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TRANSCRIPT
Determining mechanisms of change
within Mindfulness-based Cognitive Therapy
using Interpretive Phenomenological Analysis
Author: Dh. Karunavira
Presented for MSc Psychology
September 2010
Bangor University
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Abstract
Mindfulness-based cognitive therapy (MBCT) is a Mindfulness-based Approach (MBA) aimed at preventing recurring depression (Kuyken et al.,2008; Ma & Teasdale,2004; Teasdale et al.,2008). Studies demonstrate the effectiveness of MBCT and MBAs across a widening range of client populations (Allen et al.,2006). But, less is known about the mechanisms in MBCT that generate these positive outcomes. This research aims to complement and extend investigation into mechanisms of ‘helpful’ change in MBCT.
The study uses Interpretive Phenomenological Analysis (IPA) of 6 in-depth participant post-course interviews to explore what was helpful (or otherwise) about the MBCT course. This methodology focuses on exploring the significance of participants’ experience in its own terms whilst also enabling the ‘transparent’ and ‘coherent’ inclusion (Yardley,2008) of the researcher’s own extensive mindfulness and MBCT teaching experience.
The analysis revealed 4 super-ordinate themes comprised of various interrelated mechanisms of positive change. A distinction was observed between more ‘explicit mechanisms’ associated with MBCT’s careful integration of mindfulness practices and CBT and significantly reported ‘underlying mechanisms’ associated with appreciation, relaxation-calm, enhanced meaning, resilience and the supportive and normalizing ‘power of the group’.
Whilst recognizing crucial MBCT principles of non-striving and acceptance the study tentatively suggests adaptations to mindfulness instruction and group facilitation to help participants more fully access these underlying mechanisms. It also comments on important issues relating to MBCT tutor training and supervision.
Dh.Karunavira September 2010
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Chapter 1: Introduction
Mindfulness-based approaches (MBAs) have become increasingly popular in a
variety of healthcare settings over recent years. Due to its experiential nature ‘Mindfulness’
can be difficult to define but is essentially the cultivation of purposeful, “non-judgemental
awareness in the present moment”(Kabat-Zinn,1994). Mindfulness-based cognitive therapy
(MBCT) was developed as a ‘cost-effective therapeutic intervention to reduce rates of
depressive relapse’(Segal, Williams, & Teasdale,2002) based on the mindfulness-based
stress reduction programme (MBSR) (Kabat-Zinn,1990). MBCT is a manualised
intervention delivered as an eight-week group programme with weekly, two hour classes
(Segal et al.,2002,pp.81-95) comprised of mindfulness practices and cognitive therapy
exercises (Beck, Rush, Shaw, & Emery,1979).
The rationale underlying the development of MBCT was the theory of ‘cognitive
vulnerability to depressive relapse’(Post,1992; Teasdale et al.,1995). This suggests that
people who have suffered depression in the past are vulnerable to depressive relapse due to
“the particular ways in which they tend to process their experience”(Crane,2009,p.15); it was
noted how ‘everyday mood shifts’ triggered self-perpetuating and worsening ‘automatic
negative thoughts’ and feelings leading to relapse (Segal et al.,2002; Teasdale, Segal,
Williams, Soulsby, Ridgeway & Lau,2000). “The specific intention of MBCT is to provide
participants with the means to work effectively with these processes at times of potential
depressive relapse”(Crane,2002,p.15) so as to move from “autonomous relapse-related
ruminative processes”(Crane,2009,p.77), associated with ‘discrepancy monitoring’
(Teasdale et al.,1995; Segal et al.,2002,pp.68-9) and ‘experiential avoidance’
(Crane,2009,p.11), towards more open, creative and self-compassionate patterns,
characterized by ‘non-judgement’ and ‘acceptance’:
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“From being habitually self-critical and judgemental they are invited in MBCT to
bring an open, interested, warm, accepting and compassionate stance towards (all)
experience”(Crane,2002,p.19)
MBCT is recommended in National Institute for Health and Clinical Excellence
guidelines (NICE, 2009,8.1.3,p.186) for people who are currently well but have experienced
three or more previous episodes of depression. This recommendation was based on the
results of two multi-centre randomised controlled trials (RCT) using recovered, recurrently
depressed participants (Teasdale et al.,2000; Ma & Teasdale,2004). These RCTs showed that
for participants who were currently well but had experienced three or more episodes of
depression, MBCT halved rates of relapse in the following 15 months compared to
medication ‘treatment as usual’ (TAU). But, reliance on TAU, rather than ‘comparison
treatment control groups’, did not allow investigation into possible ‘mechanisms’ within
MBCT.
MBCT is becoming increasingly widely used and adapted for other client populations
such as chronic fatigue syndrome,(Surawy, Roberts & Silver,2005); eating disorders,(Baer,
Kristeller & Quillar-Wolever,2006); trauma,(Follette, Palm & Pearson 2006); recurrent
suicidal depression,(Williams et al.,2008a); anxiety disorders,(Craigie, Rees & Marsh,
2008); bipolar disorder,(Williams et al.,2008b); and for ‘currently depressed’(Barnhofer,
Crane, Hargus, Amarasinghe, Winder & Williams,2009). Several literature reviews for
MBAs (Bishop,2002; Baer,2003; Grossman, Niemann, Schmidt, & Walach,2004; Allen et
al.,2006) all report “medium to large effect-sizes across types of study (providing) support
for the specificity of the mindfulness intervention”(Grossman et al.,2004,p.40). But less is
known about mechanisms at work within MBCT and other MBAs and it is this gap that is
explored here.
“Mechanisms that may create clinical change such as exposure, relaxation and
cognitive change should be examined”(Baer,2003,p.139)
Shapiro, Carlson, Astin & Freedman (2006) proposed a theoretical model elucidating
potential mechanisms to explain how mindfulness affects positive change. The model
suggests that “intentionally attending with openness and non-judgmental-ness leads to a
significant shift in perspective termed ‘re-perceiving’ (which) is a meta-mechanism of
action”. She then suggests “four additional mechanisms”:
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i/ ‘self-regulation’: “intentionally cultivating non-judgemental attention leads
to connection... self-regulation and ultimately to...health”
ii/ ‘values clarification’: observing “our values...with greater objectivity, we
rediscover and choose values that may be truer for us”
iii/ ‘cognitive behavioural flexibility’: “observing our ever-changing inner
experience...see(ing) more clearly our mental-emotional content...fosters
greater cognitive-behavioural flexibility and less automaticity or reactivity”
iv/ ‘exposure’: “enables...experience (of) very strong emotions with greater
objectivity and less reactivity”(Shapiro et al.,2006,pp.380-82)
Shapiro continues, “future research could examine if any of these proposed
mechanisms do indeed account for a significant amount of the variance change observed”
(Shapiro et al.,2006,p.385)
Perhaps in response to this and the suggestion by Baer (2003) that ‘relaxation’ should
be explored as a possible mechanism, an RCT by Jain, Shapiro, Swanick, Roesch, Mills &
Bell (2007) reported on the relative effect of the ‘relaxation-response’(Benson,2000),
involving ‘autogenic’ progressive muscle relaxation’(Schultz,2001), alongside ‘mindfulness
meditation’.
The study being introduced here, uses Interpretive Phenomenological Analysis (IPA)
to explore such mechanisms from the perspective of the participants own words captured in
post-course interviews. It explores both ‘explicit’ or intentional mechanisms connected with
mindfulness and CBT (outlined above), and what Kuyken and Byford (2008) called possible
‘underlying mechanisms’.
Qualitative research methodology, such as IPA, capturing the detail of people’s lived
experience is particularly suited to studying “complex issues”(Bowling,2002,p.131) such as
‘mindfulness’. As noted by Kuyken et al.,(2008) relapse rates and symptom reduction may
not be very “person-centred outcomes”, or “capture the essence of the changes seen in
MBCT” and so this recent study used a qualitative methodology “to try to understand
participants’ subjective experiences”. Other significant qualitative studies include:
Ma (2002): IPA of 41 MBCT participant post-course interviews revealed 4
main themes of, i/‘ways of change’ (e.g. warning signals and action plans),
ii/‘changes in relationships’, iii/‘changes in life in general’ (e.g. feeling
empowered and confident) and iv/‘support from the group’ (e.g. being
understood).
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Rothwell (2006), in a study called ‘The Different Facets of Mindfulness’
suggests four mechanisms alongside mindfulness including the “significance
of the setting”, “the group”, “transformation of life” and “spirituality”
(Rothwell,pp.79-85)
Finucane and Mercer (2006), in an interview-based analysis of 13 people (3
months post-course) highlighted, i/‘participation in a group’ as important and
validated, ii/ the ‘importance of ongoing support’.
Kuyken et al.,(2009), in a ‘thematic analysis’ of participant evaluation-reports
(12 months post- course), reported 4 overarching themes of i/‘control’,
ii/‘acceptance’, iii/‘relationships’ and iv/‘struggle’
In two further studies applying qualitative methodologies to understand how MBCT
might be effective, a prevalent theme was ‘self-compassion’ (Mason & Hargreaves,2001;
Smith, Graham, & Senthinathan,2007). Neff (Neff, Kirkpatrick & Rude,2007) provided a
broader recognition of ‘self-compassion’ as a mechanism associated with ‘better
management of rumination’ and ‘greater life satisfaction’. The significance of MBCT/MBSR
participants learning to relate to themselves with compassion and acceptance has been
acknowledged by Kuyken et al.,(2008) as a potential key ‘underlying mechanism’.
To summarise, research into MBCT and MBAs demonstrate their effectiveness and
point to a range of possible contributory ‘mechanisms’. This study aims to:
i/ complement and extend investigation into mechanisms of ‘helpful’ change in
MBCT and, review any ‘unhelpful’ ones.
ii/ consider the relative effect of various ‘mechanisms’ and in particular of
‘underlying’ mechanisms compared to more intentional (explicit) mechanisms based
in mindfulness practice, CBT exercises, didactic elements and contextual
information.
iii/ review, in the light of the above, possible adjustments to the way MBCT courses
may be taught to maximise therapeutic effect
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Chapter 2: Method
2. i. The Context of the Study
This study is interested in what participants from one of 3 different MBCT courses
found helpful or otherwise about MBCT. All 3 courses were advertised ‘for coping with
recurring depression, stress and anxiety’‘(i.e. for ‘general vulnerability’ (Crane,2009,p.69))
and were delivered in 2 community-centre settings in the South of England. Course sizes
ranged between 12 and 18 and were led by a facilitator and a co-facilitator trained at the
Centre for Mindfulness Research and Practice (Bangor University). As the researcher I had
no contact with participants whilst they were on their course (Carmody et al.,2009). The
study was given ethical permission by the Bangor University School of Psychology
Research Ethics Committee.
Following Segal et al.,(2002) the 8 sessions of the course consisted of led
mindfulness meditation practices (mostly of 35-40 minutes) followed by an invitation for
participants to talk with the facilitator about their experience (a process called ‘inquiry’)
intended to demonstrate and underline, for the entire group, essential attitudes and skills.
Poems and stories were woven in and cognitive therapy exercises used to demonstrate for
example, how “thoughts are not facts”(Segal et al.,2002,pp.244-268) and how moods can
vary depending on how we think and act. Psycho-education about depression, stress, and
anxiety was included later on in the programme (Session 5) as well as relapse-prevention
strategies (Session 7) to help participants notice and respond to their own relapse indicators.
Daily home practice (40 minutes) was set and reviewed weekly and consisted (mainly) of
formal guided mindfulness practice (body scan, sitting meditation, mindful movement)
(Segal et al.,2002). This was supported by audio CDs and workbook, but also included
informal practices such as doing a daily activity mindfully. All interviewees had participated
in at least 6 of the 8 MBCT-group sessions (i.e. ‘the minimum dose’ (Teasdale et al.,2000))
and attended the orientation and follow up sessions.
2. ii. The Participants
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All 42 participants on these 3 courses were invited by letter (Appendix A) to
take part in the research involving a “40 to 45 minute interview” within a week or two of the
course ending “to find out first-hand about (their) experience of the MBCT course”.
Agreeing to take part in the research before starting the course helped to reduce the
“response bias” of being “more motivated to report positive changes”(Carmody,2009).
Interested participants were offered the opportunity to ask questions by phone call or e-mail,
and then sent a ‘confirmation letter’ (Appendix B) to be signed and returned. The intention
was to select 6 participants from these 3 groups and collect data from them within 2 weeks
of the course ending. Six represented a large enough pool for richness and diversity but
small enough for the analysis process to be thoroughgoing. There were no exclusion criteria
(for the course or the research) although all participants were advised at the pre-course
orientation session that it ‘may not be helpful to do the course at this time’ if they were (a)
unable to commit to attending all the sessions, (b) currently experiencing trauma, (c) abusing
substances, (d) actively psychotic or suicidal. All participants were informed that a total of 6
would be ‘randomly selected’ from those agreeing to take part in the study, weighted to
reflect the average gender balance on the courses. In the event, all the participants who
agreed to take part were selected as this, by chance, numbered 6 and reflected the gender
balance of the 3 groups (i.e. 30% male). Although the 3 courses were advertised for ‘general
vulnerability’ all 6 applicants had a common history of recurrent depression.
2. iii. The Interview Process and Data CollectionParticipants were given a choice of being interviewed at home or at one of the centres
used for the course. Following the completion of a ‘consent form’ (Appendix C) and
explanation of ‘confidentiality’ and data-storage protocols, the 40-45 minute interviews were
recorded. Audio recordings and resulting transcripts were then ‘coded’ for confidentiality
and the key to this code kept on a separate computer.
An ‘unstructured interview’ (Smith,2009,p.69) rather than ‘semi-structured’ was
chosen to allow the interaction to be even more clearly defined by the participants own lived
experience. To this end ‘person-centred’ active listening strategies (Rogers,1967,pp.331-
333) were employed in response to two simple, ‘open’ questions designed to facilitate
spontaneous reflection about i/ “what was helpful or important about the MBCT course”?
and, ii/”what was unhelpful or difficult”? This was combined with occasional probes to
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explore emerging themes guided by my experience teaching MBCT groups over the last 5
years and my training as a Person-centred counsellor (Fd.Sc. University of Brighton)
2. iv. The Analytical Strategy and Procedures
Interviews were transcribed verbatim, noting silences and tonal emphasis and then
subjected to Interpretive Phenomenological Analysis (IPA) (Smith et al.,2009). IPA was
chosen because it is “concerned with exploring experience in its own terms...when (this)
flow of experience takes on particular significance for people”. As such IPA is an
“interpretive endeavour, recognizing that access to experience is always dependent on what
participants tell us about that experience, and that the researcher then needs to interpret that
account in order to understand (it)”(Smith et al.,2009,pp.1-4)
Thus, as a methodology IPA is able to include with ‘rigor’ and in a ‘transparent,
coherent’ way (Yardley,2008) my own experience gleaned from 25 years of mindfulness
practice and also 5 years of professional experience teaching MBAs. This inclusion was
apparent from the interview stage where my sense of the significance of a particular
comment prompted clarification or requests for detail. This illustrates the ‘double
hermeneutic’ of IPA, where I, as the researcher, am trying to make sense of the participant
trying to make sense of what was ‘helpful’ for them about the MBCT course. This process
continued throughout the ‘6 steps’ of the analytical process described by Smith (2009)
(Smith et al.,2009,pp.82-103). The resulting interaction between close attention to what
participants said and my own sense of what is helpful within mindfulness and MBCT helped
to shape analysis and interpretation.
The analytic process involved first listening to the 6 interview recordings several times to
obtain an overview. Then, corresponding transcripts were read and re-read several times and
subjected to a systematic “interactive and inductive cycle” of analysis (Smith et al.,
2007,pp.78-9). Thus, from the 6 transcripts, 2 were first randomly selected for an initial
round of analysis. This was based firstly, on close, line by line, analysis of experiential
claims and understandings which were highlighted in the transcripts and coded in a left-hand
column, and secondly, by identifying emergent patterns or themes “emphasizing
convergence and divergence, commonality and nuance”(Smith et al.,2009). These were
coded as ‘emerging themes’ and entered in a right-hand column using, as far as possible,
participants own phrases and words (for example see Appendix D)
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This process led on to an inner ‘dialogue’ conducted over several weeks between my
own sense of the emergent themes derived from these two transcripts and participants’
grounded comments about what was helpful or otherwise about MBCT. From this, a list of
‘overarching’ and ‘main sub-themes’ was complied (Appendix E). This process was then
repeated in full for a third and then a fourth script, by which time there was an emerging
sense of major and lesser themes across all 4 transcripts (Appendix F). From this the last 2
transcripts were subjected to the same processes and subsequently a draft ‘grid’ of major
themes was compiled.
Creating this overarching ‘grid’ and using it as a guide gave rise to a reassessment, and
in some cases a merging and re-naming, of ‘themes’. This revision led subsequently to
compiling the ‘Grid of Major Themes’ (Appendix G) identifying major and lesser themes
across all 6 cases. This included many of the most compelling statements made by
participants in association with the codes of other closely related quotes. From this arose the
list of ‘super-ordinate’ and ‘lesser’ themes.
In this way the process of analysis involved progressive interactive and inductive cycling
between the data source and a provisionally extracted sense of meaning and value; the
intention being to ensure the emerging structure of themes continued to be grounded in the
participants’ lived experience, whilst also being informed by my experience and
understandings as an experienced MBCT and mindfulness-meditation teacher.
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Chapter 3: Findings
3. 0. IntroductionThis chapter considers the 4 super-ordinate themes determined by the “interactive
and inductive analysis” (Smith et al.,2009) of the 6 participant interviews:
1/ ‘Acceptance’
2/ ‘Perspective-choice’
3/ ‘Appreciation of Life and Relationships
4/ ‘The Power of the Group’
Of course these six participants did not speak in themes at all - they had no idea how
their unstructured interviews would be analysed or used. From them, however,
commonalities, recurrence and power were noted and subsequently sorted into a hierarchy of
super-ordinate and sub-themes (Table 1 below). Generally they augment and explain each
other and form a statement about what was most ‘helpful’ or otherwise about the course.
Throughout this chapter participant comments are referenced by a codename and a
related number code notated on the original transcripts (see Appendix C). Thus, participant
‘A’’s code name is ‘Ann’ and her quoted comments are numbered in order and prefixed with
‘A’(i.e. A1, A2, A3); participant ‘B’, ‘Brenda’; ‘C’, ‘Clive’; ‘D’, ‘Dawn’; ‘E’, ‘Eva’; and
‘F’, ‘Frank’. Participant quotes are italicised, pauses indicated by three dots(...) and tonal
emphasis emboldened (for specimen IPA pages see Appendices H - N).
(N.B. Full transcripts, with number-coded quotes, are available on request; the
number codes are included with each quote (below) to indicate its relative position in the
interview)
A note about participants’ first comments:A person's first comment in an open interview like the one used need not necessarily
indicate extra significance. Indeed most of the participants arrived at their “biggest thing”
(A 65) or “one of the big things” (B35), as a result of a process of following a thread of
reflection. But ‘first comments’ can have a weight of significance; this is what participants
first thought to say. These very first replies to the open question: “what was helpful about
the course” are threaded together below:
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“The key thing…was the experiential aspect of it(D1);a great course, the pace, the
group dynamic(E1), the overriding thing I got was to be more accepting around my
feelings(B1), you can't get it wrong so long as you are aware(A1); what stood out was
focusing on bodily sensations and their feedback loop onto emotions”(F1) (and) being
in a group with a whole range of experience(C1),
This paragraph is like a patchwork quilt offered as an introduction to the study’s
‘findings’ as an attempt to capture a sense of the ‘whole’ before dissection into themes. The
discussion of ‘findings’ is organised as illustrated in Table 1 below:
Table 1 *
Super-ordinatethemes
‘Acceptance’ ‘Perspective- choice’
‘Appreciation...of life, work &
relationships’
‘The Power of the Group’
Sub- themes
i/ ‘Just noticing stuff’
ii/ ‘Approach’
iii/’ ‘Letting be’
iv/ Acceptance as reported in relation to ‘group process’ and ‘tutor-embodiment’
i/ Control
ii/ Choice(‘self-power’)
iii/ Perspective from CBT exercises
iv Divergence- when finding perspective is too difficult
i/ Stopping and seeing
ii/ Working relationships
iii/ Family and personal relationships
i/Normalising effect/acceptance
ii/Support to practice
iii/ Import of tutor in the group
iv/ Divergence: Unhelpful aspects
*The names of themes are based in commonly used participant words and phrases
3. 1. ‘Acceptance’ Brenda speaks about acceptance as “the overriding thing” she “got out of” the course:
“ The overriding thing I got out of this course was a greater ability to be accepting
around my feelings”(B2) “When you can accept your feelings it’s easier to live with
them”(B32)
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Brenda summarises this mechanism beautifully, indicating it is something we think
we should be able to do but is, in practice, difficult; her phrase, ‘greater ability’ speaks of a
skill based in practice rather than just an idea! Acceptance is a ‘key underpinning skill’, of
the ‘first half of the MBCT programme’ (Crane,2009,p.56) and is crucial to the ‘shift from
avoidant ways of processing experience’ that lie at the root of depressive relapse
(Crane,2009,pp.15-19).
