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Mindfulness-Based Cognitive Therapy Delivered in Primary Care: a Naturalistic, Mixed-Methods Study of Participant Characteristics and Experiences

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Abstract

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.

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References

  • Allen, M., Bromley, A., Kuyken, W., & Sonnenberg, S. J. (2009). Participants’ experiences of mindfulness-based cognitive therapy: it changed me in just about every way possible. Behavioural and Cognitive Psychotherapy, 37(4), 413–430.

    Article  Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). Washington, DC: Author.

  • Ansseau, M., Dierick, M., Buntinkx, F., Cnockaert, P., De Smedt, J., Van Den Haute, M., & Vander Mijnsbrugge, D. (2004). High prevalence of mental disorders in primary care. Journal of Affective Disorders, 78(1), 49–55.

    Article  Google Scholar 

  • Baer, R. A., Lykins, E. L. B., & Peters, J. R. (2012). Mindfulness and self-compassion as predictors of psychological wellbeing in long-term meditators and matched nonmeditators. The Journal of Positive Psychology, 7(3), 230–238.

    Article  Google Scholar 

  • Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84(4), 822–848.

    Article  Google Scholar 

  • Cormack, D., Jones, F. W., & Maltby, M. (2018). A “collective effort to make yourself feel better”: the group process in mindfulness-based interventions. Qualitative Health Research, 28(1), 3–15.

    Article  Google Scholar 

  • Crane, R. S., & Kuyken, W. (2012). The implementation of mindfulness-based cognitive therapy: learning from the UK health service experience. Mindfulness, 4(3), 246–254.

    Article  Google Scholar 

  • Crane, R. S., Kuyken, W., Mark, J., Williams, G., Hastings, R. P., Cooper, L., & Fennell, M. J. V. (2012). Competence in teaching mindfulness-based courses: concepts, development and assessment. Mindfulness, 3(1), 76–84.

    Article  Google Scholar 

  • Demarzo, M. M. P., Cebolla, A., & Garcia-Campayo, J. (2015a). The implementation of mindfulness in healthcare systems: a theoretical analysis. General Hospital Psychiatry, 37(2), 166–171.

    Article  Google Scholar 

  • Demarzo, M. M. P., Cuijpers, P., Zabaleta-del-olmo, E., Mahtani, K. R., Vellinga, A., & Vicens, C. (2015b). The efficacy of mindfulness-based interventions in primary care: a meta-analytic review. The Annals of Family Medicine, 13(6), 573–582.

    Article  Google Scholar 

  • Dimidjian, S., & Segal, Z. V. (2015). Prospects for a clinical science of mindfulness-based intervention. American Psychologist, 70(7), 593–620.

    Article  Google Scholar 

  • Eatough, V., & Smith, J. (2006). I was like a wild wild person: understanding feelings of anger using interpretative phenomenological analysis. British Journal of Psychology, 97(4), 483–498.

    Article  Google Scholar 

  • Elices, M., Pascual, J. C., Portella, M. J., Feliu-Soler, A., Martín-Blanco, A., Carmona, C., & Soler, J. (2016). Impact of mindfulness training on borderline personality disorder: a randomized trial. Mindfulness, 7(3), 584–595.

    Article  Google Scholar 

  • Finucane, A., & Mercer, S. W. (2006). An exploratory mixed methods study of the acceptability and effectiveness of mindfulness-based cognitive therapy for patients with active depression and anxiety in primary care. BMC Psychiatry, 6(1), 14.

    Article  Google Scholar 

  • Goldberg, S. B., Tucker, R. P., Greene, P. A., Davidson, R. J., Wampold, B. E., Kearney, D. J., & Simpson, T. L. (2018). Mindfulness-based interventions for psychiatric disorders: a systematic review and meta-analysis. Clinical Psychology Review, 59, 52–60.

    Article  Google Scholar 

  • Hertenstein, E., Rose, N., Voderholzer, U., Heidenreich, T., Nissen, C., Thiel, N., et al. (2012). Mindfulness-based cognitive therapy in obsessive-compulsive disorder – a qualitative study on patients’ experiences. BMC Psychiatry, 12(1), 185.

    Article  Google Scholar 

  • Jacobson, N. S., & Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59(1), 12-19.

  • Kabat-Zinn, J. (1990). Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness. New York, NY: Delacorte.

    Google Scholar 

  • Khoury, B., Lecomte, T., Fortin, G., Masse, M., Therien, P., Bouchard, V., et al. (2013). Mindfulness-based therapy: a comprehensive meta-analysis. Clinical Psychology Review, 33(6), 763–771.

    Article  Google Scholar 

  • Kuyken, W., Byford, S., Taylor, R. S., Watkins, E., Holden, E., White, K., et al. (2008). Mindfulness-based cognitive therapy to prevent relapse in recurrent depression. Journal of Consulting and Clinical Psychology, 76(6), 966–978.

    Article  Google Scholar 

  • Kuyken, W., Watkins, E., Holden, E., White, K., Taylor, R. S., Byford, S., et al. (2010). How does mindfulness-based cognitive therapy work? Behaviour Research and Therapy, 48(11), 1105–1112.

    Article  Google Scholar 

  • Kuyken, W., Hayes, R., Barrett, B., Byng, R., Dalgleish, T., Kessler, D., et al. (2015). Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): a randomised controlled trial. The Lancet, 386(9988), 63–73.

    Article  Google Scholar 

  • Kuyken, W., Warren, F. C., Taylor, R. S., Whalley, B., Crane, C., Bondolfi, G., et al. (2016). Efficacy of mindfulness-based cognitive therapy in prevention of depressive relapse an individual patient data meta-analysis from randomized trials. JAMA Psychiatry, 73(6), 565–574.

