Expanding the Scope of Mindfulness-Based Cognitive Therapy: Evidence for Effectiveness in a Heterogeneous Psychiatric Sample

https://doi.org/10.1016/j.cbpra.2011.02.006Get rights and content

Abstract

Mindfulness-based interventions (e.g., MBSR; Kabat-Zinn, 1990; MBCT; Segal, Williams, & Teasdale, 2002) have demonstrated effectiveness in a number of distinct clinical populations. However, few studies have evaluated MBCT within a heterogeneous group of psychiatric adult outpatients. This study examined whether a wider variety of patients referred from a large, tertiary mood and anxiety outpatient clinic could benefit from such a program. Twenty-three psychiatric outpatients with mood and/or anxiety disorders (mean age = 53.65 years, SD = 10.73; 18 women) were included in this study. Each participant completed the Structured Clinical Interview for Diagnosis Axis I and measures of mood, life stress, and mindfulness skills, prior to the start of group and immediately following its completion. Paired t-test analyses were conducted and results revealed a significant improvement in mood and mindfulness skills in addition to a significant reduction in severity and total number of perceived life stressors. In summary, our results indicate that MBCT can effectively be administered to a group of patients whose diagnoses and difficulties may vary, who have significant comorbidity, and who are currently experiencing significant symptoms. This has important practical implications for offering this treatment within broader psychological and psychiatric service systems.

Section snippets

Purpose of the Study

Using an effectiveness design, the purpose of our study was to determine if an inclusive mindfulness-based meditation group, largely based on the protocol of Segal et al. (2002), open to adult outpatients who are seeking treatment for a variety of psychological conditions, medical conditions, or both, might be acceptable and effective in reducing negative affect. Along with mood symptoms, we also examined changes in self-reported stressors—specifically, we sought to determine whether the number

Participants

Twenty-three psychiatric outpatients (mean age = 53.65 years, SD = 10.73; 18 women) were included in this study. Patients were part of a specialized outpatient mood and anxiety service, which is publicly funded in Canada and only available after primary care treatments have been attempted—thus, the average complexity and acuity in patients on the service is quite considerable. Participants were included if they were 18 or over, have either psychological symptoms (e.g., depression, anxiety, stress),

Case Example

To illustrate the process of the group, we next describe an individual case.

Lisa was a 52-year-old married woman whose long-standing bipolar disorder had primarily been treated with mood-stabilizing medications. She was compliant with medications and was seeing her psychiatrist regularly for medication “tweaks” when she enrolled in the group. She reported that as a result of medication her mood swings were not as dramatic as they had been in the past, but many residual depressive and hypomanic

Results

We examined the mean scores of the BDI of all the participants who consented to use their pre-group data but dropped out of the mindfulness group (n = 16; mean = 19.5, SD = 11.50; range 0–40) compared to those who agreed to act as research participants and completed the group (n = 23; mean = 18.90, SD = 13.0; range 1–51) and found that the groups did not differ in terms of clinical severity level. Those participants who dropped out of mindfulness group were experiencing the same level of depressive symptom

Discussion

Following an 8-week MBCT group that was largely based on Segal et al.'s (2002) protocol, our results revealed a decrease in patients’ mood symptoms, total number of perceived life stressors, the perceived severity of those stressors, and an increase in mindfulness skills. This is consistent with one other study using a similar population and MBCT protocol (e.g., Ree & Craigie, 2007). Our results suggest that individuals with moderate symptoms on the BDI-II can complete a mindfulness program,

Clinical Implications

Overall, we broadened Segal et al.'s (2002) MBCT protocol to cover negative affect more generally as opposed to solely depression for this more heterogeneous group. The changes made to accomplish this goal were quite minimal, at least in terms of the mindfulness practices and whiteboard exercises described in the original protocol. For this portion of the protocol the language was elaborated to describe not only depression but also anxiety, stress, and pain. The heterogeneity of the group

References (16)

  • A.T. Beck et al.

    Manual for the Beck Depression Inventory-II

    (1996)
  • J. Kabat-Zinn

    Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness

    (1990)
  • J. Kabat-Zinn et al.

    The clinical use of mindfulness meditation for the self-regulation of chronic pain

    Journal of Behavioral Medicine

    (1985)
  • J. Kabat-Zinn et al.

    Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders

    American Journal of Psychiatry

    (1992)
  • A.D. Kanner et al.

    Comparison of two modes of stress measurement

    Journal of Behavioural Medicine

    (1981)
  • J.L. Kristeller et al.

    Effects of a meditation-based intervention in the treatment of binge eating

    Journal of Health Psychology

    (1999)
  • M.A. Lau et al.

    The Toronto mindfulness scale: Development and validation

    Journal of Clinical Psychology

    (2006)
There are more references available in the full text version of this article.

Cited by (28)

  • Mindfulness-Based Interventions for Anxiety and Depression

    2017, Psychiatric Clinics of North America
    Citation Excerpt :

    Recent reviews of well-designed randomized controlled trials comparing mindfulness treatments (primarily MBSR and MBCT) with active control conditions indicate that MBIs are effective in treating a broad range of outcomes among diverse populations.6–11 These outcomes include clinical disorders and symptoms such as anxiety,8,12,13 risk of relapse for depression,14,15 current depressive symptoms,9 stress,16–18 medical and well-being outcomes such as chronic pain,19 quality of life,14,20 and psychological or emotional distress.21,22 In addition, MBIs have been shown to work via changes in specific aspects of mental disorder, such as cognitive biases, affective dysregulation, and interpersonal effectiveness.17,23,24

  • How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies

    2015, Clinical Psychology Review
    Citation Excerpt :

    These include mindfulness of breath, thoughts, bodily sensations, sounds, and everyday activities. A growing body of robust evidence from randomised controlled trials (RCTs) has demonstrated that MBIs are effective in improving a range of clinical and non-clinical psychological outcomes in comparison to control conditions, including anxiety (Green & Bieling, 2012; Hofmann, Sawyer, Witt, & Oh, 2010), risk of relapse for depression (Kuyken et al., 2008; Teasdale et al., 2000), current depressive symptoms (Strauss, Cavanagh, Oliver, & Pettman, 2014), stress (Chiesa & Serretti, 2009), chronic pain (Grossman, Tiefenthaler-Gilmer, Raysz, & Kesper, 2007), quality of life (Godfrin & van Heeringen, 2010; Kuyken et al., 2008), psychological symptoms in patients with cancer (Ledesma & Kumano, 2009) and retrieval of specific autobiographical memories (Williams, Teasdale, Segal, & Soulsby, 2000), a reliable cognitive marker of depression (e.g. Brittlebank, Scott, Williams, & Ferrier, 1993). Other notable interventions which involve mindfulness principles alongside other components include acceptance and commitment therapy (ACT; Hayes & Wilson, 1994) and dialectical behavioural therapy (DBT; Linehan, 1993).

View all citing articles on Scopus
View full text