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A qualitative study of mindfulness-based cognitive therapy for depression
Abstract
Psychotherapeutic interventions containing training in mindfulness meditation have been shown to help participants with a variety of somatic and psychological conditions. Mindfulness-based cognitive therapy (MBCT) is a meditation-based psychotherapeutic intervention designed to help reduce the risk of relapse of recurrent depression. There is encouraging early evidence from multi-centre randomized controlled trials. However, little is known of the process by which MBCT may bring therapeutic benefits. This study set out to explore participants' accounts of MBCT in the mental-health context. Seven participants were interviewed in two phases. Interview data from four participants were obtained in the weeks following MBCT. Grounded theory techniques were used to identify several categories that combine to describe the ways in which mental-health difficulties arose as well as their experiences of MBCT. Three further participants who have continued to practise MBCT were interviewed so as to further validate, elucidate and extend these categories. The theory suggested that the preconceptions and expectations of therapy are important influences on later experiences of MBCT. Important areas of therapeutic change (‘coming to terms’) were identified, including the development of mindfulness skills, an attitude of acceptance and ‘living in the moment’. The development of mindfulness skills was seen to hold a key role in the development of change. Generalization of these skills to everyday life was seen as important, and several ways in which this happened, including the use of breathing spaces, were discussed. The study emphasized the role of continued skills practice for participants' therapeutic gains. In addition, several of the concepts and categories offered support to cognitive accounts of mood disorder and the role of MBCT in reducing relapse.
... This study also emphasized the importance of sufficient support to help the participants implementing new behaviours in their daily life and the need for normalizing RNT. Concerning treatment experiences of different group therapies (CBT, MBSR, MBCT, and COMET), several qualitative studies have indicated the importance of the support of the group, the sharing of experiences between the participants, the training of specific skills, and psychoeducation (Appiah et al., 2021;Bamber & Schneider, 2020;Day et al., 2011;Fitzpatrick et al., 2010;Laberg et al., 2001;Mason & Hargreaves, 2001;McHale et al., 2018;Straarup & Poulsen, 2015). ...
... Firstly, the group format itself was experienced as an important benefit of the RNT-G intervention. Support and learning from peers facing similar problems have already frequently been reported as an important therapeutic factor in different group treatments, not only to improve symptoms but also to reduce stigmatization and isolation (Bamber & Schneider, 2020;Fitzpatrick et al., 2010;Mason & Hargreaves, 2001;McHale et al., 2018). Sharing similar experiences with others increases feelings of empowerment and assertiveness (Abrahamsson et al., 2018;Dixon, 2018;Straarup & Poulsen, 2015). ...
... Especially distancing from non-helpful thoughts, changes in metacognitions, living in the here and now, commitment to exposure instead of avoiding, thinking about problems in concrete terms, and shifting from thinking to action were experienced as helpful tools, indicating the importance of including them in interventions for RNT. These techniques have already been reported to be perceived as beneficial in other studies (Day et al., 2011;Mason & Hargreaves, 2001;Umegaki et al., 2021) and are in line with the theoretical models of RNT: increased alertness at the start of the RNT-process, reallocation of attention (Koster et al., 2011), stimulus control (Borkovec et al., 1983), accepting and switching from a thinking modus style to valued action (Watkins, 2016), and living in the here and now (Borkovec, 2002). ...
Objectives:
Treatment of repetitive negative thinking (RNT) focuses rather on individual than group cognitive behaviour therapy (CBT) treatment. Additionally, little is known on how clients experienced these interventions. This study investigates clients' experiences on participating in a CBT group intervention targeting RNT (RNT-G).
Design:
Of the 80 participants, 11 were randomly selected for an in-depth, semi-structured interview after treatment. Interviews focused on what participants experienced as important on group aspects, offered interventions, homework tasks, and possible changes.
Methods:
All participants were adults, diagnosed with major depressive disorder and/or generalized anxiety disorder and being currently in mental health care treatment. After transcribing the interviews, analyses were performed according to the guidelines of thematic analysis.
Results:
Four major themes were identified. First, the group format itself was experienced as an important factor of change. The experiences about the different offered interventions during the group formed a second theme. A third theme related to changes in family or professional life and dealing with RNT as a result of the intervention. Finally, group participation, social interactions, and mental health care treatment were experienced as mutually influencing during the intervention.
Conclusions:
The results of this study shed some light on which treatment interventions were perceived as beneficial during the RNT-G and should therefore be emphasized in treatment. Further, they indicate that the treatment in a group format was experienced as helpful by the participants. Finally, a positive mutual influence between the group intervention and the ongoing individual treatment was experienced.
... Particularly, mindfulness-based cognitive therapy (MBCT) has been shown to be an effective method of reducing symptoms of depression [15][16][17][18][19][20]. MBCT has also been shown to decrease depression symptoms in individuals with chronic and treatment-resistant depression, as well as residual symptoms of recurrent depression [21][22][23]. ...
Background
Depression poses a major threat to public health with an increasing prevalence in the United States. Mindfulness-based interventions, such as mindfulness-based cognitive therapy (MBCT), are effective methods for managing depression symptoms and may help fortify existing efforts to address the current disease burden. The in-person group format of MBCT, however, incurs barriers to care such as expenses, childcare needs, and transportation issues. Alternate delivery modalities such as MBCT delivered via the web can be investigated for their capacity to overcome these barriers and still reduce symptoms of depression with adequate feasibility and efficacy.
Objective
This study protocol aims to examine the feasibility and efficacy of MBCT delivered via the web for the treatment of depression.
Methods
To attain study aims, 2 phases will be implemented using a waitlist control design. A total of 128 eligible participants will be randomized into either an 8-week MBCT intervention group plus treatment as usual (MBCT + TAU; group 1) or an 8-week waitlist control group (group 2). In phase I (8 weeks), group 1 will complete the intervention and group 2 will proceed with TAU. In phase II (8 weeks), group 2 will complete the intervention and group 1 will continue with TAU until reaching an 8-week follow-up. TAU may consist of receiving psychotherapy, pharmacotherapy, or combined treatment. Data collection will be completed at baseline, 8 weeks (postintervention for group 1 and preintervention for group 2), and 16 weeks (follow-up for group 1, postintervention for group 2). The primary outcomes will include (1) current, residual, or chronic depression symptoms and (2) psychiatric distress. Secondary outcomes will include perceived stress and facets of mindfulness. The feasibility will be measured by assessing protocol adherence, retention, attendance, and engagement. Finally, the extent of mindfulness self-practice and executive functioning skills will be assessed as mediators of intervention outcomes.
Results
This study began screening and recruitment in December 2022. Data collection from the first cohort occurred in January 2023. By November 2023, a total of 30 participants were enrolled out of 224 who received screening. Data analysis began in February 2024, with an approximate publication of results by August 2024. Institutional review board approval took place on September 11, 2019.
Conclusions
This trial will contribute to examining mindfulness-based interventions, delivered via the web, for improving current, residual, or chronic depression symptoms. It will (1) address the feasibility of MBCT delivered via the web; (2) contribute evidence regarding MBCT’s efficacy in reducing depression symptoms and psychiatric distress; and (3) assess the impact of MBCT on several important secondary outcomes. Findings from this study will develop the understanding of the causal pathways between MBCT delivered via the web and depression symptoms further, elucidating the potential for future larger-scale designs.
Trial Registration
ClinicalTrials.gov NCT05347719; https://www.clinicaltrials.gov/ct2/show/NCT05347719
International Registered Report Identifier (IRRID)
DERR1-10.2196/53966
... Compared to the above non-drug treatment methods, no adverse effect of mindfulness meditation on pregnant women or fetuses has been found. Currently, mindfulness meditation practice is used in clinics to assist in the treatment of depression (Miller et al., 1995;Speca et al., 2000;Mason and Hargreaves, 2011;Marchand, 2012). Some studies have defined "mindfulness" as an ability to focus on the present without bias (Brown and Ryan, 2003). ...
Purpose
This study systematically evaluates the effect of mindfulness meditation on depression during pregnancy. We provide evidence-based suggestions for preventing and reducing depression during pregnancy by exploring the most effective intervention mode, cycle, and frequency of mindfulness meditation.
Methods
Records were retrieved from PubMed, Web of Science, EBSCO, and Science Direct. A total of 1,612 randomized controlled trial studies on the effect of mindfulness meditation on pregnancy depression were collected. 10 studies with 658 subjects meeting the inclusion criteria were extracted and analyzed by Revman 5.3 to evaluate study qualities. Stata 12.0 was used for the meta-analysis.
Results
Mindfulness meditation had a positive effect on depression during pregnancy [standardized difference of the mean (SMD) = −0.786, 95% confidence interval (−1.289, −0.283), P < 0.001]. Subgroup analysis showed that mindfulness-based cognitive therapy (MBCT) had the best intervention effect on depression during pregnancy (SMD = 2.795), the best intervention duration was below 4 weeks (SMD = 1.756), applied from the first to the third stage of pregnancy (SMD = 1.024), the frequency guided by experts was less than six times a week (SMD = 2.055) of <60 min each time (SMD = 1.068), and completing homework by themselves every day for 30 mins (SMD = 1.822) was most significant for the improvement of depression during pregnancy. We found high heterogeneity across studies [q = 97.003, DF = 10, I² = 88.0% (P < 0.001), I² > 75%]. This may be caused by variance in measurement tools, among which Beck Depression Inventory-II was a significant source of heterogeneity.