Dawn captures the essence of this first super-ordinate theme of ‘Acceptance’ also
referring to the idea of ‘approach’, (“accepting and allowing”(Crane,2009,p.42)), rather than
‘avoidance’:
“Just noticing stuff and not doing, the whole thing about approach was really, really
helpful; strong uncomfortable emotions just dissipate when I let them be there”(D25)
This comment lists a series of three aspects that can serve as a structure for reporting the
sub-themes expressed under ‘acceptance’:
i/ ”noticing stuff and not doing”
ii/ “approach”
iii/ “uncomfortable emotions dissipate when I let them be”
3. 1. i. ‘Just noticing stuff and not doing’Mindful-acceptance proceeds from noticing or ‘paying attention’ as reflected in Jon
Kabat-Zinn’s (1990) working definition of ‘mindfulness’:
“Mindfulness is paying attention, on purpose, non-judgementally and in the present
moment”(Kabat-Zinn,1990)
The meditative tradition (Buddhism) which underpins MBCT-MBSR, uses the term
‘recollection’ as the primary translation of ‘smriti’, the sanskrit word translated more
commonly as ‘mindfulness’(Gethin,2001,p.34).This points to a fundamental dimension of
mindfulness which is active recollection in the moment. In order to ‘recollect’ in this way
one has to first cultivate a quality of attention that is open and accepting:
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“Acceptance...engages us in a turning towards rather than a turning away from
present moment experience...whether we like them or not; then we include the
“liking” and the “not liking” as simply an aspect of our whole experience”
(Crane,2009,p.54)
The first two weeks of the MBCT course uses a daily ‘Body Scan’ practice (Segal et
al.,2002,p.112) to invite ‘curiosity’ and ‘kindness’ to whatever experience is there in the
body thus assisting an embodied skill of acceptant, non-judgemental noticing, which as
Frank testifies, can have a helpful, therapeutic effect:
“Focusing on the small bits of the body helped because I would focus on that and
ignore all the rest of it for a while”(F6)
In this early comment by Frank the phrase, “all the rest of it” refers to what Clive
elsewhere describes as “negative thinking leading nowhere”, with his mind “whizzing round
like a treadmill”. It is not that Frank sees this as the end of the story; he says “for a while”,
indicating a level of realism and lightness that reflects an affective understanding of how
demanding ‘acceptance’ really is.
Dawn’s comment about ‘not doing’ seems to be referring to a quality of not reacting
but ‘staying present’(Segal et al.,2002,pp.189-217); a quality of mind described as ‘being
mode’ as distinct from ‘doing mode’ where the focus is “accepting and allowing”:
“Mindfulness provides both the means to change mental gears when disengaging
from dysfunctional “doing-related” mind states and an alternative mental gear, or
incompatible mode of mind into which to switch”( Segal et al.,2002,p77).
There seems to be a quality of self-acceptance and ‘not-doing’ (‘being’) in Frank’s
later comment about how the MBCT course ‘helped him to feel ‘okay’ about not having to
‘put on a mask all the time’:
“It's okay for me to feel like that, inside or outside of work; it's okay for me not to put
on a mask all the time. It's okay to sometimes be a bit cross”(F22)
Frank continues to say that this has also helped his work colleagues who expressed
appreciation for making their working environment clearer (see 3.3 below)
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3. 1. ii. ‘Approach’Frank continues with a comment that describes these elements of acceptance and
introduces a linked and important mechanism of ‘approach’:
“It was funny, accepting all of the things that were going on…so it was about
accepting the body sensations; if I sit for 20 minutes then I start to get back pain, it
was actually part of the meditation to think. “Well, okay, what does the back pain
feel like”? And am I going to accept it or am I going to move?”(F19)
Frank's uses the phrase: “It was actually part of the meditation to think, ‘Well okay,
what does that back pain feel like?’”, to describe ‘the approach mechanism’ (Williams et
al.,2007,p.67). This term is used on the course to describe ‘non-avoidance’ or, put
positively, ‘moving towards’ difficult experiences as part of the solution of forming a new
relationship with them. This relates perhaps to Shapiro’s ‘exposure’ and ‘self-
regulation’(Shapiro et al.,2006).
The theory is that fretting about difficulties, whether emotional or physical, is an
extra level of suffering that we add to our situation (Segal et al.,2002,pp.59-61). In the
meditative tradition underlying MBCT this skill is referred to as letting go of the ‘second
arrow’ or ‘dart’ (Nyanaponika,1983); the first arrow is the objective difficulty but the second
is the fear, anxiety or even guilt that we add. “Aversive reacting (leading to) ‘experiential
avoidance’ is a process implicated in the cause and maintenance of many psychological
problems” (Hayes et al.,1996). Frank is describing:“a distinctive feature...of MBCT...(which)
is its emphasis on learning how to notice and then intentionally transform...patterns though
choosing to turn towards or “approach” (difficult) experience”(Crane,2009,p.39)
But this skill of acceptance and ‘staying with’ difficult experience is deeply
challenging and the various transcripts demonstrate how demanding it is to practice. Dawn
speaks of this and continues to outline her reasons for engaging with something so difficult:
“When it was too difficult I used distractions, but you can't be distracted for the
whole of your life(D33). I really want to get nearer to that skill of staying with the
very difficult things, because I am aware that as I get older there’s just going to be
more and more challenges”(D38)
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3. 1. iii. ‘Emotions dissipate when I let them be’We return later to Dawn’s difficulties but for now her comment introduces the
perspective ‘that staying with the very difficult things’ offers a way forward for life’s
inevitable “challenges”. But this ‘staying-with’ also has an immediate payoff of that Frank
describes as “calming down”:
“Recognizing them ( negative thoughts and feelings), and not reacting to them and
letting them just settle down a bit… and letting them go and calming down. I found
that interesting”(F2)
Clive uses similar metaphors of ‘letting go’ and ‘de-fusing’ to describe this payoff:
“I used to be incredibly hooked up into those thoughts... now I am able to sort of let
them go or I can just notice them arising, they don't have the same charge”(C7)
As I discovered in a post-interview conversation, Clive's depression and anxiety are
based in violent gun trauma, and his negative thoughts and feelings come as an
overwhelming, relived visual package; consequently the metaphor of less ‘charge’, as if the
negativity was like an explosion, is very moving and points to how very important
‘acceptance’ has become for him.
Eva opens up this perspective in a slightly different way by using the metaphor of
play and flexibility:
“It’s the recognition that everything, any kind of emotion can be played with…and
meditation can be used to work with it…and meditation is not about sort of squeezing
it into a box”(E43)
She is saying that every kind of emotion can be played with, so you don’t have to
squeeze it to fit into some compartment in your life. It can be changed, it can be ‘worked
with’. This comment could have been classified under ‘perspective-choice’ or ‘self-power’
but I felt the main quality of mind being expressed was acceptance.
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3. 1. iv ‘Acceptance’ associated with ‘the group and ‘tutor- embodiment’
References to ‘the group’ and the importance of ‘the tutor in-the-group’ are made
many times, in association with ‘acceptance’. This is reported below under the super-
ordinate theme of ‘The Power of the Group’ (section 3.4.) but it is important to note here
how strongly ‘acceptance’ appears as a mechanism within it. Brenda illustrates this with
humour:
” The group itself was tremendously supportive
you don’t feel it’s just you who is a nutter”(B22)
3. 2. ‘Perspective-choice’
This appears as a rich, complex theme across all 6 cases, illustrating mechanisms of
‘increased perspective’ linked to ‘choice’ and ‘control’ or ‘self-power’. The title of this
theme and its sub-themes are based on recurring terms used by participants. It resonates with
Shapiro’s (Shapiro et al.,2006) ‘re-perceiving’ and ‘cognitive behavioural flexibility’, Ma’s
(2002) third theme of ‘changes in life: feeling empowered’, Kuyken’s (Kuyken et al.,2009)
first super-ordinate theme of ‘control’ and a study by Allen (Allen et al.,2009) reporting on
the impact of ‘changes in perspective’ and ‘attitude to ones internal world', and ‘emotional
regulation’.
MBA theory illustrates that ‘Acceptance’ and ‘Perspective-choice’ operate together:
‘acceptance’ first to open to experiences that hitherto were avoided (denied or distorted) and
secondly perspective, offered by this ‘psychological flexibility’, to make new ‘wiser’ choices
about how to act in the future. Crane (2009) gives this mechanism high ranking:
“The overriding emphasis throughout (MBCT) is on developing the possibility of
responding skilfully by seeing the tendency to react habitually. Rather than putting
our energies into avoiding experience... present moment acceptance becomes a
foundation from which we have the choice to respond in wiser ways”
(Crane,2009,pp.41-42)
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This second super-ordinate theme includes sub-themes of:
i/ Control
ii/ Choice
iii/ Perspective (insights) from CBT exercises
iv/ Divergence: when gaining perspective is too challenging
3. 2. i. ‘Control’‘Perspective-choice’ emerged as being linked to ‘freedom’; freedom to feel more in
‘control’ and have more ‘choice’ (‘self-power’) in one's life. Ann speaks of this being the
‘biggest thing’ that struck her about the course:
“Yeah, that was the biggest thing…wanting to be like in control of my own life and
seeing that meditation is about that”(A65)
Ann is reflecting here about how awareness gives her a more positive sense of
control or direction and a little bit later, she says meditation “is not passive”, but “gives you
choices”. Brenda expresses something similar, but focuses on the effect of awareness (“it”)
suddenly dawning as a result of mindfulness practice:
“It helps you say, ‘Hold on a minute, hold on a minute, is that really me or is it just a
voice in my head’”?(B28)
This is a light-hearted expression of feeling liberated from over-identifying with
thoughts, as if our thoughts are the truth about ‘the real me’ and not ‘just another passing
event’. Realising that thoughts are “events in the mind” (Segal et al.,2002,p.258) is a crucial
aspect, even a culminating aspect of the work done in ‘sitting meditation’ introduced from
Sessions 3. In this practice participants are directed to observe thoughts ‘arising and passing
like clouds or images on a cinema screen’ (Segal et al.,2002,p.197). This allows insight or
‘meta-cognition’ (Teasdale,1999) that we are not just our thoughts (despite the heritage of
Descartes: ‘I think therefore I am’!). This may be understood in terms of ‘awareness’ being
greater than, and including, a passing thought or feeling. When applied, as by Brenda above,
to negative ruminative thinking, a cause of depressive relapse, (Teasdale,1999,p.152) it
becomes liberating.
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It can seem paradoxical that the early emphasis on ‘acceptance’ (above) leads on to
participants expressing jubilantly that they feel more “in control” and more able to effect
“change in their lives”. This paradox is sometimes commented on in Session 6 when the
emphasis of earlier sessions on ‘open-acceptance’ of our experience begins to change to
include ‘questioning our thoughts’ as well as changing our relationship towards them, (Segal
et al.,2002,p.244; p269).
3. 2. ii. ‘Choice’The combination of ‘acceptance’ and related ‘perspective’, leading to increased
choice, is played out within each mindfulness practice at a micro-level, and then mirrored at
the macro-level in the structure given to the whole course: Sessions 1-5 are primarily
concerned with ‘acceptance-allowing’ and Sessions 6-8 with progressively bringing in the
whole idea of making choices based on a clearer perspective about how ‘to take better care
of ourselves’(Segal et al.,2002,pp.257;275-283)
This is commented on in different ways by the participants. Ann uses a narrative
form to recount this recent episode in her life:
“The sitting breathing meditation, and watching thoughts -- and it's been good if I’ve
been worried about something -- like yesterday, my boyfriend was being a bit grumpy
and I was sort of all ready to fall into my old pattern of, “Oh no!, was it because
when I said that? Or was it because I did this”? Or thinking, “He's always like this,
why does he do this?” Instead of going into all that I just let go of it and just
thought: “He’s just doing this, and it does not have to bother me, I can just detach
myself and feel a bit easier” and umm…”(A9).
This passage describes the whole process of first gaining perspective and from this
making an informed choice; it speaks powerfully about how Ann is able to not “fall into old
(habit) patterns”, which she recounts as thoughts she had going through her head “yesterday”
but how instead of “going into all that” she was able to “let go of it”. The “a bit easier”
gives a sense that she is speaking realistically and knows these habits are difficult to
completely see as just ‘thoughts and not facts’. It is clear that as a result of the meditation
she arrives at a new perspective: her boyfriend is “just doing what he does, and it does not
have to bother me”. Ann ends with a wistful ‘umm’ as she sits back and remembered the
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experience of freedom in that moment and, I guess, a sense of how she could apply this more
often in her life. Later on, she says:
“...meditation is not about being passive, is about having more control -- and being
able to choose -- being able to step outside of it and being able to choose…again, it’s
about choice”(A13)
This time, the ‘perspective’ metaphor changes to “step outside” rather than “detach”,
but the message is the same: Ann found a way to be more in control of her own life. The
repetition of the phrase ‘being able’ linked to ‘choice’ clearly describes this super-ordinate
theme; again the phrase, ‘being able’ points to a skill or a ‘tool’ and not just an idea.
The various comments made by Ann, Brenda, Clive and Frank about ‘perspective-
choice’ (‘freedom’, ‘choice’ or ‘self-power’), were approximately as common as those made
about ‘acceptance’ (I return to speak about Dawn and Eva in ‘Divergence: 3.2.iv’, below).
3. 2. iii. ‘Perspective’ (insights) from CBT exercisesIn MBCT there are various CBT exercises that augment the work done in
mindfulness practices to help build understanding and strategies based on increased
‘perspective’. Clive’s comment below (which could also be listed under the theme of ‘the
power of the group’) is in relation to a memory of one of these exercises in Session 4:
“I did find them interesting, both for myself and hearing other people's reactions -- it
was like plotting yourself on a graph -- when I heard other people's stories and
reactions, which was far more severe. I could plot my own position in relation to
them, so again. It gave that kind of perspective”(C40)
He is recounting an experience of seeing his own negative reactions in the light of
other peoples, and finding ‘perspective’. Earlier Clive spoke about the freedom he
experienced (linked to the CBT exercises) of being able to recognize “old patterns” that led
him “nowhere” and which sounded destructive and confusing to him:
20
“It is the recognition of pattern, knowing these patterns lead nowhere, the mind
whizzing round like a treadmill. In some ways just recognizing you don't want to go
down that route again”(C14)
Brenda also makes several comments about the way perspective has helped her effect
change, briefly but powerfully stating: “It helped me get a grip”.
3. 2. iv. ’Divergence’, when gaining perspective is perhaps too challengingBut for Eva and Dawn there were fewer comments about the importance of
‘perspective-choice’, and relatively more significant comments about relaxation-calm,(see
Appendix G). Eva, when prompted to speak about the CBT exercises said:
“Well I wasn't the best student, it was quite difficult for me to separate my thoughts
and feelings…and because I was getting so much benefit from the meditation I
always tried to prioritise that”(E36)
She is speaking about practising the skill of ‘de-centering’ (an important skill in the
process of gaining perspective(Crane,2009,pp.12-13))in relation to the ‘Pleasant and
Unpleasant Events’ exercises in Sessions 2 and 3 (Segal et al.,2002,p.172) and cites how she
got more “benefit from the meditation”. This intrigued me, but a bit later on, she explains
what this means:
“I think why I was attracted to the practices rather than the exercises...was about
getting the immediate benefit of them...feeling rested and calm, like I said, it's like
giving the old brain a little massage and easing out its little aches and pains”(E40).
This perhaps reveals a different inclination and sense of purpose. Eva is speaking
about an additional benefit or ‘mechanism’ within MBCT: the “immediate benefit” like a
“little massage”, “easing out aches and pains” and “feeling rested and calm”. She seems to
be talking about ‘benefits’ from the mechanisms of ‘relaxation’ and ‘calm’ and is, perhaps,
saying these, at the time, were more helpful to her than exercises designed to build
perspective.
This different tack highlights a very interesting and significant issue that runs right
through the practice of mindfulness meditation, whether in relation to MBCT or the wider
21
meditation tradition (Buddhism). This is the issue of ‘calm’ versus ‘insight’; in Buddhism
there has been a dynamic discourse over the last two millennia about whether to first
emphasise the dimension of ‘calm’ (stability-relaxation) or ‘insight’ (perspective-choice,
wisdom). Each dimension is vital to the other, but, there is a question of i/emphasis and
ii/sequence: how much should one first emphasise the ‘path of calm’ (samatha: sanskrit), in
preparation for the ‘path of insight’ (vipassana: sanskrit) (Analyayo,2003,p.88). This
significant issue of the mechanisms of ‘calm’ and-or ‘insight’ is returned to below (Chapter
4. 2.i.)
But, MBCT takes a very clear stance about the dangers of thinking that ‘calm’ or
‘relaxation’ are the object of meditation; it recognizes that people can get hooked into
wanting these experiences because they are pleasant and then find themselves being self-
critical if they can't get it, thus activating ‘discrepancy monitoring’ and related relapse
vulnerability. Eva speaks about this, saying “it” (meditation) was “like a fight”:
“It was like a fight, but I did not think, “can I be with this unpleasant experience of
sitting doing the meditations?”(E42)
But, at the same time, it is clear that Eva (and perhaps Dawn) found the calm-
relaxation aspects of the practices especially helpful or important:
“In my mind, it was wonderful…complete emptiness and umm…. the lightness and
really wonderful…not to be thinking either good things or bad things”(E11)
Eva is describing a Body Scan meditation and says that “it really inspired me to
continue”(E8), and that it was “such a powerful motivating force”(E18). As we shall see in
the discussion of ‘Appreciation of Life and Relationships’(3.3 below), both Eva and Dawn
were perhaps more attracted to the relaxation-response (calm) of meditation practice
(Jain,2007,pp.11-21) and less to perspective-giving “meta-cognitive insight”
(Teasdale,1999,pp.146-55; Crane,2002,p.152).
It is also apparent that Eva and Dawn did recognize the potential benefits of
perspective-choice derived from mindfulness practices. After using the metaphor of “a
fight”, to describe trying to meditate staying open to “difficult” experiences whilst also
looking for “calm” Eva says:
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“It's great to think about it (the course) again, because I didn't consciously register
that way of working (approach) but I think that would be a much more helpful way of
working”(E43)
This statement may include an element of ‘reassuring’ the interviewer that she does
really value the MBCT approach, but it also suggests a realisation of the limitations of just
looking for that magical experience of “wonderful emptiness and lightness”.
Clive indicates that there need not be an either-or-attitude in a series of comments
that encompass both aspects. Just after speaking about gaining perspective about the
“whizzing treadmill of his habitual negative thought patterns” he refers to meditation as
“this quiet space (which) is nurturing and rejuvenating and builds an inner a strength”.
This resonates with the important ‘mechanism’ in positive psychology of ‘resilience’
(Seligman,2002). We return to this in 4.2 below.
