J. Psych. Beh. Stud. Vol., 2 (2), 55-62, 2014
Effectiveness of Mindfulness-Based
Cognitive Therapy on Mindfulness
Awareness of Depressed Females
JOURNAL OF
JPBS
PSYCHOLOGY &
BEHAVIORAL STUDIES
Vol 2 (2): 55-62
http://www.jpbsjournal.com
ISSN: 2148-0664
Copyright © 2014
Azam Alsadat Bani Hashem1*, AliAsghar Abbasi Asfajir2,
Afsaneh Khajevand Khoshli3
1
Department of Psychology, Ayatollah Amoli Branch, Islamic Azad
University, Amol, Iran
2
Islamic Azad University, Babol Branch
3
Department of Psychology, Gorgan Branch, Islamic Azad University,
Gorgan, Iran
*
Corresponding Author: Azam Alsadat Bani Hashem
ABSTRACT The mindfulness meditation techniques help individual
to develop an observed subject separated from the contents of
consciousness and they may be useful cognitive-behavioral coping
strategies. Some other cognitive-behavioral psychotherapy such as
dialectic behavior therapy, acceptance and commitment therapy
also include mindfulness and acceptance strategies. The current
research aims to survey the effect of MBCT on mindfulness
awareness of non-patient depressed females. To this aim from 800
female visitors 210 individuals were randomly chosen and based on
drawing 32 individuals whose Beck depression scores were between
15 to 30 and higher were chosen and they were put into two
experimental and control groups, and after the beginning of training
at the desired stages (4th and 4th sessions and 30th and 50th day)
and after the end of training all individuals completed the Beck
Depression Inventory and Beck Mindfulness Awareness Scale. The
experimental group had 8 weekly sessions of two hours for
mindfulness training and the control group did not receive any
trainings. For analyzing data the t-test and two-way ANOVA test
with repeated measuring were used. Results showed that MBCT is
affective on the mindfulness awareness of depressed females. At the
end a few research suggestions are provided for the future studies.
KEYWORDS Mindfulness-Based Cognitive Therapy, Mindfulness
Awareness, Depression, Females.
INTRODUCTION
The term depression is used for different purposes and describing mood, detecting a syndrome
and as a concept in categorizing mental illnesses. Most people consider depressed mood as a
feeling of unhappiness or inability. This experience may include boredom, guilt, worthlessness,
self-despise, failure or indifference. There is not much disagreement about the constituent
elements of depressed mood and there are several scales available for measuring its severity
(Kenny & Williams, 2007). Sadness, frustration and despair in life accompanied by losing interest
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J. Psych. Beh. Stud. Vol., 2 (2), 55-62, 2014
on doing most of the activities, sleep disorders, impaired appetite, concentration and
energy are some of the most common mental problems of adolescence. Almost 15 to
20% of adolescents suffer from one or more depression events. Between 2 to 8% of
them have chronic depression and they are sad and blame themselves for several
months or sometimes several years. Mild symptoms of depression are in fact the natural
human response to several pressures of life. Lack of success in academic levels, loss of
dears, or awareness about the fact that by aging the human loses its abilities are some
of the situations often leading to depression. Depression is considered abnormal only
when it interferes with normal functioning and it continues for several weeks. Depressive
disorders are very common and about 17% of people have a period of severe depression
in their lifetime (Atkinson et al., 2000). Kessler et al (2005) designed a therapy called
MBCT in order to prevent from recurring of depression in individuals suffering from
depression, and this method of therapy is based on the differential activation hypothesis
of Interactive Cognitive Subsystems. Generally in this model the basic hypothesis is that
depression periods require a relationship between depressive mood and patterns of
negative thought. MBCT teaches the individual to reach a decentralized awareness of
physical sensations, thoughts and feelings and its aim is decentralization. This lets the
depressed individual to be aware of their thoughts and feelings at the first stages of
activation of depressive process and to put their mind out of automatic state, in other
words the aim of MBCT it to put the mind of wandering mood, because in depression the
mind is completely wandering.
