Mindfulness-based depression treatment for a hard to reach population through web and telephone groups

Introduction: Depression is a major public health problem, especially among people with chronic diseases such as epilepsy. Compounding this problem are issues like driving restrictions or other mobility limitations that create barriers to accessing depression screening and treatment. Stigma may further dissuade some from seeking care. This paper describes the development and formative evaluation of a small-group depression intervention for delivery by telephone or Internet to reach people with epilepsy at home. Methods: Beck and Colleagues' cognitive therapy of depression with Segal and colleagues' mindfulness modifications guided the development of the Project UPLIFT (Using Practice and Learning to Increase Favorable Thoughts) intervention. Three focus groups of people with epilepsy assessed the appropriateness of the information, activities, and measures proposed for inclusion in the intervention. Results and Conclusions: The final intervention was comprised of 8 hour-long sessions including discussions, instruction, and skill-building activities. The focus group participants valued the group delivery, responded favorably to the cognitive and mindfulness activities, and provided suggestions for improvement. Based upon input from experts and the focus groups, activities were selected and modified to best serve the target population. Home-based group therapy via telephone and Internet is cost effective and allows more individuals to be reached and treated. Another potential benefit of distance delivery is the relative anonymity it allows persons who may feel embarrassed by their physical and/or mental health; distance settings may ease the sharing of this information.