Dawn’s experience of trying to ‘approach’ ‘the difficult’ and gain liberating
perspective became just too challenging when, half way through the course she was faced
with physical as well as emotional pain:
“The approach mode was fine when everything was okay but when there was very
challenging emotions about and I was having physical pain as well -- there were two
things and it felt too hard to focus, too scary to focus on the emotional pain, it felt
like a barrier and too difficult, especially when I was at home”(D17)
Her description “too hard to focus” is interesting because in the course there are
instructions to establish ‘stability’ that are meant to create the conditions for such focus. In
the meditative tradition the argument for first giving greater emphasis to the mechanism of
‘calm’ (‘concentration’) is precisely that one’s ability to experience ‘insight’ is based on a
stable, clear mind. But for Dawn it “felt too hard to focus on the emotional pain” to
‘decentre’ and thereby gain liberating perspective. I suspect the metaphor of a ‘barrier’ also
refers to something preventing her almost physically from reaching a ‘desired’ calm,
peaceful place in herself. Her final comment, “especially when I was at home” points to the
mechanism of ‘support’ within the super-ordinate theme of ‘the power the group’. It was as
if she could almost do what she knew would be best for her, but conditions on her own at
home were just too scary.
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Perhaps this illustrates the course exclusion proviso about it not being ‘suitable for
people who are currently depressed’; it can just be “too scary”, “too difficult” for
participants to ‘stay with’ their experience whilst depressed. In Dawns case (and perhaps
Eva too) it seems they fell back onto looking for some ‘peace’ and calm’; that “little mental
massage” that Eva talked about. MBCT theory indicates that using meditation to find ‘calm’
is difficult for people who are currently depressed but in my experience some people find
ways to use it as ‘respite’ from their pain.
What is interesting to note here is how Eva did not give up; she adapted the practices
in terms of her posture (lying down) and the time spent doing them (“I did shorter
practices”), and this perhaps points to the way that some participants can self-manage
themselves. Dawn speaks about this too:
“What I was doing initially was following everything very rigidly…and then I
became more flexible about what I would use and I wasn’t doing it for as long…I
suppose I was putting pressure on myself… but I started to try to do it when I was
feeling ok-ish rather than when I was feeling upset or over-emotional”(D22)
Despite what appears to have been a mild depressive relapse during the course she
adapted and got what she needed from it; finding ways to experience ‘calm moments’ in her
day and within these, appreciate her world and her relationships more. For Dawn (and
perhaps Eva) it seems different mechanisms of change may have been relatively more
significant; we explore this further in Chapter 4.
3. 3. ‘Appreciation of Life and Relationships’
This third super-ordinate theme is comprised of powerful comments about how the
course increased participants’ appreciation of life and relationships with sub-themes of:
i/ Stopping and seeing
ii/ Appreciation of work and working relationships
iii/ Appreciation of family and sexual relationships
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The second and third sub-themes contribute to other studies on MBAs reporting positive
effect related to improved ‘interpersonal relationships’ (Allen et al.,2009; Evans et al.,2007;
Finucane & Mercer,2006)
3. 3. i. ‘Stopping and seeing’Ann describes how a new behaviour of ‘stopping’ gave rise to appreciation:
“The course has made me appreciate my life quite a lot ‘cos I'd stop myself in
various situations…it wasn't just when I was upset about something -- it is nice to
just stop for a minute and have a look around, and it made me appreciate all that --
and I found those parts of my day were the most memorable parts -- and at the end of
my day I'd look back and think wasn't that lovely when I stood by the sea and saw the
sun shining on the sea, and it was like diamonds”(A31,A32)
It is clear that Ann is reliving a significant and beautiful moment that had a helpful
and important impact long after the event itself, “at the end of the day”. It seems she learnt
to regularly ‘just stop’ and ‘look around’, because it brought appreciation and ‘memorable’
pleasure into her life. For someone with a long history of difficulties, it seems poignant that
she has learnt a simple way of enriching and strengthening herself.
Ann attributes this new benefit to the course and especially the ‘3 Minute Breathing
Space’(3MBS) introduced from Session 3. The mechanism, she speaks so poetically about is
more related to ‘calm’ than ‘insight’. I'm struck by how, “at the end of the day”, which can
be problematic for a person prone to rumination and depression she seems protected by this
memory of beauty; reminiscent perhaps of Clive’s comment about ‘inner strength’
(‘resilience’). Eva adds to this theme when she makes this high-ranking statement:
“One of the big things I took away from the course was to really appreciate the
things that are out there, you know, the beautiful day”(E31).
The phrase “really appreciate” (her emphasis), suggests a new-found ‘skill’ that
replaces a more habitual ‘idea’ of appreciation. The context tells us that this skill derives
from the ‘3MBS’ and the ‘mindful-activity’ exercises, introduced at the outset of the course.
Mindful-activities form an important part of MBCT, helping participants realise that
25
mindfulness can enrich everyday life. Again, with Eva, there is a sense she has learnt a skill
which she then applies in her ‘life’ to enhance its meaning and value.
Recent studies show a decrease of meaning and value in life and work is associated
with depression and anxiety; among people who have lost their jobs in the last year 71%
have suffered symptoms of depression (Guardian newspaper report, Dennis Cambell,1/5/’10;
Montgomery,1999). Conversely, participant comments suggest that increased ‘appreciation’
associated with meaning and value in everyday life is a helpful mechanism in MBCT.
Brenda makes a contribution that speaks for itself on this theme:
“It makes me more appreciative about what I have… it just starts on its own. I just
realise that I'm doing it”(B55)
Brenda uses the term “it” to describe mindfulness as if “it” were a magical person
inside her that has its own life and “just starts on its own” making her more appreciative
about what she already has. In my teaching experience participants often report feeling
surprised by the eruption of what seems like ‘automatic mindfulness’ whilst their level of
formal ‘practice’ is low, suggesting that, despite this, a skill has been learnt that grows into a
positive, appreciative habit.
It seems Eva felt more inclined towards ‘mindfulness in everyday life’ and enjoyed
some success in adapting mindfulness practice, combining a visual rhythm alongside her
breath sensations and finding this provided a route to stability and heightened appreciation of
beauty:
“I went to the beach...that was quite nice just using the waves as opposed to your
breath...I tried doing that a few times it was the same kind of rhythm and that was
nice as well …on a really beautiful bright wintry day quite a nice thing to do…the
waves coming...a visual focus of the waves, something different”(E27)
3. 3. ii. ‘Appreciation of work and working relationships’Ann speaks about the ‘3MBS’ in a classic mindfulness sense of ‘stopping’, helping to
create a gap in which greater perspective is possible:
26
“One of the things that helped me was a three-minute breathing space, you can just
stop and just ground yourself…being able to just step back from it all a bit”(A29)
A little later she speaks about a similar experience related to ‘stopping’, highlighting
the deep appreciation she felt for a moment “at the end of the day” when she saw “the sun
like diamonds” on the sea (A31). Then, interestingly, Ann revisits this metaphor of
‘stopping’, linking it to an increased gratitude and ‘appreciation’ for her life and job:
“One time I stopped when she (the little girl she child-minds for) was making a
collage, I stopped and watched her doing it and thought it was really lovely, and that
I'm really fortunate that I've got a really nice job. I felt privileged and I think that
really helped”(A33)
The phrase ”I think that really helped” resonated with me. It was not the collage or
the little girl doing it that was really nice; it was the “really lovely” experience of stopping,
noticing, and reflecting on all of this. Such experiences illustrate perhaps not only
‘appreciation’ but ‘resilience’(Seligman,2002); a positive filling up of her mind with
pleasant and self-affirming material perhaps preventing less helpful, negative patterns taking
hold.
Frank also speaks about the impact of the course on his work but focuses on
relationships with colleagues; a common source of anxiety and depressive rumination.
Franks’ comment about how the course has helped him ‘to be more himself’ and more able
to ‘show his angry moods’ is quoted in relation to ‘Acceptance’(p13 above), but seems just
as appropriate here, perhaps further demonstrating how interconnected these themes may be.
Brenda speaks of a similar quality of mind arising when she is cooking:
“I become mindful of being mindful and err -- I think it helps to increase the joy in
my life. Other things can be going on -- not particularly great -- but something as
mundane as peeling a clove of garlic…, it can have a really good effect”(B58)
She had just been crying in the interview about her mother's deteriorating dementia,
and how powerless she feels in her caring role. So the pauses in this comment, and her
understatement, “not particularly great”, are exceptionally charged, making this memory of
waking up to find a precious moment of “joy in her life”, very powerful.
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MBCT teaches an approach to practice that encourages a sense of it being a
component of ordinary everyday life. This is a major theme in the way MBSR was
developed by Jon Kabat-Zinn which influenced MBCT. Thus, everyday mindful activity,
mindful eating, walking and ‘mindful movement’ are important from early on in the course.
The idea of having to ‘get it right’ or ‘become an expert’ are positively exposed and
countered by these practices as are simple instructions for ‘posture’ using ordinary everyday
props like a chair for meditation rather than cushions on the floor.
In my teaching experience participants often speak about suddenly waking up
(becoming mindful) to appreciate everyday experiences. Such comments are often heartfelt
expressions, communicating a sense of lasting impact on their general well-being. Clive
speaks about one of these moments, driving to work:
“I think the course hits things on a number of different fronts -- I found I really
appreciate you know, appreciate the world around you, even the simple things like
driving to work, I’ve been noticing clouds and sometimes there is a never ending
constantly changing cloudscape”(C27)
Clive is a man in his mid-to-late 40’s but this comment reminds me of a child's
wonder. It is clearly not a one-off experience; he had “been noticing” and uses the term
“sometimes”, which suggests an ongoing project to bring ‘appreciative awareness’ to his
life,(Nhat Hanh,1990). Early in his interview Clive spoke about being “caught in a
treadmill” of patterns of negativity but later uses this metaphor of “constant change”,
indicating perhaps, a new-found sense of freedom and beauty.
3. 3. iii. ‘Appreciation of family and personal relationships’A sub-theme within ‘Appreciation’ relates to the effect of the course on personal
relationships:
“It’s improved my relationship with my children. I’ve struggled a bit with my eldest
daughter -- I've always struggled a bit saying: “Well come on get on with it”. Or
when she is ill, saying: “You're not really ill”. So I have been more accepting of her
emotions as well (as my own), and she is responded really well to that”(D42)
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This development in Dawn's life is related to the impact of the skill of acceptance
which has improved her very significant role as a mother, I suspect creating a positive
stream of confidence and self-esteem. It reflects an impact of the course on the quality of
her life because of improved personal relationships. This surely has significance in terms of
her resilience to negative self-view and associated rumination leading perhaps to depressive
relapse.
In a related and a detailed series of comments Clive speaks about the impact of the
course on his relationship with his partner and how this has significantly helped stabilise his
mood:
“You know these flights of fancy or unrealistic expectations -- but it's very interesting
that since I'd drawn back and not put these expectations on – particularly on my
partner, I found the relationship has improved. She can come forward -- you know I
wanted her to come closer, but I was forcing her away”(C19;20)...”I used to be, you
know, always wanting company, whereas, now I'm much happier in my own company
-- and particularly wanting to do meditation”(C28)
Clive then attributes this not only to being more self-sufficient “in his own
company”, but to “accepting things” as they are, and so “in some ways it's quite freeing
because it focuses you on the present”. The course helped Clive to recognise his old habit
patterns:
“In some ways it's the recognition of patterns knowing these patterns lead
nowhere”(C14)
He is speaking about how being more accepting of himself and his partner has
resulted in his relationship improving. As with Brenda, with her relationship to her mother
with dementia, and with Eva's relationship to her eldest daughter, I have a sense that this
shift for Clive has had a significant, strengthening, and protective longer-term impact.
Perhaps it is not possible to compare the relative effect of appreciative and
strengthening experiences such as these against the ‘relapse-protective’ effect of enhanced
perspective about negative thoughts and feelings. People are different and perhaps take from
the course what they are predisposed to by temperament or conditioning. Eva may have
found an effective mechanism to staying well and maintaining positive states that has more
29
to do with the relaxation-response (Jain et al.,2007,p.20) than creating cognitive insight. This
theme is returned to in Chapter 4, but the variety of responses across all six cases, make me
wonder if the growing drive for quantifiable outcome measures (i.e. RCTs) for
MBCT/MBAs, measuring just one variable at a time, are limited because, unlike qualitative
research, they can not sufficiently consider ‘immeasurable’ mechanisms like appreciation,
relaxation, calm, resilience and beauty.
3. 4. ‘The Power of the Group’
The discussion of ‘acceptance’ introduced the importance of ‘the group’. Alongside
this we saw how ‘tutor-embodiment’ of ‘attitudinal qualities’ enabled the group to become a
richer field of learning. The analysis process revealed linked but discrete ‘mechanisms’ of:
i/ the ‘normalising-effect’ (Nirje,1969)
ii/ ‘the group as support to practice’
iii/ the importance of the tutor-in-the-group
This section also considers ‘divergence’ under ‘Unhelpful Aspects’ associated with the
group process.
3. 4. i. The ‘Normalising Effect’ of the group
Participants described the group in terms of ‘trust’, of ‘special bond’, of ‘safety’ and
‘ease’; a place where the habit of judgements around ‘good-bad’, ‘success-failure’ could
dissolve or at least be seen more clearly as unhelpful. For example, Eva says:
“The group was really nice, to have that perspective that others were experiencing
difficulties, different difficulties but also the same ones…so it might provide an
indication of something you might experience in the future”(E19)
Eva’s use of the word ‘nice’ reminds me that ‘the group’ has an important social
aspect, enabling an experience that is enjoyable and pleasant, rich in kindness and
30
camaraderie. Her main point, however, is that she found ‘perspective’ in relation to
‘difficulties’ that had an enabling effect both in the present and as a safeguard for the future;
this illustrates the ‘normalising effect’ of the group where participants come to see that they
are ‘not alone’ in the way they think and feel about their difficulties. It also models how
individuals are all in ‘different places’ in relation to mood relapse and so illustrates
graphically the important and helpful idea that ‘change’ is a normal part of life; that people
are fluid and flexible, experiencing a variety of responses and reactions and are capable of
change.
This ‘normalising effect’ is fundamental to therapeutic group process. So it is
interesting that although MBCT explicitly says it is not group-therapy (the usual description
used is ‘psycho-educational group’) a frequent and powerfully reported mechanism is the
therapeutic effect of its group-context. The way that participants mostly speak about this is
how it helps them be more accepting of themselves, their situation, and also of others. The
group offers an opportunity to safely witness, or explore in person, ways of responding and
reacting outside of normal conditioned patterns. As succinctly put by Ann:
“The feeling that we are all human and it doesn't really matter”(A38)
It seems that the group plays an important role in the way ‘Acceptance’ is
communicated to participants. As expressed above (3.1) this skill or ‘quality of mind’ is vital
in the MBCT process, helping participants to avoid ruminative downward spirals associated
with ‘automatic thinking’ and ‘discrepancy monitoring’(Segal et al.,2002,p.70). Mindfulness
practice emphasises learning ‘acceptance’ inwardly and then the group acts as a way of
externalising and generalising this learning through the inquiry process. Ann speaks about
how this is fundamental in the process of acquiring the ‘skill’ or quality of acceptance:
“ Just knowing that, well, I could relate to other peoples experience because we are
all having fairly similar…you know that’s what meditation’s like…I hadn’t known…
you know I was thinking: “Was it just me that finds it hard”?…and sharing this with
others, “Is it ok that I fall asleep”?...Oh! So it doesn’t mean it’s necessarily bad to
have thoughts wandering or falling asleep!”(A40-43)
Ann expresses this as a dramatic narrative, reliving the moment she realised she
could adopt a different attitude to her practice and towards herself. It ‘normalised’ the
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experience of ‘falling asleep’ and having ‘thoughts wandering’ but more significantly it
normalised the whole dangerous judgemental tendency to be self-critical and so opened the
whole group to the possibility of recognising and letting go of this habit; when she said, “So
it doesn’t mean it’s necessarily bad to have thoughts wandering or falling asleep”, others in
the group, with similar judgement-based fears, could share this insight.
This ‘normalising effect’ was particularly helpful in relation to the CBT exercises
and inquiry based in these. The group created a dimension of helpful comparison for both
Dawn and Clive:
“Measuring against what other people share so it feels comfortable to share roughly
the same level of detail…the same sort of things”(D4)
“The group gave me that reassurance that I wasn’t at the lowest level of mood and
that I could plot my own position in relation to them”(C39)
The potency of the group-context in the CBT exercises resonates strongly with me.
They often become powerful, ‘live’ experiences because of the way participants witness
their peers re-living a particular event through skilful inquiry process, focusing on bodily-felt
sensations as well as emotions and thoughts. The explicit, shared, normalising of a whole
range of reactions or assumptions in inquiry can contribute to meta-cognitive insights that
are at times breathtaking; Dawn speaks about a CBT exercise aimed at seeing ‘thoughts as
events in the mind’ rather than ‘facts’:
“It’s all about acceptance and just accepting that is just the way I am thinking at the
moment…the thought may not be true”(D40)
3. 4. ii. The ‘Group as support to practice’In my experience of teaching MBCT there is an important social dimension to the
group that does not come out very strongly in the interviews. Frank speaks about a negative
assumption about the group that proved to be wrong:
“Not knowing what to expect I was a bit worried that everyone was going to be
miserable all the time and they weren’t and that was quite pleasing , you know, there
wasn’t people sitting around moping all the time, quite a lot of the time people were
quite ‘up’ and engaging and happy”(F25)
32
Mechanisms such as the ethos reflected by the ‘venue’ and the personality of the
tutors play a large part in this ‘social’ aspect of the group process. Given the reported
significance of the tutor it would seem that, ideally, their training would aim at facilitating
embodiment not only of the specific attitudes and qualities helpful to mindfulness work but
to group process as well. This theme is picked up in more detail in Chapter 4.
MBCT is classified as a psycho-educational rather than a purely therapeutic group
intervention but, in my experience, the level of engagement, openness and trust often builds
in a comparable way to short-duration group-based humanistic therapy. Perhaps this is
because of the emphasis on ‘participant commitment’, the tutor-participant relationship and
the importance of embodied experience-based learning (mechanisms highlighted as most
significant in meta-analysis of approaches to psychotherapy (Steering Committee, 2002).
Ann speaks about this:
“We didn’t all get into talking about our lives, it was very much focused on the
meditations and what we were doing…so I felt that it gave us a really different bond
to the one I’m used to having with people”(A30)
The “really different bond” points to both an unexpected effect and to something
special that Ann felt in the group, that she related to ‘immediacy’ and the focus on common
and shared experience. Eva uses the same metaphor in the context of ‘support’ in her very
first comment:
“I think it was a great course…the pace, the group dynamic worked for us…there
was I think a bond throughout the group that was really supportive”(E1)
The metaphor of ‘support’ is used in two ways by participants; firstly as a reference
to the experience of finding specific practices easier to ‘do’ in a group and second in the
more general sense of emotional support throughout. In my experience of MBCT this first
comment is very frequently made, often in relation to finding the home practice difficult;
Clive mentions it directly:
“Meditating in a group, I’ve been far more relaxed in collective settings, when I do it
on my own I feel this tightness in my chest”(C31)
33
Clive suffers from post-traumatic shock and related long term anxiety and depression
so this comment, illustrating a discovery that his symptoms change in relation to
circumstance, is very significant for him. Other participants, like Brenda, speak of feeling
more generally motivated to engage in the practices when in a ‘group context’; the home
practice CD’s try to be supportive but the group has an extra power:
“It was great for me to have a specific time each week that was set aside for me, err,
to do that meditation…it’s difficult to do things for yourself even though you know
it’s going to benefit you”(B8)
Both because of its ‘supportive’ and ‘facilitative’ mechanisms the group would seem
to be a powerful aspect of participants’ experience of MBCT.