Conclusion
Mindfulness meditation can improve the prevention, remission, and reduction of depression during pregnancy and can be used as an auxiliary measure for the clinical treatment of pregnancy depression.
... Several qualitative and meta-analytic reviews that provide an overview over the mindfulness field already exist, but are mostly partial and focused on a specific subfield of mindfulness research. For example, reviews have been published on mindfulness-based interventions performed on clinical and non-clinical populations (Mason and Hargreaves, 2001;Grossman et al., 2004;Chiesa and Serretti, 2009;Hofmann et al., 2010;Khoury et al., 2013), mindfulness-measurement scales (Goodman et al., 2017), mindfulness for children and adolescents (Carsley et al., 2018), and mindfulness in organizations (Sutcliffe et al., 2016). ...
This paper provides an overview of the mindfulness literature up until the end of 2020 by (a) uncovering its underlying intellectual structure, (b) identifying the most influential and popular themes, and (c) presenting new directions for future research on mindfulness. To this end, a systematic quantitative review based on bibliometric methods was conducted, which is perhaps less prone to researcher bias and can complement existing meta-analyses and qualitative (narrative) structured reviews as an objective approach. Three bibliometric techniques—document co-citation analysis, co-word (co-occurrence and content) analysis, and bibliographic coupling—were applied to explore the past, present, and future of mindfulness research. The co-citation analysis showed that measurement, mechanisms, mindfulness-based interventions, and examinations of the efficacy of mindfulness interventions are among the key theoretical knowledge bases from which the field of mindfulness is derived. The content analysis demonstrated the beneficial effects of mindfulness meditation for physical and mental health conditions. The bibliographic coupling revealed novel directions in cognitive behavioral therapy, emotion regulation, the application of mindfulness practice to children and adolescents, mindfulness at work, and the role of mindfulness in positive psychology. The large sample of articles that was analyzed allowed us to provide a broader and more objective overview than possible with other forms of literature reviews. The combination of the three bibliometric techniques granted deeper insights into the complex multidisciplinary field of mindfulness, along with specific suggestions for future research.
... The basic assumption of cognitive therapy is that thoughts take precedence over mood and dysfunctional beliefs lead to negative emotions such as depression. MBCT aims to enable individuals recognize and re-evaluate their negative thought patterns and change them with positive thoughts which more accurately represent reality (Mason & Hargreaves, 2001). MBCT tries to end dysfunctional and negative automatic thought processes and teach as a skill to live with feelings and thoughts in a healthy way with a more productive mind (Sipe & Eisendrath, 2012). ...
Dramatic changes in social, economic, and working life have occurred with the COVID-19 pandemic. These changes cause stress for employees. Therefore, it is important to implement cost-effective and purposive interventions targeting employee well-being during the COVID-19 pandemic. One of these interventions is Mindfulness-Based Interventions (MBIs). MBIs are generally implemented as a face to face with 8-session program. However, in the COVID-19 pandemic, remote work has been adopted widely by organizations, causing an urgent need for digital well-being interventions. This study aims to investigate effectiveness of digital mindfulness-based interventions on employees’ well-being during the COVID-19 pandemic. To do this, the effect of the COVID-19 pandemic on employee well-being will be explained in the first part. In the second part, mindfulness and mindfulness-based interventions will be discussed. In the last part, digital mindfulness interventions and their effects on employee well-being during the COVID-19 pandemic will be clarified.
... There is a place for both quantitative and qualitative research if they are undertaken by researchers skilled in such methodologies. Good mindfulness research has been carried out using qualitative methods (Mason & Hargreaves, 2001;Mackenzie et al., 2007;Monshat et al., 2013). The beauty of qualitative methodology is that the individual voice is not leveled down to an "average mean" or "statistical significance," and we get an insightful account of the practitioner's experience. ...
The growing interest in mindfulness and meditation practices have generated a corresponding interest in the Buddha’s teachings (Dhamma). The approach adopted in this article is informed by the
poem of Rumi, a 13th-century Sufi poet—Two Kinds of Intelligence—which recommends getting in touch with our intuitive (as opposed to learned) intelligence. In this article, I discuss the understanding
and applications of mindfulness and meditation in Buddhist traditions and classical texts and their articulation in contemporary contexts and literature. I also discuss the importance of practicing dana (generosity), sila (ethical conduct), and wisdom (panna) holistically with meditation and mindfulness (bhavana). I address some contemporary issues—the “debate” about acknowledging
the connections with the Dhamma in current teachings and applications of mindfulness more unequivocally; the direction and limitations of some mindfulness research and mindfulness-based
therapies; and the appraisal of the adverse effects uncovered in mindfulness research. I share anecdotes and clinical vignettes to illustrate the themes discussed in the article. Finally, I discuss my
vision and hope for how the Dhamma can contribute further to contemporary society. In unpacking some of the misconceptions about the Buddha’s teachings, especially in relation to mindfulness,
and explicating a more nuanced and “right” understanding of the Dhamma, I hope that this paper can make further contributions to the understanding and applications of mindfulness, mindfulness
research, and the place of mindfulness in psychology and psychotherapy.
Keywords: Rumi, Eightfold path and The Three Pillars, right mindfulness and the Dhamma,
research, mindfulness-based therapies and adverse effects of meditation and mindfulness
... Ensuring clients are aware of and have the opportunity to address any misconceptions fits with the wider literature. Specifically, others have reported how MBCT participants had either expected a 'cure' or that their misconceptions around MBCT later impacted on their ability to either maintain a mindfulness practice or fully benefit from MBCT (Bihari & Mullan, 2014;Finucane & Mercer, 2006;Mason & Hargreaves, 2001). Additionally, ensuring transparency is important given the popularity of MBCT and the recent push to increase access to MBCT in the NHS (Mindfulness All Party Parliamentary Group, 2015;NHS England & Health Education England, 2016). ...
Objectives
Mindfulness-based cognitive therapy (MBCT) is a well-evidenced relapse-prevention intervention for depression with a growing evidence-base for use in other clinical populations. The UK initiatives have outlined plans for increasing access to MBCT in clinical settings, although evidence suggests that access remains limited. Given the increased popularity and access to MBCT, there may be deviations from the evidence-base and potential risks of harm. We aimed to understand what clinicians believe should be best clinical practice regarding access to, delivery of, and adaptations to MBCT.
Methods
We employed a two-stage Delphi methodology. First, to develop statements around best practices, we consulted five mindfulness-based experts and reviewed the literature. Second, a total of 59 statements were taken forward into three survey rating rounds.
Results
Twenty-nine clinicians completed round one, with 25 subsequently completing both rounds two and three. Forty-four statements reached consensus; 15 statements did not. Clinicians agreed with statements regarding sufficient preparation for accessing MBCT, adherence to the evidence-base and good practice guidelines, consideration of risks, sufficient access to training, support, and resources within services, and carefully considered adaptations. The consensus was not reached on statements which reflected a lack of evidence-base for specific clinical populations or the complex decision-making processes involved in delivering and making adaptations to MBCT.
Conclusions
Our findings highlight the delicate balance of maintaining a client-centred and transparent approach whilst adhering to the evidence-base in clinical decisions around access to, delivery of, and adaptations in MBCT and have important wide-reaching implications.
... 1 The effects of mindfulness-based practices upon users have been explored over the last 40 years in the context of various illnesses and conditions and have not only shown promising benefits for people with mental healthcare disorders but also for people with a number of physical ailments and conditions, such as fibromyalgia, sleep disturbances and chronic pain. 2,3 Amongst the various benefits and outcomes that have been described in studies on mindfulness practice, positive impacts have been noted upon participants' empathy, self-compassion, esteem and self-regard, emotional regulation, attention, stress perception, internal and external awareness, and coping skills within pressured environments. 2,4,5 Prosocial behaviours were also noted to improve with various forms of mindfulness-based practice, such as improved awareness of and attentiveness to others' needs and feelings. ...
This paper examined the impact of mindfulness training of mental healthcare workers' knowledge and experience of mindfulness.
... 1 The effects of mindfulness-based practices upon users have been explored over the last 40 years in the context of various illnesses and conditions and have not only shown promising benefits for people with mental healthcare disorders but also for people with a number of physical ailments and conditions, such as fibromyalgia, sleep disturbances and chronic pain. 2,3 Amongst the various benefits and outcomes that have been described in studies on mindfulness practice, positive impacts have been noted upon participants' empathy, self-compassion, esteem and self-regard, emotional regulation, attention, stress perception, internal and external awareness, and coping skills within pressured environments. 2,4,5 Prosocial behaviours were also noted to improve with various forms of mindfulness-based practice, such as improved awareness of and attentiveness to others' needs and feelings. ...
Background: Mindfulness-based practice has gained increasing attention in the mental health community over the last four decades, and many studies have explored the evidence of its various benefits among healthcare users and providers alike. However, there remains limited research regarding the understanding of mindfulness among mental healthcare professionals. This poses the question: how much do mental healthcare professionals really know about mindfulness, and can self-practice increase the understanding of these providers?
