Evaluating a Transdiagnostic, Mindfulness-Based Cognitive Therapy (MBCT) Group for Service Users Transitioning out of Secondary Mental Health Care Services

Background: Traditional Cognitive Behaviour Therapy (CBT) has developed within a disorder-focused paradigm and focuses on altering the specific content of thoughts. However, emerging evidence suggests that there may be a number of cognitive and behavioural processes that are shared across different
psychological disorders, and are therefore “transdiagnostic”. It has been further suggested that these processes may themselves share commonalities. Mindfulness-Based Cognitive Therapy (MBCT), is thought to target a core process of "inflexible awareness" and may also target processes of “experiential avoidance” and “control”, which are thought to underlie these transdiagnostic processes.
Aims: The current study aimed to evaluate the usefulness of group MBCT within a transdiagnostic population of service users, transitioning out of secondary care services. The study further aimed to investigate the impact of group MBCT on a wide range of cognitive and behavioural processes to understand the transdiagnostic potential of the intervention. A final aim was to explore participants’ experiences of change as a result of the group and to determine which aspects of the group were helpful or unhelpful.
Methods: A mixed-methodological, small-N design was employed. Six participants from an inner-city Primary Care Mental Health Service were recruited to take part in the study. Participants attended an 8-week MBCT group facilitated by an experienced mindfulness teacher. Symptom-based, process based and goal-based outcome measures were collected on weekly basis and at one-month follow-up. Five participants subsequently took part in a semistructured qualitative interview to discuss their experiences of the group.
Results: Participants reported finding the group useful in moving towards valued outcomes and changes were observed on process-based measures. Participants tended to engage less in cognitive and behavioural trandiagnostic processes and demonstrated increases in flexible awareness and reorganisation of conflict over the course of the group. However, limited changes were observed on symptom-based measures. Participants described therapeutic change as “becoming unbound from distress” and “taking back control”. Participants offered useful insights into valued aspects of the group content, delivery and structure as well as the experience of being with others, and life events outside of the group, which impacted on the group experience.
Discussion: There was preliminary evidence that group MBCT was a useful intervention within the present population, and may provide a wider-reaching and more cost-effective alternative to disorder-focused group interventions. The findings also support arguments for a change in theoretical conceptualisations of psychological distress. Furthermore, the lack of observed change on symptom-based measures has wider implications for the types of outcomes used to measure meaningful change within mental health services.