Mindfulness-Based Cognitive Therapy: A Case Study on Experiences of Healthy Behaviors by Clients in Psychiatric Care
Affiliation(s)
1 Center for Research and Development, Evidens University College, Goteborg, Sweden. 2 Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden.
1 Center for Research and Development, Evidens University College, Goteborg, Sweden. 2 Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden.
ABSTRACT
The aim of the study was for the first time to investigate patients’ own experiences of developing healthy behavior in connection with their participation in Mindfulness-Based Cognitive Therapy (MBCT). Healthy behaviors were defined as those which aimed to improve the individual’s well-being and physical function. Two women, diagnosed with bipolar illness or depressive episodes, were recruited from a group of clients in psychiatric care who both had been treated according to MBCT. The two clients shared their views of what changes they experienced during the treatment in semi structured interviews. Data analysis was performed according to the Empirical Phenomenological Psychological (EPP) method. The analysis generated five main themes which were shown to create a causal chain where paths to healthy behavior contributed to a process of change which was mirrored in comprehensive distancing, which in turn facilitated a reduced tendency of illness-identity and the acquiring of new proficiencies which could be generalized to different situations in daily life which led to insights about healthier behavior.
The aim of the study was for the first time to investigate patients’ own experiences of developing healthy behavior in connection with their participation in Mindfulness-Based Cognitive Therapy (MBCT). Healthy behaviors were defined as those which aimed to improve the individual’s well-being and physical function. Two women, diagnosed with bipolar illness or depressive episodes, were recruited from a group of clients in psychiatric care who both had been treated according to MBCT. The two clients shared their views of what changes they experienced during the treatment in semi structured interviews. Data analysis was performed according to the Empirical Phenomenological Psychological (EPP) method. The analysis generated five main themes which were shown to create a causal chain where paths to healthy behavior contributed to a process of change which was mirrored in comprehensive distancing, which in turn facilitated a reduced tendency of illness-identity and the acquiring of new proficiencies which could be generalized to different situations in daily life which led to insights about healthier behavior.
Cite this paper
Ingvarsson, T. , Nordén, T. and Norlander, T. (2014) Mindfulness-Based Cognitive Therapy: A Case Study on Experiences of Healthy Behaviors by Clients in Psychiatric Care. Open Journal of Medical Psychology, 3, 390-402. doi: 10.4236/ojmp.2014.35041.
Ingvarsson, T. , Nordén, T. and Norlander, T. (2014) Mindfulness-Based Cognitive Therapy: A Case Study on Experiences of Healthy Behaviors by Clients in Psychiatric Care. Open Journal of Medical Psychology, 3, 390-402. doi: 10.4236/ojmp.2014.35041.
References
[1] Plank, K. (2012) Modernamyterom Mindfulness [Modern Myths of Mindfulness]. Lakartidningen, 43, 1968-1970. [2] Kabat-Zinn, J. (2003) Mindfulness-Based Interventions in Context: Past, Present, and Future. Clinical Psychology: Science and Practice, 10, 144-156.
http://dx.doi.org/10.1093/clipsy.bpg016 [3] Kahl, K.G., Winter, L., Schweiger, U. and Sipos, V. (2011) The Third Wave of Cognitive-Behavioral Psychotherapies: Concepts and Efficacy. Fortschritte der Neurologie-Psychiatrie, 79, 330-339.
http://dx.doi.org/10.1055/s-0029-1245963 [4] Segal, Z.W., Williams, J.M. and Teasdale, J.D. (2002) Mindfulness-Based Cognitive Therapy for Depression. A New Approach to Preventing Relapse. The Guilford Press, New York. [5] Hopko, D.R., Lejuez, C.W., Ruggiero, K.J. and Eifert, G.H. (2003) Contemporary Behavioral Activation Treatments for Depression: Procedures, Principles, and Progress. Clinical Psychology Review, 23, 699-717.
http://dx.doi.org/10.1016/S0272-7358(03)00070-9 [6] Fjorback, L.O., Arendt, M., Ornbol, E., Fink, P. and Walach, H. (2011) Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy—A Systematic Review of Randomized Controlled Trails. Acta Psychiatrica Scandinavica, 124, 102-119.
