Understanding the Impact of Meditative Homework on Metacognitive Processes in the Context of Mindfulness Based Cognitive Therapy (MBCT)
Condition: Depression
MeSH terms: Depression
Study type: Observational

Summary: 
      Mindfulness based cognitive therapy (MBCT) is a group psycho-educational treatment designed
      to reduce the risk of recurrent depression by integrating mindfulness based meditation
      practices with cognitive therapy techniques. MBCT comprises eight weekly two-hour group
      sessions. Additionally, participants are required to commit to one hour per day of between
      sessions meditative homework assignments six days per week. Existing quantitative research
      suggest that MBCT is an effective intervention for preventing depressive relapse in patients
      with three or more episodes of depression (Teasdale et al.2000, Ma & Teasdale, 2004). The
      focus of qualitative research has been on evaluating the acceptability of MBCT for various
      clinical populations; participants' accounts have been positive indicating MBCT may be a
      potential therapeutic tool for treating older adults (Graham & Senthinathan, 2007), psychosis
      (Abba, Chadwick, & Stevenson, 2008), Parkinson's disease (Fitzpatrick, Simpson, & Smith,
      2010) as well as acute depression (Mason & Hargreaves, 2001).

      The benefits of undertaking meditative mindfulness practice in the context of MBCT have been
      linked to changes in metacognitive processes. Two distinct multi-level information processing
      frameworks dealing with how thoughts are processed from a metacognitive perspective have been
      proposed: The Interacting Cognitive Subsystems (ICS; Teasdale, 1999a, 1999b) and the Self
      Regulatory Executive Function (S-REF; Wells, 2000) theory. The ICS framework forms a
      rationale for meditative aspects of the MBCT programme. The S-REF model differs from the ICS
      theory in its conceptualisation of the object or 'being' mode of metacognitive processing.

      Regular daily practice of mindfulness meditation has been regarded as among the most
      essential aspects of mindfulness programmes (Kabat-Zinn, 1990; Mason & Hargreaves, 2001).
      Existing studies, with their focus on effectiveness or acceptability of MBCT as an
      intervention, have thus far excluded an important aspect of the course involving the
      experience of meditative homework assignments. Therefore, the aim of this study was to
      explore subjective accounts of the meaning of carrying out meditative homework assignments in
      the context of a National Health Service (NHS) run MBCT course. The research questions
      focused on the impact of meditative homework on thought processes as well as an exploration
      of barriers and facilitating factors from a participant's perspective.Six individual in-depth
      interviews were conducted with participants all of whom had completed the full MBCT
      programme. Interpretive phenomenological Analysis (IPA) was used as the methodology for
      analysing interview transcripts. Data analysis began with a detailed examination of one case
      until a thorough analysis was completed after which subsequent cases were analysed. Finally a
      cross case analysis was carried out where individual themes were interrogated for
      similarities and differences (Smith, et al., 2009).

      Two master themes were presented: 'The relationship of meditative homework to metacognitive
      experience' and 'Motivating and discouraging factors for engagement in meditative practice'.
      Results reveal a transformation in metacognitive processes as a result of undertaking
      meditative homework. The subjective experience of metacognitive processes is examined in the
      context of existing psychological theories including the ICS (Teasdale, 1999a, 1999b) as well
      as the S-REF (Wells, 2000) theory involving metacognitions. A model for perceived
      facilitating factors and difficulties experienced in carrying out meditative homework is
      constructed based on the Integrated Theoretical Foundations Model for CBT homework assignment
      (Kazantzis, et al., 2005). The model explores participants' motivation in three stages of the
      homework process: firstly during assignment of the meditative homework task, secondly in
      completing the planned task and finally carrying out review of the task in question.
      Implications of the present study are discussed in relation to psychological literature,
      homework assignment and the practise of MBCT.
    


Intervention name(s): Mindfulness Based Cognitive Therapy (MBCT)
Intervention type(s): Behavioral
Intervention description(s): Mindfulness based cognitive therapy (MBCT) is a group psycho-educational treatment designed to reduce the risk of recurrent depression by integrating mindfulness based meditation practices with cognitive therapy techniques. MBCT comprises eight weekly two-hour group sessions with an additional one hour daily 6 days a week for meditative homework practice.
Other intervention name(s): MBCT
Observational model: Case-Only
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        Eight participants will be recruited from South London and Maudsley NHS Trust, which is a
        national health service site offering Mindfulness Based Cognitive Therapy (MBCT).
      
Keywords: MBCT; identity; depression; recurrent; homework