3. 4. ii. The importance of the tutor-in-the-groupA number of comments made by participants suggest that the role of the tutor within
MBCT is very significant. We saw that learning often proceeded from ‘the very skilful’
inquiry process with the tutor and that the whole group shared in this learning
(Crane,2009,p.57). And, because of the fundamental importance of experiential learning in
communicating subtle skills and attitudes towards ‘self’ and ‘experience’ the degree of tutor-
embodiment of these is paramount. Dawn describes this as the most helpful thing and
indicates why:
“The most helpful thing was the tutors’ questioning…it is very skilful isn’t it…subtly
leading you to a thought about something… moving you on in some subtle way
without feeling you are being challenged in any way”(D5-6) The tutors’ skill was
obviously really key and important, moving you on, slightly forward with your ideas,
and the fact that it was completely non-judgemental… you don't get that very often
when you talk to people”(D8)
She is recounting how she felt being gently moved forward by this process of inquiry
and how rare ‘complete non-judgement’ is. Once again the learning experience she had was
available to the rest of the group and I sense this witnessing is more than a simple sharing
34
but a potent element in the process of adapting life-long attitudes to ‘self’. Frank also
observes the tutors embodied quality of acceptance in this comment:
“I like the fact it wasn't too precious, the tutors were quite accepting, no very
accepting. When people...well...whatever people did, was what they did.(F8) And I
thought the tutors’ doing their sessions did them incredibly well. They were not
directive at all.(F13) The things that were standing out for me was the tutors
reactions to events and to people and how they cope with that; I was intrigued and
interested in the whole business of acceptance”(F18)
Ann also gives a descriptive analysis that highlights the ‘role of the tutor in the
group’ in communicating this counter-intuitive skill of acceptance:
“And the tutors were really good at sort of… they wouldn't just kind of move on, they
go deeper, and you'd get to expand on it… so it felt like you could really say more,
really inviting you to go on…”(A44)
Ann is recounting an experience about ‘failure’ in her practice but she felt she was
met by the tutors with a real interest about this: ‘they wouldn’t move on’ they’d ‘want you to
expand on it’. The result was a deep feeling of acceptance of her experience of so called
‘failure’ which I imagine was shared by others in the group.
It is clear from these comments by Ann, Frank, Dawn and Eva that the ‘foundational’
quality of acceptance was learnt as an aspect of group-process and that the role of the tutor in
this was very significant. Acceptance, both as an explicit major theme linked to
‘mindfulness’ practice and as an important ‘underlying’ aspect of the ‘Power of the Group’
and of ‘Tutor embodiment’, runs through the transcripts like a flashing golden thread in an
otherwise rich and colourful tapestry.
3. 4. iv. Divergence, how the group was experienced as ‘Unhelpful’ Critical comment is scarce across all 6 cases but when it occurs it is either in relation
to finding the practices difficult or it is about difficulties within ‘the group’. In this respect
methodology that uses an interviewer known by participants to have a positive bias towards
MBCT needs to be remembered although ‘no contact’ before or during the course helped
with this.
35
But although rare, divergence from otherwise strong positive feelings about the
course in relation to ‘the group’ is interesting and may point to themes worthy of more
research. With the exception of one small comment by Ann (A72) all the other criticisms of
‘the group’ are made by the two men (participants on different courses). My first reflection
on this revolved around the gender stereotype of men as not so good at ‘touchy-feely’
communication. But closer inspection reveals divergent criticism indicating nuance. Thus,
Frank says:
“For me personally I didn’t find the break-out sessions (the small-group inquiry
process) that useful…the small group thing and the discussion that went on in them…
It just didn’t suit me so I felt in those sessions it was a bit of down time…it was a bit
too slow for me, dare I say that?”(F29)
Whilst Clive says:
“You know we split into two groups and, on reflection I think it would have been
better to have had more flexibility about those groups…some people we didn’t get to
know and there were people I’d have liked to get to know a bit more…I don’t want to
sound too negative but sometimes it got to be a bit repetitive. If certain people are
talking all the time then the other people don’t have the space…including myself, I
felt like I was competing for the space”(C35)
There is a similarity expressed by both, one using the metaphor of ‘down-time’ and
the other of ‘a bit repetitive’; these perhaps suggest a male stereotypical desire to ‘get on’
and ‘move faster’ and be less ‘process’ orientated. But in the interview both spoke
sensitively and reflected back an interest in ‘process’. There might be, in Frank’s case, a
slight (cultural) tendency towards ‘matter-of-factness’ and wanting more action and
crispness. But for Clive his frustration appears to include a desire to divide the bigger group
more flexibly so he would be able to meet other participants. When I explored further with
the MBCT course tutor (taking care not to divulge the person concerned) I found out that
Clive was in a small inquiry group (i.e. 9 participants) with a very difficult individual who
lacked awareness about ‘hogging’ attention and time. Clive speaks directly about this:
36
“There was one person I found quite irritating but you know that is inevitable…err,
certain people got caught up in their own circumstances and would babble on and
on”(C37)
It is clear that Clive’s experience of the unhelpfulness of the small group was at least
partly to do with its particular makeup and how this was managed (or not) by the tutor (a
point we return to in Chapter 4). Clive’s criticisms were mainly in relation to this aspect of
group division and secondly to insufficient tutor intervention to moderate a ‘difficult’
participant. But there is also perhaps a slight sense the pace was too slow and, in this,
perhaps a link with Frank’s comments.
But, Clive also made very positive comments about the helpfulness and significance
of ‘the group’ reporting that it “gave reassurance” and the valuable perspective “of people
with a whole range of experiences”. Frank also had positive things to say about ‘the group’
as a whole including how “it was good to hear there were people not doing their home
practice as well” and how “it helped (him) to feel a bit more normal”
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Chapter 4: Discussion
This chapter considers the range, effect and interrelatedness of mechanisms of
change within MBCT. A distinction, made in the introduction, is explored between more
‘explicit’, mechanisms (i.e. related to ‘mindfulness’, CBT and didactic inputs) and
‘underlying mechanisms’ (i.e. associated with ‘calm-relaxation’, ‘appreciation’, ‘the group’
etc). The relative impact of these mechanisms and related implications for tutor training and
course delivery are also tentatively explored.
4. 1. Explicit mechanismsMBA theory illustrates that the first 2 super-ordinate themes of ‘Acceptance’ and
‘Perspective-choice’ operate together (Segal et al.,2002,pp.223-4); first to open to
experiences hitherto avoided (denied or distorted) and secondly, based on the new
perspective offered by this ‘psychological flexibility’, to make wise choices about how to act
in the future:
“Acceptance-based treatment methods are targeted at reducing experiential
avoidance by encouraging clients to behave effectively and in accordance with
valued life directions, which requires active contact with naturally occurring,
sometimes aversive, private experiences”(Orsillo et al.,2003)
Having pointed to the way these first two major themes work together they will be
discussed separately because the participant comments point to discrete mechanisms that
helped in different ways.
4. 1. i. AcceptanceAcceptance in this context is an attitudinal skill built on first ‘noticing’ or “paying
attention, on purpose” (Kabat-Zinn,1990). Shapiro et al.,(2006) describes it as “the essential
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building block of mindfulness” arising from the three “interwoven aspects of…intention,
attention and attitude”. The importance of acceptance and related attitudes such as non-
judgement, curiosity and patience is reflected in many of the comments quoted in the
‘findings’:
“ The overriding thing I got out of this course was a greater ability to be accepting
around my feelings” (B2) “when you can accept your feelings it’s easier to live with
them” (B32)
Through doing the course, the training in acceptance has clearly helped participants
to learn ‘to live with’ difficulties. In the Buddhist mindfulness tradition this is described as
removing the ‘second dart’ (Nyanaponika,1983) of psychological distress, anxiety and
related patterns of rumination, exacerbated by avoidance or distortion. The second dart is
removed from the wound by firstly accepting that the first one has hit home. In this way the
chances of relapse related to negative rumination are reduced in a sustainable and non-
chemically invasive way. Thus, Brenda says, “when you can accept your feelings it’s easier
to live with them”. This comment illustrates a crucial aspect of the way MBCT works to
prevent depressive relapse, “offsetting the tendency for our attention to be automatically
hijacked by passing moods or thoughts... (and) allowing the chain of conditioned habitual
responses to be broken…(whilst) giving the person a chance to see if his or her thoughts are
accurate or telling the truth” (Segal et al.,2002,p.223).
But, in many cases the comments on acceptance also suggest a ‘calming down’
aspect of ‘letting be’(F2,C7). Eva’s comment speaks of ‘playing’ with and ‘working with’
her experience and as such links strongly with not only ‘Perspective-choice’ but also
‘Appreciation of Life’. The calming and appreciative mechanisms related to the mindfulness
elements of MBCT are discussed separately (below) but they also seem conditionally linked
to this super-ordinate theme of Acceptance.
A similar point will be made in relation to acceptance as an element of ‘The Power of
the Group’, demonstrating how this potent mechanism of MBCT and other MBAs is a
product not only of “paying attention...non-judgementally”, but of ‘The Group’ and also
‘Tutor Embodiment’. The ‘inquiry process’ (Crane2009,pp.143-5) described by Ann
(4.4.i,p.42) is one of the most significant aspects of ‘the group’ and the course in general,
where skills are taught and qualities of mind ‘caught':
39
“Mindfulness is caught, not taught” (aphorism: Sangharakshita, personal teaching)
In particular, participants ‘catch’ the essential mindfulness attitude of ‘curiosity’
from the radical ‘acceptance’ shown towards them by tutors. In my experience of co-
tutoring, the quality of the ‘inquiry’ process is largely dependent on the degree that the tutor
embodies kind-curiosity, and genuine interest. On the surface, ‘inquiry’ delivers the MBCT
‘road map’(Mark Williams,2006, personal communication) through didactic input, but its
deeper value would seem to be its communication of attitudes essential to mindfulness via
embodiment.
4. 1. ii. Perspective-choice and Self-powerThis second super-ordinate theme points to several mechanisms described variously
in previous research (3.2,p.17above). Participant comments delineating this major theme
speak about ‘positive control’, ‘freedom’ and ‘turning situations around’. These are all
aspects of gaining “greater clarity and objectivity... based in ‘decentering” (Segal et
al.,2002,p.38) and as such underpin the change in processing style whereby relapse is
prevented from taking hold.
But, many of these comments suggest there is more involved than a simple cognitive
shift (‘reperceiving’) and related mood-stabilisation (‘emotional regulation’). They illustrate
how mindfulness, as a mechanism, includes underlying elements like finding calm,
appreciation-based resilience, self-compassion and positivity facilitated by the group.
The testimony about the mechanism called ‘Perspective-choice’ suggests multi-
dimensionality, speaking of new perspectives in a way that suggests a comprehensive shift in
how participants appreciate and live their lives; this becomes clearer in the section below
about the theme of ‘Appreciation of Life’ that so often overlaps with ‘Perspective-choice’.
My own meditation teacher Sangharakshita has coined the aphorism:
“Awareness is revolutionary” (Sangharakshita,2004).
In the mindfulness-meditation tradition ‘awareness’ is coterminous with
‘mindfulness’ hence this aphorism neatly sums up the radical nature of the mechanism of
‘Perspective-choice’. Mindfulness can create a new-found and radical freedom to choose
how we wish to feel about ourselves and, based on this, how we wish to live our lives. It is
worth noting that in this wider mindfulness tradition (Buddhism) the intention is to engage in
40
this personal revolution out of compassion for all life; perhaps ‘compassion’ and even
‘generosity’ (independent of ‘self’-compassion) are yet other mechanisms at work, but
currently too ‘spiritually’ defined to be included in mainstream psychological research.
4. 2. Underlying Mechanisms
‘Appreciation of Life and Relationships’ together with the last super-ordinate theme
of ‘The Power of the Group’ moves the discussion into ‘underlying’ mechanisms within
MBCT.
MBCT, as a manualised course to help people to stay out of recurring depression, has
a preventative rationale. A general, or common view about how to prevent depression (or
stress and anxiety), might well be: “appreciate the small things in life”, “appreciate your
loved ones”, or perhaps “do something active, kind or helpful for yourself each day”! But the
theory underlying MBCT highlights the preventative mechanism of:
“Developing...a de-centred perspective...which recognises that negative ruminative
thoughts are aspects of experience rather than a central aspect of self”
(Crane,2009,p.13)
The findings support this theory but they also support the lay person’s sentiment
before it, suggesting that the underlying mechanisms of ‘Appreciation of life and
relationships’ and ‘The Group’ are important. I was struck by Clive’s comment “Meditation
is nurturing, rejuvenating and builds inner strength” pointing to a different kind of
‘preventative mechanism’ that positive psychology calls ‘resilience’ (Seligman,2002).
MBCT teaches the need for stability (of mind) in order to develop a capacity to
observe thoughts as passing events; this skill of stabilising or calming the mind facilitates
stepping back from automatic negative thoughts and habitual emotions to recognize them for
what they are (Segal et al.,2002,pp.194-9; Teasdale et al.,2000,pp.615-23).
There is, however, a very real tension or, ‘edge’, between encouraging skills
supportive of ‘stability’ in order to develop perspective (insight) and encouraging these skills
and attitudes as a basis for calm-relaxation. This tension is found within the Buddhist
meditation tradition, as the two-millennia old debate as to what relationship there should be
between the intention to develop calm, concentrated states of mind (samatha), and insight
41
(vipassana) (Analayo,2003,pp.88-91) This is perhaps echoed in the study, by the way some
participants in particular (and all six participants at some time) reported mindfulness
practices as ‘helpful’ more in relation to finding calm, or appreciation than ‘meta-
cognition’(insight).
4. 2. i. ‘The importance of ‘Appreciation of Life and Relationships’Comments made by all six participants suggest that one helpful mechanism was
finding calm and alongside this an increased ‘appreciation of life and relationships’. They
reported ‘slowing down’, ‘stopping’, ‘noticing more’ and, linked this to ‘appreciation’. A
mechanism that William Davies poetically renders as:
“What use this life of care, if we have not time to stop and stare”
Mindfulness exercises, intended to develop ‘objectivity’ and ‘wise responding’, were
alternatively described by some participants as developing calm-relaxation: ‘a little mind
massage’, ‘deeply cleansing’, ‘revitalising’, ‘illuminating’, ‘peaceful’, ‘blissful’,
‘rejuvenating’ and ‘awesome’! Many went on to indicate that such experience, linked to
mindfulness practice, became a helpful part of their everyday life. Thus, a link was
expressed between the mechanisms of mindfulness and mechanisms of calm-relaxation
(‘concentration’) leading to appreciation (‘gratitude’, ‘joy’ and ‘peace’) and associated
‘resilience’.
If these mechanisms can be shown to be important for at least some participants,
might it suggest adapting the way MBCT is taught? Originally it was important for this
medical use of mindfulness to establish a clear separation from associations with the Far
Eastern meditative traditions (i.e. blissful Buddha images and calm, compassion-filled faces
of meditating monks). But has something been lost in the increasing demand for Evidence
Based Medicine (Ovretveit,2005,p.266) with its insatiable demand for underpinning
theoretical rationales, statistical credibility and scientific rigour? Has the element of calm,
bliss or spirituality been sanitised-out of medical uses of mindfulness both because of the
legitimate dangers of encouraging vulnerable people to strive for unattainable goals (Segal et
al.,2002,pp.68-9) and because of fears that it will not be taken seriously if seen to be
associated with ‘spiritual’ experiences like ‘peace’, ‘awe’, ‘bliss’ and ‘calm’?
When I asked Jon Kabat-Zinn, the founder of contemporary therapeutic uses of
mindfulness, about my interest in developing the teaching of ‘concentration’ (calming)
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techniques to augment what is already indicated in the MBCT manual, he simply said, “Yes,
if it works, bring it in, people do need to be able to establish calm states of mind to do this
work”. (Kabat-Zinn, personal communication, Gaia House Retreat, 2007). Elsewhere in his
writings he says: “Concentration is the cornerstone of mindfulness practice. Your
mindfulness will only be as robust as the capacity of your mind to be calm and stable”
(Kabat-Zinn,2005,p.72). In my own meditation experience the value of developing calm and
stable mind states goes far beyond the way it facilitates ‘mindfulness’ as meta-cognitive
insight; deep calm and stability in the mind has its own enduring, psychologically
prophylactic as well as spiritually nurturing and stimulating effect.
Thus, as an MBCT tutor, I have offered simple techniques like ‘counting’ alongside
the breath meditation in Sessions 4-6 to augment instructions for ‘establishing stability’ or,
the use of simple phrases that reflect the felt-sense of the breath (i.e. “rising-and-falling” or
“lifting-and-returning”). Such ideas are commonplace in mindfulness meditation schools
such as the Insight Meditation Society, to help participants re-engage associative-thinking
(‘distracted-mind’) with the meditation focus (‘the breath’). Introducing such techniques that
can be misused to ‘strive’ for better or higher mind states needs to be done with great care
and subtlety, guided by the tutor’s personal meditation experience in this area.
Related to this perception of the importance of calm-concentration in mindfulness
work I have found myself leaving longer silences in led meditations and giving more
emphasis to spaciousness and calm in my tone and approach to leading (whilst guarding
against soporific quasi-spiritual murmuring!). Thus, partly in response to testimony
expressed by participants, I have tentatively given more emphasis to conditions supportive of
calm-spaciousness alongside stressing the importance of letting go of striving; it is a very
subtle edge to walk! An experienced meditator, familiar with this very subtle ‘edge’ between
‘striving’ and ‘staying-open’, will be more able to authentically communicate how best to
navigate this seeming paradox. Ideally, tutors need to embody an understanding of such
nuances of practice and offer this rather than ‘manualised’ or ‘formalistic’ guidance. A
personal example is how to respond wisely to a participant who has just experienced an
extreme state of calm-concentration (‘jhana’(Sanskrit) : Gelthin,2001,p.344) which, whilst
often alarming or misleading in the short run (i.e. conducive to ‘striving’), in the longer term
holds seeds of radical well-being.
In relation to this, MBCT tutors could perhaps benefit from increased understanding
and experience in mindfulness meditation approaches, such as the Anapanasati Sutta
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(Rosenberg,1999); this approach more explicitly and continuously utilises the breath to i/
support stability and ii/ experience embodied (i.e. breath-related) ‘thoughts or emotions as
passing mental events’. A much simplified version of this approach does in fact underpin
MBCT and establishing stability (‘concentration’), is a main emphasis (especially) in the
first half of the 8 week course. But in my general mindfulness teaching (i.e. non-MBCT) I
give more time and technical input to help participants learn this ‘skill’ of experiencing
“thoughts as passing events in the mind” (Session 4 onwards) (Segal et al.,2002,pp.196-7).
Thus, I find it helpful to suggest noticing simple thoughts (or feelings) that are directly
related to one’s breath-sensations (e.g. the thought: ‘this breath seems longer than the last
one’, or: ‘this breath feels smoother’), as an accessible way to introduce this skill. Once this
is established, experiencing ‘meta-cognitive’ insight in relation to more complex negative
thoughts (or feelings) becomes easier. (Rosenberg,1999,pp.39-41,&,pp.66-67)
The question becomes, given i/ the limited time available in MBCT and ii/ the
complication of vulnerable participants with unhelpful discrepancy monitoring, how might
they be better prepared as meditators for what is asked of them from Session 5 onwards?
Also, how might increasing skills associated with concentration (stability) enhance
mechanisms of change associated with the theme of ‘appreciation’?
Perhaps MBCT teachers with an established background in meditation already do
this because they more fully appreciate the need, and independent value of, calm-
concentration in mindfulness work (Segal et al.,2002,pp.49-50 &,pp.83-4 ). But, with MBCT
increasingly taught by medical professionals with relatively few years of meditation
experience, might it be necessary to re-emphasise this aspect in training and supervision?
(e.g. the draft ’governance’ for MBCT teachers in the NHS Sussex Partnership Trust is, only
“at least one year of regular, personal meditation practice”!).
The Master Grid (Appendix G) illustrates that the 2 participants who have
commented least about ‘perspective’ and ‘choice’ said more about relaxation, calm and
appreciation of life and relationships. Is it possible that some participants may be helped
more by relaxation-calming mechanisms than by developing a ‘de-centred perspective’ and
the ‘wise-choices’ this brings? Is it also possible that all participants could be helped by
strategies that encourage both these mechanisms to work more in tandem?
Might relaxation-calm and related appreciation be helpful underlying mechanisms in
MBCT? And might they be particularly significant for some participants who, in the midst
of stronger suffering, find ‘approaching the difficult’ too challenging and seek respite; or, for
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those with a temperamental bias towards meditative calm? The theory that vulnerable people
become more distressed if trying to use meditation to find calm-relaxation does not always
match my experience; some people suffering regular low mood use mindfulness, with an
emphasis on stability, to self-manage (calm) and strengthen themselves. I have also noted
‘positive effect’ arising from mindfulness practice which is framed in a context of
developing higher (or deeper) appreciation for life and the world. From my own 25 years of
meditation experience (with an emphasis on ‘mindfulness’), I am aware that ‘appreciation’
(Beauty) features equally with ‘insight’ (Truth) in my practice:
"Beauty is truth, truth beauty," - that is all
Ye know on earth, and all ye need to know.
