportunities to organizing their home or taking part in social or leisure activities. The CAT clinician provides strategies and easy-to-use tools, such as reminder signs, calendars or alarm clocks, to help a client in their own environment.

Research showed that CAT worked, but it required a great deal of clinicians’ time. Also, the benefits that clients experienced did not last after the weekly meetings ended.

Together, researchers at CAMH and the University of Texas decided to study a modified version of CAT that was shorter and less labour-intensive, and with a goal of maintaining improvements. Twenty-four people took part in this pilot study.

The modified CAT study involved pairing a clinician with a person with schizophrenia for four months of intensive cognitive adaptation training, versus nine months in the original model. Over these four months, the pair met for at least an hour a week to work toward the client’s goals.

After this initial stage, the client’s case manager provided followup care for five months. As part of the study, the case manager had received training in providing CAT. The case manager met with the client once or twice a month, as well as by phone or at the clinic as needed.

The study showed that this modified model helped people continue to make progress toward their goals. “We observed truly remarkable improvements in the lives of people with some of the most challenging forms of the illness,” says CAMH’s Dr. Sean Kidd. (You can see the results of this pilot project in the journal Schizophrenia Research.)

The shorter, more sustainable approach could make this beneficial treatment available to more people.

Since completing the study, the research team has trained more than 80 health-care professionals throughout CAMH and at other organizations in providing CAT as a treatment and has developed a regional CAT community of practice for health-care professionals.

CAT is one example of how approaches to mental health care are constantly evolving through research to provide clients with ever-improving care.


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