Teacher Training

Mindfulness-Based Cognitive Therapy is Effective Regardless of Teacher Competence

psyjdc Leave a comment

Mindfulness-Based Cognitive Therapy is Effective Regardless of Teacher Competence

 

By John M. de Castro, Ph.D.

 

 “Over the past 15 years, the results of numerous randomized controlled trials have demonstrated that MBCT can be a powerful intervention for people who have experienced clinical depression three or more times. Evidence indicates MBCT may reduce the rate of relapse for individuals with recurrent depression by 50%. MBCT has also been applied to mood and anxiety concerns other than depression, with reported success.” – Good Therapy .org

 

Clinically diagnosed depression is the most common mental illness, affecting over 6% of the population. Major depression can be quite debilitating. It is also generally episodic, coming and going. Some people only have a single episode but most have multiple reoccurrences of depression.  Depression can be difficult to treat and usually treated with anti-depressive medication. But, of patients treated initially with antidepressant drugs only about a third attained remission of the depression. After repeated and varied treatments including antidepressant drugs, therapy, exercise etc. only about two thirds of patients attained remission. Also, many patients who achieve remission have relapses and recurrences of the depression. In addition, antidepressant drugs often have troubling side effects and can lose effectiveness over time.

 

Being depressed and not responding to treatment or relapsing is a terribly difficult situation. The patients are suffering and nothing appears to work to relieve their intense depression. Suicide becomes a real possibility. So, it is imperative that other treatments be identified. Mindfulness training is another alternative treatment for depression. It has been shown to be an effective treatment for depression and is also effective for the prevention of its recurrence. Mindfulness Based Cognitive Therapy (MBCT) was specifically developed to treat depression and can be effective even in the cases where drugs fail. MBCT is usually delivered by trained certified teachers but is fairly scripted and standardized. So, it is unclear what the importance of the level of teacher training and competence is.

 

In today’s Research News article “Teacher Competence in Mindfulness-Based Cognitive Therapy for Depression and Its Relation to Treatment Outcome.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5506231/, Huijbers and colleagues examine the importance of the competence of the MBCT teacher in the effectiveness of MBCT for depression. They recruited patients who had had at least 3 episodes of depression, were in remission, taking antidepressants, and were engaged in a Mindfulness Based Cognitive Therapy (MBCT) program. MBCT was delivered in of 8 weekly sessions of 2.5 hours.

 

Patients were measured before and after MBCT training and 15 months later for rumination, self-compassion, mindfulness, cognitive reactivity, depressive symptoms, and depression relapse. The MBCT teachers were assessed for competence by two independent professional evaluators who rated a tape recorded MBCT session for “(1) coverage, pacing, and organization of session curriculum; (2) relational skills; (3) embodiment of mindfulness; (4) guiding mindfulness practices; (5) conveying course themes through interactive inquiry and didactic teaching; and (6) holding of group learning environment.” An overall competence rating was calculated as the sum of the 6 component competence scores.

 

They found that following treatment there were significant increases in patient self-compassion and mindfulness and significant decreases in rumination and cognitive reactivity. They also found that teacher competence did not significantly predict the number of sessions that the patients attended, and patient changes in self-compassion, mindfulness, rumination, and cognitive reactivity, or depression severity. In addition, the likelihood of relapse during the 15 month follow-up period was not significantly related to teacher competence. This was true for the overall competence and for each of the 6 competence domains.

 

These results are quite remarkable and suggest that the level of competence and expertise of the instructors in Mindfulness Based Cognitive Therapy (MBCT) does not affect the patient outcomes. These results are contrary to the recent findings that the level of teacher training with Mindfulness-Based Stress Reduction (MBSR) programs is associated with the effectiveness of the program to reduce stress and improve well-being.

 

It’s difficult to reach firm conclusion from the negative results of the present study as the range of teacher competencies was restricted wherein only 2 teachers were characterized as beginner and 2 as advanced. The lack of effect of teacher competence may also be due to the fact that MBCT programs are highly standardized and scripted by the treatment protocol and that patients are supplied with prerecorded materials for home practice. Nevertheless, the results suggest that only modest teacher competence and training is sufficient, with a standardized program, to produce maximal results.