Aim: This descriptive or exploratory case study aimed to explore the understanding of mindfulness amongst 15 mental healthcare professionals.
Setting: The study took place at Weskoppies Psychiatric Hospital.
Method: The study was conducted following a 6-week training course in which the participants were taught, and carried out mindfulness-based practices and techniques. The study also explored the following: (1) the healthcare workers’ experiences, benefits and challenges regarding the consistent practice of mindfulness and (2) their confidence when explaining the concept of mindfulness, and the practices learned, to other colleagues and patients. Data were collected in the form of semi-structured interviews with the participants, 4–6 weeks after completion of the training course.
Results: Three main themes were identified: (1) understanding of mindfulness expanded with practice; (2) unexpected experiences during the mindfulness course; and (3) experience caused partial gains in confidence and skills. Overall, 15 subthemes were derived from the data collected.
Conclusion: Self-practice of mindfulness can increase one’s understanding of the concept and the confidence to teach informal techniques. More research is needed to determine how the design and duration of such training could impact this understanding and confidence.
... The benefits of formal and informal mindfulness practice allowed mothers to cope with challenging situations during the postpartum period through accepting the present stressful moment (Duncan & Bardacke, 2010;Malis et al., 2017). The practice of informal mindfulness allowed mothers to live in the present moment and adopt accepting attitudes (Mason & Hargreaves, 2001). The postpartum period was found to be stressful and hectic for first-time mothers and the presence of ...
Background:
Mindfulness-based childbirth education programs are gaining popularity among expectant parents.
Purpose:
To synthesize knowledge on current available evidence of mindfulness-based childbirth education programs on maternal outcomes and to provide recommendations to improve future mindfulness-based childbirth education programs.
Method:
A mixed-studies systematic review using a narrative synthesis was conducted. Four electronic databases were searched from each database's inception, through November 26, 2018.
Findings:
Three themes emerged from the synthesis: (a) the duration and receptivity of the programs, (b) improved maternal psychosocial outcomes, and (c) the practice of mindfulness during the postpartum period. A conceptual map was produced.
Discussion:
The programs resulted in improved maternal psychosocial outcomes. A greater focus on the practice of informal mindfulness should be taught in future mindfulness-based childbirth education programs. Nurses can consider teaching mindfulness techniques in current antenatal classes. The cost effectiveness and receptivity of the programs should be examined. Future mixed-methods longitudinal studies with ideal sample sizes and the exclusion of participants with prior yoga or medication experiences should be conducted.
... Indeed, this position is supported by qualitative studies suggesting that participants find the group context largely very helpful (e.g. Allen et al. 2009;Mason and Hargreaves 2001). ...
Mindfulness interventions have been shown to be effective for health and wellbeing, and delivering mindfulness programmes online may increase accessibility and reduce waiting times and associated costs; however, research assessing the effectiveness of online interventions is lacking. We sought to: (1) assess the effects of an online mindfulness intervention on perceived stress, depression and anxiety; (2) assess different facets of mindfulness (i.e. acting with awareness, describing, non-judging and non-reacting) as mechanisms of change and (3) assess whether the effect of the intervention was maintained over time. The sample was comprised of 118 adults (female, n = 95) drawn from the general population. Using a randomised waitlist control design, participants were randomised to either an intervention (INT) or waitlist control (WLC) group. Participants completed the online intervention, with the WLC group starting after a 6-week waitlist period. Participants completed measures of depression (PHQ-9), anxiety (GAD-7) and perceived stress (PSS-10) at baseline, post-treatment, 3- and 6-month follow-up. Participants who completed the mindfulness intervention (n = 60) reported significantly lower levels of perceived stress (d = − 1.25 [− 1.64, − 0.85]), anxiety (d = − 1.09 [− 1.47, − 0.98]) and depression (d = − 1.06 [− 1.44, − 0.67]), when compared with waitlist control participants (n = 58), and these effects were maintained at follow-up. The effect of the intervention was primarily explained by increased levels of non-judging. This study provides support for online mindfulness interventions and furthers our understanding with regards to how mindfulness interventions exert their positive effects.
... Hence, I also included some studies performed using other qualitative methods in order to be able to focus on articles that covered participants' experiences of being mindful rather than experiences of the intervention. Finally, nine articles covering different contexts were chosen (Bruce & Davies, 2005;Chadwick, Kaur, Swelam, Ross, & Ellet, 2011;Doran, 2014;Mackenzie, Carlson, Munoz, & Speca, 2007;Mason & Hargreaves, 2001;Monshat et al., 2013;Stew, 2011;Worsfold, 2013;York, 2007). van Manen also describes a second step in this procedure, namely, turning to phenomenological literature, that is, finding a phenomenological frame of reference that could support the following procedures. ...
Purpose:
The purpose of this article is to reflect on being mindful as a phenomenological attitude rather than on describing mindfulness as a therapeutic intervention. I will also explore the possibilities that being mindful might open up in relation to nursing research and holistic nursing.
Design and method:
I will describe and interpret mindfulness as a state of being by means of van Manen's phenomenological method, using the language of phenomenology rather than the language of reductionist science. Thus, this article can be considered a reflective narrative, describing both the process of orienting to the phenomenon, making preunderstandings-including own experiences of mindfulness-visible, and a thematic analysis of nine scientific articles describing the phenomenon.
Findings:
Being mindful as a phenomenological attitude can be described as a deliberate intentionality, where the person is present in the moment and open to what is going on, bridling personal values and accepting the unfamiliar, thus achieving a sense of being peacefully situated in the world, and able to apprehend one's being-in-the-world.
Conclusions:
Being mindful as a phenomenological attitude can contribute not only to phenomenological nursing research but also support nurses' presence and awareness.
... In order to develop more insight into whether the standard MBSR is suitable for older individuals with cognitive complaints, a complementary qualitative approach may reveal which aspects of the training program could be adjusted to better meet the needs of this specific population. Qualitative studies to analyze the experiences of the participants on MBI have been conducted with a variety of other populations, such as participants with breast cancer (Hoffman, Ersser, & Hopkinson, 2012), depression (Mason & Hargreaves, 2001), CONTACT Lotte Berk lotte.berk@maastrichtuniversity.nl and Parkinson's disease (Fitzpatrick, Simpson, & Smith, 2010). Themes that emerge are often related to the pillars of mindfulness such as coping with stress and accepting things as they are. ...
Objectives: In a rapidly aging world population, an increasingly large group faces age-related decline in cognitive functioning. Cognitive complaints of older adults are often related to worries and concerns associated with age-related functional decline. Mindfulness-Based Stress Reduction (MBSR) can successfully target stress, worry and ruminative thinking, but the applicability of this method in middle-aged and older adults with memory complaints is unclear.
Method: Patients of a university hospital memory clinic (n = 13), aged 45–85 years, with memory complaints but no diagnosis of cognitive disorder, participated in a standard 8-week MBSR program, consisting of weekly group meetings and a one-day silent retreat. After completion, semi-structured qualitative interviews were conducted. Questionnaires (administered before, one week after and five weeks after the intervention) assessed quality of life, psychological distress (stress, anxiety and depressive symptoms), mindfulness, self-compassion, and subjective memory functioning. Neurocognitive functioning was assessed online, before and after the intervention.
Results: The qualitative analysis showed positive effects of the training (e.g. increased serenity), many participants worrying less about memory complaints. The self-reported measures were in line with the results of the qualitative analysis.
Conclusion: This exploratory mixed-methods study suggests that MBSR is feasible and well received among older individuals with cognitive complaints.
... In his discussion about alternative approaches to the measurement of mindfulness, Grossman (2011) suggested that researchers should place greater emphasis on qualitative investigations (e.g., Mason & Hargreaves, 2001). In line with this suggestion, included in the task was the opportunity to describe more specifically the relationships between the items and triangle. ...
Despite the growing interest in mindfulness and its demonstrated benefits, there are concerns about the reliance on subjective assessment tools. This study focused on the measurement of Langerian mindfulness, which refers to the active process of noticing new things and flexibly responding to the current context. Some of its key features overlap with the construct of creativity, which can be used to create a direct assessment for central components of mindfulness. The aim is to start a discussion in the field about how a direct creativity-based tool to current subjective measures might best be used.
This chapter delves into the multifaceted relationship that self-rumination has with depression and suicidality through psychological, neurological, and linguistic lenses. It explores how self-focused thoughts and language contribute to depressive symptoms and suicidal behaviors. The psychological section examines the self-focus model, differentiates between rumination and reflection, and highlights their impacts on happiness and social functioning. The neurological section investigates brain areas like the default mode network, medial prefrontal cortex, and anterior cingulate cortex, focusing on the roles of these regions in self-referential processing and emotional regulation. The linguistic section discusses how language use, particularly self-focused language, reflects underlying psychological conditions and ruminative patterns. Finally, the chapter synthesizes the observations of the relevant studies, with the aim of providing a comprehensive understanding of how self-rumination exacerbates depression and suicidality.
