Preventing Depression Relapse: A Qualitative Study on the Need for Additional Structured Support Following Mindfulness-Based Cognitive Therapy

Chelsea J Siwik; Shelley R Adler; Patricia J Moran; Willem Kuyken; Zindel Segal; Jennifer Felder; Stuart Eisendrath; Frederick M Hecht

doi:10.1177/27536130221144247

Preventing Depression Relapse: A Qualitative Study on the Need for Additional Structured Support Following Mindfulness-Based Cognitive Therapy

Glob Adv Integr Med Health. 2023 Apr 13:12:27536130221144247. doi: 10.1177/27536130221144247. eCollection 2023 Jan-Dec.

Authors

Chelsea J Siwik¹, Shelley R Adler¹, Patricia J Moran¹, Willem Kuyken², Zindel Segal³, Jennifer Felder¹, Stuart Eisendrath⁴, Frederick M Hecht¹

Affiliations

¹ Osher Center for Integrative Health, University of California, San Francisco, San Francisco, CA, USA.
² Oxford Mindfulness Centre, University of Oxford, Oxford, UK.
³ Department of Psychological Clinical Science, University of Toronto, Scarborough, Toronto, ON, Canada.
⁴ Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.

Abstract

Background: Mindfulness-based cognitive therapy (MBCT) is an effective group intervention for reducing rates of depression relapse. However, about one-third of graduates experience relapse within 1 year of completing the course.

Objective: The current study aimed to explore the need and strategies for additional support following the MBCT course.

Methods: We conducted 4 focus groups via videoconferencing, two with MBCT graduates (n = 9 in each group) and two with MBCT teachers (n = 9; n = 7). We explored participants' perceived need for and interest in MBCT programming beyond the core program and ways to optimize the long-term benefits of MBCT. We conducted thematic content analysis to identify patterns in transcribed focus group sessions. Through an iterative process, multiple researchers developed a codebook, independently coded the transcripts, and derived themes.

Results: Participants said the MBCT course is highly valued and was, for some, "life changing." Participants also described challenges with maintaining MBCT practices and sustaining benefits after the course despite using a range of approaches (ie, community and alumni-based meditation groups, mobile applications, taking the MBCT course a second time) to maintain mindfulness and meditative practice. One participant described finishing the MBCT course as feeling like "falling off a cliff." Both MBCT graduates and teachers were enthusiastic about the prospect of additional support following MBCT in the form of a maintenance program.

Conclusion: Some MBCT graduates experienced difficulty maintaining practice of the skills they learned in the course. This is not surprising given that maintained behavior change is challenging and difficulty sustaining mindfulness practice after a mindfulness-based intervention is not specific to MBCT. Participants shared that additional support following the MBCT program is desired. Therefore, creating an MBCT maintenance program may help MBCT graduates maintain practice and sustain benefits longer-term, thereby decreasing risk for depression relapse.

Keywords: depression relapse; maintenance program; mindfulness-based cognitive therapy.