Understanding the Impact of Meditative Homework on Metacognitive Processes in the Context of Mindfulness Based Cognitive Therapy (MBCT)

This study has been completed.
Sponsor:
Collaborators:
University of East London
South London and Maudsley NHS Foundation Trust
Information provided by (Responsible Party):
Marika Lahtinen, University of East London
ClinicalTrials.gov Identifier:
NCT00938873
First received: July 13, 2009
Last updated: February 27, 2012
Last verified: February 2012
  Purpose

Mindfulness based cognitive therapy (MBCT) is a group psycho-educational treatment designed to reduce the risk of recurrent depression by integrating mindfulness based meditation practices with cognitive therapy techniques. MBCT comprises eight weekly two-hour group sessions. Additionally, participants are required to commit to one hour per day of between sessions meditative homework assignments six days per week. Existing quantitative research suggest that MBCT is an effective intervention for preventing depressive relapse in patients with three or more episodes of depression (Teasdale et al.2000, Ma & Teasdale, 2004). The focus of qualitative research has been on evaluating the acceptability of MBCT for various clinical populations; participants' accounts have been positive indicating MBCT may be a potential therapeutic tool for treating older adults (Graham & Senthinathan, 2007), psychosis (Abba, Chadwick, & Stevenson, 2008), Parkinson's disease (Fitzpatrick, Simpson, & Smith, 2010) as well as acute depression (Mason & Hargreaves, 2001).

The benefits of undertaking meditative mindfulness practice in the context of MBCT have been linked to changes in metacognitive processes. Two distinct multi-level information processing frameworks dealing with how thoughts are processed from a metacognitive perspective have been proposed: The Interacting Cognitive Subsystems (ICS; Teasdale, 1999a, 1999b) and the Self Regulatory Executive Function (S-REF; Wells, 2000) theory. The ICS framework forms a rationale for meditative aspects of the MBCT programme. The S-REF model differs from the ICS theory in its conceptualisation of the object or 'being' mode of metacognitive processing.

Regular daily practice of mindfulness meditation has been regarded as among the most essential aspects of mindfulness programmes (Kabat-Zinn, 1990; Mason & Hargreaves, 2001). Existing studies, with their focus on effectiveness or acceptability of MBCT as an intervention, have thus far excluded an important aspect of the course involving the experience of meditative homework assignments. Therefore, the aim of this study was to explore subjective accounts of the meaning of carrying out meditative homework assignments in the context of a National Health Service (NHS) run MBCT course. The research questions focused on the impact of meditative homework on thought processes as well as an exploration of barriers and facilitating factors from a participant's perspective.Six individual in-depth interviews were conducted with participants all of whom had completed the full MBCT programme. Interpretive phenomenological Analysis (IPA) was used as the methodology for analysing interview transcripts. Data analysis began with a detailed examination of one case until a thorough analysis was completed after which subsequent cases were analysed. Finally a cross case analysis was carried out where individual themes were interrogated for similarities and differences (Smith, et al., 2009).

Two master themes were presented: 'The relationship of meditative homework to metacognitive experience' and 'Motivating and discouraging factors for engagement in meditative practice'. Results reveal a transformation in metacognitive processes as a result of undertaking meditative homework. The subjective experience of metacognitive processes is examined in the context of existing psychological theories including the ICS (Teasdale, 1999a, 1999b) as well as the S-REF (Wells, 2000) theory involving metacognitions. A model for perceived facilitating factors and difficulties experienced in carrying out meditative homework is constructed based on the Integrated Theoretical Foundations Model for CBT homework assignment (Kazantzis, et al., 2005). The model explores participants' motivation in three stages of the homework process: firstly during assignment of the meditative homework task, secondly in completing the planned task and finally carrying out review of the task in question. Implications of the present study are discussed in relation to psychological literature, homework assignment and the practise of MBCT.