Background
Pregnancy and the postpartum period are times of significant transition for women, with changes in maternal physical and mental health. The formation of a relationship between a mother and her baby is vital and has been recognised as laying the foundation for later child development. There is considerable evidence that this early relationship is influenced by a woman’s well-being during pregnancy and in the early post-partum period. Mindfulness-based programs have previously revealed positive outcomes, primarily in reducing maternal stress, anxiety, and depression. However, there remains a need for considering the influence of mindfulness on the mother-baby relationship and embodiment during pregnancy and the first trimester post-partum. This study aimed to conduct an in-depth exploration of pregnant women’s experiences of a nine-session prenatal mindfulness relationship-based (PMRB) program to support its feasibility.
Methods
Information about pregnant women’s (n = 13) experiences of the PMRB program was collected through online interviews during the sessions, including their birth stories. Responses to an open-ended question about how the program had supported them during pregnancy, labour/birth, and the first post-partum trimester were summarised using thematic analysis.
Results
Sixteen themes were identified and organised in four categories: (1) expectations and motivations (healthy pregnancy and mental health, non-medicalised birth, contribution to the field); (2) experiences of the PMRB program (positive experiences, shared experience, engagement with mindfulness practices, pain, stress, and anxiety relief); (3) changes attributed to the PMRB program (a new way of responding to stressors, trusting the process, connecting to body, breath, and unborn baby, awareness of the unborn baby as a sentient being); (4) changes attributed to the mindfulness practice (increased mindfulness/self-awareness, stop look listen, embracing the moment, acceptance).
Conclusions
The evaluation suggested the PMRB program may help women cope with pain and emotional challenges and be more connected to their bodies and infant. The program may also help women become more aware of their unborn baby as a sentient being and the influence of their health and mental well-being on the baby development and health. Furthermore, the program may facilitate the mother-baby relationship during pregnancy, post-partum, and breastfeeding.
Preregistration
The trial has been successfully registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) following ethical approval from Bond University Human Research Ethics Committee (BUHREC—Application AS03534, approved 20 December 2022) and allocated the Australian clinical trials registration number (ACTRN): ACTRN12623000679684.
Depression commonly features the experience of hopelessness and a loss of the ability to imagine and believe in one's positive future. This article considers this important feature of depression and how effective recovery from depression includes the restoration of hope and a belief in actualizing a positive future. It provides in detail a treatment strategy that is focused on cocreating with the patient a positive therapeutic outcome in the patient's future and encourages patients to internalize a representation of the future experience of recovery and restoration of hope. This approach is described in detail and begins by guiding the client suffering from depression to experience a positive therapeutic outcome during hypnosis. This is followed by having the client internalize this positive resolution and recovery and integrate this experience on conscious and subconscious levels. As the client "returns from the future" to the present, bringing back with them this experience of having achieved a resolution and recovery from depression, this corrective emotional experience can affect their daily behavior in the present arising from a significant change in thoughts, feelings, and actions. Case examples that illustrate the use of the future focused strategy in clinical practice are included.
This feasibility study sought to investigate the impact of an online 9-session Prenatal Mindfulness Relationship-Based (PMRB) group treatment program upon maternal mental health (depression, anxiety, and stress), interoception, and mother-infant relationship during pregnancy and post-partum. The study was designed in two parts 1) a quantitative examination of pre, post-treatment and 10-12 weeks post-partum measures targeting 13 pregnant women from a non-clinical population and 2) a qualitative exploration of the same pregnant women’s experiences of the PMRB program reported during the sessions, including their birth stories. Responses to an open-ended question about how the program had supported them during pregnancy, labor/birth and the first post-partum trimester were summarised using thematic analysis. Women (N = 36) were recruited to the non-randomised feasibility study and 13 were allocated to the PMRB program. Women were excluded due to the online recruitment timeframe, missing baseline gestational age and unavailability for the proposed time. All the allocated women completed the program during pregnancy and the baseline and post-treatment surveys. There were 12 women who completed the post-partum follow-up. Only one participant was lost to the follow up for unknown reasons. Results revealed an improvement in mindfulness, depression, interoception and mother-infant relationship post-treatment and at postpartum follow-up. The qualitative analysis led to the identification of 16 themes, which were organized in four categories describing the experience of participants. Findings provide preliminary support for the feasibility of the PMRB program to improve maternal mindfulness, interoception, mental wellbeing and mother-infant relationship during pregnancy and post-partum. The qualitative evaluation suggested the PMRB program may help women cope with emotional challenges and be more connected to their bodies and infant. The program may also help women become more aware of their unborn infant as a sentient being and the influence of their health and mental wellbeing on the infant development and health. Furthermore, it may be a facilitator of the mother-infant relationship during pregnancy and post-partum, promoting infant’s healthy development.
Objectives
To (1) characterize complementary and alternative medicine studies for posttraumatic stress disorder symptoms, (2) evaluate the quality of these studies, and (3) systematically grade the scientific evidence for individual CAM modalities for posttraumatic stress disorder.
Design
Systematic review. Eight data sources were searched. Selection criteria included any study design assessing posttraumatic stress disorder outcomes and any complementary and alternative medicine intervention. The body of evidence for each modality was assessed with the Natural Standard evidence-based, validated grading rationale.
Results and Conclusions
Thirty-three studies (n = 1329) were reviewed. Scientific evidence of benefit for posttraumatic stress disorder was strong for repetitive transcranial magnetic stimulation and good for acupuncture, hypnotherapy, meditation, and visualization. Evidence was unclear or conflicting for biofeedback, relaxation, Emotional Freedom and Thought Field therapies, yoga, and natural products. Considerations for clinical applications and future research recommendations are discussed.
Introduction
The current Increasing Access to Psychological Therapies (IAPT) agenda that focuses on the widespread dissemination of CBT in primary care services is considered alongside the emergence of third wave therapies and their role in the treatment of depression.
Review
Theoretical models and empirical outcomes for Mindfulness-based Cognitive Therapy, Metacognitive Therapy, and Acceptance and Commitment Therapy as third wave treatments for depression are examined with implications for how mindfulness approaches can be integrated into the therapeutic work of counselling psychologists (CoPs). Conclusion: Further theoretical and empirical considerations for the inclusion of third wave therapies into the IAPT agenda are discussed with suggestions for further research.
In this chapter, we compare third-wave psychotherapeutic approaches to earlier approaches, using MBCT as a primary example. A wealth of research shows that MBCT is an efficacious and cost-effective alternative to CBT and antidepressants in preventing depression relapse and recurrence among people who have a history of depression. From a combination of quantitative and qualitative studies, we are starting to better understand how MBCT brings about its therapeutic effects, for example, by training people to see thoughts and emotions as mental events instead of facts and to respond to these mental events with an attitude of acceptance and non-judgement.
Background:
MBCT is a relapse-prevention intervention for people experiencing major depression. Three qualitative meta-syntheses investigating experiences of taking part in MBCT and/or Mindfulness-based Stress Reduction (MBSR) across different diagnostic populations reported themes including control, choice, group processes, relationships, and struggles. As multiple studies have been published since, we aimed to update, systematically review, and synthesise the experiences of participants with depression taking part in MBCT.
Methods:
Four databases were searched systematically (PsycInfo, Web of Science, Medline, CINAHL) up to and including the 12th November 2021. Twenty-one qualitative studies met the review criteria. All papers were rated as fair using a quality appraisal tool. Meta-ethnography was applied.
Results:
Across 21 studies of participants with current or previous depression who had participated in MBCT, three overarching themes were developed: "Becoming skilled and taking action", "Acceptance", and "Ambivalence and Variability". Participants became skilled through engagement in mindfulness practices, reporting increased awareness, perspective, and agency over their experiences. Participants developed acceptance towards their experiences, self, and others. There was variability and ambivalence regarding participants' expectations and difficulties within mindfulness practices.
Limitations:
Many studies were conducted in MBCT-research centres who may hold conflicts of interest. Many studies did not address the impact of the participant-researcher relationship thus potentially affecting their interpretations. Studies were skewed towards the experiences of female participants.
Conclusions:
Our findings help to enhance participant confidence in MBCT, alongside understanding the processes of change and the potential for difficulties. MBCT is beneficial and provides meaningful change for many but remains challenging for some.
Research using qualitative methods has historically provided critical knowledge and scientific advances in the field of Clinical Psychology. Qualitative research methods offer unique perspectives and insights on psychological phenomena and the sociocultural contexts in which they are embedded. Qualitative methods of data collection are designed to gather information on context-specific human experiences, behavior, attitudes, feelings and emotions from the perspective of a specific population of interest. Qualitative methods of data analysis seek to describe, interpret, and gain an in-depth understanding of how research participants make sense of personal life events and experiences within specific sociocultural contexts. The goal of this article is to provide the reader with an overview of the distinctive characteristics, guiding principles, and current uses and practices of qualitative methods, with a focus on their specific application in Clinical Psychology.
Background
The regular practice of mindfulness has been shown to provide benefits for mental well-being and prevent depression relapse. Technology-mediated interventions can facilitate the uptake and sustained practice of mindfulness, yet the evaluation of interactive systems, such as brain-computer interfaces, has been little explored.
