Clinical trial NCT04680559: Mindfulness Training for Psychotherapeutic Care
Official title: Influence of a Mindfulness and Compassion-Based Intervention in Psychotherapists: Analysis of Its Effects on Empathy, the Therapeutic Alliance and the Symptomatic Evolution of Their Patients
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Mindfulness, Compassion
Empathy, Working Alliance, Patients' Symptomatology, Psychotherapeutic Process
Psychotherapist
Lead sponsor: University of Valencia
Sponsor class: OTHER
First posted: 2020-12-23
Enrollment: 204
Sex: ALL
Minimum age (years): 25
Maximum age (years): 75
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: SUPPORTIVE_CARE

Brief 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.

Eligibility criteria: Inclusion Criteria:

* Therapists inclusion criteria:

  * Have a psychology degree.
  * Be able to read and write using the Spanish language.
  * Be doing therapy with at least one patient.

Eligible participants were contacted through the main psychotherapeutic schools and university centers to invite them to an explanatory meeting of the study.

* Patient inclusion criteria:

  * Be between 18 and 75 years old.
  * Be able to read and write using the Spanish language.

Eligible participants were contacted by their personal psychotherapist, either by a phone call or regular therapy appointment to invite them to participate in the study.

Exclusion Criteria:

* Therapists exclusion criteria:
* Have extensive experience in mindfulness practice
* Use mindfulness in therapy with your patients.
* Do not engage in clinical psychology or psychotherapy
* Patient exclusion criteria:

  * Serious active mental disorders (schizophrenia, bipolar disorder, psychotic disorders) • Disorders due to active substance use (if consumed in the last year)
  * Cognitive impairment
  * Take more than 2 and a half years in therapy with the same therapist

Primary outcomes:
measure: Changes in Empathic Understanding Scale Therapist's Version (EUS-TV)
timeFrame: 8 weeks, 6 months
measure: Empathic Understanding Scale Patient's Version (EUS-PV)
timeFrame: 8 weeks, 6 months
measure: Changes in Cognitive and Affective Empathy Test (TECA)
timeFrame: 8 weeks, 6 months
measure: Changes in Working Alliance Theory of Change Inventory (WATOCI): reduced version of the Therapeutic Alliance Inventory (WAI-S)
timeFrame: 8 weeks, 6 months
measure: Changes in Alliance Negotiation Scale (ANS)
timeFrame: 8 weeks, 6 months
measure: Changes in Brief Sympton Inventory (BSI-18)
timeFrame: 8 weeks, 6 months
Secondary outcomes:
measure: Changes in Five Facet Mindfulness Questionnaire (FFMQ)
timeFrame: 8 weeks, 6 months
measure: Changes in the short scale of self-compassion (SCS-SF)
timeFrame: 8 weeks, 6 months
measure: Changes in the Mindfulness Instruction Questionnaire (MIQ; adapted from the Mindfulness In Parenting Questionnaire MIPQ)
timeFrame: 8 weeks, 6 months
measure: Changes in Personal Style of the Therapist (PST-Q)
timeFrame: 8 weeks, 6 months
measure: Changes in Depression Anxiety Stress Scale (DASS-21)
timeFrame: 8 weeks, 6 months
measure: Changes in the Pemberton Happiness Index (PHI)
timeFrame: 8 weeks, 6 months
measure: Changes in Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM)
timeFrame: 8 weeks, 6 months
measure: Changes in State Emotion Regulation Inventory (SERI)
timeFrame: 8 weeks
measure: Changes in the State-Trait Anxiety Inventory (STAI)
timeFrame: 8 weeks
measure: Changes in Positive and Negative Affect Schedule (PANAS)
timeFrame: 8 weeks
Other outcomes:
measure: Qualitative "Mindfulness and Compassion-Based Intervention" post-training measures
timeFrame: 8 weeks
measure: Quantitative record on "Mindfulness and Compassion-Based Intervention" post-training results
timeFrame: 8 weeks
measure: Qualitative measures post-registration Waiting List Group
timeFrame: 8 weeks
measure: Registration of attendance at sessions
timeFrame: 8 weeks
measure: Record the mindfulness practice between sessions
timeFrame: 8 weeks
measure: Introspective record during therapy sessions Wait List Group
timeFrame: 8 weeks
Locations:
city: Valencia
country: Spain
facility: Universitat de València
Study officials:
affiliation: Universitat de València
name: Elena Garrote Caparrós, Student
role: PRINCIPAL_INVESTIGATOR
affiliation: Universitat de València
name: Miguel Bellosta Batalla, Dr.
role: STUDY_DIRECTOR
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