A promising new study has shed light on mindfulness-based cognitive therapy (MBCT) as an effective, affordable treatment for people whose depression persists despite standard care, with implications for improving support strategies in Thailand’s mental health services. The research, recently highlighted by The Conversation, found that MBCT could fill a crucial gap for the so-called “missing middle”—patients left behind after common therapy and medication fail to fully relieve their symptoms.
Around 30% of people living with depression face an unyielding daily struggle: even after therapy and medication, the fog of low mood, fatigue, and hopelessness lingers. This phenomenon not only takes a toll on individuals, but also affects Thai families, workplaces, and the broader economy, echoing trends observed globally. Depression, already a leading cause of disability in Thailand, imposes significant direct and indirect costs on society, including lost productivity and higher health care expenditures (WHO Thailand).
Internationally, the challenge of treating people who do not respond to standard interventions is well-documented. The new study, led by clinical psychologists and published in May 2025, underscores that despite large-scale therapy programs—like England’s NHS Talking Therapies, which supports over 1.2 million people each year—about half of those treated still feel depressed upon completing care. For many, further treatment options are lacking, leaving them in a state of limbo: ill enough to need more support, but not sick enough to qualify for specialised mental health services (The Conversation).
In Thailand, a similar gap exists, with the Department of Mental Health noting that mental health resources—especially specialist therapists—are stretched thin, and many people with moderate or persistent depression end up cycling between basic care at local health clinics and long waiting times for more intensive support (Thai Public Health Ministry). This context makes the latest research on MBCT especially relevant.
In the study, more than 200 patients who had finished standard therapy but continued to experience depression symptoms participated. Half joined an eight-week MBCT course via small online groups; the other half continued with usual care. MBCT blends cognitive therapy, which challenges negative thinking styles, with intensive mindfulness training that encourages staying present, identifying harmful thought patterns, and responding to tough emotions with compassion. The result is a toolkit participants can use throughout their lives.
Outcomes were encouraging. Those in the MBCT programme experienced greater improvements in depression symptoms compared to those receiving standard care. Six months later, not only did benefits persist—they slightly increased. Moreover, MBCT participants made fewer demands on health and social care services in the following six months, demonstrating cost-effectiveness with the programme costing less than £100 (about 4,600 baht) per person.
One clinical lead from the research explained, “When depression doesn’t respond to standard treatment, it upends lives—people struggle to work, maintain relationships, and care for families. MBCT gives people practical skills to manage their symptoms and reclaim their agency.”
This potential paradigm shift is especially compelling amid constrained health care budgets. In Thailand, the strain on public health resources often means long waits for psychological therapy and minimal follow-up after initial interventions (Bangkok Post). Integrating MBCT into Thailand’s existing community health networks could relieve some of these pressure points. The therapy’s group format, low cost, and adaptability to online delivery are all strengths for Thai service providers aiming to extend care into rural areas or underserved urban communities.
MBCT is already approved in some countries as a preventive intervention to avoid depression relapse, and a core strength is its focus on building practical coping skills. The study advocates for extending access to MBCT, especially for those stuck in the “missing middle”—those too complex for ordinary GP-level care, but not severe enough for specialist services.
Mental health advocates in Thailand have called for more stepwise, community-based approaches that bridge the gap between basic and specialised care. Integrating MBCT into school wellness programmes, community hospitals, and digital health platforms could help address the rise in depression and suicide, particularly among young people and working-age adults (WHO Thailand).
As a cultural society that values mindfulness, Thailand is especially well-positioned to adapt MBCT principles. Mindfulness already forms a pillar of Buddhist teaching, and many Thais are familiar with meditation practices for well-being. By leveraging Buddhist traditions and recruiting local temple communities and meditation centers as partners, MBCT’s reach and acceptability could multiply, especially in provinces outside Bangkok.
The MBCT model’s focus on group engagement also aligns with Thai social norms emphasising community support. However, adaptation for local contexts should include translation of materials, integration of Thai cultural concepts, and involvement of community health volunteers trained in MBCT basics. Monitoring frameworks would be needed to track long-term impact and promote best practices.
Looking ahead, expanding training opportunities for Thai psychologists, nurses, and counsellors in MBCT could create a pipeline of qualified facilitators. Partnering with digital platforms to deliver MBCT—especially following Thailand’s accelerated adoption of telemedicine during the Covid-19 pandemic—would help broaden its accessibility. Evaluating outcomes in the Thai context could also contribute valuable data for global mental health initiatives.
For Thai readers or families affected by persistent depression, this study offers hope and a practical path forward. Actionable steps include asking health providers about MBCT options, exploring online facilitator-led mindfulness groups, and seeking information from the Department of Mental Health or reputable NGOs. Local Buddhist centers and community health units may also offer mindfulness training that echoes MBCT principles. For policy makers, investing in MBCT pilot projects and supporting nationwide facilitator training could foster more resilient, supportive mental health landscapes across Thailand.
Citations: