Mindfulness-based cognitive therapy (MBCT) is a relatively new intervention that has been developed to help people with recurrent depression stay well in the long term. Although there is evidence that depression impacts negatively on parenting, little is known regarding MBCT’s potential impact on parenting. This study used a qualitative design to explore how parents with a history of recurrent depression experience their relationships with their children one year after MBCT. We interviewed 16 parents who had participated in MBCT as part of a randomized controlled trial (RCT) (Kuyken et al., 2008). Thematic analysis was used to identify prevalent themes in parents’ accounts, including: (i) emotional reactivity and regulation; (ii) empathy and acceptance; (iii) involvement; (iv) emotional availability and comfort; and (v) recognition of own needs. Based on these exploratory findings, we suggest that some components of MBCT may help parents with a history of depression with emotional availability, emotion regulation and self-care and set out avenues of further research.
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Depression co-occurs in 20% of people with cardiovascular disorders, can persist for years and predicts worse physical health outcomes. While psychosocial treatments have been shown to treat acute depression effectively in those with comorbid cardiovascular disorders, to date, there has been no evaluation of approaches aiming to prevent relapse and treat residual depression symptoms in this group. Consequently, the current study aimed to examine the feasibility and acceptability of a randomised controlled trial design evaluating an adapted version of mindfulness-based cognitive therapy (MBCT) designed specifically for people with comorbid depression and cardiovascular disorders. A three-arm feasibility randomised controlled trial was conducted, comparing MBCT adapted for people with cardiovascular disorders plus treatment as usual (TAU), mindfulness-based stress reduction (MBSR) plus TAU and TAU alone. Participants completed a set of self-report measures of depression severity, anxiety, quality of life, illness perceptions, mindfulness, self-compassion and affect and had their blood pressure taken immediately before, after and 3 months following the intervention. Those in the adapted-MBCT arm additionally underwent a qualitative interview to gather their views about the adapted intervention. Three thousand four hundred potentially eligible participants were approached when attending an outpatient appointment at a cardiology clinic or via a GP letter following a case note search. Two hundred forty-two (7.1%) were interested in taking part, 59 (1.7%) were screened as being suitable and 33 (< 1%) were eventually randomised to the three groups. Of 11 participants randomised to adapted-MBCT, 7 completed the full course, levels of home mindfulness practice were high and positive qualitative feedback about the intervention was given. Twenty-nine out of 33 randomised participants completed all the assessment measures at all three time points. The means Patient Health Questionnaire (PHQ)-9 scores for the MBCT-Heart and Living Mindfully (HeLM) group were lower at post-intervention and at the 3-month follow-up compared to the MBSR and TAU groups. The sample was heterogeneous in terms of whether they reported current depression or had a history of depression and the time since the onset of cardiovascular disorders (1 to 25 years). The adapted-MBCT intervention was feasible and acceptable to participants; however, certain aspects of the trial design were not. In particular, low recruitment rates were achieved and there was a high withdrawal rate between screening and randomisation. Moreover, the heterogeneity in the sample was high, meaning the adapted intervention was unlikely to be well tailored to all the participants needs. This suggests that if the decision is made to move to a definitive trial, study recruitment procedures will need to be revised to recruit a target sample that optimally matches the adapted intervention.
Depression co-occurs in 20% of people with cardiovascular disorders, can persist for years and predicts worse physical health outcomes. While psychosocial treatments have been shown to treat acute depression effectively in those with comorbid cardiovascular disorders, to date, there has been no evaluation of approaches aiming to prevent relapse and treat residual depression symptoms in this group. Consequently, the current study aimed to examine the feasibility and acceptability of a randomised controlled trial design evaluating an adapted version of mindfulness-based cognitive therapy (MBCT) designed specifically for people with comorbid depression and cardiovascular disorders. A three-arm feasibility randomised controlled trial was conducted, comparing MBCT adapted for people with cardiovascular disorders plus treatment as usual (TAU), mindfulness-based stress reduction (MBSR) plus TAU and TAU alone. Participants completed a set of self-report measures of depression severity, anxiety, quality of life, illness perceptions, mindfulness, self-compassion and affect and had their blood pressure taken immediately before, after and 3 months following the intervention. Those in the adapted-MBCT arm additionally underwent a qualitative interview to gather their views about the adapted intervention. Three thousand four hundred potentially eligible participants were approached when attending an outpatient appointment at a cardiology clinic or via a GP letter following a case note search. Two hundred forty-two (7.1%) were interested in taking part, 59 (1.7%) were screened as being suitable and 33 (< 1%) were eventually randomised to the three groups. Of 11 participants randomised to adapted-MBCT, 7 completed the full course, levels of home mindfulness practice were high and positive qualitative feedback about the intervention was given. Twenty-nine out of 33 randomised participants completed all the assessment measures at all three time points. The means Patient Health Questionnaire (PHQ)-9 scores for the MBCT-Heart and Living Mindfully (HeLM) group were lower at post-intervention and at the 3-month follow-up compared to the MBSR and TAU groups. The sample was heterogeneous in terms of whether they reported current depression or had a history of depression and the time since the onset of cardiovascular disorders (1 to 25 years). The adapted-MBCT intervention was feasible and acceptable to participants; however, certain aspects of the trial design were not. In particular, low recruitment rates were achieved and there was a high withdrawal rate between screening and randomisation. Moreover, the heterogeneity in the sample was high, meaning the adapted intervention was unlikely to be well tailored to all the participants needs. This suggests that if the decision is made to move to a definitive trial, study recruitment procedures will need to be revised to recruit a target sample that optimally matches the adapted intervention.
Over recent decades, there has been an exponential growth in mindfulness-based interventions (MBIs). To disseminate MBIs with fidelity, care needs to be taken with the training and supervision of MBI teachers. A wealth of literature exists describing the process and practice of supervision in a range of clinical approaches, but, as of yet, little consideration has been given to how this can best be applied to the supervision of MBI teachers. This paper articulates a framework for supervision of MBI teachers. It was informed by the following: the experience of eight experienced mindfulness-based supervisors, the literature and understandings from MBIs, and by the authors’ experience of training and supervision. It sets out the nature and distinctive features of mindfulness-based supervision (MBS), representing this complex, multilayered process through a series of circles that denote its essence, form, content and process. This paper aims to be a basis for further dialogue on MBS, providing a foundation to increase the availability of competent supervision so that MBIs can expand without compromising integrity and efficacy.
Over recent decades, there has been an exponential growth in mindfulness-based interventions (MBIs). To disseminate MBIs with fidelity, care needs to be taken with the training and supervision of MBI teachers. A wealth of literature exists describing the process and practice of supervision in a range of clinical approaches, but, as of yet, little consideration has been given to how this can best be applied to the supervision of MBI teachers. This paper articulates a framework for supervision of MBI teachers. It was informed by the following: the experience of eight experienced mindfulness-based supervisors, the literature and understandings from MBIs, and by the authors’ experience of training and supervision. It sets out the nature and distinctive features of mindfulness-based supervision (MBS), representing this complex, multilayered process through a series of circles that denote its essence, form, content and process. This paper aims to be a basis for further dialogue on MBS, providing a foundation to increase the availability of competent supervision so that MBIs can expand without compromising integrity and efficacy.
Over recent decades, there has been an exponential growth in mindfulness-based interventions (MBIs). To disseminate MBIs with fidelity, care needs to be taken with the training and supervision of MBI teachers. A wealth of literature exists describing the process and practice of supervision in a range of clinical approaches, but, as of yet, little consideration has been given to how this can best be applied to the supervision of MBI teachers. This paper articulates a framework for supervision of MBI teachers. It was informed by the following: the experience of eight experienced mindfulness-based supervisors, the literature and understandings from MBIs, and by the authors’ experience of training and supervision. It sets out the nature and distinctive features of mindfulness-based supervision (MBS), representing this complex, multilayered process through a series of circles that denote its essence, form, content and process. This paper aims to be a basis for further dialogue on MBS, providing a foundation to increase the availability of competent supervision so that MBIs can expand without compromising integrity and efficacy.
Over recent decades, there has been an exponential growth in mindfulness-based interventions (MBIs). To disseminate MBIs with fidelity, care needs to be taken with the training and supervision of MBI teachers. A wealth of literature exists describing the process and practice of supervision in a range of clinical approaches, but, as of yet, little consideration has been given to how this can best be applied to the supervision of MBI teachers. This paper articulates a framework for supervision of MBI teachers. It was informed by the following: the experience of eight experienced mindfulness-based supervisors, the literature and understandings from MBIs, and by the authors’ experience of training and supervision. It sets out the nature and distinctive features of mindfulness-based supervision (MBS), representing this complex, multilayered process through a series of circles that denote its essence, form, content and process. This paper aims to be a basis for further dialogue on MBS, providing a foundation to increase the availability of competent supervision so that MBIs can expand without compromising integrity and efficacy.
Over recent decades, there has been an exponential growth in mindfulness-based interventions (MBIs). To disseminate MBIs with fidelity, care needs to be taken with the training and supervision of MBI teachers. A wealth of literature exists describing the process and practice of supervision in a range of clinical approaches, but, as of yet, little consideration has been given to how this can best be applied to the supervision of MBI teachers. This paper articulates a framework for supervision of MBI teachers. It was informed by the following: the experience of eight experienced mindfulness-based supervisors, the literature and understandings from MBIs, and by the authors’ experience of training and supervision. It sets out the nature and distinctive features of mindfulness-based supervision (MBS), representing this complex, multilayered process through a series of circles that denote its essence, form, content and process. This paper aims to be a basis for further dialogue on MBS, providing a foundation to increase the availability of competent supervision so that MBIs can expand without compromising integrity and efficacy.
Mindfulness-Based Cognitive Therapy (MBCT) and Mindfulness-Based StressReduction (MBSR) emphasize the importance of mindfulness practice at home as an integral part of the program. However, the extent to which participants complete their assigned practice is not yet clear, nor is it clear whether this practice is associated with positive outcomes.
Mindfulness-Based Cognitive Therapy (MBCT) and Mindfulness-Based StressReduction (MBSR) emphasize the importance of mindfulness practice at home as an integral part of the program. However, the extent to which participants complete their assigned practice is not yet clear, nor is it clear whether this practice is associated with positive outcomes.
Mindfulness-based cognitive therapy (MBCT) is an efficacious psychosocial intervention for recurrent depression (Kuyken et al., 2008; Ma & Teasdale, 2004; Teasdale et al., 2000). To date, no compelling research addresses MBCT's mechanisms of change. This study determines whether MBCT's treatment effects are mediated by enhancement of mindfulness and self-compassion across treatment, and/or by alterations in post-treatment cognitive reactivity. The study was embedded in a randomized controlled trial comparing MBCT with maintenance antidepressants (mADM) with 15-month follow-up (Kuyken et al., 2008). Mindfulness and self-compassion were assessed before and after MBCT treatment (or at equivalent time points in the mADM group). Post-treatment reactivity was assessed one month after the MBCT group sessions or at the equivalent time point in the mADM group. One hundred and twenty-three patients with ≥3 prior depressive episodes, and successfully treated with antidepressants, were randomized either to mADM or MBCT. The MBCT arm involved participation in MBCT, a group-based psychosocial intervention that teaches mindfulness skills, and discontinuation of ADM. The mADM arm involved maintenance on a therapeutic ADM dose for the duration of follow-up. Interviewer-administered outcome measures assessed depressive symptoms and relapse/recurrence across 15-month follow-up. Mindfulness and self-compassion were measured using self-report questionnaire. Cognitive reactivity was operationalized as change in depressive thinking during a laboratory mood induction. MBCT's effects were mediated by enhancement of mindfulness and self-compassion across treatment. MBCT also changed the nature of the relationship between post-treatment cognitive reactivity and outcome. Greater reactivity predicted worse outcome for mADM participants but this relationship was not evident in the MBCT group. MBCT's treatment effects are mediated by augmented self-compassion and mindfulness, along with a decoupling of the relationship between reactivity of depressive thinking and poor outcome. This decoupling is associated with the cultivation of self-compassion across treatment.
Mindfulness-based cognitive therapy (MBCT) is an effective depression prevention programme for people with a history of recurrent depression. In the UK, the National Institute for Clinical Excellence (NICE) has suggested that MBCT is a priority for implementation. This paper explores the exchange, synthesis and application of evidence and guidance on MBCT between the academic settings generating the evidence and delivering practitioner training and the practice settings where implementation takes place. Fifty-seven participants in a workshop on MBCT implementation in the NHS were asked for their experience of facilitators and obstacles to implementation, and a UK-wide online survey of 103 MBCT teachers and stakeholders was conducted. While MBCT is starting to become available in the NHS, this is rarely part of a strategic, coherent or appropriately resourced approach. A series of structural, political cultural, educational, emotional and physical/technological obstacles and facilitators to implementation were identified. Nearly a decade since NICE first recommended MBCT, only a small number of mental health services in the UK have systematically implemented the guidance. Guiding principles for implementation are set out. We offer an implementation resource to facilitate the transfer of MBCT knowledge into action.
Parental depression can adversely affect parenting and children’s development. We adapted mindfulness-based cognitive therapy (MBCT) for parents (MBCT-P) with a history of depression and describe its development, feasibility, acceptability and preliminary estimates of efficacy. Manual development involved interviews with 12 parents who participated in MBCT groups or pilot MBCT-P groups. We subsequently randomised 38 parents of children aged between 2 and 6 years to MBCT-P plus usual care (n = 19) or usual care (n = 19). Parents were interviewed to assess the acceptability of MBCT-P. Preliminary estimates of efficacy in relation to parental depression and children’s behaviour were calculated at 4 and 9 months post-randomisation. Levels of parental stress, mindfulness and self-compassion were measured. Interviews confirmed the acceptability of MBCT-P; 78 % attended at least half the sessions. In the pilot randomised controlled trial (RCT), at 9 months, depressive symptoms in the MBCT-P arm were lower than in the usual care arm (adjusted mean difference = −7.0; 95 % confidence interval (CI) = −12.8 to −1.1; p = 0.02) and 11 participants (58 %) in the MBCT-P arm remained well compared to 6 (32 %) in the usual care arm (mean difference = 26 %; 95 % CI = −4 to 57 %; p = 0.02). Levels of mindfulness (p = 0.01) and self-compassion (p = 0.005) were higher in the MBCT-P arm, with no significant differences in parental stress (p = 0.2) or children’s behaviour (p = 0.2). Children’s behaviour problems were significantly lower in the MBCT-P arm at 4 months (p = 0.03). This study suggests MBCT-P is acceptable and feasible. A definitive trial is needed to test its efficacy and cost effectiveness.
Original MBCT course manual: Segal, Williams & Teasdale (2002) –adapted manual shown below. Adapted manual written by Joanna Mann, Willem Kuyken and Alison Evans who hold the copyright
Original MBCT course manual: Segal, Williams & Teasdale (2002) –adapted manual shown below. Adapted manual written by Joanna Mann, Willem Kuyken and Alison Evans who hold the copyright
Based on Segal, Williams and Teasdale (2002) –Mindfulness-Based Cognitive Therapy for Depression
Based on Segal, Williams and Teasdale (2002) –Mindfulness-Based Cognitive Therapy for Depression
Based on Segal, Williams and Teasdale (2002) –Mindfulness-Based Cognitive Therapy for Depression
BackgroundRecently, there has been an increased interest in studying the effects of mindfulness-based interventions for people with psychological and physical problems. However, the mechanisms of action in these interventions that lead to beneficial physical and psychological outcomes have yet to be clearly identified.
Purpose
The aim of this paper is to review, systematically, the evidence to date on the mechanisms of action in mindfulness interventions in populations with physical and/or psychological conditions.
Method
Searches of seven databases (PsycINFO, Medline (Ovid), Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, AMED, ClinicalTrials.gov) were undertaken in June 2014 and July 2015. We evaluated to what extent the studies we identified met the criteria suggested by Kazdin for establishing mechanisms of action within a psychological treatment (2007, 2009).
Results
We identified four trials examining mechanisms of mindfulness interventions in those with comorbid psychological and physical health problems and 14 in those with psychological conditions. These studies examined a diverse range of potential mechanisms, including mindfulness and rumination. Of these candidate mechanisms, the most consistent finding was that greater self-reported change in mindfulness mediated superior clinical outcomes. However, very few studies fully met the Kazdin criteria for examining treatment mechanisms.