Astin (1997) shows that mindfulness meditation techniques help individual to develop an
observed subject separated from the contents of consciousness and they may be useful
cognitive-behavioral coping strategies. Some other cognitive-behavioral psychotherapy
such as dialectic behavior therapy, acceptance and commitment therapy also include
mindfulness and acceptance strategies. Research results have shown that using the
mindfulness method results in decreasing the return of depression strikes and activate
an area in brain which is associated with positive emotions and beneficial effects of
operation immunization. Mindfulness awareness meditation is an important component
and an active part of MBCT (Clark et al., 1999). This meditation has short-term biological
and clinical effects and long-term physical and mental effects on the individual. One of
its main biological outcomes is increase of activity of alpha and beta waves in EEG
associated with deep relaxation and peace. Evidence based on neuroimaging show that
brain areas and sub-cortical structures engaged in mindfulness are thicker in
professional meditators compared to the control group, and there is no significant
decrease in their cerebral gray matter volume and mindfulness functions by increase of
age (Chiesa & Serretti, 2011).
Mindfulness awareness about the present time is a special quality of awareness and
attention to the experience of every moment of life (Abdi et al., 2008). Cognitive
psychologists use different explanatory models in order to explain factors affecting
awareness and enhancing awareness status. Along with this recently the concept of
mindfulness awareness has been proposed. Brown and Ryan defined the mindfulness
awareness as a special quality of awareness and attention to the experience of every
moment of life. Mindfulness awareness is the clear awareness about the present time
reality and awareness about the personal emotions. This concept is rooted in Buddhism
and other religious schools of thought in whom awareness is more actively promoted.
Lack of excessive preoccupation of mind with past or future, awareness about the
personal emotions, optimal performance of short-term memory in following up the
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current events, ability to concentrate on performing tasks, lack of acceleration if eating
food and automatic performance of daily tasks are some of the most important instances
of mindfulness awareness that provide the appropriate conditions for effectively dealing
with life problems and issues (Abdi et al., 2008). Several studies show that mindfulness
awareness training for the patients suffering from mood and anxiety disorders results in
significant improvement of mental health. Also its benefit as an intervention for a wide
range of chronic mental disorders has been proved. In all the therapies based on
mindfulness it has been recognized to be effective for a wide range of individuals
suffering from mood disorders, stress, eating disorders and prevention of recurring of
depression. Additionally mindfulness awareness is negatively associated with complains
about the physical symptoms. The enhancing mindfulness awareness approach is also
effective in decreasing the psychological distress related to chronic diseases. High
mindfulness awareness in patients suffering from cancer has a correlation with mood
disturbance and stress symptoms. From the Islamic perspective mindfulness awareness
is considered as one of the criteria for mental health. Basically the aware human being
breath in the present time and unhealthy human being is drowned in the past or future.
According to Grossmann and et al awareness about the every moment of life experiences
provides a more lively and effective sense of environment and also provides more
appropriate and practically effective perceptions of the world which result in a more
sense of control in the individuals (Filly et al., 2012).
Omidi et al (2008) surveyed the combinatory effectiveness in treatment of patients
suffering from active phase of depression. Results support the efficiency of combinatory
therapy in reducing symptoms, clinical syndromes, dedication of memory perplexity,
reducing the inefficient attitudes, being coping oriented, and coping strategies.
Mohammadkhani (2005) In Iran for the first time MBCT was introduced in 2003 in a joint
research between the University of Social Welfare & Rehabilitation Sciences and
University of Calgary in Canada. In this research the effectiveness of MBCT compared to
the new cognitive-behavioral therapy-based on prevention of depression recurring and
the conventional therapy (mostly medication) for treatment of patients suffering from
major depression in partial recovery phase was tested and findings showed that two
treatments of MBCT and CBT were significantly effective in reducing the remained
symptoms of depression and also other psychological symptoms. In a research Godfrin
and Heeringen (2010) surveyed the effectiveness of MBCT in depression recurring,
mental health and quality of life of 106 depressed patients. The effectiveness of MBCT
was evaluated in a 56 week period. The period of relapse/recurrence in the combinatory
group compared to the first group had been decreased and also a significant decrease
was observed in the short/long-term depressed mood and in contrast improved mood
states and better quality of life was observed in the combinatory group compared to the
first group.
