A staged approach to improve mental health and well-being across the population: the potential for mindfulness-based programmes and practices

Addressing mental health across the population is an important global mental health initiative as it helps individuals and communities build protective factors and greater resilience and protects mental health as fundamental human right for all. Mindfulness-based approaches align with global mental health initiatives in that both prioritize prevention; aim to strengthen resilience on the individual, societal, and global level; and recognise the importance of addressing the mental health spectrum, from mental ill health to flourishing. Past work has demonstrated promising effects for mindfulness-based approaches in improving mental well-being across a range of population samples (e.g., those with a mental health or physical health condition; general population; and non-clinical). However, there are unanswered questions regarding the potential universal mechanisms that may help shift a wider distribution of the population more towards flourishing and away from mental ill health and the extent to which mindfulness-based approaches and their sub-components can target these mechanisms.
This thesis sits within these broader aims of (1) identifying universal mechanisms that may help shift a wider distribution of the population more towards flourishing and away from mental ill health and (2) evaluating the extent to which mindfulness-based approaches and their subcomponents target these mechanisms. This thesis also sits within the broader aim of evaluating a proposed care pathway (staged approach) whereby individuals across the mental health spectrum can learn foundational resilience skills to better support their mental health, specifically through a range of mindfulness-based programmes (MBPs).
The first data chapter (Chapter 2) includes a comprehensive scoping review that aims to summarize the literature on potential psychological mechanisms, underlying MBPs and independent mindfulness practices, which may be responsible for producing effects in mental health and well-being outcomes. The next chapter (Chapter 3) includes an exploratory randomised trial that aims to explore mental health outcomes and potential mechanisms underlying four mindfulness practices derived from an introductory low-dose mindfulness-based programme (i.e., “Mindfulness-Based Cognitive Therapy-Finding Peace in a Frantic World”; M-FP), which can be offered at the beginning of the proposed staged-approach. The subsequent data chapters (Chapters 4 and 5) aim to examine another mindfulness-based programme derived from MBCT (“Mindfulness-Based Cognitive Therapy - Taking it Further”; MBCT-TiF). This programme is specifically tailored to those that have already completed a mindfulness-based programme who wish to find ways of extending and sustaining benefits and this format can be offered at the end of the proposed staged-approach.
Across these four data chapters, the thesis provides preliminary support for mindfulness, decentering, and self-compassion as potential universal mechanisms that may help address the spectrum of mental health (mental ill health to flourishing). An additional finding was that mindfulness practices, as one key component of mindfulness-based programmes, may have the potential to target mechanisms that are responsible for producing change in outcome. In terms of research implications, the field moving forward should build on the findings presented in this thesis and continue to evaluate mechanisms, using formal mediation methods, and outcomes that address the mental health spectrum in relation to different population samples, settings, and contexts. Moreover, other components beyond formal mindfulness practices (e.g., informal practices, retreats, psychoeducation, group effect, teacher inquiry, etc.) can be explored to further understand how other components of MBPs may drive change in outcome. In the context of the wider MBCT literature, the results of this thesis have clinical implications in that MBCT may help support those that are at-risk of depressive relapse or languishing with the original MBCT for Depression curriculum whereas adapted MBCT formats (e.g., M-FP) can be offered to those that may still be languishing or relatively well and could benefit from experiencing higher levels of mental well-being. The MBCT-TiF curriculum can then be offered to better support those who have already completed an MBP and are looking for ways to sustain improvements and experience even further gains in mental well-being.

Keywords: mindfulness practices
mental health
mindfulness-based
mechanisms
mediation
well-being
Advisor: Kuyken, W
Martin, M
Surawy, C