Mindfulness Based Cognitive Therapy is an innovative treatment program for relapse prevention of depression and the treatment of anxiety disorders.
Mindfulness Based Cognitive Therapy (MBCT) may be seen by patients more along the lines of adult education rather than a mental health intervention, thus helping to de-stigmatise depression and anxiety.
Preconceptions, motivations and expectations.
While the majority of participants had past experience of some form of psychological intervention (10/13), ranging from counselling to relaxation exercises, and five had seen a psychiatrist, only one participant had past experience of meditation.
Several people in the group indicated that the chronicity of their problems with anxiety and depression was a major motivating factor for participating in the program.
“I was eh, at a stage, I still am at a stage, where I will do anything”-P1. (P1 = patient 1 for confidentiality reasons).
“Because I have suffered for a lot of years with anxiety and bouts of depression”-P9
Avoiding medication was highlighted by only one of the participants as an important reason for persisting with the course.
“I didn’t want anti-depressants or things like that. I wanted to take control of things myself… …I was determined when I started to stick to it, to get to the end of the course and understand what the course was about. I also went into it thinking this might not help me, but I am giving it a try. I am going to see it through and it did help.”-P5
A few participants mentioned the importance of commitment and self-help as an important part of recovery from depression.
” I’ve always had the attitude that if I don’t do it nobody else can do it for me. So you know, it was there and I wanted to try it and I got the opportunity to do it. So it was a sort of self help thing”-P9
“You have got to work at these things you know…my downfall is I’m very undisciplined I don’t follow things through”-P8
“(the MBCT course was) Something I could work with and something I saw myself practising out”-P6
One woman, who had struggled with severe anxiety and depression for 30 years, described having high expectations prior to starting the course and feeling disappointed afterwards.
“Because I’ve got severe anxiety and depression so I thought coming along to this I would be immediately cured â€“ so I am disappointed in that”-P3
Being in a group
This was the first time that any of the participants, except one, had been in a group ‘intervention’. For several people this seemed to be an important normalising process. Themes such as being understood by the group, realising that you were not alone and being able to show emotion in a safe environment, emerged as common positive aspects to being in a group.
“It was really good and I got to know other people as well, that I’m not on my own. There is other people with the same sort of problems which is good”-P10
For one man being in a group was an important turning point in his understanding of mental illness;
“Don’t ask me, what I was expecting the other people to be? Raving lunatics, people with axes in their hands, I haven’t a clue â€“ but they were not….it was you, it was my next door neighbour. They weren’t giggling half wits. I know that is rather narrow minded but they were ordinary everyday run of the mill people which reinforces the fact that that is what I am as well. I’m not a nut…I’m just an ordinary, everyday run of the mill person who ended up in the crap for whatever reason, and so are they. So that was another thing that was a great plus”-P1
However, not everyone found being in a group a positive experience. One man with a history of panic attacks, usually provoked in social circumstance, found the group claustrophobic. For him, the group conjured up images of an Alcoholics Anonymous meeting and he was afraid that he might become more depressed if he stayed in the group;
“I found I was a lot better than I had been when I started the course anyway, with going back to work. And things seemed to be picking up. But I found, I wouldn’t say it dragged me back down, but I felt it started to almost like reawaken kind of feelings of anxiety being in close proximity to them, so many people and just in the group that kind of thing you know”-P7
Two people talked about how the group helped them persevere with the meditation exercises.
“I think if you are on your own you would quite easily walk way and give up whereas you’ve got the support there and you know that everybody’s sort of helping you out and you would go back in for the groups sake and try again.”-P9
Several people in the group expressed relief about not having to talk about their personal problems.
“I didn’t like it at first…in case I have to say what my problems were….You were under no pressure whatsoever. If you wanted to come in and not participate that night, just sit, watch and listen that was fine by him”-P6
Length of the course
While most of the group found the course enjoyable the majority of the group thought the course was too short. Although some participants commented that it was long enough to learn the basics of practice, most of the group would have liked the course to go on for another 3â€“4 weeks.
Nine out the eleven interviewed expressed a desire for some form of follow-up and one woman spoke about feels of loss of support following completion of the course.
“I felt it was about right…what a few of us was saying, actually at the end we wished it would continue for a wee bit longer cause we enjoyed it so much…the people I was getting up to the bus stop at night that’s what they where saying, they would have loved it to have continued.”-P5
“I think it could have been longer, much longer…maybe another 4 weeks on top of that would have been better.”-P11
“If we even said …monthly or quarterly something like that whereby you have still got this link and you would still have each other. It’s like you had this sort of support if you like and then it’s just gone. So I think personally a follow up is a must”-P9
“I know meditation would be a good thing and I would enjoy it if I could get into it, it’s very beneficial and I think it would have helped if it had gone on longer but it just wasn’t long enough.”-P3
One participant thought that some additional one-to-one sessions with the course facilitator would allow participants to discuss personal problems without having to air them in front of the group.
Part 3 to be published soon: The participants views on the course exercises, the benefits and their on-going practice of the course exercises.
Andy Finucane and Stewart W Mercer. 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. Copyright Â© 2006 Finucane and Mercer; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the (http://creativecommons.org/licenses/by/2.0).
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