 

So, it appears that Mindfulness-Based Cognitive Therapy is effective regardless of teacher competence.

 

“MBCT teaches people to pay attention to the present moment, rather than worrying about the past or the future, and to let go of the negative thoughts that can tip them over into depression. It also gives people a greater awareness of their own body, helping them to identify the signs of oncoming depression and ward off the episode before it starts.” – BeMindful

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Huijbers, M. J., Crane, R. S., Kuyken, W., Heijke, L., van den Hout, I., Donders, A. R. T., & Speckens, A. E. M. (2017). Teacher Competence in Mindfulness-Based Cognitive Therapy for Depression and Its Relation to Treatment Outcome. Mindfulness, 8(4), 960–972. http://doi.org/10.1007/s12671-016-0672-z

 

Abstract

As mindfulness-based cognitive therapy (MBCT) becomes an increasingly mainstream approach for recurrent depression, there is a growing need for practitioners who are able to teach MBCT. The requirements for being competent as a mindfulness-based teacher include personal meditation practice and at least a year of additional professional training. This study is the first to investigate the relationship between MBCT teacher competence and several key dimensions of MBCT treatment outcomes. Patients with recurrent depression in remission (N = 241) participated in a multi-centre trial of MBCT, provided by 15 teachers. Teacher competence was assessed using the Mindfulness-Based Interventions: Teaching Assessment Criteria (MBI:TAC) based on two to four randomly selected video-recorded sessions of each of the 15 teachers, evaluated by 16 trained assessors. Results showed that teacher competence was not significantly associated with adherence (number of MBCT sessions attended), possible mechanisms of change (rumination, cognitive reactivity, mindfulness, and self-compassion), or key outcomes (depressive symptoms at post treatment and depressive relapse/recurrence during the 15-month follow-up). Thus, findings from the current study indicate no robust effects of teacher competence, as measured by the MBI:TAC, on possible mediators and outcome variables in MBCT for recurrent depression. Possible explanations are the standardized delivery of MBCT, the strong emphasis on self-reliance within the MBCT learning process, the importance of participant-related factors, the difficulties in assessing teacher competence, the absence of main treatment effects in terms of reducing depressive symptoms, and the relatively small selection of videotapes. Further work is required to systematically investigate these explanations.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5506231/

Teacher Training Improves the Effectiveness of Mindfulness Training

psyjdc Leave a comment

Teacher Training Improves the Effectiveness of Mindfulness Training

 

By John M. de Castro, Ph.D.

 

“Ultimately, it is the depth of your own personal commitment to learning, growing and healing – as well as a dedication to the well-being of others – that will contribute most to your integrity and effectiveness as a teacher.” ~Center for Mindfulness, UMass Medical Center

 

“Mindfulness is awareness that arises through paying attention, on purpose, in the present moment, non-judgmentally. It’s about knowing what is on your mind.” (Jon Kabat-Zinn). It has been shown to be highly related to the health and well-being of the individual. Mindfulness training has also been found to be effective for a large array of medical and psychiatric conditions, either stand-alone or in combination with more traditional therapies. As a result, mindfulness training has been called the third wave of therapies. In fact, though, little is known about the components that maximize the effectiveness of mindfulness training.

 

Mindfulness-Based Stress Reduction (MBSR) is a classic mindfulness training that combines meditation, yoga, and body scan meditation practices. In most cases MBSR is conducted by a certified trained therapist. But, recently, it has been shown to be effective when presented on-line without the presence of an instructor. When MBSR is taught live by a certified instructor is costly and many clients can’t afford it. In addition, the participants must be available to attend multiple sessions at particular scheduled times that may or may not be compatible with their busy schedules or at locations that may not be convenient. But many believe that that the interpersonal interactions, compassion, understanding, and modelling provided by a teacher is crucial for MBSR effectiveness. So, it is unclear whether the presence of an instructor produces benefits that balance or exceed the added costs.