Conclusion
There was evidence that global changes in mindfulness are linked to better outcomes. This evidence pertained more to interventions targeting psychological rather than physical health conditions. While there is promising evidence that MBCT/MBSR intervention effects are mediated by hypothesised mechanisms, there is a lack of methodological rigour in the field of testing mechanisms of action for both MBCT and MBSR, which precludes definitive conclusions.
BACKGROUND:Recently, there has been an increased interest in studying the effects of mindfulness-based interventions for people with psychological and physical problems. However, the mechanisms of action in these interventions that lead to beneficial physical and psychological outcomes have yet to be clearly identified.
Background: Recently, there has been an increased interest in studying the effects of mindfulness-based interventions for people with psychological and physical problems. However, the mechanisms of action in these interventions that lead to beneficial physical and psychological outcomes have yet to be clearly identified.Purpose: The aim of this paper is to review, systematically, the evidence to date on the mechanisms of action in mindfulness interventions in populations with physical and/or psychological conditions.
Method: Searches of seven databases (PsycINFO, Medline (Ovid), Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, AMED, ClinicalTrials.gov) were undertaken in June 2014 and July 2015. We evaluated to what extent the studies we identified met the criteria suggested by Kazdin for establishing mechanisms of action within a psychological treatment (2007, 2009).
Results: We identified four trials examining mechanisms of mindfulness interventions in those with comorbid psychological and physical health problems and 14 in those with psychological conditions. These studies examined a diverse range of potential mechanisms, including mindfulness and rumination. Of these candidate mechanisms, the most consistent finding was that greater self-reported change in mindfulness mediated superior clinical outcomes. However, very few studies fully met the Kazdin criteria for examining treatment mechanisms.
Conclusion: There was evidence that global changes in mindfulness are linked to better outcomes. This evidence pertained more to interventions targeting psychological rather than physical health conditions. While there is promising evidence that MBCT/MBSR intervention effects are mediated by hypothesised mechanisms, there is a lack of methodological rigour in the field of testing mechanisms of action for both MBCT and MBSR, which precludes definitive conclusions.
In my parent’s generation there was a sea change in health behaviour. Not so long ago smoking was considered normal, diets were conducive to heart disease and exercise was a marginal pursuit. In just fifty years most people acknowledge the importance of exercise and diet. Smoking has become a marginal pursuit. There has been a huge tipping point.
We aimed to evaluate whether mindfulness-based cognitive therapy (MBCT) was feasible and acceptable for young people, their parents and the clinicians working with them; whether a parallel course for parents was a useful addition; and whether attendance at MBCT was associated with improved outcomes. The design was a mixed-method service evaluation of an eight-session MBCT programme for young people who were recovering from depression. The course was a manualised eight-session group intervention. Both young people (n = 18) and parents (n = 21) completed validated measures before and after the course. Semi-structured interviews were completed with some group participants and clinical staff working in the service. Care records were searched for additional contact following the intervention. Qualitative data from young people, parents and clinicians suggested that MBCT was acceptable and feasible and provided strategies to cope. The parent course was reported to provide personal support to parents and helped them cope with their child’s depression whilst also impacting the family, promoted shared understanding of depression and strategies to combat it and addressed intergenerational aspects of depression. Eighty-four per cent of participants attended at least 6/8 sessions, and 48% required no further intervention within the following year. Young people had statistically significant improvements across all outcome measures, whilst parents had statistically significant improvements in rumination, self-compassion and decentring.
Mindfulness-based cognitive therapy (MBCT) was developed as a psychological approach for people at risk for depressive relapse who wish to learn how to stay well in the long-term. In this article we set out the rationale for MBCT, outline the treatment approach, overview the efficacy research to date and look to future challenges.
The Mindfulness-Based Interventions: Teaching Assessment Criteria (MBI:TAC) is a tool for supporting good practice in mindfulness-based teaching, training supervision and research contexts. It has been taken up in practice in teacher training organizations worldwide. The MBI:TAC sits within the wider consideration within research contexts of building methodological rigor by developing robust systems for ensuring intervention integrity. Research on the tool is at an early stage and needs development. The process of implementation needs careful attention to ensure reliability and good practice. Future research is needed on the tool's reliability, validity and sensitivity to change, and on the relationships between mindfulness-based teaching, participant outcomes and key contextual factors, including the influence of participant population, culture and context.
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