(Keats ‘Ode to a Grecian Urn’ in ‘Selected Poems’,2007)
In the wider Buddhist mindfulness tradition, the importance of appreciating nature,
beauty and life in general is reflected in, for example, the Zen Garden, the tea ceremony,
beautiful statues and peaceful images. Within MBCT I am often struck and delighted by the
response that participants can have in the first mindfulness practice they do. This is the
‘raisin exercise’ (i.e. paying close attention to a simple everyday object) where in addition to
realising how much of their life is spent on ‘autopilot’, (a dangerous state for someone who
is prone to relapse), participants often remark about beauty, awe or wonder, with comments
divided between more insightful and more appreciative ones. Mindfulness proceeds from
‘stopping’ and then ‘noticing’, and the experience produced by this is often both informative
(insightful) and aesthetic.
It would seem, from the powerful comments made, that MBCT might benefit by
developing the mechanism of appreciation within it. Some contemporary mindfulness
teachers (perhaps more so MBSR) are exploring this; for example Chris Germer’s (2010)
‘compassionate body scan’. It is perhaps a question of emphasis. One way that mechanisms
related to appreciation might be encouraged without introducing unhelpful striving (Segal et
al., 2002,pp.68-9) is to give greater prominence to ‘mindfulness in everyday activity’
(Sessions 2 and 3) which could be extended and developed in Sessions 4 and 5
A further idea might be an adapted form of ‘Breathing Space’ that could be
introduced alongside the ‘Coping Breathing Space’ (Session 5), specifically aimed at
‘stopping’ and opening to the possibility of appreciating life. As such, the instructions might
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include doing the practice regularly when out in quiet or beautiful places, including ordinary
beautiful places such as the garden, park, or just looking out of the window. This
‘Appreciative Breathing Space’, as it might be called, could be introduced as a way of
developing greater appreciation of beauty, meaning and value in life.
Within the wider mindfulness tradition (Buddhism) ‘pleasure’ is a recognised
mechanism. Pleasure, as “piti and sukkha , sometimes referred to as higher kinds of
happiness” represent 2 of the 5 factors of meditative absorption enabling one “to use the
calm mind, even the joy that comes from it to look deeply into ourselves. That is the heart of
vipassana” (Sanskrit: ‘insight’) (Rosenberg1998,pp.48-50). Ideally in MBCT, a balance can
be forged, encouraging participants to stay open to difficult, painful experiences whilst also
becoming skilled in cultivating, (bhavana) and dwelling-in, pleasant enriching experience.
“Calm (samatha) and insight (vipassana) are at their best when developed in skilful
cooperation”(Analayo,2003,p.88); (see also Gethin,1992,p.345)
There is perhaps a spiritual dimension within the mechanisms associated with
appreciation and calm. Carmody et al., (2007) makes tentative but intriguing links between
spirituality, mindfulness and health-related symptoms; what exactly happens when a
participant “ stops and looks at the light on the sea looking like diamonds” is far beyond any
single simplistic explanation. Within the meditation tradition of Buddhism, the path of calm-
concentration (samatha) is not encouraged simply for relaxation or superficial pleasure, but
is seen as an intrinsic ‘way’ to heal oneself and by extension, the world:
“Monks, this is the direct path for the purification of beings, for the surmounting of
sorrow and lamentation, for the disappearance of suffering and discontent…namely
the four foundations of mindfulness”
(Sattipathana Sutta, opening verse in Analyayo,2003)
4. 2. ii. ‘The Power of the Group’This study throws light on the value of the group in creating conditions for
communicating subtle attitudes, skills and values crucial to mindfulness practice and general
well-being. Thus the role of the group, and the tutor, in authentically communicating the
quality of acceptance, so fundamental to an increase of perspective and choice, is very
significantly reported.
46
The role of the tutor in developing the group into a rich and versatile learning
environment is also reported as very significant. From the outset, the design of MBCT
included recognition of the importance of the tutor embodying mindfulness skills and
qualities (Segal et al.,2002,pp.56-7). Existing protocols ensure that MBCT tutors teach from
their own embodied mindfulness-meditation experience, but from the participants’ frequent
and powerful testimony about the importance of the ‘tutor in the group’ it would seem that
ideally they would also embody specific attitudes and qualities helpful to group-process.
Given the very short duration of the course the tutor is a highly significant element in
that he/she is crucial in the cultivation of an ethos of trusting, ‘openness-to-experience’, so
fundamental to effective MBCT. I have copied my own teacher’s aphorism “mindfulness is
caught not taught” many times through my teaching notes as a frequent reminder about the
importance of ‘walking the talk’ and the extreme subtlety required for effective teaching.
The tutor is capable of creating different emphasis and so different learning within
each session, through the way he/she manages the inquiry and the led practices; for example
a grounded, confident and empathic tutor who can meet a participant’s despair with
genuineness and lightness may create quite a different outcome to someone who is
technically highly skilled but less self aware.
Given its reported significance, could there be more emphasis given, in MBCT tutor
training to both personal development (self-awareness) and facilitating group processes? For
example, more emphasis and understanding given to these areas might enable tutor(s) to
manage the ‘orientation session’ in ways that promote and early beginning to the important
mechanism of ‘group-process’. Or, given the impact of different expectations, and group
imbalances might tutor training and supervision give such issues more focus. The broader
question raised by these perspectives is: what qualities, experience and skills, apart from
those identified with mindfulness and CBT, might MBCT tutors ideally seek to embody in
order to maximise their effectiveness?
In my experience teaching MBCT there is also an important ‘social dimension’ to the
group in the way people enjoy ‘good company’, network and share ideas, book titles and so
on. In a recent course I led for ‘older persons’ (+65years), with lifelong histories of
depression we, (the tutor team) developed this dimension because, as the weeks went by, it
was increasingly seen to be a very effective ‘underlying’ mechanism of change. I wonder if
more could be made of this ‘community-aspect’ of MBCT to support general learning, well-
being and make attending important ‘ongoing’ post-course practice classes more attractive.
47
4. 2. iii. Divergence: other lessons about group processes in MBCTComments about ‘unhelpful aspects’ of the course are rare but when they occur they
relate to the group and arise from the 2 men interviewed. A number of interesting issues
emerged including i/ might men benefit from more focussed and faster paced inquiry-
process? ii/ do ‘men’ require more challenge and ‘pace’ in group work? iii/might the gender-
ratio norm require compensatory elements (awareness) to be introduced into the group
process (i.e. the average gender ratio over the 400+ participants I have taught over the last 5
years is less than 1: 3, which means men are always a small, but vocal minority).
It seems that one of the main ‘unhelpful aspects’ of the MBCT course relates to the
experience of inquiry in small-groups (in the case of the 3 courses studied the ‘large group of
18 was divided into ‘small-groups of 9 for inquiry); this was due partly to the particular
make up of the group and in partly to the emphasis on ‘process’ that the two male
participants in the study found too “repetitive” or “slow”. This study is too small to draw any
specific conclusions about how to better manage gender bias in the group inquiry process but
this may benefit from more investigation.
4.3. Limitations to the Study and future researchIt is recognised that reliance on self-evaluation is a potential limitation: “Self-report
methods can be subject to response biases, and it is possible that MBA participants who
agreed to have their responses used for research purposes (68%) were more motivated to
report positive changes”(Carmody et al.,2009). Also, the very small number of participants
interviewed means that any generalities claimed from the analysis should be very lightly and
tentatively held. But, interviews, taken at a time close to the end of an MBCT course do
represent an important record of the participants lived experience of ‘what was helpful and
unhelpful’ about the course. This study perhaps acts as a signpost for further research which
could employ more rigorous methodologies to examine its findings about the relative impact
and importance of ‘underlying mechanisms’ of change.
4.4. Summary of clinical implications
48
Bearing in mind the limitations of this study and that tutors already vary and adapt
their delivery of MBCT, some of the possible clinical implications mentioned are
summarised here:
MBCT participants may benefit from the introduction of alternative and-or additional
meditation ideas and techniques for establishing calm-stability as a basis for meta-
cognitive insight from Session 5 onwards (e.g. participants might benefit from the
instruction to first notice present-moment thoughts directly related to their breath-
sensations as a basis for then noticing more difficult thoughts and feelings). Some
participants might also benefit from the careful recognition (by tutors) of the
independent value and effect of the relaxation-response.
MBCT may benefit participants by (further) developing their skills and aptitude for
‘appreciation’ related, in the study, to building: inner strength (resilience), self-
confidence, relationships and value-clarification. Specific MBCT course adaptations
might include i/ an ‘Appreciative 3 Minute Breathing Space’ perhaps introducing this
alongside the ‘Coping Breathing Space’ ii/ extension of ‘everyday mindful activities’
into Session 3 and 4, and, iii/ increased inclusion of appreciative instructions
(generally) in led practices. Incorporating a more general awareness of the
importance of the aesthetic and even spiritual dimensions of ‘mindfulness’ might also
be explored.
MBCT participants may also benefit from tutors bringing increased awareness about
the various ways in which the group acts as a therapeutic mechanism and about the
importance of the role of tutor in the group. A consequence might be that MBCT
tutor-training and supervision ensures specific group facilitation skills-training and
prizes tutor ‘self-development’ and ‘self-awareness’.
Some MBCT participants might benefit from an increased emphasis or awareness of
the potential ‘social’ aspect of the group which could be developed as a basis for
encouraging networking and ongoing (post course) peer led practice groups.
49
Chapter 5: Conclusions
This conclusion considers the overall picture of mechanisms of change within
MBCT, suggesting implications and areas worthy of further investigation.
The analysis revealed 4 super-ordinate themes, differentiating ‘explicit’ from more
‘underlying’ mechanisms of change. These latter mechanisms associated with ‘appreciation
of life’ and the ‘power of the group’ represented a significant proportion of the participants
comments but are, perhaps, more difficult to objectify. Is it possible that, in addition to
posing challenges for rigorous research, their effect within MBCT is relatively under-
appreciated?
The analysis noted frequent overlap of major themes suggesting they are comprised
of complex, inter-connected mechanisms of change. Also, although generally concordant,
participants did vary in what they found most helpful. In particular 2 of the 6 participants
seemed to value mindfulness practices for their effect of ‘calm’ or heightened ‘appreciation
of life’ than for the more ‘explicit’ mechanisms they facilitate. This study asks: might greater
tutor awareness of such differences within a group enhance the overall effectiveness of the
course?
The study demonstrates how life-enriching and enhancing awareness can be; how the
effects of mindfulness practices whether formal or informal can transform appreciation of
life and relationships. There are indications that the relaxation-response associated with
50
mindfulness practices also has an influence on general well-being and resilience, helping to
re-shape life-values and priorities. An implication of this might be to broaden out the MBCT
course to more explicitly include practices supportive of ‘appreciation’.
The study also illustrates the importance of mechanisms facilitated by ‘the group’
and the ‘role of the tutor in the group’. This strengthens the existing protocol of ensuring
MBCT tutors have an established personal mindfulness practice and additionally suggests
that more emphasis might be placed on embodiment of skills and qualities conducive to
effective group facilitation.
In addition to these implications for development, this study offers tutors (and
trainees) compelling, nuanced and heartfelt confirmation of the importance and helpfulness
of MBCT. It illustrates powerfully how acceptance of ‘the difficult’, ‘de-centring’, ‘gaining
perspective’ and simply learning to ‘stop and see’, all contribute to participants’ sense of
value, well-being and positive control in their lives. This evidence can be very important for
tutors to connect with, especially in relation to the intensely challenging demands made in
Sessions 4 and 5 when it asks participants to befriend their pain and negative emotions. This
can lead to considerable distress and doubt as participants question the sense of moving
towards difficult feelings, instead of using lifelong default settings of distraction or denial.
The very positive testimony and perspective held in qualitative studies such as this one can
provide confidence and encouragement for tutors at such times.
Throughout this study the metaphor of ‘Freedom’ stands out as a meta super-ordinate
theme: freedom derived from knowing when to wisely accept ones experience, ‘just as it is’,
and freedom, based on meta-cognition, to know when to change that experience to prevent
relapse and promote wellness. Freedom also describes the state of simply ‘being’ that allows
us to stop, notice and appreciate, finding value, meaning and strength in the ordinary
moments that make up our lives.
“Awareness is revolutionary”
(Aphorism, Sangharakshita,1995)
51
(Word count excluding references and appendices: 15,600 words)
52
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Appendices
Contents:
Appendix A: Initial information letter to participants p58
Appendix B: Confirmation of participation’ letter p60
Appendix C: Consent Form: ‘MBCT Research’ p62
Appendix D: Sample Transcript ( initial round of IPA) p69
Appendix E: List of ‘Overarching Themes’ and Main ‘Sub-themes’ p72
Appendix F: Grid of themes for scripts 1, 2, 3 and 4 p75
Appendix G Grid of Major Themes across all cases p78
Appendix G.i Themes from script number 6 p81
Appendix H: Extract from interview 1 (female, late 20’s) p85
Appendix I Extract from interview 2 (female late 40’s) p88
Appendix J Extract from interview 3 (male mid 40’s) p91
Appendix K Extract from interview 4 (female, late 30’s) p96
Appendix L Extract from interview 5 (female, early 40’s) p100
Appendix M Extract from interview 6 (male, late-50’s) p104
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Appendix A: Initial information letter to participants
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Appendix A
October 2008
Dear Participant,
This letter is an invitation to take part in a study about the course you
are embarking on.
MBCT courses are used world-wide to help people learn how to stay
well and improve the quality of their lives; continuing research helps to make
them more effective. This study aims to find out first hand about participants
experience of the MBCT course. To do this I wish to interview about 6
participants within a week or two of the course ending. The interview will last
about 45minutes. All information gathered from these interviews will be
completely anonymous and not identifiable in any way.
So, at this stage I am asking you to consider helping. It really is an open
invitation; please do not feel any pressure to join in.
If you think you would be interested in helping I would very much like
to hear back from you, so we can talk over how to make it easy for you to
participate. Please let me know if you think you’d like to help using the e-mail
address below or by telephone/text
Thank you for considering this request. Your course tutors, Tara and
Nick may remind you about this invitation and you can, if you prefer, let them
know if you wish to participate (they can then pass on your contact details to
me).I hope you enjoy the course,
Thanks, KarunaviraTel: 01273 703107 or text/mobile: 07792969058
E-mail: [email protected]
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Appendix B: ‘Confirmation of participation’ letter
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Appendix BConfirmation letter
November 2008
Dear (enter name),
Thank you very much for agreeing to take part in the study I am conducting about the MBCT course you are now almost half way through. This letter is to give you more information about what you will be invited to do to and some of the logistics around this.
So, you are one of six participants who have agreed to take part in this study (not all from your particular course). In the week following the end of your course I will contact you by phone or text to arrange a convenient time to meet for the 45 minute interview. I will be asking if it is convenient for you to travel to the Buddhist Centre (17 Tichbourne Street BN1 1UR) for this as it has a quiet and private space that is very suitable. If this journey is difficult for you I can arrange to pay for your parking in the adjacent NCP or pay your taxi costs (please keep a receipt). If for any reason you would prefer to be interviewed at your home this can be arranged too so please let me know if this is the case.
The interview will be very simple and focussed around your experiences of doing the MBCT course. I am allowing 45 minutes for it but if we run out of things to say it can end before that time. The whole process is invitational and if at any time you choose to stop that is fine.
The interview will be recorded and this will be kept safely and confidentially until September 2010 when my study will be completed. It will then be destroyed. Your name or initials will not appear in any form on the transcript I will make from the recording (the recording will be identifiable only by a code know to me and kept separately from it). When the study is complete I will give you an opportunity to read it.
Following on from the interview there will be an opportunity to arrange to speak to someone (one of your tutors perhaps) if any issues arise that seem unresolved or problematic.
I hope this is sufficient information for you to feel happy to go ahead with the interview. Please let me know you have received this letter and are in agreement with the process it describes. If so, please sign and return the ‘consent’ form attached.
Please feel free to contact me by e-mail or phone if you wish to ask for any more information…or if you simply wish to talk more about the process.
Very best wishes,Karunavira
My contacts are: [email protected]: 07792969058; land 01273 703107
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Appendix C : Consent Form: ‘MBCT Research’
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Appendix C
Consent Form: ‘MBCT Research’
I give my consent for the content my interview about the Mindfulness-based
Cognitive Therapy Course I have completed to be used for research purposes.
I understand the interview will be transcribed and then studied to find provide
the basis of a research thesis exploring:
“‘How important do MBCT participants think their course has been for
them and why do they think this?
I also understand that all references to my name or other names used in the
interview will be removed or coded so as to ensure anonymity. Other
references that may be used to identify the speaker will also be codified or
removed.
I therefore understand that any quotes used in the final write up or publication
of the research thesis will be absolutely anonymous.
The digital recording is stored without reference to the speakers name; a code
is referenced to the name in a separate file kept elsewhere. At the completion
of the thesis the recording will be destroyed unless you request a copy of it
below.
Signed by…………………………………………………..
Please print name…………………………………………
Post Code…………Date……………………
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Appendix D: an example of initial round of IPA
Key:
Colours: red and blue colours are used alternately to highlight significant comments made in the script. This is for ease of matching to the researchers comments (made in the same colour for each comment) in the adjacent column. Comments in black indicate the researchers own thoughts and reflections.
Number and letter coding: each highlighted quote/comment is given an identifying letter code (A, B etc) matching the participants’ name code and a number code matching its order of appearance in the transcript.(e.g. A1, or B23)
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Appendix D: An example of the initial round of IPA: first half of transcript
Notes arising from the script
Code: ‘A1’, ‘A2’ etc
A1/ the course gave a helpful “really strong” message about not making ‘right-wrong’ judgements …
A2/ this seems to be a qualification about ‘so long as you’re aware of what you are doing’
A3/ link between non-judgemental attitude and motivation to practice
A4/ a development of A3 about motivation but it adds a common kind of judgement about the need for “calm” for it to “work”
Interview ‘A’ (female, early 30’s)(NB: possible useful quotes in bold italics and in colour)
Q. What did you find helpful about the MBCT course you just
finished… two weeks ago?
A: Well, from a meditation point of view I've been trying to meditate since I
was about 13 years old and never being quite sure if I been getting it right
and um it was a really good… they gave me a really strong message that
you can’t… well you can't get it wrong… so long if you're aware of
what you doing it is fine
I think because I was being quite judgemental about what I was doing
when I was meditating I was a lot less likely to do it…I used to think if
I'm not in the right kind of state of mind… if I'm not calm – if I cant get my
mind to be quiet then it hasn’t worked whereas now I’m much more
likely to just do it however I am feeling…if I am aware that i am all over
the place then I’m doing it right…you know…so it…
um, just means that I am feeling more confident in doing it so it will be
Possible Emerging themes
Non-judgement?
Awareness is key?
Motivational link toIntention?
Motivational point again but also introduces the‘Calm’ versus ‘Insight’ polemic
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A5/ links ‘confidence’ in doing it with ‘usefulness’ and the need for ‘regularity’
A6/ ‘consistency’ linked to how helpful meditation is
A7/ My prompt is trying to elicit what she means by ‘practice’…the ‘it’ in A5-6
A8/ clarifies ‘it’ is sitting medt. But goes on to refine this to single out ‘watching thoughts’ and getting a better perspective on them…so she can “detach myself and feel a bit easier”
A9/ a positive use of the term ‘detachment’ and of using thought to counter troubling thoughts; from feeling bothered…she let it go a bit.. so not passivity??
A10/ I wanted to check if this is what she was talking about
a lot more useful to me because I will be doing it regularly err…not
every day but well at least every other day… I have never been able to do it
that consistently and I can see it is only if I do it consistently that it is
really helpful.
so it… um just means that
Q. When you say you do practice regularly…Is that the sitting
meditation or the lying down body scan?
A. The sitting breathing meditation... and watching thoughts and its
been good if I’ve been a bit worried about something…like yesterday
my boyfriend was being a bit grumpy…and I was sort of all ready to fall into
my old pattern of “OH no! …was it because when I said that or was it
because I did this”…or thinking like: “he is always like this… why does he
do this”…instead of going into all that I just let it go a bit and just thought:
“He is just doing this… and it doesn’t have to bother me…I can just
detach myself and feel a bit easier and
Q. Was it that bit about ‘thoughts are not facts’ that came in a bit then
there?