http://dx.doi.org/10.1111/j.1600-0447.2011.01704.x [7] Beck, A.T. and Alford, B.A. (2009) Depression Causes and Treatment. University of Pennsylvania Press, Philadelphia. [8] Lau, M.A., Zindel, V., Segal, J. and Williams, M.G. (2004) Teasdale’s Differential Activation Hypothesis: Implications for Mechanisms of Depressive Relapse and Suicidal Behavior. Behavior Research and Therapy, 42, 1001-1017.
http://dx.doi.org/10.1016/j.brat.2004.03.003 [9] Segal, Z.V. and Ingram, R.E. (1994) Mood Priming and Construct Activation in Tests of Cognitive Vulnerability to Unipolar Depression. Clinical Psychology Review, 14, 663-695.
http://dx.doi.org/10.1016/0272-7358(94)90003-5 [10] Post, R.M. (1992) Transduction of Psychosocial Stress into the Neurobiology of Recurrent Affective Disorder. American Journal of Psychiatry, 149, 999-1010. [11] Post, R.M., Rubinow, D.R. and Ballenger, J.C. (1986) Conditioning and Sensitization in the Longitudinal Course of Affective Illness. British Journal of Psychiatry, 149, 191-201.
http://dx.doi.org/10.1192/bjp.149.2.191 [12] Ehnvall, A. and Agren, H. (2002) Patterns of Sensitization in the Course of Affective Illness. A Life-Charting Study of Treatment-Refractory Depressed Patients. Journal of Affective Disorders, 70, 67-75.
http://dx.doi.org/10.1016/S0165-0327(01)00328-7 [13] Nolen-Hoeksema, S. (2000) The Role of Rumination in Depressive Disorders and Mixed Anxiety/Depressive Symptoms. Journal of Abnormal Psychology, 109, 504-511.
http://dx.doi.org/10.1037/0021-843X.109.3.504 [14] Teasdale, J.D., Segal, Z.W., Williams, J.M., Ridgeway, V.A., Soulsby, J.M. and Lau, M.A. (2000) Prevention of Relapse/Recurrence in Major Depression by Mindfulness-Based Cognitive Therapy. Journal of Consulting and Clinical Psychology, 68, 615-623.
http://dx.doi.org/10.1037/0022-006X.68.4.615 [15] Ma, S.H. and Teasdale, J.D. (2004) Mindfulness-Based Cognitive Therapy for Depression: Replication and Exploration of Differential Relapse Prevention Effects. Journal of Consulting and Clinical Psychology, 72, 31-40.
http://dx.doi.org/10.1037/0022-006X.72.1.31 [16] Piet, J. and Hougaard, E. (2011) The Effect of Mindfulness-Based Cognitive Therapy for Prevention of Relapse in Recurrent Major Depressive Disorder: A Systematic Review and Meta-Analysis. Clinical Psychology Review, 31, 1032-1040.
http://dx.doi.org/10.1016/j.cpr.2011.05.002 [17] Chiesa, A. and Serretti, A. (2010) Mindfulness Based Cognitive Therapy for Psychiatric Disorders: A Systematic Review and Meta-Analysis. Psychiatry Research, 187, 441-453.
http://dx.doi.org/10.1016/j.psychres.2010.08.011 [18] Kuyken, W., Watkins, E., Holden, E., White, K., Taylor, R.S., Byford, S., Evans, A., Radford, S., Teasdale, J.D. and Dalgleish, T. (2010) How Does Mindfulness-Based Cognitive Therapy Work? Behavior Research and Therapy, 48, 1105-1112.
http://dx.doi.org/10.1016/j.brat.2010.08.003 [19] Brown, K.W. and Ryan, R.M. (2003) The Benefits of Being Present: Mindfulness and Its Role in Psychological Well-Being. Journal of Personality and Social Psychology, 84, 822-848.
http://dx.doi.org/10.1037/0022-3514.84.4.822 [20] Bengtsson, L. and Odéhn, E. (2010) Experiences of Group Treatments Behavioral Activation and Mindfulness-Based Cognitive Therapy for Intractable Depression. Goteborg University, Goteborg. [21] Finucane, A. and Mercer, S.W. (2006) An Exploratory Mixed Methods Study of the Acceptability and Effectiveness of Mindfulness-Based Cognitive Therapy for Patients with Active Depression and Anxiety in Primary Care. BMC Psychiatry, 6, 14.
