Teacher Competence in Mindfulness-Based Cognitive Therapy for Depression and Its Relation to Treatment Outcome
Mindfulness
Teacher Competence in Mindfulness-Based Cognitive Therapy for Depression and Its Relation to Treatment Outcome
Marloes J. Huijbers 0 1 2 3 4 5
Rebecca S. Crane 0 1 2 3 4 5
Willem Kuyken 0 1 2 3 4 5
Lot Heijke 0 1 2 3 4 5
Ingrid van den Hout 0 1 2 3 4 5
A. Rogier T. Donders 0 1 2 3 4 5
Anne E.M. Speckens 0 1 2 3 4 5
0 Outpatient Clinic for Mental Health , Dokter Bosman, Houttuinlaan 16A, 3447 GM Woerden , The Netherlands
1 Present Mind, Mindfulness Training and Education , 1053 RN Amsterdam , The Netherlands
2 Department for Health Evidence, Radboud University Nijmegen Medical Centre , Geert Grooteplein 21, 6525 EZ Nijmegen , The Netherlands
3 Department of Psychiatry, Radboud University Nijmegen Medical Centre , Reinier Postlaan 10, 6525 GC Nijmegen , The Netherlands
4 Department of Psychiatry, Warneford Hospital, University of Oxford , Oxford OX3 7JX , UK
5 Centre for Mindfulness Research and Practice, School of Psychology, Bangor University , Bangor LL57 2AS , UK
As mindfulness-based cognitive therapy (MBCT) becomes an increasingly mainstream approach for recurrent depression, there is a growing need for practitioners who are able to teach MBCT. The requirements for being competent as a mindfulness-based teacher include personal meditation practice and at least a year of additional professional training. This study is the first to investigate the relationship between MBCT teacher competence and several key dimensions of MBCT treatment outcomes. Patients with recurrent depression in remission (N = 241) participated in a multi-centre trial of MBCT, provided by 15 teachers. Teacher competence was assessed using the Mindfulness-Based Interventions: Teaching Assessment Criteria (MBI:TAC) based on two to four randomly selected video-recorded sessions of each of the 15 teachers, evaluated by 16 trained assessors. Results showed that teacher competence was not significantly associated with adherence (number of MBCT sessions attended), possible mechanisms of change (rumination, cognitive reactivity, mindfulness, and self-compassion), or key outcomes (depressive symptoms at post treatment and depressive relapse/recurrence during the 15-month follow-up). Thus, findings from the current study indicate no robust effects of teacher competence, as measured by the MBI:TAC, on possible mediators and outcome variables in MBCT for recurrent depression. Possible explanations are the standardized delivery of MBCT, the strong emphasis on self-reliance within the MBCT learning process, the importance of participant-related factors, the difficulties in assessing teacher competence, the absence of main treatment effects in terms of reducing depressive symptoms, and the relatively small selection of videotapes. Further work is required to systematically investigate these explanations.
Mindfulness-based cognitive therapy; Recurrent depression; Intervention integrity; Therapist competence; Teacher competence
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Published online: 12 January 2017
# The Author(s) 2017. This article is published with open access at Springerlink.com
Introduction
Mindfulness-based cognitive therapy (MBCT) is an
increasingly popular intervention in mental health care and beyond. It
was developed by Segal et al. (2002b) as a relapse prevention
method for patients with recurrent major depressive disorder
(MDD). The evidence base of MBCT is growing, and a recent
individual patient data meta-analysis suggests it is superior to
usual care and at least as effective as other active treatments
(Kuyken et al. 2016)
. It is recommended by guidelines on
depression prevention such as those by the American
Psychiatric Association
(American Psychiatric Association
2006)
and the National Institute for Health and Clinical
Excellence (NICE)
(National Institute for Clinical
Excellence 2004)
and the Dutch guidelines on
evidencebased practice
(Spijker et al. 2012)
. MBCT is based on the
rationale that people become more vulnerable to developing
depression when they have strong automatic patterns of
(negative) thinking or behaving in response to a stressful event
or a decrease in mood, referred to as cognitive reactivity
(Scher et al. 2005). Cognitive reactivity often leads to a further
lowering of mood, eventually turning into a depressive
relapse/recurrence
(Segal et al. 1999)
. In MBCT, participants
learn to become aware of their automatic cognitive reactions
to low mood or stress and to observe these reactions with
kindness and curiosity
(Segal et al. 2012)
. There is evidence
that MBCT diminishes the ‘toxic’ relationship between
cognitive reactivity and poor outcome—i.e. cognitive reactivity
no longer predicted depression severity at 1-year follow-up in
patients who participated in MBCT, in contrast with those
receiving antidepressant medication
(Kuyken et al. 2010)
.
Other studies have suggested that rumination, which refers
to the recurrent thinking about one’s own depressive
symptoms and their possible causes and implications, may also b (...truncated)