Objective
The objective of this paper is to present an interactive mindfulness-based technology to improve mental well-being in people who have experienced depression. The system, Anima, is a brain-computer interface that augments mandala coloring by providing a generative color palette based on the unfolding mindfulness states during the practice. In addition, this paper outlines a multiple-baseline, single-case experimental design methodology to evaluate training effectiveness.
Methods
Adult participants who have experienced depression in the past, have finished treatment within the last year, and can provide informed consent will be able to be recruited. The Anima system, consisting of 2 tablets and a nonintrusive mental activity headband, will be delivered to participants to use during the study. Measures include state and trait mindfulness, depression symptoms, mental well-being, and user experience, and these measures will be taken throughout the baseline, intervention, and monitoring phases. The data collection will take place in the form of a questionnaire before and after each mandala-coloring session and a semistructured interview every 2 weeks. Trial results will be analyzed using structured visual analysis, supplemented with statistical analysis appropriate to single-case methodology.
Results
Study results will offer new insights into the deployment and evaluation of novel interactive brain-computer interfaces for mindfulness training in the context of mental health. Moreover, findings will validate the effectiveness of this training protocol to improve the mental well-being of people who have had depression. Participants will be recruited locally through the National Health Service.
Conclusions
Evidence will assist in the design and evaluation of brain-computer interfaces and mindfulness technologies for mental well-being and the necessary services to support people who have experienced depression.
International Registered Report Identifier (IRRID)
PRR1-10.2196/20819
Cognitive behavioural therapy (CBT) which includes Exposure and Response (ERP) is a highly effective, gold standard treatment for Obsessive-Compulsive Disorder (OCD). Nonetheless, not all patients with OCD significantly benefit from CBT. This has generated interest in the potential benefits of Mindfulness-Based Interventions (MBIs), either integrated with CBT, to enhance engagement with ERP tasks, or delivered as a stand-alone, first-line or therapy to augment CBT. This paper reports on two qualitative studies that involved a thematic analysis of interview data with participants in a 10-week Mindfulness-Based ERP (MB-ERP) course (study 1) and a 9-week Mindfulness-Based Cognitive Therapy course adapted for OCD (MBCT-OCD) (study 2). Whilst MB-ERP integrated a mindfulness component into a standard ERP protocol, MBCT-OCD adapted the psychoeducational components of the standard MBCT for depression protocol to suit OCD, but without explicit ERP tasks. Three common main themes emerged across MB-ERP and MBCT-OCD: ‘satisfaction with course features’, ‘acceptability of key therapeutic tasks ‘and ‘using mindfulness to respond differently to OCD’. Sub-themes identified under the first two main themes were mostly unique to MB-ERP or MBCT-OCD, with the exception of ‘(struggles with) developing a mindfulness practice routine’ whilst most of the sub-themes under the last main theme were shared across MB-ERP and MBCT-OCD participants. Findings suggested that participants generally perceived both MBIs as acceptable and potentially beneficial treatments for OCD, in line with theorised mechanisms of change.
Background:
Globally, national guidelines for depression have prioritised evidence from randomised controlled trials and quantitative meta-analyses, omitting qualitative research concerning patient experience of treatments. A review of patient experience research can provide a comprehensive overview of this important form of evidence and thus enable the voices and subjectivities of those affected by depression to have an impact on the treatments and services they are offered. This review aims to seek a comprehensive understanding of patient experiences of psychological therapies for depression using a systematic and rigorous approach to review and synthesis of qualitative research.
Method:
PsychINFO, PsychARTICLES, MEDLINE, and CINAHL were searched for published articles using a qualitative approach to examine experiences of psychological therapies for depression. All types of psychological therapy were included irrespective of model or modes of delivery (e.g. remote or in person; group or individual). Each article was assessed following guidance provided by the Critical Appraisal Skill Programme tool. Articles were entered in full into NVIVO and themes were extracted and synthesized following inductive thematic analysis.
Results:
Thirty-seven studies, representing 671 patients were included. Three main themes are described; the role of therapy features and setting; therapy processes and how they impact on outcomes; and therapy outcomes (benefits and limitations). Subthemes are described within these themes and include discussion of what works and what's unhelpful; issues integrating therapy with real life; patient preferences and individual difference; challenges of undertaking therapy; influence of the therapist; benefits of therapy; limits of therapy and what happens when therapy ends.
Conclusions:
Findings point to the importance of common factors in psychotherapies; highlight the need to assess negative outcomes; and indicate the need for patients to be more involved in discussions and decisions about therapy, including tailoring therapy to individual needs and taking social and cultural contexts into account.
This study involved applying mindful awareness to external attentional targets by substituting the breath with nature sounds or music in mindfulness practice. We hypothesised that this would influence mindfulness attentional skills acquisition, psychological functioning, physiological wellbeing, and session attendance. Seventy-nine healthy adults either mindfully focused on the breath (Control), nature sounds (Nature Sounds) or music tracks (Music) throughout an eight-week structured group mindfulness programme. Participants completed the Outcome Rating Scale (ORS) and session rating questionnaire every session, the Five Facet Mindfulness Questionnaire (FFMQ), Brief Resilience Scale (BRS), and Depression Anxiety Stress Scale-42 (DASS-42) at the start and end of the programme. Heart rate variability (HRV) was assessed using the Alive® Programme at the start and end of the programme too. We analysed both quantitative and qualitative outcomes in this study. Both Nature Sounds and Music conditions had enhanced session attendance rates compared to the Control condition. Each condition showed unique patterns of mindfulness attentional skills acquisition. Furthermore, only Nature Sounds and Music conditions showed within-condition reductions in symptoms of depression, anxiety, and stress. Participants in Nature Sounds and Music conditions also reported increased likelihood to generalise skills acquired in-session into everyday life, noted imagery, and acknowledged the impermanence of their experiences. Future research should involve applying the current study’s protocol to suitable subclinical populations, to further elucidate the process involved in mindfully attuning to nature sounds and music, to augment mindfulness attentional skills, psychological functioning, physiological wellbeing, and session attendance.
The current study evaluated the effectiveness of a novel three-hour Guided Mindfulness Program on participants’ management of depression, anxiety and stress. The intervention included an educational component emphasizing the psychological value of mindfulness practice combined with a practical training component in mindfulness techniques. The Depression Anxiety Stress Scale was administered at three points in time before and after participation in the program. Additionally, semi-structured interviews were conducted to explore perceived quality of life, happiness, and stress 4 to 8 weeks following the program. All participants reported improvements in overall well-being and reported significant decreases in negative affect when comparing pre-program scores (baseline) to follow-up scores. Notably, qualitative interview results indicated that participants attributed most positive post-program results to informal mindfulness practice.
Crisis Resolution Home Treatment Teams (CRHTT’s) provide an alternative to hospital admission for people in acute mental health crises, including those who are suicidal. With men being at increased risk of suicide and more likely to present to services in the acute phase of illness, CRHTT’s may play an important role in helping to reduce the high rates of suicide in men. Furthermore, there is a growing need for effective psychological interventions in this setting. The following chapter provides an overview of a psychological model for crisis intervention (Sullivan in Clinical Psychology Forum 310: 39–43, 2018) refined to be gender sensitive to men who are suicidal and in crisis.
Objectives
Mindfulness-based cognitive therapy (MBCT), an intervention that integrates mindfulness with cognitive-behavioral therapy, is an 8-week program originally developed to prevent relapses in patients with depression. Previous studies have demonstrated the efficacy of MBCT for preventing relapse, but few studies have evaluated MBCT in naturalistic conditions with real-world samples. Therefore, we sought to explore the characteristics and experiences of individuals receiving MBCT in primary care.
Methods
Mixed-methods approach combining descriptive and qualitative data. Quantitative data were obtained from 269 individuals from different socioeconomic backgrounds who participated in an MBCT program in our healthcare area during the years 2017 and 2018. Qualitative data were obtained from a subsample of participants who agree to participate in semi-structured individual interviews. An interpretative phenomenological analysis (IPA) approach was used to analyze the qualitative data.
Results
In the whole sample (n = 269), the most commonly diagnosed disorders were adjustment (41.6%), mood (22.7%), and anxiety (14.1%). Most participants (60%) were taking psychotropic medications (mainly antidepressants). Overall, mindfulness training improved depressive and anxiety symptoms, regardless of the specific diagnosis. A subsample of 14 individuals participated in the qualitative study. Four overarching themes emerged from the IPA analysis in this subsample: (1) effects of mindfulness practice, (2) learning process, (3) group experience, and (4) mindfulness in the healthcare system.
Conclusions
The findings of this naturalistic, mixed-methods study suggest that MBCT could be an effective approach to treating the symptoms of common mental disorders in the primary care setting.
Objectives
Mindfulness-based interventions (MBIs) like mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) teach mindfulness in a group-based format. Empirical research has shown that many therapists working in individual therapy integrate mindfulness practices (e.g., body scan, sitting meditation) into their treatments. However, research on this topic is in its infancy. The purpose of this paper is to present recommendations for a responsible use of mindfulness in individual therapy.
Methods
Informed by a literature review, an expert group developed guidelines for a responsible use of mindfulness in individual therapy.