Based on the mentioned subject matters and surveying the subject literature the present
study aims to survey the effect of group program of 8 weeks of MBCT on the intensive
training of mindfulness meditation integrated with cognitive-behavioral therapy on the
mindfulness awareness of non-patient depresses females.
MATERIALS AND METHODS
In the current research from the 800 female visitors 210 individuals were chosen based
on the sample size formula and the depression and mindfulness awareness
questionnaires were handed to them. After the initial screening 32 individuals whose
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scores were higher than the cut point and higher than the normal level were chosen and
they were randomly put into two 16-individual experimental and control groups. The
experimental group received 8, two hour sessions of MBCT training, and the control
group received none. After the 8 weeks of therapy again the experimental and control
group members completed the questionnaires and the required data were extracted and
processed via statistical program software. The resent research is an experimental
study, Research design includes pretest, posttest and control group and it consists of two
examinee groups and they are measured twice. The first measurement was conducted
by implementing a pretest and the second measurement was conducted after the
independent variable operation on experimental group with one posttest on both
experimental and control groups. The random sampling was used in order to create two
experimental and control groups. Half of the examinees were put in the 1 st group and
the other half were put in the 2nd group. By the use of random sampling both groups
were similar to each other and measurement of dependent variable for both of them
happens at the same time and under same conditions. Data collecting tools include Beck
Depression inventory-II, this questionnaire includes 21 items and the respondents are
asked to grade the severity of symptoms on a 0 to 3 scale (Beck and et al, 1996).
Recently a study has been conducted in Tehran University of Medical Sciences on
Roozbeh Hospital and the validity of this test has been 0.70 and the reliability has been
0.77 (Kaviani, 2008), another data collecting tools is Mindful Attention Awareness Scale
designed by Brown and Ryan in 2003 and it includes 15 single-agent items. Grading is
conducted positively and with a 6-degree Likert scale (1=almost always to 6=almost
never). The minimum and maximum score of each individual in this scale is from 15 to
90. Brown and Ryan stated that the internal consistency of this scale is 0. The validity
and reliability of the university sample for this scale was 82 and it was conducted by
Abdi in Iran, in which for surveying the construct validity the confirmatory factor analysis
based on the main components among MAAS showed that the Persian version of the
university students scale has an appropriate validity and it has internal consistency (Abdi
et al., 2008). In this research for comparing the effect of training the t-test has been
used, and for the independent samples the difference of scores of pretest and posttest or
follow-up were used. The variance analysis of repeated comparisons was used in a way
that group (experimental and control) was considered as the intergroup variable and the
session (pretest, 4th session, 8th session, 1st follow-up, 2nd follow-up) as the intragroup.
The statistical analysis was conducted by the use of SPSS16 software.
RESULTS
Table 1. Comparing the pretest and posttest of experimental group in test of
mindfulness scale.
Test
Pretest and posttest
Mean
55.4375
Mindfulness scale
Pretest and posttest Mean
Difference
df
Sig.
-1.10001
15
0.000
66.4375
Based on the results achieved from table 1 for mindfulness variable regarding the
calculated sig (sig=0.000) and (df=15) because the sig level is smaller than sig=0.005
thus statistically the calculated sig is significant. Thus it could be said that the
mindfulness awareness posttest scores of MBCT training group had a significant
difference with the pretest scores and by comparing the mean differences of group in
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J. Psych. Beh. Stud. Vol., 2 (2), 55-62, 2014
pretest and posttest it is determined that there is a difference between the mean of
mindfulness of MBCT training group in pretest and posttest and the amount is -1.10001
and statistically this difference is significant at level 0.01.
Table 2. Comparing the means of experimental and control group in test of mindfulness
scale.
Groups
Posttest of groups
Mean differences
2.62500
df
30
Sig.
0.001
Z
Based on the results achieved from table 2 for mindfulness variable regarding the
calculated sig (sig=0.001) and (df=30) because the sig level 0.000 is smaller than
sig=0.005 thus statistically the calculated sig is significant. Thus it could be said that the
mindfulness posttest scores of MBCT training group and control group had a significant
difference and by comparing the mean differences of both groups it is determined that
there is a difference between the mean of mindfulness of MBCT training group and
control group and the amount is 2.62500, and statistically this difference is significant at
level 0.01. Regarding the significance of mean differences with 0.99 confidence level it is
stated that research hypothesis based on the matter that MBCT results in increase of
mindfulness in non-patient depressed females is confirmed.
