Project MH30

(ATTEND) A mindfulness-based approach for adolescent non-responders to first-line treatments of depression and their carers: establishing feasibility of implementation and delivery

This project aims to explore if mindfulness therapy adapted for teenagers supports recovery from depression and prevents relapse amongst 15-18-year-olds who risk developing recurrent depression as adults.


In the UK, it is estimated that 140,000 15–19-year-olds experience depression. An estimated 35,000 young people access NHS treatment for depression, of which, about 14,000 do not respond. A further 8,000 are likely to experience depression again after initial successful treatment. Teenagers who still have symptoms after treatment for depression, or who relapse quickly, need more treatment options. These young people have a high risk of substance-misuse, self-harm, and school or relationship failure, as well as poor adult mental and physical health. Parenting a teenager with depression is stressful and can damage family relationships. Teenagers whose parents have depression are more likely to develop mental health problems in adulthood. Mindfulness-Based Cognitive-Therapy (MBCT) combines training in mindfulness meditation with principles from cognitive therapy. It teaches skills to recognise early warning signs of depression, avoid repetitive thinking patterns that make depression more likely, and respond in ways that protect mental health. Although MBCT is recommended for adults who have experienced three or more depressive episodes, MBCT for teenagers is relatively untested. We developed Mindfulness for Adolescents and Carers (MAC) as a version of MBCT adapted to be more engaging for teenagers.  MAC aims to help teenagers recover from depression and support parents and carers to cope better.

Project Aims

This project will explore if Mindfulness for Adolescents and Carers (MAC) supports recovery and prevents relapse amongst 15-18-year-olds who risk developing recurrent depression as adults.

This programme would refine, evaluate, and optimise implementation of MAC for young people and their carers, using cutting edge efficient methodologies by drawing on a hybrid effectiveness implementation trial design and advanced modelling methods that aim to address the following question:

  • Could MAC improve recovery among young people with depression who fail to completely respond to first line treatment or relapse rapidly?

Project Activity

This project has five parts that will finalise the therapist-training programme. This includes co-producing an App to encourage and measure mindfulness practice. Recruit 480 teenagers and their parents. Half will access MAC and half will access the standard NHS treatment currently available. This will allow us to compare the differences between the two treatment results and their costs to see whether MAC works and is value for money. This project aims to find out how MAC works and who benefits the most by exploring changes in how teenagers and parents feel, think, and relate to each other. This will better the understanding of how best we can get MAC into mental health services across the NHS. 

This project will be split into 5 different work packages, including: 

  • Work package 1: will optimise training and supervision of practitioners to ensure fidelity in MAC delivery in WP3.
  • Work package 2: will increase adherence to practice and improve the accuracy of the measurement of practice via co-design and co-development of apps (one for young people and one for parents) 
  • Work package 3: will evaluate whether MAC plus treatment as usual (TAU) is more effective and cost-effective in producing a sustained reduction of symptoms of depression in adolescents compared to TAU alone
  • Work package 4: will test whether MAC targets key intermediates on the pathway between treatment and outcome, and whether these targets relate to outcome
  • Work package 5: will produce an implementation plan to support rapid scale-up of MAC should it prove effective and cost-effective.

It is important to note that this project will include Public and Patient Involvement (PPI) in varying roles. 

Anticipated Impact

  • Two manuals (MAC and the MAC training curriculum)
  • Two apps (one for young people and one for carers) to support home practice 
  • MAC Implementation Plan and Toolkit
  • RCT data linked to administrative health and education data that would support longer term follow up
  • Each work package will lead to at least one national or international conference presentation, such as at the British Association of Behavioural and Cognitive Therapists; International Association of Child and Adolescent Mental Health.
  • PPI impact assessment
  • Each work package will produce at least one academic paper

Who is involved?

  • Co-Principle Investigator: Professor Tamsin Ford, University of Cambridge
  •  Co-Principle Investigator: Patrick Smith, King's College London
  • Steve Morris, University of Cambridge
  • Ms Gemma Giove-Hunt, University of Cambridge
  • Kim Goldsmith, King's College London
  • Jessica Richardson, King's College London
  • Kat Nellist, Experts by Experience
  • Leon Farmer, Experts by Experience
  • Rachel Hayes, University of Exeter
  • Vashti Berry, University of Exeter
  • Kristian Hudson, Improvement Academy NIHR ARC Yorkshire and Humber
  • Thorsten Barnhofer, University of Surrey
  • Willem Kuyken, University of Oxford
  • Clara Strauss, Sussex Partnership NHS Foundation Trust
  • Tim Sweeny, Nottingham Healthcare NHS Foundation Trust


Professor Tamsin Ford,