 

In today’s Research News article “Impact of Mindfulness-Based Teacher Training on MBSR Participant Well-Being Outcomes and Course Satisfaction.” (See summary below). Ruijgrok-Lupton and colleagues examined whether the amount of training that MBSR instructors have received is associated with improved outcomes. They recruited Mindfulness-Based Stress Reduction (MBSR) certified instructors who varied in the amount of training either Basic Teacher Training (Level 1), Advanced Teacher Training (Level 2) or Advanced Teacher Training with Continuing Professional Development (Level 3). They then recruited participants who were attending one of the instructors’ 8-week MBSR classes. They measured the participants before and after the class for mindfulness, self-compassion, well-being, perceived stress, and teacher satisfaction including impact on daily life and teacher support.

 

There were too few teachers in the Level 1 group (n=2), so comparisons were restricted to the Level 2 and Level 3 groups. They found that overall the participants in the MBSR classes not surprisingly showed significant gains in mindfulness and reductions in perceived stress. Importantly, they also found that the participants in the MBSR classes taught by Level 3 teachers had significantly greater gains in well-being and significantly greater reductions in perceived stress than those taught by Level 2 teachers. In addition, the participants in the MBSR classes taught by Level 3 teachers indicated significantly greater satisfaction with their teachers than those taught by Level 2 teachers.

 

The findings suggest that MBSR teachers with advanced teacher training plus continuing professional development produce better results than teachers with advanced teacher training only. The lack of a sufficient number of teachers with only basic teacher training was disappointing since this greatly restricted the range of teacher training levels. But, the fact that only adding continuing professional development to advanced teacher training had significant effects is striking. After all, both groups are highly professionally trained. These results, then, clearly suggest that the greater the training, even of highly trained teachers, of the MBSR teachers the greater their effectiveness. Future research should include more basic level instructors and an on-line comparison condition.

 

But, it’s clear that teacher training improves the effectiveness of mindfulness training.

 

“The teaching of mindfulness is never a matter of merely teaching or operationalizing techniques. Mindfulness is a way of being in a wiser relationship to one’s experience, not one particular mental state to be pursued and attained. Thus, the non-instrumental dimensionality of the work and of the practice of mindfulness is the foundation of effective practice and teaching.” – Jon Kabat-Zinn

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Ruijgrok-Lupton, P.E., Crane, R.S. & Dorjee, D. Impact of Mindfulness-Based Teacher Training on MBSR Participant Well-Being Outcomes and Course Satisfaction. Mindfulness (2017). doi:10.1007/s12671-017-0750-x

 

Abstract

Growing interest in mindfulness-based programs (MBPs) has resulted in increased demand for MBP teachers, raising questions around safeguarding teaching standards. Training literature emphasises the need for appropriate training and meditation experience, yet studies into impact of such variables on participant outcomes are scarce, requiring further investigation. This feasibility pilot study hypothesised that participant outcomes would relate to teachers’ mindfulness-based teacher training levels and mindfulness-based teaching and meditation experience. Teachers (n = 9) with different MBP training levels delivering mindfulness-based stress reduction (MBSR) courses to the general public were recruited together with their course participants (n = 31). A teacher survey collected data on their mindfulness-based teacher training, other professional training and relevant experience. Longitudinal evaluations using online questionnaires measured participant mindfulness and well-being before and after MBSR and participant course satisfaction. Course attendees’ gains after the MBSR courses were correlated with teacher training and experience. Gains in well-being and reductions in perceived stress were significantly larger for the participant cohort taught by teachers who had completed an additional year of mindfulness-based teacher training and assessment. No correlation was found between course participants’ outcomes and their teacher’s mindfulness-based teaching and meditation experience. Our results support the hypothesis that higher mindfulness-based teacher training levels are possibly linked to more positive participant outcomes, with implications for training in MBPs. These initial findings highlight the need for further research on mindfulness-based teacher training and course participant outcomes with larger participant samples.