An randomised controlled trial of a self-help
mindfulness book for student stress
Billie Lever Taylor (University of Surrey)
Clara Strauss (Sussex Partnership & University of Surrey)
Fergal Jones (Sussex Partnership & CCCU)
Kate Cavanagh (University of Sussex)
MARS Conference
16 November 2012
Billie Lever Taylor
Kate Cavanagh
What is mindfulness?
• Mindfulness has been defined as the capacity to intentionally pay
attention to current experience non-judgementally (Kabat-Zinn, 1994)
• Mindfulness skills can be cultivated through mindfulness practice (formal
and informal) and reflection on practice
A mindfulness practice ...
Mindfulness – psychological mechanisms?
• Reducing rumination
• Changing meta-cognitive beliefs about the importance of thoughts
• Increasing self-compassion
Mindfulness-Based Therapies
• Mindfulness practice and principles have been incorporated into therapies
for over 30 years.
• MBSR and MBCT are 8-session group interventions comprising of a
range of practices (in session and at home) and reflections on practice
• PBCT, DBT and ACT also include mindfulness practice and principles
Outcomes for Depression
• MBCT in comparison to TAU halves the risk of relapse over 12 months for
people with three or more episodes of depression (Ma & Teasdale, 2004)
• MBCT is equivalent to anti-depressant medication in preventing relapse
from depression (Kuyken et al, 2010)
• MBCT reduces symptoms of depression for people currently depressed in
comparison to treatment as usual (Barnhofer et al, 2009)
Accessing mindfulness-based therapies
• Governance criteria for MBCT and MBSR group facilitators are
necessarily strict (not easy to roll out quickly)
• There may be practical barriers to attending groups (work, childcare, cost
for non-NHS groups)
• Not everyone is willing to attend a group-based intervention
Increasing Access: Self-Help Mindfulness-Based Interventions
• Large number of self-help mindfulness resources including books (e.g.
Williams & Penman, 2011) and internet-based (www.bemindful.co.uk)
• Acceptability and effectiveness has only begun to be explored (e.g.
Krusche et al, 2012), with the focus on internet-based interventions
• Not everyone has access to the internet or would find an internet based
intervention acceptable.
Self-Help Mindfulness-Based Bibliotherapy
• There is no published evaluation to our knowledge of a self-help
mindfulness book
• RCTs of ACT self-help books in non-clinical populations showing benefits
in comparison to no-intervention (Fledderus et al, 2012; Jeffcoat & Hayes,
2012). BUT mindfulness was not the focus of these interventions and they
had limited or no formal mindfulness practice
• This current study is an RCT of a mindfulness self-help book.
Current Study Aims and Design
• To evaluate a self-help mindfulness book for students experiencing stress
• 80 student participants self-identifying as experiencing stress
• Randomised to receive the book with automated weekly support or to a
no-intervention control group
• 8 weeks to read the book (one chapter per week) and to use the
accompanying mindfulness practice CD
Measures
Measures at baseline, at post-group (8 weeks) and at 10-week follow-up:
Psychological wellbeing:
• Depression Anxiety Stress Scales, Positive and Negative Affect Scales
Quality of Life
• Satisfaction with Life Questionnaire
Mechanisms of Change
•Five-facet mindfulness questionnaire, Self-Compassion Scale
•
Additional Measures
• Also measures of:
• Expectation of benefit at baseline
• Engagement with the intervention
• Number of chapters read
• Amount of mindfulness practice
Early Findings
• After 41 participants have completed pre and post measures
• Follow-up data not yet available
• Full findings will be available in early 2013
• Per-protocol findings are reported here, ITT will be reported in final analysis
Psychological Wellbeing Outcomes...
DASS Stress Scale
There is a significant time*group
interaction (F(1,39)=13.2,
p=.001).
There were greater reductions in
stress in the mindfulness group
with a very large effect size
(t(20)=7.76, p<.001, d=1.75) than
in the control group (t(19)=2.73,
p=.013, d=0.49).
That is, mindfulness participants
showed significantly greater
improvements in stress than the
no-intervention participants.
DASS Depression Scale
There is a significant time*group
interaction (F(1,39)=7.57,
p=.009).
There were greater reductions in
depression in the mindfulness
group with a large effect size
(t(20)=4.56, p<.001, d=0.85) than
in the control group (t(19)=1.78,
p=ns, d=0.18).
That is, mindfulness participants
showed significantly greater
reductions in depressive
symptoms than the nointervention participants.
DASS Anxiety Scale
There is a time*group interaction
that approaches significance
(F(1,39)=3.54, p=.067).
There were greater reductions in
anxiety in the mindfulness group
with a large effect size
(t(20)=4.87, p<.001, d=1.09) than
in the control group (t(19)=2.19,
p=0.041, d=0.39).
That is, mindfulness participants
showed greater reductions in
anxiety symptoms than the nointervention participants, but this
effect is only approaching
significance.
Satisfaction with Life Outcomes...
Satisfaction With Life Scale
There is a significant time*group
interaction (F(1,39)=17.23,
p<.001).
There were greater improvements
in satisfaction with life in the
mindfulness group with a large
effect size (t(20)=-4.91, p<.001,
d=0.98) than in the control group
(t(19)=0.00, p=1.00, d=0.00).
That is, mindfulness participants
showed significantly greater
improvements in satisfaction with
their lives than the no-intervention
participants.
Potential Mechanisms of Change...
Self-Compassion Scale
There is a significant time*group
interaction (F(1,39)=15.65,
p<.001).
There were greater improvements
in self-compassion in the
mindfulness group with a very
large effect size (t(20)=-6.11,
p<.001, d=1.67) than in the control
group (t(19)=-1.27, p=0.22,
d=0.23).
That is, mindfulness participants
showed significantly greater
improvements in self-compassion
than the no-intervention
participants. We will explore if selfcompassion is a possible mediator
of change in the full analysis.
•FFMQ data has yet to be coded but we plan to look at this data
in the full analysis and to see if improvements in mindfulness
are related to improvements in psychological wellbeing and in
satisfaction with life.
Conclusions to date ...
•Initial findings suggest that the self-help mindfulness book resulted in
significant improvements in stress, depression and satisfaction with life and
with self-compassion in comparison to no intervention.
• Full findings will be from 80 participants and will include 10-week followup data in order to see if changes are maintained after the end of the study.
Next Steps
• The research team are currently applying for funding to evaluate the selfhelp book using the same design for people experiencing sub-threshold,
mild or moderate depression.
•The clinical intervention will include weekly contact with a PWP (no more
than 10 minutes a week)
• Depending on findings, this research has the potential to lead to an
increase in access to mindfulness-based therapies.
Final points
• Early findings suggest promise for a self-help mindfulness book in
improving psychological wellbeing, satisfaction with life and selfcompassion.
• However, the self-intervention lacks the group context and facilitator
guidance that is central to MBCT and MBSR.
• Self-help mindfulness interventions may be one way to increase access to
mindfulness approaches but are not a substitute for therapy groups.