Building a Grounded Theory of Engagement in Mindfulness-Based Group Therapy for Distressing Voices

Treatment experiences during a cognitive behaviour therapy group intervention targeting repetitive negative thinking: A qualitative study

OBJECTIVES

Treatment of repetitive negative thinking (RNT) focuses rather on individual than group cognitive behaviour therapy (CBT) treatment. Additionally, little is known on how clients experienced these interventions. This study investigates clients' experiences on participating in a CBT group intervention targeting RNT (RNT-G).

DESIGN

Of the 80 participants, 11 were randomly selected for an in-depth, semi-structured interview after treatment. Interviews focused on what participants experienced as important on group aspects, offered interventions, homework tasks, and possible changes.

METHODS

All participants were adults, diagnosed with major depressive disorder and/or generalized anxiety disorder and being currently in mental health care treatment. After transcribing the interviews, analyses were performed according to the guidelines of thematic analysis.

RESULTS

Four major themes were identified. First, the group format itself was experienced as an important factor of change. The experiences about the different offered interventions during the group formed a second theme. A third theme related to changes in family or professional life and dealing with RNT as a result of the intervention. Finally, group participation, social interactions, and mental health care treatment were experienced as mutually influencing during the intervention.

CONCLUSIONS

The results of this study shed some light on which treatment interventions were perceived as beneficial during the RNT-G and should therefore be emphasized in treatment. Further, they indicate that the treatment in a group format was experienced as helpful by the participants. Finally, a positive mutual influence between the group intervention and the ongoing individual treatment was experienced.

Home practice in mindfulness-based interventions for psychosis groups: a systematic review and qualitative study

BACKGROUND

Regular home practice is considered a core component of mindfulness groups and may be associated with better treatment outcomes. This study aimed to (1) review the existing evidence on how much home practice people do in mindfulness-based interventions for psychosis groups, and (2) explore participants' experiences of the barriers and facilitators to completing home practice in a mindfulness for psychosis group using a qualitative study.

METHODS

In study 1, we conducted a systematic review of mindfulness-based interventions for psychosis studies and extracted data on home practice rates. In study 2, we conducted semi-structured interviews with people who had completed a mindfulness for psychosis group (N = 5) as part of their routine community care, specifically focusing on experiences of home practice.

RESULTS

Out of 43 studies included in the systematic review, only 5 reported any data on amount of home practice, and none examined the relationship between completion of home practice and treatment outcomes. In the qualitative study, participants described home practice as being difficult but important. Arising themes were similar to findings from previous (non-psychosis) studies suggesting that generic challenges are common, rather than being specific to psychosis.

CONCLUSIONS

We recommend that future mindfulness-based interventions for psychosis studies record data on home practice rates, in order to investigate any association between home practice and treatment outcome. Our qualitative findings suggest home practice can be a valued part of mindfulness for psychosis group, and a normalising approach could be taken when and if participants encounter common challenges.

"I wanted to do more of the homework!"-Feasibility and acceptability of blending app-based homework with group therapy for social cognition in psychosis

OBJECTIVES

Evidence suggests social-cognitive difficulties are linked to poor community functioning in people with psychosis, however, there is limited evidence that social-cognition interventions improve functioning. This may be due to poor generalization of therapy learning; digital technologies may be useful to support this. This study evaluates the feasibility of a brief, blended intervention (group therapy plus app) for individuals with psychosis.

METHODS

A total of 14 clients diagnosed with psychosis-spectrum difficulties participated. Feasibility was assessed by referral, adherence and completion rates, and acceptability via semi-structured interview (thematically analyzed).

RESULTS

The procedures were considered feasible and acceptable. The face-to-face component of the intervention was particularly valued, and participants reported benefits to their daily lives. The app was experienced as helpful, alongside some difficulties.

CONCLUSIONS

Development of blended interventions may prove an important avenue to maximize the adherence and reach of psychological interventions. The results of this study reinforce the need to maintain face-to-face components alongside digital.

A service evaluation of a group mindfulness-based intervention for distressing voices: how do findings from a randomized controlled trial compare with routine clinical practice?

Background:

Person-based cognitive therapy (PBCT) was developed as a treatment for psychosis. The effectiveness of group PBCT was examined in the Mindfulness for Voices (M4V) randomized controlled trial and generated promising results. Group PBCT was implemented as a trans-diagnostic treatment for distressing voices within the Sussex Voices Clinic (SVC), a specialist secondary care mental health service.

Aim:

To conduct a service evaluation of engagement, outcomes and cost of group PBCT within SVC, and to compare engagement and outcomes from routine practice with the M4V trial. Secondary aims were to explore predictors of levels of engagement and change in group PBCT.

Method:

Service level data from 95 SVC patients were evaluated. Descriptive statistics, hypothesis tests and linear regression models were used. The primary clinical outcome was voice-related distress. Engagement levels and pre–post effect sizes were estimated; associated predictors were explored.

Results:

Fifty-nine per cent of patients completed group PBCT within SVC, compared with 72% within M4V. Completers within SVC had lower baseline depression scores compared with non-completers. There were significant improvements in voice-related distress (Cohen’s d = –0.47; p = 0.001), subjective recovery (Cohen’s d = 0.35; p = 0.001) and depression (Cohen’s d = –0.20; p = 0.044); these outcomes were comparable to M4V. Higher baseline subjective recovery and lower depression both predicted improvement in voice-related distress. Therapy within SVC cost an average of £214 per patient.

Conclusion:

PBCT groups can be delivered trans-diagnostically in routine clinical practice. Engagement was lower when compared with an RCT, but outcomes were comparable. The low level of resources involved suggests that group PBCT can offer value for money.