http://dx.doi.org/10.1186/1471-244X-6-14 [22] Allen, M., Bromley, A., Kuyken, W. and Sonnenberg, S.J. (2009) Participants’ Experiences of Mindfulness-Based Cognitive Therapy: “It Changed Me in Just about Every Way Possible”. Behavioural and Cognitive Psychotherapy, 37, 413-430.
http://dx.doi.org/10.1017/S135246580999004X [23] Bailie, C., Kuyken, W. and Sonnenberg, S. (2012) The Experience of Parents in Mindfulness-Based Cognitive Therapy. Clinical Child Psychology and Psychiatry, 17, 103-119.
http://dx.doi.org/10.1177/1359104510392296 [24] Hertenstein, E., Rose, N., Voderholzer, U., Heidenreich, T., Nissen, C., Thiel, N., Herbst, N. and Kulz, A.K. (2012) Mindfulness-Based Cognitive Therapy in Obsessive-Compulsive Disorder—A Qualitative Study Concerning Patients’ Experience. BMC Psychiatry, 12, 185.
http://dx.doi.org/10.1186/1471-244X-12-185 [25] Mason, O. and Hargreaves, I. (2001) A Qualitative Study of Mindfulness-Based Cognitive Therapy for Depression. British Journal of Medical Psychology, 74, 197-212.
http://dx.doi.org/10.1348/000711201160911 [26] Karlsson, G. (1993) Psychological Qualitative Research from a Phenomenological Perspective. Alqvist & Wiksell International, Stockholm. [27] Edebol, H., Bood, S.A. and Norlander, T. (2008) Chronic Whiplash Associated Disorders and Their Treatment Using Flotation-REST (Restricted Environmental Stimulation Technique). Qualitative Health Research, 18, 480-488.
http://dx.doi.org/10.1177/1049732308315109 [28] Niklasson, M., Niklasson, I. and Norlander, T. (2010) Sensorimotor Therapy: Physical and Psychological Regressions Contributes to an Improved Kinesthetic and Vestibular Capacity in Children and Adolescents with Motor Difficulties and Concentration Problems. Social Behavior and Personality, 38, 327-346.
http://dx.doi.org/10.2224/sbp.2010.38.3.327 [29] Nordén, T., Eriksson, A., Kjellgren, A. and Norlander, T. (2012) Involving Clients and Their Relatives and Friends in the Psychiatric Care: Case Managers’ Experiences of Training in Resource Group Assertive Community Treatment. PsyCh Journal, 1, 15-27.
http://dx.doi.org/10.1002/pchj.1 [30] Nyklicek, I. (2010) Mindfulness, Emotion Regulation and Well-Being. In: Nyklícek, I., Vingerhoets, A. and Zeelenberg, M., Eds., Emotion Regulation and Well-Being, Springer Science and Business Media, New York, 101-118. [31] Branstrom, R., Kvillemo, P., Brandberg, Y. and Moskowitz, J.T. (2010) Self-Report Mindfulnes as a Mediator of Psychological Well-Being in a Stress Reduction Intervention for Cancer Patients. A Randomized Study. Annals of Behavioral Medicine, 39, 151-161.
http://dx.doi.org/10.1007/s12160-010-9168-6 [32] Rosenkranz, M.A., Davidson, R.J., MacCoon, D.G., Sheridan, J.F., Kalin, N.H. and Lutz, A. (2013) A Comparison of Mindfulness-Based Stress Reduction and an Active Control in Modulation of Neurogenic Inflammation. Brain, Behavior, and Immunity, 27, 174-184.
http://dx.doi.org/10.1016/j.bbi.2012.10.013 [33] Marmarosh, C., Holtz, A. and Schottenbauer, M. (2005) Group Cohesiveness, Group-Derived Collective Self-Esteem, Group-Derived Hope, and the Well-Being of Group Therapy Members. Group Dynamics: Theory, Research, and Practice, 9, 32-44.
