RANDOM ACT & MINDFULNESS

COUNSELLING AND PSCYHOLOGICAL SERVICES, 2010

Overview of Study

› A series of ‘Mindfulness Training’ courses were advertised and provided for 246 students from Jan 2009- Dec 2010

› Courses were either a manualised ACT or MBCT program and these conditions were offered in a randomised order.

› Each course had 6 weekly sessions of 2 hour duration

› Sessions were provided by two therapists for up to 20 participants

Modifications for Students

MBSR

› Shorter format – sessions 2-3 and sessions 7-8 collapsed

› Reduced expectation for long formal practice/ flexibility re home practice

› Didactic components of program adjusted for students/uni context/anxiety, depression, stress

› Meditation and exploration of meditation experience was still the central component of this program

ACT

› Similar theme as MBCT used for each group

› Less emphasis on extended mindfulness practice. Same CD given.

› Greater use of metaphor

› Active experiences

› Values work

Research questions

› Are MBCT and ACT useful for this population? Do they decrease stress, anxiety and depression?

› Is one more suitable than the other or is it dependant on student's presenting issues or personality traits?

› Do these compressed versions of MBCT and ACT increase mindfulness and acceptance?

Measures – Pre, Post, 3mth Post

› The Depression, Anxiety Stress Scale (Lovibond, P. F.,1998).

› SQ10 (QOL)

› Ten Item Personality Inventory (Gosling, S. D., et al, 2003).

› Toronto Mindfulness Scale (Lau et al 2006)

› Five Factor Mindfulness Questionnaire (Baer, R et al ,2006)

› Acceptance Action Questionnaire –II (Bond, F. W., et al,in press).

Sample Characteristics

MBCT n = 114 ACT n = 132

67% Female 76% Female

83% Single 81% Single

Age 26.1 (7.5) Age 25.9 (7.4)

Uni Yr 3.2 (1.5) Uni Yr 3.5 (1.6)

Student Faculty

MBCT ACT

Arts 31% Arts 29%

Science 26% Science 21%

Health 12% Bus/Econ 18%

Bus/Econ 11% Health 9%

Other 20% Other 23%

Student Personality Traits

MBCT ACT

Extraversion 8.6 (0.3) 8.1 (0.4)

Agreeableness 10.1 (0.3) 10.0 (0.2)

Conscientiousness 8.4 (0.3) 9.7 (0.4)*

Emotional stability 7.8 (0.3) 6.3 (0.3)*

Openness 9.4 (0.3) 10.5 (0.3)*

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Attrition

› Many students attended the first session and then did not continue. There was no significant difference between dropout rates between conditions.

MBCTACT

Enrolled: 114132

Attended 1st session & Questionnaire: 72 64

Attended 3+ sessions & Questionnaire: 4945

› Non-attendance tended to be common as assessment periods approached.

Results & Effect sizes

› No significant difference between MBCT and ACT conditions

› Both conditions associated with significant decrease in stress, anxiety & depression. And significant increase in mindfulness & acceptance                            

  Mindfulness     ACT Stress          0.64 0.67                    

   Anxiety          0.96 0.48      Depression    0.48 0.63         DASS_Total      0.85 0.72       

TMS                 0.71 1.04     FFMQ                0.99                  1.49        AAQ-II              1.04 0.93*   

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Personality Traits X Group Allocation XTreatment Gains

› Students with higher levels of Openness reported significantly higher reductions in anxiety across groups (p=0.04) and there is a trend for these students doing better when allocated to the MBCT condition (p=0.058)

› No other significant differences in treatment gains or group allocation associated with the personality traits of students

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Facilitation Experience: Hard work

› Students experienced interactions in group sessions challenging: › Lecture mode = auto pilot in sessions

- Dependent/passive learners eg. “I hoped someone would tell me what to do”- External locus of control - A tendency for intellectualising

› Absence of contact with their experience

› Interaction varied widely with diagnostic factors - Some ‘Shut down’, ‘nothingness’, ‘flat’ . Others too anxious/evaluating self too much to contribute

› Low levels of home practice meant that periods of enquiry were limited

› Low participation at times...yet say that they are getting a lot out of it?

Qualitative Results - MBCT

› I expected this course to ‘cure me’. I was looking for a quick fix. I learnt that others can’t fix me unless I start the process from within.

› The course has taught me to tame my mind. To stop, look and listen and become more involved.

› I began to realise during this course that I am not my emotions... I think it has been difficult for me in the past to see anything else. This semester I have only had one or two days where I feel lost in my emotions.. Last semester it was every day.

› It was the most positive, supportive and encouraging time in my university week

Qualitative Results - MBCT

› I have realised that achieving success at uni is not all that I want. I want my life to be about much more than that.

Values

Defusion Fusion

Qualitative Results - ACT

› I am not ruled by my thoughts and feelings. I have all these ‘passengers’ that I can cope with.

› My anxiety and worries were really holding me back from living my life. I have begun to understand myself better and develop acceptance

Qualitative Results - ACT

› I have done self-help things before and had a problem with the way you had to change negative things. I liked the fearless part of the course – that it is ok to have negative things, that they will make up part of your life.

› This course has reminded me why I am here.

Acceptance based processes

› Experiential avoidance

› Fusion

› Acceptance

› Defusion

Self struggle

Self struggle

Openness to

experience

Openness to

experience

Successful living

Successful living

Values: Personally meaningful projects

› Student are psychologically inflexible due to focus on short term goals i.e. next assignment vs broader issues of life and values. Narrow focus on academic success due to academic context. However can experience open aware active approach to living

› As people grow older may be more orientated to issues that satisfy deeper psychological needs and less interested in short term superficial or achievement needs.

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Transdiagnostic

› Idea of common processes useful but our experience need to address specific features such as flatness in depression and feeling overwhelmed in anxiety.

› MBCT built for those with longer term pattern

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Conclusions: Building skills for wellbeing

› Acceptance based therapies are effective in the university context: Training attention to be accepting, caring and discerning provide beneficial states of mind

› Acceptance based therapies are based on positive health model not a disease model.

› Target a risk factor EA that is relevant for various conditions and appears to have transdiagnostic relevance.

› Group based interventions may be useful in providing greater sense of community and are cost effective.

› Personality traits – levels of openness…

Future Directions: Secrets of the Mind

› Acceptance & Commitment Therapy may be more suitable for this setting

- For ease of facilitation and to maximise group interaction

- Due to longer training requirements for MBCT

› Intervention options to address attrition:

- Suggestion for one off ‘taster’ session prior to enrolling in such a course to address initial drop out

- Course recruitment should occur as close as possible to course start

- Importance of having a motivational component of sessions

- Ongoing mindfulness group drop- in program

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