05-08-2017 | ORIGINAL PAPER | Uitgave 2/2018 Open Access

The Co-creation and Feasibility of a Compassion Training as a Follow-up to Mindfulness-Based Cognitive Therapy in Patients with Recurrent Depression
- Tijdschrift:
- Mindfulness > Uitgave 2/2018
Electronic supplementary material
Introduction
Method
Participants
Group 1 (
N = 14)
|
Group 2 (
N = 13)
|
||
---|---|---|---|
Doubles (
N = 10)
|
Novices (
N = 3)
|
||
Female (
N)
|
13
|
9
|
2
|
Age (SD)
|
56 (9.8)
|
58.7 (5.7)
|
57.8 (2.1)
|
Age range
|
37–71
|
46–66
|
56–60
|
Time lapse since MBCT (months)
|
32.1
|
47.3
|
54
|
Procedure
Measures
Data Analyses
Results
First Focus Group Interview
Facilitators
|
Description
|
---|---|
Didactic teaching
|
Evolutionary development and universality of the three emotion regulation systems
Addressing and explanation of the back draft effect as a possible occurrence
|
Compassion practices
|
The explicit focus on self-compassion development in the practices, as well as on obstacles to self-compassion (inner bully/critic)
|
Embodiment teacher
|
Consistent mild attitude/responsiveness of the teachers
Practical translation of compassion in daily life
|
Facilitators
The explanation, I found so illuminating. Which system you automatically step into. It starts with your brain, so enlightening. … It’s applicable to every brain and that is also comforting.
Compassion Practices
The inner bully was addressed extensively and that was a real eye-opener for me, …very recognizable as one of the major causes of distress. And by naming it and looking at it more compassionately, it got a place for me and it is a less dominant factor in my life than before.
Teacher Embodiment of Compassion to Self and Others
It’s just that they [the teachers] also shared their own struggles with things that are difficult, so you’re really investigating this together.
It really connects with me … when you listen to what people are sharing and what reactions you as instructors have to that. That is what’s helped me most of all … that translation ... in a safe group, which I found the most important, I’ve really experienced that.
Peer Support
You’re in a very democratic process of struggling together with what it is, and err yes that helps (…) especially when you’re depressed a lot, you think: o help, I’m so pathetic, and here you come into this group and yes, you’re in it together.
Structure of the Training
Barriers
Barriers
|
Description
|
---|---|
Compassion development
|
Being confronted with one’s lack of self-compassion as well as lack of compassion for others
The resurfacing of old pain, i.e. the back draft effect
|
Structure of the training
|
Lack of structure
Lack of core practice
Too many practice options
Unappealing course folder: language/volume
|
Compassion Development
… to look at myself more compassionately, has (…) made me confront a whole bunch of things that (…) are hard. I’ve found that (…) the price of this training, that it wasn’t easy for me, (…) it’s something to take into account.
For me, it would have been easier if it had been addressed in some form in each session.
Structure of the Training
Perhaps followed by a summary and a reference of what the next step was going to be, what will we do next time and why is that a logical step considering what we’ve done before.
You [the teacher] returned to the soothing system and I thought: ah, finally, that’s what it’s about; I’ve been waiting five sessions to hear that.
I do see the advantage of having a large shop in which to choose what I like, but for me I tend to walk past the shop when it’s like that.
Now everyone had done something else, so you can’t share so much how you’ve struggled with a particular practice.
It would have helped me to know which exercises are specific for this session, and then to be offered the rest as added options, in case you want to do more.
A characteristic of depressed people is their difficulty with making decisions.
I’ve really had words which I had to look up on the Internet.
It was a difficult, heavy read for me.
Yes, … it’s finally your turn and then you already had to transfer to someone else and then I thought, yeah but I don’t feel like doing that at all, I am finally on a roll with myself so that can wait a couple of sessions. I’m not saying to take it out of the program but it’s very liberating that you’re allowed to just have compassion with yourself for a change.
Adaptations to the MBCL Program After the First Focus Group Interview
Second Focus Group Interview
The second time we took more time to exchange experiences in the group on what was encountered, if you were managing to practice or not, how you dealt with yourself. For me, I feel that taught me most of all, because you [the teachers] were very consistent in being mild.
Yes, okay, it’s explained, but still.. and then someone would say something that would make it click with me, so what they [the teachers] said became clear through her [participant] story.
In the first course, the inner bully was addressed extensively and that was a huge eye-opener for me like that is so recognizable as one of the major causes of all the unrest, and by naming it and looking at it from a compassionate viewpoint, it has a less dominant role in my life than before.