A. Yeah…yeah it was… and I’ve been aware of that for a long time…sort
Importance of regularity of practice
This (above) linked to confidence
Awareness of thoughts as event in the mind and not facts?
Detachment but not passivity
Thoughts are not 67
A11/ knowing it already but the ‘sort of’ suggests that the course helped her rediscover this and that it is an ongoing practice
A12/ awareness of the progressive nature of negative states…and how it is possible to ‘let go’
A13/ a major point about how the ‘mindfulness’ approach to meditation can seem like passivity…relating to the negativity as just another ‘illusion’…this is a common criticism and fear of insight meditation that focuses on ‘allowing’ and ‘just seeing’ what is present rather than introducing an intention to move towards the ‘positive’
A14/ we have a choice about how to respond…how we relate to our experiences
A15/ the course helped to clarify this…and this was “really good”
A16/ this seems to reflect a view she picked up about meditation that was unhelpful…and perhaps
of knowing that of course thoughts are not facts…but you do still
believe them sometimes anyway and its good to remember not to…if their
not helpful…and I could see that i was all ready to go into a spiral that
wasn’t going to help and I could sort of let go of it…
And I think also when I sort of thought like I am feeling unhappy or I could
go a bit passive… I can worry that I can go a bit passive… and I could
think it is all a bit of an illusion…life…all the things happening to me
(that I don’t like) I could just sit here and just let it all just happen to
me…I think: “No I don’t want to do that…to become passive…just
letting everything just happen to me”…and the course was really good
about saying that it (meditation) is not about being passive…its about
having more control and about being able to choose instead of saying:
“Oh well it doesn’t matter…it
does matter…it matters to me right now…how you feel does matter to you
and you have got a choice about how you want to respond and that’s
been really good to clarify that…
Facts
Awareness of neg. spirals…and ‘letting go’
Distinguishing passivity from (‘positive’) acceptance
Choice and control in ones life
Choice and responding not reacting
Importance of ‘clarifying’ not just
68
formed a resistance to practising.
A17/ the point is refined by this illustration…and a distinction is made and attributed to a tutor making a direct teaching point: about not boxing oneself up…being able to step outside of our view of ourselves…and finding choice in what we ‘do’ or what we think our ‘role’ is
A18/ I wanted to clarify if these old views and ideas were restrictive and give a chance to open out the topic cos it seemed really relevant stuff
A18/ a continuation of A17 but moves into existential fear and the whole issue of
Um…the other thing was that I was sort of wondering, before the
course… if meditation was sort of saying that the ‘mind’ is kind of a bit
silly…that it goes off on silly little stories and that your ego is a bit
silly and goes off in stories…I didn’t like that…I do find the mind is useful
and it does come up with some useful things and my identity is everything
that I need in my life…and to sort of like try and break down this ego…I just
thought well…I don’t see how I would function in the world if I did that…I
asked them(the tutors) about that and Nick, the guy…I was in his group…
he, you know, said its not like that… its just about not letting it control
you …not boxing yourself up and saying I’m like this…or… I have to
do that…that’s my role or whatever…being able to step outside of it
and being able to choose…again it’s a choice.
Q. You are saying it was helpful to have some of your fears looked
into? To talk about them…one of them was about not becoming
passive…
A. And about (not) loosing my identity…not being anybody….i dunno I
think I was quite scared about that i thought what if I do this meditation am I
going to disappear in puff of smoke…if I do it properly…what is going to
learning things from scratch
Clarifying old restrictive ideas about meditation
Meditation or awareness of ones mind gives choice
Choice in our ‘doing’ and ‘identity’
Resistance to meditation
69
fear that meditation might stop normal ‘functioning’ in real lifeAlso, a sub-point about not being sure what one is aiming for“fear getting in the way of doing a regular meditation practice”
A19/ I wanted to get the discourse back to the MBCT course and its effects
A20/ past experience led her expectations…confusion or upset was helped by meditating
A21/ a comment on how it worked for her…getting a bit of space around the upset/confusion
A22/ glimpses of how much more helpful than talking to a good friend
happen to my child and my friends…and my family you know… how will I
pay my bills…you know( laughter) whose going to do the housework
(laughter)…you know I don’t want to step out I think that was a fear that
was getting in the way of doing a regular meditation (before the
course)…’cos I was thinking I am not sure where this is going…what am I
aiming for and I’m not sure I want to be aiming for this
Q. So what were you aiming for when you started the course? What
did you have in mind… what were your expectations?
A. Well the reason why I did it… what I was expecting was because I’d
found in the past that when I’ve been really confused about something
or really upset about something that meditation really did help me…if I
sat down and got a bit of space around it, it just felt much better and I
used it to do that a few times and it hasn’t worked every time but I’ve had
glimpses of how much more helpful that can be… that sort of (thing)…
even than calling a friend and talking about it …sometimes it is good to
call a friend and talk and I do like to talk through my problems as well….but
I also have this sort of awareness that I can’t really expect other people to
Fears about being able to live in the ‘real world’
Resistance to regular practice /going deeper
Motivation based in past experience
Meditation helps upset and confusion by giving space…Perspective?
Alternative to talking therapy
70
A23/ a motivation to do the course was around how it focuses on self-help…self reliance“I’ve got a constant person in myself I can turn to”
A24/ this summarises the above point : wanting to feel more self-sufficient
A25/ getting back on track about what was actually helpful within all the different aspects and practices on course.
A26/ a new level of specificity…the 3 minute breathing space
A27/ the first point is often significant : the breathing space can be done anywhere and what it does is allow you to i/ stop and ii/ get
fix this for me…if I’ve got something that is really bothering me then yeah, I
could call my friend, but she might be busy, or she might not say exactly
what I wanted her to say cos, she’s not my puppet… so really if I want
somebody to give me a particular response, that person that I can
really rely on is me…
And just knowing that If there is something the matter then I’ve got a
constant person in myself that I can turn to…that I’m not clutching
round sort of feeling “oh god… you know… can anybody say the right thing
to me”. And, sort of been feeling like that for years… sometimes if I have a
problem I don’t phone anybody because I think that’s not quite the right
thing to do… sometimes it doesn’t feel right…but sometimes I think I don’t
want to call somebody and, you know, lay it all on them…bring this thing to
their door…and I just wanted to feel a bit more self-sufficient….
Q. So what was it about the course that helped you feel that?
A. Um, I think what helped me….one of the things that helped me was
um, the breathing…the three… the three minute breathing…space that
you can just stop anywhere in the middle of the street…or wherever
and just ground yourself in…’cos you know quite often if you have
something you are quite worried about I am all in my head about it and it
Self reliance…self power
Faith in self-help approach to troubles
Self-sufficiency
3 min. breathing space most helpful
71
groundedA28/ some very significant points: i/ “in my head about” the problem…ii/ its not happening right now…and iii/ meanwhile there are supportive and positive things (life going on and beauty) that one does not notice because of being in ones head…in thoughts…in ruminations…on auto pilot!
A29/ questioning is it real and being able, through doing the practice, to step back from it all; perspective and choice…at least for a bit (accepting it is not the end of the story)A30/ I’m wanting to check for more specificityA31/ so yes, she did adapt the practice…she let go of the structure and i/ just stood and breathed…and ii/ looked around…and iii/ just being there, iv/ just stop; so she used sight as well as sensations to ground herself and let go of the stages
A32/ whole bit about the effect of this practice not only helping gain a perspective and calm but also, appreciating ones life and this adding to quality of ones
is not happening right now and right now there is… you know… the
sun is like shining through the clouds over there… and there is a man
walking across the street and there somebody on a bicycle…and you
get to feel like nothing (bad) is actually happening right now…and that
it is all in my head… Is it real?…and being able to just step back from it
all a bit….
Q. Did you adapt the Breathing Space… you know…did you change
the 3 bits in it?
A. You know…(laughter) I can’t even remember what the three bits were
actually…so I just stood and sort of breathe and look around and just
be there for a few minutes…and just stop…that was how I do it…I think
it made me appreciate my life quite a lot ‘cos I’d stop myself in various
situations…like you know, it wasn’t just when I was upset about
something…it could be anytime I just thought well…it would be nice
just to stop for a minute and have a look around and it made me really
appreciate all that…places that I go and things that I see…and I found
that those parts of my day were the most memorable parts of my day
and at the end of my day I’d
practice
PortabilityGrounding in the breath
Getting out of the head (ruminations) and into the body
Appreciation of life as a result
Present moment is safe
Stepping back from it all: gaining a bigger perspective
‘being mode’?
Greater appreciation of life and work as a result of practice
72
day/life
73
Appendix E : List of ‘Overarching Themes’ and Main ‘Sub-themes’
74
75
Appendix E
List of ‘Overarching Themes’ and Main ‘Sub-themes’: derived from reflection and correlation of the ‘grouped themes’ from interviews 1 and 3
1/ My process (what grabbed my interest and why)
2/ Motivating Factors (to do the course)
3/ What Supports Practicei/ The Course structure (discipline and support)ii/ ‘Intention’ as a support to practiceiii/ Non-judgement helps motivation,iv/ Confidence in practice
4/ The Practices Were Helpful in Different Ways i/ 3 Minute Breathing Spaceii/ sitting meditationii/ Mindful Movement(when energy is low or anxiety)
BUT: Fears and resistance to meditation (of passivity and of loosing ‘real’ grip)
5/ Perspective and Increased Choice and Self-Determinationi/ Self-reliance- empowermentii/ Gaining a bigger perspective and so, choice iii/ Tools to work with, self-reliance
6/ Impact of the course on the quality of the rest of ones life i/ appreciating life (everyday ordinary things and activities) ii/ improved relationships (expectations and allowing)iii/ initiated other supportive things/activities/rekindled interestsiv/ increased self-compassion/nurturing
7/ Importance of the group: i/ Group Practice (ability to relax and engage better in a group) ii/ Group Process: ‘normalising’ effect and importance of trust and opennessiii/ Tutors and the group process (embodiment of values/attitudes)
8/ The Venue: i/ Community base helpful as intro to other supportsii/ Atmosphere and ethos supportive to calm and practice
9/ Unhelpful aspects of the Coursei/ Small-group organisation and effect on process +inquiry repetitive ii/ Tutors lack of control of participants iii/ Balance of practices (M.M. and M. Yoga not emphasised enough)iv/ Preparing for the future not emphasised enoughv/ balance between personal input and the here and now emphasis
10/ ‘Awareness’ and Mindfulness and memory
11/ ‘Acceptance’ and the ‘Being Mode’ and importance of the ‘Present Moment
76
Appendix F : Grid of themes for scripts 1, 2, 3 and 4
77
Appendix F: (Initial ) Grid of themes for scripts 1, 2, 3 and 4Motivation to come and keep coming
Helpful structure of the Course
The Practices (meditation breathing spaces etc)
Self-PowerReliance & confidence
Gaining Perspective…choices
Improving the Quality of Life relationshipsM’fulness in Everyday life
The power of AcceptanceNon-judgement
Self –comp-assion
The Power of the Group:collectivepractice
The Power of the Group:normalising effect
TutorsAnd venue
1
A20/ past experience led her expectations…confusion or upset was helped by meditating
A42/ about how “ the structure of the course over 8 weeks builds trust” etc
A5 Importance of regularity of practice
A26/ one of the things that helped me was the 3 minute breathing space
A65 “yeah that was the biggest thing, wanting to be like in control of my own life and seeing that medt is about that”A23 “the person I can really rely on is me”A50 “you keep the power in youA13” more control…being able to choose
A9 “I can just detach myself and feel a bit easier” A28A11 “sort of knowing that of course thoughts are not facts”A8, A12, A13, A14, A17, A21 A29’being able to just step back from it all’A50”a really god thing about the course that you keep the power in you”
A31 I think it made me appreciate my life quite a lot ‘cos I’d stop myself in various situations”
A33 “it was like things I wouldn’t have noticed”
A55, A56, A57, A60, A61 etcA64”you can really appreciate it(life) if you decide to”
A1”the course gave me a really strong message that I cant get it wrong
A58” not a right wrong way of doing it that makes me wait for the perfect time…perfect mood…that never comes if you are waiting for it”
A52 “ not relying on others to sort you out”
A62 just giving me that feeling of gratitude
A35 and 36A40”helped me to dispel fears about doing it right or wrong”
A49” nobody was getting all their problems out…it was purely about the meditation”
A46”I could relate to other peoples experiences because we are all having fairly similar”A41, 42A38 “the feeling that we are all human and it doesn’t really matter”
A44A45 they really helped the trust in the group”
A72 the tutors could have…
2B1 prof + personal recommendation…and motivated to help deal with mothers dementure
B8: “the supportive aspect of the structure of the course= commitment?…”a specific time each week”
Also B12,
B24: it’s the actual practice of meditation was helpful
B27: Breathing Space and this backed up by longer sitting meditation…
B31 it helped me to get a grip
B28 “it just helps you to go ‘hold on a minute, just hold on a minute, is that really me or is that actually a voice in my head that’s telling me I’m crap”
B29” you become more aware that you are going down a depressive spiral and I have benefited more than other people”
B28: it helps you to say “hold on a minute, hold on a minute is that really me or is it a voice in my head”B29,B31, B32, B33, B42 etc
B55 “it helps me to be more appreciative about what I have”
B56
B58 “being mindful when I was peeling the garlic
B59”it just starts on its own, I’ll just realise that im doing it”
B60 “I think its helps to increase the joy in my life”
B2” the overriding thing I got out of the course was a greater ability to be accepting around my feelingsB23 BIG POINT“it’s acceptance really (linked point to group)B47 BIG POINT “and the non-judgemental flavour of itB52 “not wrong, just to accept itB53 , B55B32” and then when you can accept your feelings its easier to live with them”
B12” I found it a very reassuring thing to be able to do”
B14” I have leant to be a bit kinder to myself…that is the really important thing”
B44 “it just felt very supportive”
B21” the group itself was tremendously supportiveB22 “you don’t feel it’s just you who is a nutter”
A43
A41 tutors very supportive towards meA48 link point on judgement and tutor attitudes
Appendix
78
Motivation to come and keep coming
Structure of the Course
The Practices (meditation breathing spaces etc)
Self-PowerReliance & confidence
Gaining Perspective… Choices
Improving the Quality of Life, relationships,M’fulness Everyday life
The power of AcceptanceNon-judgement
Self –comp-assion
The Power of the Group:Supportive to collectivepractice
The Power of the Group:‘normalising’ effect
TutorsAnd venue
Otherinterest
3
No comments
C46/ I liked the way the course evolved…how it built week by week
C2/ sitting meditation is helpful: cleansing the mind
C29/ meditation; this quiet space with no distractions is nurturing and rejuvenating and builds inner strength
C14 it’s the recognition of patterns, knowing these patterns lead nowhere, the mind whizzing round like a treadmill…in some ways just recognising you don’t want to go down that route again”C44 “it sort of pushes you back on yourself and to the essence of things”
C14 “in some ways it’s the realisation of old patterns”
C40: “I could see that maybe I’m not feeling so bad after all…on a scale from one to ten…so again it gave that kind of perspectiveC15, C21, C41,C45 etc
C9: “And it’s also encouraged me to go on from that”C 11: “the course has been a catalyst in trying to move forward in lots of other directions”C27”I found I really appreciate… also being able to umm…you know appreciate the world around you…even the simple things like driving to work
C7”now I am able to sort of let them go or I can just notice them arising and err they don’t have the same chargeC18 ”accepting things as they are, and in some ways that’s quite freeing because it does focus you on the present”C20 “now I’ve moved back it allows her to move forward”
C13 one of the other by-products of the course is looking after yourself, looking after your own needs, bringing them more to the foreC14 being more assertive …mindful of my own needs
C1 “what was helpful?...i suppose being in a group with other people with well with a whole range of experiencesC31 BIG “ meditating in a group I’ve been far more relaxed in that collective setting, when I do it on my own I feel this tightness on my chest
C39 gave me that reassurance that I wasn’t at the lowest level of mood and then when I heard other peoples stories I could plot my own position in relation to them”C41 BIG quoteC43
C48 venue big quote
C52 another big quote on venue
4
D9 exp. Of B.sc. “ this exp. really motivated me throughout the rest of the course
D46 ideas to help keep practising
D1” it was a great course, the pace, the group D3expereintial aspect: ‘just to do these things to try to work out what we were trying to gain’D4(discipline) ‘just do it philosophy’ ’just a little bit of repetition’D23 home practice v. difficult (and D37 “failure” D39 home practice: “difficult”
D6 and D8 ‘Beginners Mind’ with B.Sc. aspect of calm and pleasure and ‘success’D11B.Sc.“wonderful, lightness, just being in the moment”D8 B Sp. Much less cluttered mindD10 B.Sc was almost like a mental massage” a relief from rumination”D12,D16,D17 B.sc. “quite profound” D27 adapting
D44: it’s trying to relearn the way you communicate with yourself that is often quite deeply engrained
D44b “we could get up to a level where we are not so vulnerable “
D15 auto pilot: “oh I know this bit and then off I will go”
D22: meta cognitions seeing “what a contrary little mind you are”
D22a “they are all thoughts even when you are having the thought I am having no thoughts that is a thought!...So, that was very enjoyable”
D12 “even the supermarket…”D28 “So I went on one of the day medt courses”D30 “definitely…a benefit…taking the time to appreciate life”D31” we wrote down a list of things that made us feel good and it has really made me think that going down to the beach on a lovely day makes me very happy”D35 to really appreciate the things that are out there, you know the beautiful day”“every day is really a gift”
D41:D43: ‘Everything can be played with and medt. Can be used to work with it’…‘not about sort of squeezing it (emotions) into a box’
D44T again:Definition of MBCT: ‘trying to relearn the way you communicate with yourself’
D40 “it is like giving the old brain a little massage and easing out its little aches and pains”
D1 there was I think a bond…throughout the group that was really supportive
D19a
D32 (CBT Ex.)“It was a powerful motivator…to pool all our ideas”
D19 “that others were exp difficulties, different difficulties but also the same ones… might provide an indication something you might exp in the future”
No references
D18 calm and pleasure as motivators
See D23 as well for evidence
D27Adapting the practice… using visual sensations
D31 D32CBT ex make a big impact
79
Appendix
Motivation to come and keep coming
G :
Helpful structure of the Course
Practices (meditation breathing spaces etc)
Self-PowerReliance & confidence
Gaining Perspective…choices
Improving the Quality of Life relationshipsM’fulness in Everyday life
The power of AcceptanceNon-judgement
Self –comp-assion
The Power of the Group:collectivepractice
The Power of the Group:normalising effect
TutorsAnd venue
1A20/ past experience led her expectations…confusion or upset was helped by meditating
A42/ about how “ the structure of the course over 8 weeks builds trust” etc
A5 Importance of regularity of practice
A26/ one of the things that helped me was the 3 minute breathing space
A65 “yeah that was the biggest thing, wanting to be like in control of my own life and seeing that medt is about that”A23 “the person I can really rely on is me”A50 “you keep the power in youA13” more control…being able to choose
A9 “I can just detach myself and feel a bit easier” A28A11 of course thoughts are not facts”A8, A12, A13, A14, A17, A21 A29’being able to just step back from it all’A50”a really good thing you keep the power
A31 I think it made me appreciate my life quite a lot ‘cos I’d stop myself in various situations”
A33 “it was like things I wouldn’t have noticed”
A55, A56, A57, A60, A61 etcA64”you can really appreciate it(life) if you decide to”
A1”the course gave me a really strong message that I cant get it wrong
A58” not a right wrong way of doing it that makes me wait for the perfect time…perfect mood…that never comes if you are waiting for it”
A52 “ not relying on others to sort you out”
A62 just giving me that feeling of gratitude
A35 and 36A40”helped me to dispel fears about doing it right or wrong”
A49” nobody was getting all their problems out…it was purely about the meditation”
A46”I could relate to other peoples experiences because we are all having fairly similar”A41, 42A38 “the feeling that we are all human and it doesn’t really matter”
A44A45 they really helped the trust in the group”
A72 the tutors could have…
2
B1 prof + personal recommendation…and motivated to help deal with mothers dementure
B8: “the supportive aspect of the structure of the course= commitment?…”a specific time each week”
Also B12,
B24: it’s the actual practice of meditation was helpful
B27: Breathing Space and this backed up by longer sitting meditation…
B31 it helped me to get a grip
B28 “it just helps you to go ‘hold on a minute, just hold on a minute, is that really me or is that actually a voice in my head that’s telling me I’m crap”
B29” you become more aware that you are going down a depressive spiral and I have benefited more than other people”
B28: it helps you to say “hold on a minute, hold on a minute is that really me or is it a voice in my head”B29,B31, B32, B33, B42 etc
B55 “it helps me to be more appreciative about what I have”
B56
B58 “being mindful when I was peeling the garlic
B59”it just starts on its own, I’ll just realise that im doing it”
B60 “I think its helps to increase the joy in my life”
B2” the overriding thing I got out of the course was a greater ability to be accepting around my feelingsB23 BIG POINT“it’s acceptance really (linked point to group)B47 BIG POINT “and the non-judgemental flavour of itB52 “not wrong, just to accept itB53 , B55B32” and then when you can accept your feelings its easier to live with them”
B12” I found it a very reassuring thing to be able to do”
B14” I have leant to be a bit kinder to myself…that is the really important thing”
B44 “it just felt very supportive”
B21” the group itself was tremendously supportiveB22 “you don’t feel it’s just you who is a nutter”