Results
Recommendations for the following issues were developed: (a) different types of integration; (b) diagnoses/clinical problems for which integration of mindfulness in individual therapy could be useful; (c) qualification of therapists; (d) case formulation; (e) the inquiry process; (f) types and optimal duration of mindfulness practices in individual therapy; (g) managing difficult experiences; (h) integration of mindfulness into individual therapy training programs. Finally, we formulate important topics for research on the integration of mindfulness into individual therapy.
Conclusions
By formulating recommendations for the most important issues of the integration of mindfulness into individual therapy, we want to stimulate the discussion on a responsible use of mindfulness in this setting. Since research on this topic is scarce, our recommendations can only be tentative.
There are substantial gaps in research on Health Related Quality of Life (HRQoL) in students aged 18 and above in West Virginia. The purpose of this study is to explore the associations between mindful self-care, perceived stress, and the HRQoL in this population. We conducted a cross-sectional study between March and April 2017. We included participants who were students, aged 18 years and above, living in West Virginia and were able to answer online questions in English. Data was obtained from an online survey using a structured questionnaire, including the SF12v2®, mindful self-care scale- SHORT, and Perceived Stress Scale (PSS)-10. We applied linear regressions to determine the predictors of HRQoL (physical health and mental health) using SF12v2®. 194 participants met the inclusion criteria of the study. Mindful self-care was negatively associated with perceived stress. Better mindful self-care mediated the relationship between perceived stress and psychological well-being, controlling for gender, age, race, marital status, education level, annual household income, and chronic disease status. Perceived stress and mindful self-care were not related to the physical well-being. Better mindful self-care may safeguard against perceived stress among students aged 18 years and above. Our findings in this study recommend more mindfulness-based interventions targeted to this subpopulation to improve psychological well-being.
Background
In the search for effective interventions aiming to prevent perinatal stress, depression and anxiety, we are evaluating a Mindfulness Based Childbirth and Parenting (MBCP) Program. In this study we explore the participants’ experiences of the program.
Method
This is a descriptive qualitative study with influences of phenomenology. The participants were expectant couples who participated in the program and the pregnant women had an increased risk of perinatal stress, anxiety and depression. Ten mothers and six fathers were interviewed in depth, at four to six months postpartum. Thematic analysis of the transcripts was conducted.
Results
The participants’ descriptions show a variety in how motivated they were and how much value they ascribed to MBCP. Those who experienced that they benefitted from the intervention described that they did so at an intra-personal level–with deeper self-knowledge and self-compassion; and on an inter-personal level–being helpful in relationships. Furthermore, they perceived that what they had learned from MBCP was helpful during childbirth and early parenting.
Conclusion
Our findings demonstrate that most of the parents experienced MBCP as a valuable preparation for the challenges they met when they went through the life-changing events of becoming parents. The phenomenon of participating in the intervention, integrating the teachings and embodying mindfulness seems to develop inner resources that foster the development of wisdom.
Trial registration
ClinicalTrials.gov ID: NCT02441595, May 4, 2015.
Electronic supplementary material
The online version of this article (10.1186/s12884-018-2098-1) contains supplementary material, which is available to authorized users.
There is currently no consistent psychological model for working with people in crisis resolution home treatment teams. The following article provides an overview of a psychological model for psychologists in this setting.
Recently, there has been increased interest in using mindfulness-based interventions (MBIs) in brain injury rehabilitation. However, no previous qualitative research has explored the experiences of individuals with acquired brain injury (ABI) receiving these interventions. The present study, therefore, aimed to explore how individuals with ABI make sense of their experiences of learning mindfulness skills. Six focus group interviews were conducted with 14 participants with ABI after they had completed an eight-week mindfulness group. The group interviews were transcribed verbatim and analysed using Interpretative Phenomenological Analysis (IPA). Four themes provided in-depth information about participants’ lived experiences of mindfulness training and being in the group; “Developmental learning process”, “Group as a supportive environment for learning”, “Increased awareness” and “Benefits of mindfulness”. The accounts capture participants’ journeys through the process of learning mindfulness skills and implementing them in their everyday lives. The findings also suggested that most participants considered mindfulness beneficial in terms of helping them to cope with the emotional and cognitive consequences of ABI.
Background:
Psychological distress with symptoms of depression and anxiety is common and unrecognized in patients with coronary artery disease (CAD). Efforts have been made to treat psychological distress in CAD with both conventional methods, such as antidepressant drugs and psychotherapy, and non-conventional methods, such as stress management courses. However, studies focusing on the experiences of mindfulness training in this population are still scarce. Therefore, the aim of this study was to explore immediate experiences of mindfulness practice among CAD patients with depressive symptoms.
Methods:
A qualitative content analysis of diary entries, written immediately after practice sessions and continuously during an 8-week long Mindfulness Based Stress Reduction course (MBSR), was applied.
Results:
Twelve respondents participated in the study. The main category: a journey through chaos and calmness captured the participants' concurrent experiences of challenges and rewards over time. This journey appears to reflect a progressive development culminating in the harvesting of the fruits of practice at the end of the mindfulness training. Descriptions of various challenging facets of mindfulness practice - both physical and psychological - commonly occurred during the whole course, although distressing experiences were more predominant during the first half. Furthermore, the diary entries showed a wide variety of ways of dealing with these struggles, including both constructive and less constructive strategies of facing difficult experiences. As the weeks passed, participants more frequently described an enhanced ability to concentrate, relax and deal with distractions. They also developed their capacity to observe the content of their mind and described how the practice began to yield rewards in the form of well-being and a sense of mastery.
Conclusions:
Introducing MBSR in the aftermath of a cardiac event, when depressive symptoms are present, is a complex and delicate challenge in clinical practice. More nuanced information about what to expect as well as the addition of motivational support and skillful guidance during the course should be given in accordance with the participants' experiences and needs.
Trial registration:
The trial was retrospectively registered in clinicaltrials.gov (registration number: NCT03340948 ).
This chapter focuses on healthcare provision for people with CFS in line with recommendations made by the CMO and the CFS/ME Working Group. The chapter begins with a survey of patient and GP illness beliefs and goes on to discuss the efficacy of pharmacological therapies. Finally, the chapter presents outcomes of three behavioural therapies used to manage symptoms of the illness. These include multi-convergent therapy developed by a physiotherapist and the counselling services and rehabilitation courses run by Action for ME. The efficacy of these therapies was evaluated using the subjective and objective developed in previous research.
Background:
Few investigations of patient perceptions of suicide prevention interventions exist, limiting our understanding of the processes and components of treatment that may be engaging and effective for high suicide-risk patients.
Aims:
Building on promising quantitative data that showed that adjunct mindfulness-based cognitive therapy to prevent suicidal behavior (MBCT-S) reduced suicidal thinking and depression among high suicide-risk patients, we subjected MBCT-S to qualitative inspection by patient participants.
Method:
Data were provided by 15 patients who completed MBCT-S during a focus group and/or via a survey. Qualitative data were coded using thematic analysis. Themes were summarized using descriptive analysis.
Results:
Most patients viewed the intervention as acceptable and feasible. Patients attributed MBCT-S treatment engagement and clinical improvement to improved emotion regulation. A minority of patients indicated that factors related to the group treatment modality were helpful. A small percentage of patients found that aspects of the treatment increased emotional distress and triggered suicidal thinking. These experiences, however, were described as fleeting and were not linked to suicidal behavior.
Limitations:
The sample size was small.
Conclusion:
Information gathered from this study may assist in refining MBCT-S and treatments to prevent suicidal behavior among high suicide-risk patients generally.
Researchers having same interest in field of human-robot interaction (HRI) have made large investments in robots for the purpose of interacting with human. However, there is still sparse evidence regarding response of person between animal robots and animals are different. Animal-robot PARO is classified as Class II medical device by Food and Drug Administration (FDA). PARO has a potential to be used as assistive device for treatment of mental illness specially dementia and depression. PARO is helpful through improving mood and help patients to be calm. The aim of this study is to explore the difference among evaluation of the animal-robot by the people in Malaysia. The constructed questions were focused to find out respondent’s background such as age and gender, direct effect interaction with PARO, and preferable duration of interact session. Subjective evaluation of animal-robot PARO was conducted during Science, Technology, Engineering and Math education (STEM) exhibitions that were held in Negeri Sembilan and Melaka. Statistical analysis was conducted with total of 120 respondent using dataset. 95.8% responds agree that PARO able to make them calm. Both adult and children dislike PARO with the percentage less than 5%. Half an hour was chosen as the best time so spend with PARO. In future, PARO will be used as a device in rehabilitation center to assists in depression therapy.
Near-death experiences (NDEs) are life transformational events that are increasingly being subjected to empirical research. However, to date, no study has investigated the phenomenon of a meditation-induced near-death experience (MI-NDE) that is referred to in ancient Buddhist texts. Given that some advanced Buddhist meditators can induce NDEs at a pre-planned point in time, the MI-NDE may make NDEs more empirically accessible and thus advance understanding into the psychology of death-related processes. The present study recruited 12 advanced Buddhist meditators and compared the MI-NDE against two other meditation practices (i.e. that acted as control conditions) in the same participant group. Changes in the content and profundity of the MI-NDE were assessed longitudinally over a 3-year period. Findings demonstrated that compared to the control conditions, the MI-NDE prompted significantly greater pre-post increases in NDE profundity, mystical experiences and non-attachment. Furthermore, participants demonstrated significant increases in NDE profundity across the 3-year study period. Findings from an embedded qualitative analysis (using grounded theory) demonstrated that participants (i) were consciously aware of experiencing NDEs, (ii) retained volitional control over the content and duration of NDEs and (iii) elicited a rich array of non-worldly encounters and spiritual experiences. In addition to providing corroborating evidence in terms of the content of a “regular” (i.e. non-meditation-induced) NDE, novel NDE features identified in the present study indicate that there exist unexplored and/or poorly understood dimensions to NDEs. Furthermore, the study indicates that it would be feasible—including ethically feasible—for future research to recruit advanced meditators in order to assess real-time changes in neurological activity during NDEs.
