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MBCT Relapse Prevention Indication — MRCPsych Paper B MCQ

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ModerateMood DisordersMBCT Relapse Prevention IndicationMRCPsych Paper B

A 42-year-old has achieved remission from a third episode of depression after treatment with an antidepressant alone. Two episodes occurred within the past 2 years, and rumination persists despite remission. They are assessed as being at higher risk of relapse, wish to discontinue the antidepressant gradually, and request psychological treatment to help them remain well. Which intervention is most consistent with NICE guidance?

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Correct answer: D — MBCT with an explicit focus on relapse-prevention skills

MBCT with an explicit relapse-prevention focus is appropriate. Recurrent and recent episodes, together with residual rumination, indicate a higher risk of relapse. NICE recommends considering group CBT or MBCT for higher-risk people who remitted with antidepressant medication alone but do not wish to continue it; the therapy should develop relapse-prevention skills and usually comprises eight sessions over 2–3 months. Acute-symptom CBT without relapse-prevention work does not meet this specification. Psychodynamic psychotherapy and counselling are not the psychological interventions recommended here, and psychological treatment can reduce relapse risk, so medication is not the only preventive option. Current NG222 does not restrict MBCT to a mandatory threshold of three or more episodes; episode frequency and recency contribute to an overall relapse-risk assessment.

Reference: National Institute for Health and Care Excellence. Depression in adults: treatment and management (NG222), recommendations 1.8.2 and 1.8.5–1.8.6. 2022; reviewed 2026. https://www.nice.org.uk/guidance/ng222/chapter/recommendations