Table 3. Analysis of repeated comparisons of test of mindfulness.
Effect
Hotelling's Trace, Repeated analysis
of mindfulness scale
Source
Sphericity
Value
F
1.704
4.222
Type III Sum of Squares
1777.950
df
4
Sig.
0.023
F
3.497
Partial Eta Squared
0.585
Sig
0.012
Based on the sig=0.012 related to the test of sphericity there is the prerequisite for the
repeated comparisons. Based on the test of sphericity (1777.950) and df=4 and F=3.497
and sig=0.012 there is a significant difference in this process. In other words, regarding
the significance of repeated comparisons with 0.99 confidence level it could be stated
that research hypothesis based on the matter that MBCT results in increase of
mindfulness in non-patient depressed females is confirmed. In diagrams 1 and 2 the
mindfulness scale for both control and experimental groups is shown.
Figure 1. Analysis of repeated comparisons (Mindfulness scale of control group).
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Figure 2. Analysis of repeated comparisons (Mindfulness scale of experimental group).
DISCUSSION AND CONCLUSION
Mindfulness awareness meditation is an important component and an active part of
MBCT. This meditation has short-term biological and clinical effects and long-term
physical and mental effects on the individual. Mindfulness awareness about the present
time is a special quality of awareness and attention to the experience of every moment
of life. The current research aim was to study the effectiveness of MBCT on the
mindfulness awareness of depressed females. Results showed that MBCT results in
increase of mindfulness awareness of non-patient depressed females. This finding is
consistent with the research results of Evans et al (2007) and Craigie et al (2008). Also
in the department of conducted research in Iran in the field of current research it was
consistent with the research findings of Golpourchamhar Koohi and Mohammadamini
(2012).
In measuring the mean score of healthy population in mindfulness awareness (Brown &
Ryan, 2003), Ghasemipour and Ghorbani (2010) reached the score 4.35, which is close
to the mean scores of research of Evans et al (2007) 4.2, and it indicates that clients
reach these scores after receiving the MBCT and success in therapy. In order to explain
this finding that how the MBCT is effective in increase of mindfulness awareness in nonpatient depressed females it could be said that mindfulness skills and interpersonal
behavior (observing, describing, acting with awareness, and accepting without
judgment) result in better detection of physical sensations, anxiety, rumination, turmoil
and ultimately result in more self-mindfulness awareness. Nowadays it is believed that
mindfulness awareness increases the individual’s welfare. Researches show that negative
emotion, hostile rage, rumination, social anxiety and self-help are associated with lack of
mindfulness and positive emotion, optimism, self-esteem, attention and clarity have a
direct correlation with mindfulness (Strub, 2012).
Several studies show that mindfulness awareness training for the patients suffering from
mood and anxiety disorders results in significant improvement of mental health. Also its
benefit as an intervention for a wide range of chronic mental disorders has been proved.
In all the therapies based on mindfulness it has been recognized to be effective for a
wide range of individuals suffering from mood disorders, stress, eating disorders and
prevention of recurring of depression. Additionally mindfulness awareness is negatively
associated with complains about the physical symptoms.
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One of the limitations of this research was that based on the span and huge volume of
educational contents there was a limited time which was one of the main problems of the
current research preoccupying the current researcher’s mind and we cannot ignore the
effect of this factor in the research. Also the low number of possible sample limits the
generalizability of the results. The current research along with the similar researches
measures the effectiveness of all the implemented programs. In addition to the
researches concentrating on results it is better to conduct researches to determine the
effective processes or mechanisms of implementing these interventions. Also as a
process design it is recommended to determine which part of the program is more
effective and which part of the program is less effective. This could help to design more
beneficial and/or shorter programs in the future. At the end it is recommended to use
this training in training-therapy programs of different educational groups and to compare
their results with each other and with the control group.
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