A43
A41 tutors very supportive towards meA48 link point on judgement and tutor attitudes
Appendix G: Grid of Major Themes across all cases
80
Appendix GMotivation to come
Structure of the Course
The Practices (meditation breathing spaces etc)
Self-PowerReliance & confidence
Gaining Perspective… Choices
Improving the Quality of Life, M’fulness Everyday life
The power of AcceptanceNon-judgement
Self –comp-assion
The Power of the Group:Supportive to practice
Power of the Group:‘normalising’ effect
TutorsAnd venue
Otherinterest
3
No comments
C46/ I liked the way the course evolved…how it built week by week
C2/ sitting meditation is helpful: cleansing the mind
C29/ meditation; this quiet space with no distractions is nurturing and rejuvenating and builds inner strength
C14 it’s the recognition of patterns, knowing these patterns lead nowhere, the mind whizzing round like a treadmill…in some ways just recognising you don’t want to go down that route again”C44 “it sort of pushes you back on yourself and to the essence of things”
C14 “in some ways it’s the realisation of old patterns”
C40: “I could see that maybe I’m not feeling so bad after all…on a scale from one to ten…so again it gave that kind of perspectiveC15, C21, C41,C45 etc
C9: “And it’s also encouraged me to go on from that”C 11: “the course has been a catalyst in trying to move forward in lots of other directions”C27”I found I really appreciate… also being able to umm…you know appreciate the world around you…even the simple things like driving to work
C7”now I am able to sort of let them go or I can just notice them arising and err they don’t have the same chargeC18 ”accepting things as they are, and in some ways that’s quite freeing because it does focus you on the present”C20 “now I’ve moved back it allows her to move forward”
C13 one of the other by-products of the course is looking after yourself, looking after your own needs, bringing them more to the foreC14 being more assertive …mindful of my own needs
C1 “what was helpful?...i suppose being in a group with other people with well with a whole range of experiencesC31 BIG “ meditating in a group I’ve been far more relaxed in that collective setting, when I do it on my own I feel this tightness on my chest
C39 gave me that reassurance that I wasn’t at the lowest level of mood and then when I heard other peoples stories I could plot my own position in relation to them”C41 BIG quoteC43
C48 venue big quote
C52 another big quote on venue
4
D9 exp. Of B.sc. “ this exp. really motivated me throughout the rest of the course
D46 ideas to help keep practising
D1” it was a great course, the pace, the group dynamicD3expereintial aspect: ‘just to do these things as opposed to try to work out what we were trying to gain’D4(discipline) ‘just do it philosophy’ ’just a little bit of repetition’D23 home practice v. difficult (and D37 “failure” D39 home practice:
D6 and D8 ‘Beginners Mind’ with B.Sc. aspect of calm and pleasure and ‘success’D11B.Sc.“wonderful, lightness, just being in the moment”D8 B Sp. Much less cluttered mindD10 B.Sc was almost like a mental massage” a relief from rumination”D12,D16,D17 B.sc. “quite profound” D27 adapting
D44: it’s trying to relearn the way you communicate with yourself that is often quite deeply engrained
D44b “we could get up to a level where we are not so vulnerable “
D15 auto pilot: “oh I know this bit and then off I will go”
D22: meta cognitions seeing “what a contrary little mind you are”
D22a “they are all thoughts even when you are having the thought I am having no thoughts that is a thought!...So, that was very enjoyable”
D12 “even the supermarket…”D28 “So I went on one of the day medt courses”D30 “definitely…a wide benefit…taking the time to appreciate life”D31” we wrote down a list of things that made us feel good and it has really made me think that going down to the beach on a lovely day makes me very happy”D35 to really appreciate the things that are out there, you know the beautiful day”“every day is really a gift”
D41:D43: ‘Everything can be played with and medt. Can be used to work with it’…‘not about sort of squeezing it (emotions) into a box’
D44T again:Definition of MBCT: ‘trying to relearn the way you communicate with yourself’
D40 “it is like giving the old brain a little massage and easing out its little aches and pains”
D1 there was I think a bond…throughout the group that was really supportive
D19a
D32 (CBT Ex.)“It was a powerful motivator…to pool all our ideas”
D19 “that others were exp difficulties, different difficulties but also the same ones… might provide an indication something you might exp in the future”
No references
D18 calm and pleasure as motivators
See D23 as well for evidence
D27Adapting the practice… using visual sensations
D31 D32CBT ex make a big impact
81
Appendix G
Motivation to come and keep coming
Structure of the Course
The Practices (meditation breathing spaces etc)
Self-PowerReliance & confidence
Gaining Perspective… Choices
Quality of Life, relationships,M’fulness Everyday life
The power of AcceptanceNon-judgement
Self –comp-assion
The Power of the Group:Supportive to collectivepractice
The Power of Group:‘normalising’ effect
TutorsAnd venue
Otherinterest
5
E8:”The B.Sc. exp really inspired me to continue, it was very nice”E18: ” the B.Sc. was such a powerful motivating force”
E32” the cbt ex: I knew anyway but to see it all actually written down was quite a powerful motivator for me”
E2: “ the homework was difficult to fit in but very importantE24 adapting the B.Sp: I go pretty much straight to the breathing, yeah!
E27: also adapting the practices: “just using the waves as opposed to your breath…the same kind of rhythm…a visual focus at the beach
E6:” the B Sc. Medt was quite a unique exp for me and oddly I have not exp the same thing again”E15 (auto pilot): “for some reason my mind goes “oh I know this bit” and then off it will go”E17:”the B Sc particularly helpful that’s the one I’ve gone for”E19 and 19a on thoughts as events in the mind= tricky mind!E23 B sp diff!E38“imp. thing was doing the practices
Not much here= unusual, she seems to have gone for calm rather than self-power etc
E32” the cbt ex: I knew it anyway but to see it all actually written down was quite a powerful motivator for me”
Not much here= unusual,she seems to have gone for calm rather than perspective!
E30 “yeah I definitely would say it’s a wide benefit just taking the time to appreciate lifeE31”near the end of the course we wrote down some things that made us feel good and it has really made me think that going down to the beach on a lovely day makes me feel very happy…its not very far but you get caught up in the washing up”E35 “one of the big things I took away from the course…(to) really appreciate the things that are out there, you know the beautiful day”
E43: “It’s the recognition I guess that everything can…any kind of emotion can be played with and meditation can be used to work with it and meditation is not about sort of squeezing it into a box
E44(the course) its trying to re-learn the way you communicate with yourself that is often deeply engrained”
E40 “ why I was attracted to the practices rather than the rest of the ex and the recording things in the book was about getting the immediate effect of them and feeling rested
E1:” it was a great course…The pace, the group dynamic…a bond, throughout the group that was really supportive”
E19 “the gp was really nice, to have that perspective and that others were exp difficulties, different diff but also the same ones
IMPORT of CALM!E10:“Im sure I do ruminate a lot and just to have the B.Sc. was like a mental massage”E11:“In my mind it was wonderful, complete emptiness and um lightness and really wonderful not to think either good things or bad things”
E39 and E40 Big points
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Appendix G.i Themes from transcript number 6 (not included on grid)
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Appendix G.i: Interview 6 ; quotes under theme headings
F1, Practices: using body sensations to work with emotions
F2, acceptance allowing:F1 what stood out for me was the focusing on bodily sensation and their impact, their feedback loop, onto emotion
F2, acceptance allowing:F2 recognising them and not reacting to them and letting them just settle down a bit …and letting them go ad calm down…I found that interesting
F3, thoughts as events in the mindF3 I’d not really had the experience before of thinking where thoughts are coming from and what they are like
F4, again thoughts as “passing” events…not (all) important and worth analysing F4 rather than thinking that, they are just passing fancies often without much meaning at all and they are just…random flashes that could come and go and just be observed, and they pass
F5, Self awareness: of our experience de-clustered into thought s emotions etcF5I found from that was just how many thoughts and sensations there were all the time and the first time I did it I was almost overwhelmed by the barrage
F6, Body scan as way to positively decentre from “all the rest of it for a while” F6 focussing on the small bits of the body helped because I would just focus on that bit and ignore all the rest of it for a while
F7, structure of the course: regular time and home practiceF7 I thought having a regular time to go was a useful part of the course and that being constant you knew when it was going to be and I liked the homework practice
F8, Acceptance (and lightness?) as embodiment in tutors( I think this title hits the nail on the head and can be applied to all the other scriptsF8 I liked the fact that it wasn’t too precious…you were quite accepting…no, very accepting when people…well, whatever people did was what they did and there wasn’t that sort of school attitude
F9, structure of course: (But I prompted this comment and the reply did not seem to have much energy around it)F9 to know that this was what was going to happen next week and bringing that to the session…
F10, Structure of the course: Different types of medt. And experimentation
F10 what was it in particular about the content, “the different types of meditation and just the experimenting with different things
F11, Technical issue:Home made CD’s and background noises…distractions etcF11I could hear what sounded like the whirl of the…was it a reel to reel tape recorder and sometimes I could hear the planes… and sometimes I would think here is where the turbo props going to come through on the tape and so I was looking out for that rather than…
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F12, the group: small group sessions not usefulF12 I didn’t find the break out sessions (breaking into two smaller ‘inquiry’ groups) that useful F14 time it was a bit too slow for me
F13, Tutor and group:Non-directive…incredibly well doneF13 I thought the people doing those sessions did them incredibly well they weren’t directive at all…
F15, Group: inquiry style of the group…”like listening in on various conversations”F15 I never felt it was really a ‘group’…they were more like conversations between one person and the tutor and a bit of interaction but not a lot
F16, group: critical point againF16 I wasn’t getting a lot out of listening to it
F17, Group/tutor: the inquiry process and acceptance embodied etc etcF17 what I was reflecting on in that was actually the style of the person leading the group and how they were conducting (the inquiry) that rather than actually getting something out of the interaction itself…so I was more intent on the way the tutor was handling the session than the content of the individuals conversation
F18, Acceptance:“I was intrigued and interested in the whole business of acceptance”F18 the things that were standing out was the tutors reactions to events and to people and how you coped with that…I was intrigued and interested in the whole business of acceptance…
F19 Acceptance: in the practices…accepting all that happens in a practice of medt…the discomfort boredom etc…so practice at acceptance “was quite an interesting thing to work on”F19 “it was, for me, more about accepting all of the things that were going on… so it was about accepting the body sensations…if I sit up for 20 minutes when I start to get back pain …it was actually part of the meditation… to think “Well ok! what does that back pain feel like?”. And, am I going to accept it or am I going to move… so that was quite an interesting thing to work on(links with choices and self-power)
F20a, acceptance: details of what I get out of it F20 “there is a bit more to it than, “well, it’s helpful to accept ones life the way it is”… I think what I get out of it is more about accepting what I feel about things rather than accepting the outside things(links with choices and self-power)
F21, acceptance and how it helps in everyday life and relationshipsF21 “so there is more of the feeling of well ok it wont be like that tomorrow and I’ve accepted it and even on occasions I’ve say to people “Look I’m feeling a bit cross today so…” ; “If im a bit short with you it’s because I’m feeling a bit cross today” And that’s quite interesting because I have said that to people and they’ve said I’m glad you said it because I was thinking it was because it was something I’d done(links with choices and self-power and self-compassion?)
F22, acceptance: of my emotions…congruency…I can leave my ‘mask’ off sometimes
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F22 “its ok to feel like that and that if I’m dealing with you inside or outside of work… it’s ok for me not to put on a mask all the time… its ok to sometimes be a bit cross
F23, Impact of course on life: “ a bit more up and down and that is fine”F23 “so im thinking I am coming across a bit more up and down and that’s fine…so I don’t have to be this steady and calm person all the time…its ok to say to someone that I’m feeling a bit cross today…(links with choices and self-power)F23a “not keep it in and not be tense about it and accept it and to accept that some days I’ll be different to other days and….i think that’s fair enough…
F24, Venue: was great…the spaceF24 “The venue itself was great I really like the space and the first time I saw it I thought ‘wow’ because I really wasn’t expecting that
F25 Expectations and Group:Not “miserable and mopping but quite a lot of the time quite ‘up and engaging and happy”F25 “not knowing what to expect I was a bit worried that everyone was going to be miserable all the time and they weren’t and that was quite pleasing, you know, there wasn’t people sitting round mopping all the time…quite a lot of the time people were quite ‘up’ and engaging and happy…
F26, Mindful Movement:Self-conscious…and frivolous? “come on man do something useful”F26 I wasn’t sure about the movement exercises…some of it were interesting but sometimes I felt a bit self conscious about it and I remember doing this slow walking thing and just for a moment I thought “well if someone came in the room and saw this what would they make of it”…what are these people doing?....come on man get on and do something useful!...(laughter)…
F27, Movement and Body awareness:Really quite interesting…can feel a bias…F27 “I’m more conscious of my right hand side that of my left hand side…and I thought that was really quite interesting
F29, difficulty change suggestions on Course Structure and Group:F29: “I would have preferred more one to one interaction (rather than the small groups) and I would have accepted that there was less time devoted to the small group (inquiry)… and maybe even that the those session were interlaced with another activity other people were doing…I felt that activity was a sort of down timeF29a too much of group rather than the exerci
F30, Group: normalising around practice and failureF30 “one thing about the group time that was useful was that it was good to hear there were other people who were not doing their home practice so that was useful… I wasn’t being absolutely aberrant not doing the 30 minutes a day…helped me feel a bit more like it was normal at times
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Appendix H: extract from interview 1 (female, late 20’s)
Key:
Colours: red and blue colours are used alternately to highlight significant comments made in the script. This is for ease of matching to the researchers comments (made in the same colour for each comment) in the adjacent column. Comments in black indicate the researchers own thoughts and reflections.
Number and letter coding: each highlighted quote/comment is given an identifying letter code (A, B etc) matching the participants’ name code and a number code matching its order of appearance in the transcript.(e.g. A1, or B23)
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Notes arising from the script
Code: ‘A1’, ‘A2’ etc
A1/ the course gave a helpful “really strong” message about not making ‘right-wrong’ judgements …
A2/ this seems to be a qualification about ‘so long as you’re aware of what you are doing’
A3/ link between non-judgemental attitude and motivation to practice
A4/ a development of A3 about motivation but it adds a common kind of judgement about the need for “calm” for it to “work”
A5/ links ‘confidence’ in
(NB: possible useful quotes in bold italics and in colour)
Q. What did you find helpful about the MBCT course you just
finished… two weeks ago?
A: Well, from a meditation point of view I've been trying to meditate
since I was about 13 years old and never being quite sure if I been
getting it right and um it was a really good… they gave me a really
strong message that you can’t… well you can't get it wrong… so
long if you're aware of what you doing it is fine
I think because I was being quite judgemental about what I was
doing when I was meditating I was a lot less likely to do it…I used
to think if I'm not in the right kind of state of mind… if I'm not calm – if
I cant get my mind to be quiet then it hasn’t worked whereas now
I’m much more likely to just do it however I am feeling…if I am
aware that i am all over the place then I’m doing it right, you know so it..
um, just means that I am feeling more confident in doing it so it will
be a lot more useful to me because I will be doing it regularly err…
Possible Emerging themes
Non-judgement?
Awareness is key?
Motivational link toIntention?
Motivational point again but also introduces the‘Calm’ versus ‘Insight’ polemic
Importance of regularity of
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doing it with ‘usefulness’ and the need for ‘regularity’
A6/ ‘consistency’ linked to how helpful meditation is
A7/ My prompt is trying to elicit what she means by ‘practice’…the ‘it’ in A5-6
A8/ clarifies ‘it’ is sitting medt. But goes on to refine this to single out ‘watching thoughts’ and getting a better perspective on them…so she can “detach myself and feel a bit easier”
A9/ a positive use of the term ‘detachment’ and of using thought to counter troubling thoughts; from feeling bothered…she let it go a bit..not passivity??
not every day but well at least every other day… I have never been
able to do it that consistently and I can see it is only if I do it
consistently that it is really helpful.
so it… um just means that
Q. When you say you do practice regularly…Is that the sitting
meditation or the lying down body scan?
A. The sitting breathing meditation... and watching thoughts and
its been good if I’ve been a bit worried about something…like
yesterday my boyfriend was being a bit grumpy…and I was sort of all
ready to fall into my old pattern of “OH no! …was it because when I
said that or was it because I did this”…or thinking like: “he is always
like this… why does he do this”…instead of going into all that I just let
it go a bit and just thought: “He is just doing this… and it doesn’t
have to bother me…I can just detach myself and feel a bit easier
and
practice
This (above) linked to confidence
Awareness of thoughts as event in the mind and not facts?
Detachment but not passivity
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Appendix I : extract from interview No 2 (female late 40’s)
Key:
Colours: red and blue colours are used alternately to highlight significant comments made in the script. This is for ease of matching to the researchers comments (made in the same colour for each comment) in the adjacent column. Comments in black indicate the researchers own thoughts and reflections.
Number and letter coding: each highlighted quote/comment is given an identifying letter code (A, B etc) matching the participants’ name code and a number code matching itsorder of appearance in the transcript. (e.g. A1, or B23)
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B1: motivations for course…prof + personal recommendation…and motivated to help deal with mothers dementureB2: a big statement about benefit of the course…accepting around my f
Q12: I felt I needed to move into empathic counsellor mode to meet her upset at this point…so I tried to reflect back her feelings
B55: acceptance again…first point as she gathered herself back from tears and composed herself
B56: appreciation of:i/ what I have and ii/ everyday activities/skills…”I suddenly felt happy”
B57: but the thought took her back to the upset about her mums condition…
Q: what was helpful or unhelpful about the course you have recently
finished?
A: Um…I was recommended to go on the course by a clinical
psychologist at the Hospital who I saw for 6 weeks in relation to the fact
that my mother has ********** (illness) the clinical psychologist herself had
done the course and she thought it might be helpful for me…I was seeing
the psychologist to help me understand more about dementure…and err
not because I was in need of clinical psychologist for taking her trousers
off…but this is my mum you know… (cries…gets tissues) I know it
sounds silly but…its err…so im not completely serene…(GAP TO END
PAGES)
Q: It seems like a big change…your mum used to be a **************( a
prominent professional) and now…
A: Yeah…but the meditation does help me to be more accepting…. the
other thing it helps me to be more appreciative about what I have…a little
while ago I was…you know I like cooking…I was actually peeling alcove
of garlic and suddenly I felt really happy cos I knew what I was doing and
I was able to do it and I had the manual dexterity to do this fiddly thing
and also engaged in this purposeful task and I just felt really happy
NB: in this column: ‘convergence’ and/or ‘divergence’ from previous correlated themes (Interviews 1 and 3 )are put in bold italics with the code of ‘D’ and ‘C’ before the number from ‘left side’ column.Also:Theme headings are underlined in the text
D1: ‘motivation’…linked to personal recommendation and to deal with a particular life circumstance
C55: acceptance again
C55: appreciation of lifeEveryday activities and skills
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B58: mindfulness in everyday life…suddenly feeling happy
B59: mindfulness in everyday life…it just starts on its own
B60: being mindful, “it helps to increase the joy in my life”Even the mundane can be great
B61: counting ones blessings…seeing what we already have rather than being caught in what we would like to see change…contentment and mindfulness…enjoying the pot plant
Q13: this reminds me of one of my favourite maxims: “blossom where you are planted” …I felt a tingle of recognition and noted the time was up!
because my mum hasn’t got that (crying again)…she’s lost…she doesn’t
k now what day of the week it is…no short term memory…she doesn’t
have any of those abilities any more …to do something for a propose…
she’s got none of this…and I think it was the mindfulness…you know I
was being mindful when I was peeling the garlic and it reminded me…I
do bring it into my everyday life…
and I do catch myself you know…waiting for the bus and I will start to be
mindful and its not always deliberate I will just realise that I am doing it…I
become mindful of being mindful and it’s very err…I think its helps to
increase the joy in my life…other things can be you know going on not
particularly great but something as mundane as peeling a clove of garlic
can…you know it can have a really good effect…and I’m not one to tell
people to count their blessings normally but it does actually make me
more aware of your present time and I’m trying to …you know im truing to
catch the idea of “When I’ve done that…when I’ve got a bigger
garden...when I’ve…ill be happy”…instead of trying to just enjoy the pot
plant that you have at the time…!