Preliminary Effectiveness
Group 1 (
N = 14)
|
Group 2 (
N = 13)
b
|
||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Scale
|
Subscale
|
Mean
|
CI (diff)
|
p
|
d
|
Scale
|
Subscale
|
Mean
|
CI (diff)
|
p
|
d
|
||
Pre (SD)
|
Post (SD)
|
Pre (SD)
|
Post (SD)
|
||||||||||
BDI-II
|
Depression
|
13.14 (9.9
|
10.79 (7.7)
|
−1.90–6.61
|
.253
|
0.26
|
BDI-II
|
Depr
|
21.13 (12.4)
|
13.00 (12.1)
|
4.60–11.66
|
.001
b
|
0.66
|
PSWQ
a
|
Worry
|
43.69 (6.7)
|
42.15 (6.7)
|
−1.97–5.05
|
.359
|
0.23
|
PSWQ
c
|
Worry
|
43.14 (8.3)
|
45.57 (8.2)
|
−9.16–4.30
|
.411
|
0.29
|
FFMQ
|
Mindfulness
|
80.64 (8.8)
|
83.79 (9.1)
|
−8.13–1.84
|
.196
|
0.35
|
FFMQ
|
Mindf
|
79.38 (17.2)
|
81.63 (14.5)
|
−8.12–3.62
|
.395
|
0.14
|
Observe
|
15.93 (1.1)
|
17.00 (1.5)
|
−1.87–−0.27
|
.013
a
|
0.81
|
Obs
|
15.50 (3.0)
|
15.86 (2.6)
|
−2.32–1.57
|
.662
|
0.13
|
||
Describe
|
20.00 (4.2)
|
20.21 (3.8)
|
−1.85–1.42
|
.782
|
0.05
|
Descr
|
18.88 (4.9)
|
17.88 (4.4)
|
−0.84–2.84
|
.240
|
0.21
|
||
Act with awareness
|
15.36 (2.2)
|
15.93 (3.1)
|
−2.31–1.16
|
.489
|
0.21
|
Act
|
16.25 (4.4)
|
16.63 (3.3)
|
−1.92–1.17
|
.584
|
0.10
|
||
Non-judgment
|
14.14 (2.7)
|
15.14 (4.0)
|
−2.52–0.52
|
.179
|
0.29
|
Non-judg
|
14.25 (3.0)
|
16.63 (3.9)
|
−4.32–−0.43
|
.023
b
|
0.68
|
||
Non-reactivity
|
15.21 (2.7)
|
15.50 (2.8)
|
−1.86–1.29
|
.702
|
0.11
|
Non-reac
|
15.50 (4.2)
|
14.63 (3.2)
|
−1.42–1.17
|
.826
|
0.23
|
||
SCS
a
|
Self-compassion
|
23.09 (5.2)
|
26.25 (6.0)
|
−6.21–−0.11
|
.043
a
|
0.56
|
SCS
b
|
Self-comp
|
22.31 (7.8)
|
25.26 (8.0)
|
−5.81–−0.09
|
.045
b
|
0.37
|
Self-kindness
|
4.03 (1.2)
|
4.60 (1.4)
|
−1.14–0.03
|
.059
|
0.44
|
Self-kind
|
3.81 (1.6)
|
4.63 (1.5)
|
−1.53–−0.09
|
.032
b
|
0.53
|
||
Self-judgment
|
4.33 (1.1)
|
4.04 (1.3)
|
−0.90–1.48
|
.606
|
0.24
|
Self-judg
|
4.00 (1.3)
|
4.41 (1.4)
|
−2.51–1.70
|
.662
|
0.30
|
||
Common humanity
|
4.10 (1.3)
|
4.75 (1.1)
|
−1.28–−0.03
|
.041
a
|
0.54
|
Comm hum
|
3.72 (1.6)
|
4.14 (1.7)
|
−1.26–0.43
|
.281
|
0.25
|
||
Isolation
|
4.56 (1.1)
|
4.02 (1.3)
|
−0.80–1.87
|
.397
|
0.49
|
Isol
|
4.75 (1.7)
|
3.81 (1.6)
|
−1.76–3.63
|
.438
|
0.57
|
||
Mindfulness
|
4.51 (1.0)
|
4.90 (0.9)
|
−0.80–0.02
|
.058
|
0.41
|
Mindf
|
4.25 (1.4)
|
4.60 (1.4)
|
−0.70–0.01
|
.054
|
0.25
|
||
Overidentification
|
4.67 (1.1)
|
3.94 (1.1)
|
−0.49–1.95
|
.218
|
0.69
|
Overid
|
4.72 (1.1)
|
3.70 (1.1)
|
−0.68–2.74
|
.197
|
0.93
|
Doubles (
N = 10)
a
Mean
|
Novices (
N = 3)
Mean
|
|||
---|---|---|---|---|
Pre (sd)
|
Post (sd)
|
Pre (sd)
|
Post (sd)
|
|
BDI-II
|
20.6 (11.9)
|
10.4 (11.6)
|
25 (9)
|
22 (1.4)
|
PSWQ
|
42.8 (7.8)
|
41.7 (7.1)
|
54 (2)
|
59 (0)
|
FFMQ
|
79.8 (15.2)
|
85.7 (12.8)
|
70 (14.4)
|
72.5 (17.7)
|
SCS
|
24.2 (6.5)
|
28.5 (7.5)
|
15.3 (4.5)
|
18.2 (1.5)
|