Condition Intervention
Depression
Behavioral: Mindfulness Based Cognitive Therapy (MBCT)

Study Type: Observational
Study Design: Observational Model: Case-Only
Time Perspective: Retrospective
Official Title: Understanding the Impact of Meditative Homework on Metacognitive Processes in the Context of Mindfulness Based Cognitive Therapy (MBCT)

Resource links provided by NLM:


Further study details as provided by Lahtinen, Marika:

Primary Outcome Measures:
  • The project involves one 60-minute interview per participant aiming to evaluate lived experience of having taken part in an MBCT programme. The specific focus is on MBCT programme's possible impact on personal identity, barriers and facilitating factors. [ Time Frame: Interviews are conducted upon completion of MBCT course ] [ Designated as safety issue: No ]

Enrollment: 7
Study Start Date: December 2009
Study Completion Date: April 2011
Primary Completion Date: April 2010 (Final data collection date for primary outcome measure)
Groups/Cohorts Assigned Interventions
Mindfulness Based Cognitive Therapy
The present study will use participants who have experienced more than three episodes of depression as judged by South London and Maudsley NHS Trust. No restrictions are placed in terms of participants' use of antidepressant medication. Participants will be 18 to 65 years old and would have participated in an MBCT course run by South London and Maudsley NHS Trust.
Behavioral: Mindfulness Based Cognitive Therapy (MBCT)
Mindfulness based cognitive therapy (MBCT) is a group psycho-educational treatment designed to reduce the risk of recurrent depression by integrating mindfulness based meditation practices with cognitive therapy techniques. MBCT comprises eight weekly two-hour group sessions with an additional one hour daily 6 days a week for meditative homework practice.
Other Name: MBCT

  Eligibility

Ages Eligible for Study:   18 Years to 65 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population

Eight participants will be recruited from South London and Maudsley NHS Trust, which is a national health service site offering Mindfulness Based Cognitive Therapy (MBCT).

Criteria

Inclusion Criteria:

  • Participants will be 18 to 65 years of age and recruited through an NHS Trust offering MBCT.
  • At present I am uncertain of the exact inclusion and exclusion criteria as the relevant NHS trust is yet to be determined, so the guidelines recommended by Teasdale et al., (2000) and Ma and Teasdale (2004) will be used.
  • These authors suggest that MBCT has no significant effect on reducing the relapse rates of depression in patients with ≤ 2 episodes of depression.
  • Therefore the present study will use participants who have experienced more than three episodes of depression as judged by the relevant NHS Trust.
  • No restrictions are placed in terms of participants' use of antidepressant medication.

Exclusion Criteria:

  • Exclusion criteria consists of disorders where the participant would have difficulties understanding and/or applying mindfulness techniques, including current alcohol or substance dependence, borderline personality disorder, organic mental disorder or pervasive developmental delay, schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder and psychotic disorder not otherwise specified.
  • Potential participants engaging in yoga or Buddhist meditation more than twice a week are excluded as these practices significantly overlap with the MBCT program.
  Contacts and Locations
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Please refer to this study by its ClinicalTrials.gov identifier: NCT00938873

Locations
United Kingdom
South London & Maudsley NHS Trust
London, United Kingdom, SE5 8AZ
Sponsors and Collaborators
Lahtinen, Marika
University of East London
South London and Maudsley NHS Foundation Trust
Investigators
Principal Investigator: Marika Lahtinen University of East London
  More Information

Additional Information:
No publications provided

Responsible Party: Marika Lahtinen, Dr, University of East London
ClinicalTrials.gov Identifier: NCT00938873     History of Changes
Other Study ID Numbers: 1-Lahtinen
Study First Received: July 13, 2009
Last Updated: February 27, 2012
Health Authority: United Kingdom: National Health Service
United Kingdom: Research Ethics Committee

Keywords provided by Lahtinen, Marika:
MBCT
identity
depression
recurrent
homework

Additional relevant MeSH terms:
Depression
Depressive Disorder
Behavioral Symptoms
Mood Disorders
Mental Disorders

ClinicalTrials.gov processed this record on August 18, 2014