C58 appreciation of life: mindfulness in everyday life
C59 appreciation of life again
C60: appreciating life…the joy of the ordinary… increases
C61: the present moment and finding that it helps increase positivity
Making what you have now sufficient because you enjoy it more and it releases you from ‘wanting more’
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Appendix J : extract from interview No 3 (male mid 40’s)
Key:
Colours: red and blue colours are used alternately to highlight significant comments made in the script. This is for ease of matching to the researchers comments (made in the same colour for each comment) in the adjacent column. Comments in black indicate the researchers own thoughts and reflections.
Number and letter coding: each highlighted quote/comment is given an identifying letter code (A, B etc) matching the participants’ name code and a number code matching its order of appearance in the transcript.(e.g. A1, or B23)
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Q1/ wanted to emphasise the helpful first in all interviews
C1/ this question provokes a list as an opening answer:i/ Group: support of being with people with range of experiencesii/ Group: giving support to othersiii/ Courses regular framework and related disciplineiv/The CD’s (related point)v/ The practices of:Body scan and sitting meditation
C2/ a reflection about how the practice of sitting meditation is helpful: cleansing the mind
C3/ a moderation of the idea of ‘cleansing’: its helpful because it ‘shifts
Q: So what was helpful or not helpful about the course you have just finished?A: Right ok…umm…what was helpful?...i suppose being in a
group with other people with well with a whole range of
experiences I did find that supportive to an extent although I
found that giving support to other people was good err…the
regular framework and the regular discipline of weekly classes
sessions was good I managed to come to every session which I
was pleased about…umm…the cd’s I found very useful and I’m
continuing to use them…the body scan and the sitting meditation
cd’s…I do the body scan very morning…and try and do the
sitting meditation every day as well…it is funny (laughter) I was
thinking about it the other day…and… in some ways it’s like
brain washing isn’t it it’s …it’s…maybe that’s the best use of the
word…its cleansing the brain…cleansing the mind, or shifting
the mind to think in a different way…um… my, you know I did
have quite bad states of low mood and anxiety and panic attacks
The response begins with a list of what was helpful: the order of this list I perhaps significant:i/ Groupii/ Course structure and frameworkiii/ Practices of Body Scan and then Sitting Meditation
Sitting meditation is singled out for a comment on why it was useful…Two themes:
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the mind to think in a different way’
C4/ the course was helpful in making moods more stable…less panic and anxiety and ‘low’
C5/ reflection about cause of his difficulties…caught up in the past…by past trauma
C6/ (continuation of A5)…hooked by thoughts…not able to get rid of them
C7/ ‘how’ and ‘why’ the course helped was to enable him to: let go…just notice them arising…and they don’t have same charge or resonance
C8/ a continuing reflection on ‘why’: sure it’s the
so particularly the low moods have very much err, not
disappeared but…far less severe…in fact my moods generally
are pretty relatively stable particularly compared with what they
used to be…you know I used to get very obsessed and
disturbed by certain thoughts and err…went through a major
trauma last year which triggered memories of another trauma 30
years ago, umm so I was caught up in the past by err both sets
of trauma, and now they seem to have retreated…and umm…
thoughts that come up now are not so much associated with the
trauma but with relationships following that…err I used to get
incredibly hooked into those thoughts… they were in my head
and I couldn’t get rid of them…now I am able to sort of let them
go or…and I can just notice them arising and err they don’t
have the same charge...the same resonance…so err I don’t get
caught up I them to the same extent…I’m sure it’s the course but
then it’s (also) the on-going practice as well that umm maintains
i/ Cleansing the mindii/ Shifting perspective?
Two points:i/ Less severe moodsii/ Improved stability: moods and mind states
A5-A6Statement about the problem before the course…how he sees this problem now ( he was ‘caught in the past’)…so perhaps the theme of ‘being present’ ‘off auto pilot’
Themes around:i/ ‘Letting go’ii/ Noticing ‘thoughts as events in the mind’ (less ‘charge’)
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course and the ongoing practice enabling more steady mind states
Q2/ intention to help build trust and positivity…so reassuring the interviewee as to the content of his opening stream of consciousness
C9/ encouraging to go on from the course…wider implications in ones ongoing life
that um progress really and enables me to have more steady
mind states…you know… so that was a bit of stream of
consciousness…sorry…(laughter).. but I answered your
question didn’t I?....
Q: No, no it’s good…that’s a classic kind of statement about
how mindfulness ‘should’ or can…sort of work…
A: And it’s also encouraged me to go on from that in that…
um… I’m reading that JKZ book on ‘Full Catastrophe Living’…
which in fact my sister sent me about 2 years ago and I never
read it…I sort of looked at the first few pages and dismissed it
because it was all full of American jargon and so looking at the
surface rather than the content and again that was absolutely
classic so now…having done the course and actually reading it I
am finding it very readable and very accessible and builds on
you know the course…it fills in gaps and you know…etc...etc…
Theme of need to maintain progress through ongoing practice
Impact of course on rest of ones life…quality of life etc?
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C10/ the course as a catalyst in trying to move forward
C11/ I think this point makes sense if you read it as another thing that helps one keep moving forward is to share/communicate about the value of the course(mindfulness?) and the boost given by finding empathetic connections around this
etc.
Um, then I’m also reading that book ‘The Power of Now’…it talks
about being caught up in the past or the future mind states so,
you know the course has been a catalyst in trying to move
forward in lots of other directions but also I’ve found that ..um,
you
(same as above?)
New detail on this: course impacts on friendships and communication
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Appendix K : extract from interview 4: (female, late 30’s)
(N.B. the same process is used but initial comments are colour coded on the right instead of the left)
Key:
Colours: red and blue colours are used alternately to highlight significant comments made in the script. This is for ease of matching to the researchers comments (made in the same colour for each comment) in the adjacent column. Comments in black indicate the researchers own thoughts and reflections.
Number and letter coding: each highlighted quote/comment is given an identifying letter code (A, B etc) matching the participants’ name code and a number code matching its order of appearance in the transcript.(e.g. A1, or B23)
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‘all useful’…no particular aspect…works as a whole?
BUT! Key thing…experiential approach of it…not trusting ideas from books…
Also, importance of making commitment and clarity of the detail of this
the experiential point repeated as a summary of all this…
Q: What was helpful about the course?
Of all the different things on the course…I don’t know what I gravitate to
most of all because I found it all useful…but I think the key thing for me
was (that) because I’m in my head all the time …I have a job that means
I’m in my head and I live my life in my head… it’s the sort of thing I could
have read a book about and thought that sounds great, I’ll do a bit of that…
and it would have hardly happened and I might have been able to just talk
about it a bit…so….it was the experiential aspect of it…and making a
commitment to practice …I thought that things like body scan and the
meditation type things at home was going to be the most challenging so I
thought about it and made a commitment before I started that I’d spend a
certain amount of time each day…even if I didn’t feel like it I’d do it every
day. I found all of that a lot easier than I thought I would…so it was the
experiential side of it that made the most difference for me…probably…
But, I couldn’t possibly have done it without the classes…umm…I liked the
theory (laughter) because that’s the kind of person I am…I want to know
how it works and I’m stimulated by that umm…so I found that interesting
and yeah, just having that understanding and back up… just helped me
believe that it would work I suppose…umm…
Then there’s the group discussions…they were really interesting…I think
that would vary enormously depending on who was in your group…it would
d1 Experiential approach
d1 Again: commitment
d2 Structure of course “commitment that I’d spend a certain amount of time each day”…made it easier
d1 again (emphatically)
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a point about the structure of the course and the practices…set against just the the theory
So, a point about ‘trust’ coming from the theoryBUT…could not possibly have done it without the practical aspect of the classes
next in this list of what was helpful comes ‘the group discussion’
Not easy at beginning…not sure about level of openness and detail to share
what else? This tells me that she has kept the list idea going in her head…
be interesting to do it again and to see what came out of that….It didn’t
always feel (easy)…particularly at the beginning because we didn’t know
each other very well and your not completely sure about what’s
appropriate to share and what’s not appropriate to share…umm… and also
measuring that against what other people share so it feels comfortable to
share roughly the same level of details…same sort of things and the same
amount of information…
What else?...So, staying with the group a little…the most helpful thing
was the tutors questioning…it is very skilled isn’t it…questioning and very
subtly leading you to a thought…about something…can’t think of an
example… but sort of moving you on in some very subtle way to think
about something differently, without feeling that you are being challenged
in any way….In our group…I don’t know if its always like this but in our
group…there wasn’t …in the little group, not the whole big group, because
we divided into small groups….
i think there was less interchange between people it was more umm…us
talking to the tutor and I suppose I would have like more interchange…I
d3 (good) structure of course:Theory and trust in the approach: “ I liked the theory…I want to know how it works
d4; the Group:Trust at the beginning an issue…feeling comfortable to share by measuring against others openness
d5: Tutor Skill and inquiry: “the most helpful thing was tutors questioning…it is very skilled…subtly
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wants to stay with the group… and in this pulls out ‘inquiry’
this is a very perceptive comment
this is unusually early on to have a point about ‘improving’ the course: ‘more interchange’….peer to peer ‘would have been helpful’
‘Well I suppose’: I think I asked with my eyes what she meant by ‘helpful’…again very tuned in to the interview intentionGoes on to mention comfort and safety in relation to more peer sharing
this is a reflection to fill out why peer responses would be more helpful than vicarious listening to tutor to participant sharing…
suppose I did try and do that but it might be about personalities there…it
got a bit more as the weeks went on umm…but this would have been
helpful…
well I suppose it would have made me feel more comfortable talking about
stuff…I suppose cos you’d have more of a feel where other people might
be coming from so it would make you feel safer I suppose…umm and also,
to see what other people are (doing and feeling)…
I suppose other people saying things to him about how they feel is different
to someone saying something in response to what you’ve said or to you
saying something in response to something someone else has said…
because what you said might have triggered something and visa versa…so
it could be a direct response to your experience or about experience…
leading you to a thought” (meta-cognition)
d6: Tutor skill in inquiry+ groupmoving you on in some very subtle way to think about something differently, without feeling that you are being challenged in any way
d7 Improvements to the course: “ there was less interchange between people” so perhaps needed more peer to peer interchanges…to
“make you feel safer”
“Also to see what other people are doing”
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Appendix L: extract from interview 5 (female, early 40’s)
Key:
Colours: red and blue colours are used alternately to highlight significant comments made in the script. This is for ease of matching to the researchers comments (made in the same colour for each comment) in the adjacent column. Comments in black indicate the researchers own thoughts and reflections.
Number and letter coding: each highlighted quote/comment is given an identifying letter code (A, B etc) matching the participants’ name code and a number code matching its order of appearance in the transcript.(e.g. A1, or B23)
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E1 I think it was a great course… the pace, the group dynamic
E1a there was I think a bond…throughout the group that was really supportiveE2 home work was difficult to fit in but very important
E3 / 4so the ‘just do it’ philosophy really worked for me and also just a little bit of repetition just emphasising that we should do the home practice because it did demand a little bit of
Q: what was helpful or not helpful about the course you have
recently finished
A: I think it was a great course… the pace, the group dynamic
worked for us. I think everybody at the end was quite sad to leave
even though we hadn’t spent that much time in the group sessions
it was mainly in meditations…there was I think a bond…throughout
the group that was really supportive the err home work was difficult
to fit in but very important it was very good that we were told at the
beginning of the course just to do these things as opposed to try to
work out what we were trying to gain as a result of practising these
various meditative techniques… so the ‘just do it’ philosophy really
worked for me and also just a little bit of repetition just emphasising
that we should do the home practice because it did demand a little
bit of discipline in your life… you did have to fit it in…and it want
always that easy… but like a lot of things in life you get out what
you put in and I think it really was the case with this particular
course…Um…i think I was really enamoured on the first day when
we did the body scan meditation that was quite a unique
(e1) general comment…first point v. affirmative
(e1a)Group: a bond…really supportive
(e2)Home practice: important but!
(e3)Course structure/styleExperiential learning style:the ‘just do it’ philosophy(e4)Course style…Discipline‘just a little bit of repetition’
(e4)Not always that easy
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discipline in your life
the body scan meditation
e6 that was quite a unique experience for me and oddly I have not experienced the same thing again
E8 that it really inspired me to continue…it was very nice…E9 It was really special…it really motivated me throughout the rest of the course
E10 im sure I do ruminate a lot and I know things are always going on in my mind and just to have that body scan and really it was almost like a mental
experience for me and oddly I have not experienced the same
thing again…maybe its me but….the fact that it was so new to me
and hopefully the fact that im not feeling such a profound effect
these days means that im perhaps closer to that level that I was
attaining to after that first medt… as opposed to maybe the much
more cluttered mind that I had before hand so that it really inspired
me to continue… very nice
Q: Tell me about that body scan?
It was really special…it really motivated me throughout the rest of
the course…I guess I tend to be one of these people who is always
kind of thinking about things and I know a lot of the course is about
rumination…im sure I do ruminate a lot and I know things are
always going on in my mind and just to have that body scan and
really it was almost like a mental massage…if you like… so I err…
went into Waitrose afterwards and it was just um I was describing
it to someone yesterday… and I don’t know if you’ve seen that
programme shooting stars… with Vic Reeves.. they have this um…
let me think of a different way to describe this….it was like one of
these ghost towns in America where they have these tumble
weeds blowing across and down the streets and the bells chiming
out and there is no one there and it was like that in my mind and it
to fit it in
(e5) Course discipline: you get out what you put in
(e6)Practice detail: Beginners Mind…a unique experience for me…the fact it was so new to me.
(e7)(A positive interpretation of this)And…perhaps it means I am closer (generally) to that level I was attaining at the first time
(e8)Effect of the Body Scan on her; a much less cluttered mind
(e9a)Inspired to continue by ‘success’ and pleasure (it was very nice)
(e9b continuing) ‘it really motivated me throughout the rest of the course
(e10) link reflection about
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massage
E11 there is no one there and it was like that in my mind and it was wonderful…complete emptiness and um a lightness and it was really wonderful to not think either good things or bad things just real just being in the moment
E12 even the supermarket experience didn’t detract from the feeling that I was getting from it so that was really a wonderful experience
was wonderful…complete emptiness and um a lightness and it
was really wonderful to not think either good things or bad things
just real just being in the moment…it felt quite spacey I think…
which means…well it was on a Wednesday afternoon after the
schools had come out and there were quite a few junior kids
around so I think maybe even the supermarket experience didn’t
detract from the feeling that I was getting from it so that was really
a wonderful experience…and that really spurred me on and I had I
definitely had seen the benefits after doing these practices but that perhaps because it was so new to me…because I was so new
to it… because I was addressing it for the first time…because it
was so new
rumination and body scan ‘like a mental massage’(import of CALM?)
(e11) Description of the effects of a Body Scan Medt:i/ wonderfulii/ complete emptinessiii/ lightnessiv/ really wonderful to not think either good or bad thingsv/ just realvi/ just being in the moment
(e12)Effects continuing into everyday life ‘even the supermarket didn’t detract from the feeling I was getting from it’
(e13) import of experiencing…
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Appendix M: extract from interview 6 (male, late-50’s)
Key:
Colours: red and blue colours are used alternately to highlight significant comments made in the script. This is for ease of matching to the researchers comments (made in the same colour for each comment) in the adjacent column. Comments in black indicate the researchers own thoughts and reflections.
Number and letter coding: each highlighted quote/comment is given an identifying letter code (A, B etc) matching the participants’ name code and a number code matching its order of appearance in the transcript.(e.g. A1, or B23)
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NB: I think I moved too far into a counselling relationship with the person half way thro and the interview has suffered because of this
F1 what stood out for me was the focusing on bodily sensation and their impact, their feedback loop, onto emotion
F2 recognising them and not reacting to them and letting them just settle down a bit …and letting them go ad calm down…I found that interesting
F3 I’d not really had the experience before of thinking where thoughts are coming from and what they are like
F4 rather than thinking that, they are just passing fancies often without much meaning at all and they are just…random
Q: what was helpful or unhelpful about the MBCT course you
recently finished?
A: Ok…where to start…what I particularly liked about the course…
what stood out for me was the focusing on bodily sensation and
their impact, their feedback loop, onto emotion. And recognising
them and not reacting to them and letting them just settle down a bit
…and letting them go ad calm down…I found that interesting …the
other thing that was useful was thoughts…and I’d not really had the
experience before of thinking where thoughts are coming from and
what they are like and whenever id thought about thoughts in the
past it had always been on the frame work of thinking there is
something important about them, lets analyse them and where they
are coming from rather than thinking that they are just passing
fancies often without much meaning at all and they are just…
random flashes that could come and go and just be observed, and
they pass. So there was that and I had done a bit of the mindfulness
F1, Practices: using body sensations to work with emotions
F2, acceptance allowing:
F3, thoughts as events in the mind
F4, again thoughts as “passing” events…not (all) important and worth analysing
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flashes that could come and go and just be observed, and they pass
F5I found from that was just how many thoughts and sensations there were all the time and the first time I did it I was almost overwhelmed by the barrage
F6 focussing on the small bits of the body helped because I would just focus on that bit and ignore all the rest of it for a while
meditation before because I had the book and I had the CDs…but it
reminded me of that and what I found from that was just how many
thoughts and sensations there were all the time and the first time I
did it I was almost overwhelmed by the barrage there was all the
time of things going on…and focussing on the small bits of the body
helped because I would just focus on that bit and ignore all the rest
of it for a while because there’s enough going on and I was also
aware that there are those sensations that you think about but
there’s a whole myriad of other things that you are not thinking
about…sometimes with good reason because say thinking about
your hands when you are just shaking them…there are things then
that I don’t want to feel like the pull on the joints and as they stretch
out…I really don’t need that kind of experience…im quite happy
letting that (kind of thing) go….
I thought having a regular time to go was a useful part of the
course and that being constant you knew when it was going to be
F5, Self awareness: of our experience de-clustered into thought s emotions etc
F6, Body scan as way to positively decentre from “all the rest of it for a while”
F7, structure of the course: regular time and home practice
F8, Acceptance (and lightness?) as embodiment in tutors( I think this title hits the nail on the head and can be applied to all the other scripts
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F7 I thought having a regular time to go was a useful part of the course and that being constant you knew when it was going to be and I liked the homework practice
F8 I liked the fact that it wasn’t too precious…you were quite accepting…no, very accepting when people…well, whatever people did was what they did and there wasn’t that sort of school attitude
F9 to know that this was what was going to happen next week and bringing that to the session…
and I liked the homework practice
I liked the fact that it wasn’t too precious…you were quite
accepting…no, very accepting when people…well, whatever people
did was what they did and there wasn’t that sort of school attitude of
why haven’t you done your 30 minutes…
Q: when you say that you found the regular structure of times
for the sessions and homework useful and helpful ….?In what
ways
A: Well I think what I mean buy that is the weekly structure…of
sessions… I knew they were coming up and unlike the period over
the xmas break (just gone) you didn’t have the sense that you’d just
forget…for a long period of time…(pause, quiet
F9, structure of course: (But I prompted this comment and the reply did not seem to have much energy around it)
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