(Reprinted with permission from Journal of Evidence-Based Complementary & Alternative Medicine, 19(3): 161-175, 2014).
There is growing interest in mindfulness-based interventions (MBIs) in the management of multiple physical and mental health issues. Although MBIs utilize a group format, research on how this format impacts teaching and learning mindfulness is lacking. This study aimed to develop a detailed theory of MBI group processes utilizing a grounded theory methodology. This article presents our subsequent model, developed from semistructured interviews conducted with MBI students, teachers, and trainers (N = 12). A core category, the group as a vessel on a shared journey, and three higher-order categories emerged from the data. They illustrate how MBI group processes navigate a characteristic path. Teachers build and steer the group “vessel” in a way that fosters a specific culture and sense of safety. The group is facilitated to share communal experiences that augment learning and enrich mindfulness practice. Limitations and implications for clinicians and researchers are discussed.
Objectives:
This study sought to investigate how people who had tested positive for the Huntington's disease (HD) gene mutation understood and experienced psychological distress and their expectations of psychological therapy.
Design:
A qualitative methodology was adopted involving semi-structured interviews and interpretative phenomenological analysis (IPA).
Method:
A total of nine participants (five women and four men) who had opted to engage in psychological therapy were recruited and interviewed prior to the start of this particular psychological therapeutic intervention. Interviews were transcribed verbatim and analysed using IPA whereby themes were analysed within and across transcripts and classified into superordinate themes.
Results:
Three superordinate themes were developed: Attributing psychological distress to HD: 'you're blaming everything on that now'; Changes in attributions of distress over time: 'in the past you'd just get on with it'; and Approaching therapy with an open mind, commitment, and hope: 'a light at the end of the tunnel'.
Conclusion:
Understandings of psychological distress in HD included biological and psychological explanations, with both often being accepted simultaneously by the same individual but with biomedical accounts generally dominating. Individual experience seemed to reflect a dynamic process whereby people's understanding and experience of their distress changed over time. Psychological therapy was accepted as a positive alternative to medication, providing people with HD with hope that their psychological well-being could be enhanced.
Practitioner points:
People with the Huntington's disease gene mutation have largely biomedical understandings of their psychological distress. This largely biomedical understanding does not, however, preclude them for being interested in the potential gains resulting from psychological therapy. The mechanisms of psychological therapy should be explained in detail before therapy and explored along with current attributions of distress.
Background
Health guidelines are developed to improve patient care by ensuring the most recent and ‘best available evidence’ is used to guide treatment recommendations. The National Institute for Health and Care Excellence's (NICE's ) guideline development methodology acknowledges that evidence needed to answer one question (treatment efficacy) may be different from evidence needed to answer another (cost‐effectiveness, treatment acceptability to patients). This review uses counselling in the treatment of depression as a case study, and interrogates the constructs of ‘best’ evidence and ‘best’ guideline methodologies.
Method
The review comprises six sections: (i) implications of diverse definitions of counselling in research; (ii) research findings from meta‐analyses and randomised controlled trials (RCTs); (iii) limitations to trials‐based evidence; (iv) findings from large routine outcome datasets; (v) the inclusion of qualitative research that emphasises service‐user voices; and (vi) conclusions and recommendations.
Results
Research from meta‐analyses and RCTs contained in the draft 2018 NICE Guideline is limited but positive in relation to the effectiveness of counselling in the treatment for depression. The weight of evidence suggests little, if any, advantage to cognitive behaviour therapy (CBT) over counselling once risk of bias and researcher allegiance are taken into account. A growing body of evidence from large NHS data sets also evidences that, for depression, counselling is as effective as CBT and cost‐effective when delivered in NHS settings.
Conclusion
Specifications in NICE's updated guideline procedures allow for data other than RCTs and meta‐analyses to be included. Accordingly, there is a need to include large standardised collected data sets from routine practice as well as the voice of patients via high‐quality qualitative research.
This chapter discusses the case of Michael, a 22-year-old college student, who came to counseling after a breakup with Maggie, his girlfriend of 2 years. The breakup triggered a downward spiral into depressive symptoms and he could not get over with the fact that he had “let Maggie down”. The author worked with Michael from a mindfulness-informed perspective. He taught Michael some mindfulness techniques to help him begin to connect with the wisdom of his senses and observe his experience nonjudgmentally. The Wheel of Wellness provides a comprehensive framework for understanding and integrating salient facets of life. This model allows the counselor to address many important facets of a client's life and provides a strong foundation for the integration of religion and spirituality into the counseling process. Mindfulness-based therapy (MBT) often is used to alleviate depression and to help a client accept what is currently happening in his life.
Purpose
The purpose of this paper is to explore the mechanisms underlying prevention-focus and promotion-focus, two distinct dimensions of regulatory focus undertaken to fulfill different goals. The authors explore distinct triggers (mindfulness and leader-member exchange (LMX)) and outcomes (role overload and burnout) of each.
Design/methodology/approach
The model is grounded in regulatory focus theory (Higgins, 1997), and is tested with data collected at two times from 206 full-time workers.
Findings
Findings revealed mindfulness was positively related to prevention- and promotion-focus, while LMX was positively related to only promotion-focus. Prevention-focus mediated the relationship between mindfulness and role overload and burnout, while promotion-focus mediated the relationship between both mindfulness and LMX and role overload, but not burnout.
Originality/value
This research expands the nomological network describing individual and dyadic antecedents to regulatory focus. It also explores the nature of the relationships between regulatory focus and career management consequences, and may allow us to offer useful advice for practicing managers trying to understand employee career trajectories.
As mindfulness-based cognitive therapy (MBCT) becomes an increasingly mainstream approach for recurrent depression, there is a growing need for practitioners who are able to teach MBCT. The requirements for being competent as a mindfulness-based teacher include personal meditation practice and at least a year of additional professional training. This study is the first to investigate the relationship between MBCT teacher competence and several key dimensions of MBCT treatment outcomes. Patients with recurrent depression in remission (N = 241) participated in a multi-centre trial of MBCT, provided by 15 teachers. Teacher competence was assessed using the Mindfulness-Based Interventions: Teaching Assessment Criteria (MBI:TAC) based on two to four randomly selected video-recorded sessions of each of the 15 teachers, evaluated by 16 trained assessors. Results showed that teacher competence was not significantly associated with adherence (number of MBCT sessions attended), possible mechanisms of change (rumination, cognitive reactivity, mindfulness, and self-compassion), or key outcomes (depressive symptoms at post treatment and depressive relapse/recurrence during the 15-month follow-up). Thus, findings from the current study indicate no robust effects of teacher competence, as measured by the MBI:TAC, on possible mediators and outcome variables in MBCT for recurrent depression. Possible explanations are the standardized delivery of MBCT, the strong emphasis on self-reliance within the MBCT learning process, the importance of participant-related factors, the difficulties in assessing teacher competence, the absence of main treatment effects in terms of reducing depressive symptoms, and the relatively small selection of videotapes. Further work is required to systematically investigate these explanations.
Mindfulness-based therapies are becoming increasingly common in the treatment of mental health conditions. While the popularity of yoga continues to rise in Western culture, little has been done to explore the psychological benefits of yoga from a qualitative, clinical perspective. This study explores participant experiences of the "Yoga Therapy for the Mind Eight-Week Course" (YTFTM), an international, manualized yoga and mindfulness-based intervention for depression and anxiety. Eight female participants took part in semi-structured interviews, and transcripts were analyzed using an interpretative phenomenological analysis, with four master themes emerging: "Personal Journey of Change," "Ambivalence," "Mind/Body Connection," and "Group Experience." The findings highlight potential challenges of yoga and mindfulness-based interventions and the importance of providing adequate support in overcoming these. Findings also reveal that participants experience psychological benefits from the practice of yoga asana in addition to mindfulness, such as a more holistic understanding of psychological distress, adaptive coping strategies, and enhanced well-being.
Objectives: Mindfulness-based cognitive therapy (MBCT) has been successful in reducing depressive symptoms in people with chronic-recurrent depression. However, the research evaluating the efficacy of this approach, and other innovative treatments for mood disorders, has mainly been with people under 65 years. This paper aims to help redress this imbalance by exploring older people's own reflections of their experience of MBCT.
Methods: A qualitative approach was used to explore 13 participants' experiences of MBCT; participants were interviewed pre and post-intervention and again after six months. To see whether the standard course requires any adaptations for older participants, the two MBCT course facilitators were interviewed post-intervention.