    Article  Google Scholar 

  • Magán, I., Sanz, J., & García-Vera, M. P. (2008). Psychometric properties of a Spanish version of the Beck Anxiety Inventory (BAI) in general population. The Spanish Journal of Psychology, 11(2), 626–640.

    Article  Google Scholar 

  • Mason, O., & Hargreaves, I. (2001). A qualitative study of mindfulness-based cognitive therapy for depression. British Journal of Medical Psychology, 74(2), 197–212.

    Article  Google Scholar 

  • Parke, A., & Griffiths, M. (2012). Beyond illusion of control: an interpretative phenomenological analysis of gambling in the context of information technology. Addiction Research & Theory, 20(3), 250–260.

    Article  Google Scholar 

  • Piet, J., & Hougaard, E. (2011). The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: a systematic review and meta-analysis. Clinical Psychology Review, 31(6), 1032–1040.

    Article  Google Scholar 

  • Roca, M., Gili, M., Garcia-Garcia, M., Salva, J., Vives, M., Garcia Campayo, J., & Comas, A. (2009). Prevalence and comorbidity of common mental disorders in primary care. Journal of Affective Disorders, 119(1–3), 52–58.

    Article  Google Scholar 

  • Rycroft-Malone, J., Gradinger, F., Griffiths, H. O., Crane, R., Gibson, A., Mercer, S., et al. (2017). Accessibility and implementation in the UK NHS services of an effective depression relapse prevention programme: learning from mindfulness-based cognitive therapy through a mixed-methods study. Health Services and Delivery Research, 5(14), 1–190.

    Article  Google Scholar 

  • Sanz, J., Perdigón, A. L., & Vázquez, C. (2003). The Spanish adaptation of Beck’s Depression Inventory-II (BDI-II): psychometric properties in the general population. Clínica y Salud, 14(3), 249–280.

    Google Scholar 

  • Sanz, J., García-Vera, M. P. A. Z., Espinosa, R., Fortún, M., & Vázquez, C. (2005). Adaptación española del inventario para la depresión de Beck-II (BDI-II): Propiedades psicométricas en pacientes con trastornos psicológicos. Clínica y Salud, 16(2), 141–142.

    Google Scholar 

  • Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression. New York, NY: The Guilford Press.

    Google Scholar 

  • Segal, Z. V., Bieling, P., Young, T., MacQueen, G., Cooke, R., Martin, L., & Levitan, R. (2010). Antidepressant monotherapy vs sequential pharmacotherapy and mindfulness-based cognitive therapy, or placebo, for relapse prophylaxis in recurrent depression. Archives of General Psychiatry, 67(12), 1256–1264.

    Article  Google Scholar 

  • Smith, J. A., Flowers, P., & Larkin, M. (2009). Interpretative phenomenological analysis. Theory, method and research. London: Sage Publications Ltd.

    Google Scholar 

  • Sundquist, J., Sa Lilja, Å., Palmé, K., Memon, A. A., Wang, X., Johansson, L. M., & Sundquist, K. (2015). Mindfulness group therapy in primary care patients with depression, anxiety and stress and adjustment disorders: randomised controlled trial. The British Journal of Psychiatry, 206(2), 128–135.

    Article  Google Scholar 

  • Teasdale, J. D., Segal, Z. V., Williams, J. M., Ridgeway, V. A., Soulsby, J. M., & Lau, M. A. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 68(4), 615–623.

    Article  Google Scholar 

  • van der Velden, A. M., Kuyken, W., Wattar, U., Crane, C., Pallesen, K. J., Dahlgaard, J., et al. (2015). A systematic review of mechanisms of change in mindfulness-based cognitive therapy in the treatment of recurrent major depressive disorder. Clinical Psychology Review, 37, 26–39.

    Article  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Bradley Londres for his help in editing the manuscript.

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Author notes

    Authors and Affiliations

    1. Institut de Neuropsiquiatria i Addiccions (INAD), Institut Hospital del Mar d’Investigacions Mèdiques, (IMIM), Parc de Salut Mar, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain

      Miguel Gárriz, Matilde Elices, Mar Peretó, Luis Miguel Martín-López, Azucena Justicia & Víctor Pérez

    2. Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain

      Matilde Elices, Mar Peretó, Luis Miguel Martín-López, Azucena Justicia & Víctor Pérez

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    1. Miguel Gárriz
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    2. Matilde Elices
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    3. Mar Peretó
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    4. Luis Miguel Martín-López
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    5. Azucena Justicia
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    6. Víctor Pérez
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    Contributions

    MG: designed and executed the study. ME: executed the study and wrote the paper. MP: executed the study, collaborated with data analysis, and wrote part of the results. LMM: collaborated with the writing of the study. AJ: collaborated in the writing and data analyses. VP: collaborated with the writing of the final manuscript. All authors approved the final version of the manuscript for submission. Miguel Gárriz and Matilde Elices contributed equally to this work

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    Correspondence to Matilde Elices.

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    The authors declare that they have no conflicts of interest.

    Ethical Approval

    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Clinical Research Ethics Committee of the Hospital del Mar (Barcelona Spain).

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    Informed consent was obtained from all individual participants included in the study.

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    Gárriz, M., Elices, M., Peretó, M. et al. Mindfulness-Based Cognitive Therapy Delivered in Primary Care: a Naturalistic, Mixed-Methods Study of Participant Characteristics and Experiences. Mindfulness 11, 291–302 (2020). https://doi.org/10.1007/s12671-019-01166-y

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    • DOI: https://doi.org/10.1007/s12671-019-01166-y

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