Mindfulness Training for Psychotherapeutic Care
Condition: Mindfulness, Compassion; Empathy, Working Alliance, Patients' Symptomatology, Psychotherapeutic Process; Psychotherapist
Study type: Interventional

Summary: 
      It has been shown that mindfulness-based interventions (MBI) applied to psychotherapists
      improve their empathy and increase the therapeutic alliance. It is expected that these
      improvements may beneficially affect the results of psychotherapy. However, new studies are
      needed to examine whether an MBI can have an effect on the healthy evolution of these
      professionals' patients.

      The objective of this project is to analyze the influence of a mindfulness and compassion
      based intervention (MCBI) applied to psychotherapists, on the empathy perceived by their
      patients, the therapeutic alliance and their symptomatology.

      This study is a randomized clinical trial of an intervention based on MBSR and adapted to the
      population of psychotherapists, including in the last two sessions the practice of
      compassion, called Mindfulness and Compassion Based Intervention (MCBI). The subjects (n =
      63) were randomly assigned to MCBI (n = 33) or to a Waiting List group in which they fill in
      a self-record of their own feelings, thoughts, etc. in therapy for 8 weeks (n = 30).
      Participants in the MCBI intervention condition were asked to meet weekly during a two-hour
      session for two months. Pre / post-intervention and five-month evaluations were performed as
      a follow-up.

      Mindfulness measures (FFMQ) will be taken for the evaluation of psychotherapists,
      Self-compassion (SCS-SF), negative symptomatology (DASS-21), empathy (EUS-T, TECA), personal
      therapist style (EPT-C) and mindfulness instructional style (MIQ).

      For the evaluation of patients, measures of mindfulness (FFMQ), self-compassion (SCS-SF) will
      be taken - to try to control without these skills they can be vicariously modified without
      being directly trained-, subjective well-being (PHI), psychological well-being (BSI),
      therapeutic alliance (WATOCI, ENAT) and perceived empathy (EUS-P).
    

Detailed description: 
      The practice of psychotherapy involves the formation and development of a series of skills by
      the professional. These skills encourage the establishment of a quality therapeutic link,
      which helps to improve the effectiveness of therapy sessions. In this sense, current research
      indicates that the link established between the psychotherapist and his patients has a high
      effect on the evolution and results of psychotherapy. This improvement is to a greater extent
      attributed to the establishment of the link than to the specific techniques that are applied
      in therapy.

      Among the variables that favor the link, the empathy of the psychotherapist has been widely
      studied, and has proven to be highly related to the benefits of psychological interventions.

      Therefore, the development of healthy empathy is one of the most important variables on which
      the benefits of psychotherapy are based. It facilitates a true understanding of the vital
      situations of the patients and is essential in establishing the therapeutic link.

      The influence of the latter on the results of psychological interventions has meant that
      empathy training is one of the basic objectives to follow in the training of clinical and
      health psychologists, increasing research on effective strategies for this, among which
      mindfulness and compassion based interventions (MCBI) stand out.

      In recent years, the MCBI have established themselves as a very useful intervention in the
      healthcare field, and several authors suggest the advantages of their application in
      psychotherapists, pointing out their beneficial influence on the therapeutic relationship and
      the psychotherapeutic process.

      The MCBI are structured interventions in which a series of attitudes and mental states
      associated with mindfulness and compassion are trained through different meditation
      techniques. You also learn to generalize these states in the way we relate to the experiences
      we live. Based on this, the MCBI can be an especially useful strategy to train a series of
      skills that beneficially influence the therapeutic link and the results of psychotherapy. In
      relation to the above, it has been seen that MCBI have a beneficial effect on the levels of
      self-reported empathy of clinical and health psychologists. In addition, an interesting
      association has been observed between the levels of mindfulness and self-reported empathy in
      psychotherapists, and between these variables and the therapeutic alliance established with
      their patients. An association has also been found between the results of the therapeutic
      alliance measures between therapists and patients after a Mindfulness-based Intervention
      (MBI). Finally, it has been seen that the application of an MCBI in psychotherapists
      indirectly influences the evolution of their patients, helping to reduce their symptoms and
      increase their levels of well-being.

      These results imply important support for the advantages of including the MCBI in the
      training of clinical and health psychologists, in order to increase their levels of empathy
      and the effectiveness of their interventions. However, there are many limitations we find in
      these results.

      First, the studies that have analyzed the influence of MCBI on empathy only include a
      self-reported evaluation of psychotherapists on this variable. In addition, this evaluation
      does not give us information about whether the MCBI affects the empathy that patients
      perceive in their therapists, which prevents us from assessing whether these benefits exert a
      real influence on the therapeutic relationship and the psychotherapeutic process.

      On the other hand, studies that have established a relationship between levels of mindfulness
      and direct results in therapeutic alliance include only mindfulness-based interventions
      (MBI), not including compassion training in a manner explicit. We are interested in observing
      whether a MCBI significantly influences the perception of the therapeutic alliance by
      patients.

      Finally, in Grepmair's study in which the benefits of applying an MCBI in psychotherapists on
      the evolution of their patients have been observed, the mediating variables that could
      explain these results were not evaluated. The objective of this project is to identify the
      mechanisms of action of the MCBI and its effect on the different variables that could be
      influencing the results of psychotherapy, such as the empathy of the psychotherapist and the
      therapeutic alliance established with their patients.
    

Intervention name(s): MCBI; Active Comparator
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The topics covered in the sessions are: Week 1: Introduction to mindfulness and attention to breathing. Week 2. Open awareness of bodily sensations. Week 3: Work with thoughts, introductory theory and practice in attention to sounds. Week 4: Working with thoughts, advanced theory and practice in mental landscape. Week 5: Introductory theory and practice in labeling emotions. Session 6: Advanced theory in working with emotions and practice in difficult emotions. Week 7: Introductory theory on self-compassion and compassion. Practice in self-compassion. Week 8: Practice in compassion and active compassion (acts of kindness and shared humanity).; Free observation of the psychotherapist's own feelings, thoughts, distractions, biases and behavior in general for 8 weeks. Observations of these variables are recorded during psychotherapy sessions with patients participating in the research.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care