Results: Thematic analysis identified five overarching themes and showed that older people reported positive changes in their mental health and well-being and reported being ‘released from the past’. The facilitators reported that they needed to be aware of later life issues, such as loneliness and potential physical limitations, but otherwise only minor adaptations were needed to the standard MBCT course for older people.
Conclusion: MBCT is an acceptable approach for people aged 65 years and over and further research should explore potential mechanisms of change including changes in meta-cognitive awareness and self-compassion.
This study was designed to determine the effectiveness of a group stress reduction program based on mindfulness meditation for patients with anxiety disorders.
The 22 study participants were screened with a structured clinical interview and found to meet the DSM-III-R criteria for generalized anxiety disorder or panic disorder with or without agoraphobia. Assessments, including self-ratings and therapists' ratings, were obtained weekly before and during the meditation-based stress reduction and relaxation program and monthly during the 3-month follow-up period.
Repeated measures analyses of variance documented significant reductions in anxiety and depression scores after treatment for 20 of the subjects--changes that were maintained at follow-up. The number of subjects experiencing panic symptoms was also substantially reduced. A comparison of the study subjects with a group of nonstudy participants in the program who met the initial screening criteria for entry into the study showed that both groups achieved similar reductions in anxiety scores on the SCL-90-R and on the Medical Symptom Checklist, suggesting generalizability of the study findings.
A group mindfulness meditation training program can effectively reduce symptoms of anxiety and panic and can help maintain these reductions in patients with generalized anxiety disorder, panic disorder, or panic disorder with agoraphobia.
This article reviews the theoretical and empirical literature associated with the mediators and moderators of change in cognitive therapy (CT) of depression. Covariation between change in cognition and change in depression, specific effects for cognitive versus behavioral components of CT, specific effects for CT versus other treatments, moderating influence of nonspecific and technical aspects of the therapeutic environment, and moderating influence of client characteristics are reviewed. The clinical implications of prior research and suggestions for future research on identifying the critical ingredients of change in CT of depression are discussed.
Previous research on depressed and suicidal patients and those with posttraumatic stress disorder has shown that patients' memory for the past is overgeneral (i.e., patients retrieve generic summaries of past events rather than specific events). This study investigated whether autobiographical memory could be affected by psychological treatment. Recovered depressed patients were randomly allocated to receive either treatment as usual or treatment designed to reduce risk of relapse. Whereas control patients showed no change in specificity of memories recalled in response to cue words, the treatment group showed a significantly reduced number of generic memories. Although such a memory deficit may arise from long-standing tendencies to encode and retrieve events generically, such a style is open to modification.
This study evaluated mindfulness-based cognitive therapy (MBCT), a group intervention designed to train recovered recurrently depressed patients to disengage from dysphoria-activated depressogenic thinking that may mediate relapse/recurrence. Recovered recurrently depressed patients (n = 145) were randomized to continue with treatment as usual or, in addition, to receive MBCT. Relapse/recurrence to major depression was assessed over a 60-week study period. For patients with 3 or more previous episodes of depression (77% of the sample), MBCT significantly reduced risk of relapse/recurrence. For patients with only 2 previous episodes, MBCT did not reduce relapse/recurrence. MBCT offers a promising cost-efficient psychological approach to preventing relapse/recurrence in recovered recurrently depressed patients.
Psychotherapeutic interventions containing training in mindfulness meditation have been shown to help participants with a variety of somatic and psychological conditions. Mindfulness-based cognitive therapy (MBCT) is a meditation-based psychotherapeutic intervention designed to help reduce the risk of relapse of recurrent depression. There is encouraging early evidence from multi-centre randomized controlled trials. However, little is known of the process by which MBCT may bring therapeutic benefits. This study set out to explore participants' accounts of MBCT in the mental-health context. Seven participants were interviewed in two phases. Interview data from four participants were obtained in the weeks following MBCT. Grounded theory techniques were used to identify several categories that combine to describe the ways in which mental-health difficulties arose as well as their experiences of MBCT. Three further participants who have continued to practise MBCT were interviewed so as to further validate, elucidate and extend these categories. The theory suggested that the preconceptions and expectations of therapy are important influences on later experiences of MBCT. Important areas of therapeutic change ('coming to terms') were identified, including the development of mindfulness skills, an attitude of acceptance and 'living in the moment'. The development of mindfulness skills was seen to hold a key role in the development of change. Generalization of these skills to everyday life was seen as important, and several ways in which this happened, including the use of breathing spaces, were discussed. The study emphasized the role of continued skills practice for participants' therapeutic gains. In addition, several of the concepts and categories offered support to cognitive accounts of mood disorder and the role of MBCT in reducing relapse.
Two hundred twenty-five chronic pain patients were studied following training in mindfulness meditation. Large and significant overall improvements were recorded post-intervention in physical and psychological status. These gains were maintained at follow-up in the majority of subjects. Follow-up times ranged from 2.5-48 months. Status on the McUill Melzack Fain Rating Index (PRI). however, tended to revert to preintervention levels following the intervention. Most subjects reported a high degree of adherence with the meditation techniques, maintenance of improved status over time, and a high degree of importance attributed to the training program. We conclude that such training can have long-term benefit for chronic pain patients.
(C) Lippincott-Raven Publishers.
The first part of this book examines the problem of depression, evidence about it and answers previously offered in the literature. The second part describes the Interacting Cognitive Subsystems model (ICS), its advocacy of two levels of meaning and the way it addresses emotion. The third part examines how the model handles mood and memory effects. The fourth part of the book discusses ICS, negative thinking and the maintenance of depression. Part five deals with ICS, depression and psychological treatment and the concluding part raises some broader issues concerning the application of psychology theories in real world contexts.
There is encouraging evidence that structured psychological treatments for depression, in particular cognitive therapy, can reduce subsequent relapse after the period of initial treatment has been completed. However, there is a continuing need for prophylactic psychological approaches that can be administered to recovered patients in euthymic mood. An information-processing analysis of depressive maintenance and relapse is used to define the requirements for effective prevention, and to propose mechanisms through which cognitive therapy achieves its prophylactic effects. This analysis suggests that similar effects can be achieved using techniques of stress-reduction based on the skills of attentional control taught in mindfulness meditation. An information-processing analysis is presented of mindfulness and mindlessness, and of their relevance to preventing depressive relapse. This analysis provides the basis for the development of Attentional Control Training, a new approach to preventing relapse that integrates features of cognitive therapy and mindfulness training and is applicable to recovered depressed patients.
Fibromyalgia is a chronic illness characterized by widespread pain, fatigue, sleep disturbance, and resistance to treatment. The purpose of this study was to evaluate the effectiveness of a meditation-based stress reduction program on fibromyalgia. Seventy-seven patients meeting the 1990 criteria of the American College of Rheumatology for fibromyalgia took part in a 10-week group outpatient program. Therapists followed a carefully defined treatment approach and met weekly to further promote uniformity. Patients were evaluated before and after the program. Initial evaluation included a psychiatric structured clinical interview (SCID). Outcome measures included visual analog scales to measure global well-being, pain, sleep, fatigue, and feeling refreshed in the morning. Patients also completed a medical symptom checklist, SCL-90-R, Coping Strategies Questionnaire, Fibromyalgia Impact Questionnaire, and the Fibromyalgia Attitude Index. Although the mean scores of all the patients completing the program showed improvement, 51% showed moderate to marked improvement and only they were counted as "responders." These preliminary findings suggest that a meditation-based stress reduction program is effective for patients with fibromyalgia.
This study tests the hypothesis that stress reduction methods based on mindfulness meditation can positively influence the rate at which psoriasis clears in patients undergoing phototherapy or photochemotherapy treatment.
Thirty-seven patients with psoriasis about to undergo ultraviolet phototherapy (UVB) or photochemotherapy (PUVA) were randomly assigned to one of two conditions: a mindfulness meditation-based stress reduction intervention guided by audiotaped instructions during light treatments, or a control condition consisting of the light treatments alone with no taped instructions. Psoriasis status was assessed in three ways: direct inspection by unblinded clinic nurses; direct inspection by physicians blinded to the patient's study condition (tape or no-tape); and blinded physician evaluation of photographs of psoriasis lesions. Four sequential indicators of skin status were monitored during the study: a First Response Point, a Turning Point, a Halfway Point, and a Clearing Point.
Cox-proportional hazards regression analysis showed that subjects in the tape groups reached the Halfway Point (p = .013) and the Clearing Point (p = .033) significantly more rapidly than those in the no-tape condition, for both UVB and PUVA treatments.
A brief mindfulness meditation-based stress reduction intervention delivered by audiotape during ultraviolet light therapy can increase the rate of resolution of psoriatic lesions in patients with psoriasis.
Grounded theory techniques
- B G Glaser
- A L Strauss
Glaser, B. G., & Strauss, A. L. (1967). Grounded theory techniques. New York: Sage.
The wider application of cognitive therapy: the end of the beginning
- J M G Williams
- S Moorey
Williams, J. M. G., & Moorey, S. (1989). The wider application of cognitive therapy: the end of the beginning. In J. Scott, J. M. G. Williams, & A. T. Beck (eds), Cognitive therapy in clinical practice—an illustrative casebook (pp. 97–112)