http://dx.doi.org/10.1037/1089-2699.9.1.32 [34] Chambers, R., Gullone, E. and Allen, N.B. (2009) Mindful Emotion Regulation: An Integrative Review. Clinical Psychology Review, 29, 560-572.
http://dx.doi.org/10.1016/j.cpr.2009.06.005 [35] Baer, R.A. (2003) Mindfulness Training as a Clinical Intervention: A Conceptual and Empirical Review. Clinical Psychology: Science and Practice, 10, 125-143.
http://dx.doi.org/10.1093/clipsy.bpg015 [36] Nydahl, O. (2008) The Way Things Are. O Books, London. [37] Blackledge, J.T. and Hayes, S.C. (2001) Emotion Regulation in Acceptance and Commitment Therapy. Journal of Clinical Psychology, 57, 243-255.
http://dx.doi.org/10.1002/1097-4679(200102)57:2<243::AID-JCLP9>3.0.CO;2-X [38] Teasdale, J.D. (1999) Metacognition, Mindfulness and the Modification of Mood Disorders. Clinical Psychology and Psychotherapy, 6, 146-155.
http://dx.doi.org/10.1002/(SICI)1099-0879(199905)6:2<146::AID-CPP195>3.0.CO;2-E [39] Shapiro, S.L., Carlson, L.E., Astin, J.A. and Freedman, B. (2006) Mechanisms of Mindfulness. Journal of Clinical Psychology, 62, 373-386.
http://dx.doi.org/10.1002/jclp.20237 [40] Wells, A. (2009) Metacognitive Therapy for Anxiety and Depression. The Guilford Press, New York. [41] Hayes, S.C., Luoma, J., Bond, F., Masuda, A. and Lillis, J. (2006) Acceptance and Commitment Therapy: Model, Processes, and Outcomes. Behavior Research and Therapy, 44, 1-25.
http://dx.doi.org/10.1016/j.brat.2005.06.006 [42] Feldman, C. and Kuyken, W. (2011) Compassion in the Landscape of Suffering. Contemporary Buddhism: An Interdisciplinary Journal, 12, 143-155.
http://dx.doi.org/10.1080/14639947.2011.564831 [43] Leary, M.R., Tate, E.B., Allen, A.B. and Hancock, J. (2007) Self-Compassion and Reactions to Unpleasant Self-Relevant Events: The Implications of Treating Oneself Kindly. Journal of Personality and Social Psychology, 92, 887-904.
http://dx.doi.org/10.1037/0022-3514.92.5.887 [44] Gilbert, P. (2009) The Compassionate Mind. Constable, London. [45] Trungpa, C. (1973) Cutting through Spiritual Materialism. Shambhala Publications, Boston. [46] Lutz, A., Brefczynski-Lewis, J., Johnstone, T. and Davidson, R.J. (2008) Regulation of the Neural Circuitry of Emotion by Compassion Mediation: Effects of Meditative Expertise. PLoS ONE, 3, el897. [47] Slagter, H.A., Lutz, A., Greischer, L.L., Francis, A.D., Nieuwenhuis, S., Davis, J.M. and Davidson, R.J. (2007) Mental Training Affects Distribution of Limited Brain Resources. PLoS Biology, 5, e138.
http://dx.doi.org/10.1371/journal.pbio.0050138
[1] Plank, K. (2012) Modernamyterom Mindfulness [Modern Myths of Mindfulness]. Lakartidningen, 43, 1968-1970. [2] Kabat-Zinn, J. (2003) Mindfulness-Based Interventions in Context: Past, Present, and Future. Clinical Psychology: Science and Practice, 10, 144-156.
http://dx.doi.org/10.1093/clipsy.bpg016 [3] Kahl, K.G., Winter, L., Schweiger, U. and Sipos, V. (2011) The Third Wave of Cognitive-Behavioral Psychotherapies: Concepts and Efficacy. Fortschritte der Neurologie-Psychiatrie, 79, 330-339.
http://dx.doi.org/10.1055/s-0029-1245963 [4] Segal, Z.W., Williams, J.M. and Teasdale, J.D. (2002) Mindfulness-Based Cognitive Therapy for Depression. A New Approach to Preventing Relapse. The Guilford Press, New York. [5] Hopko, D.R., Lejuez, C.W., Ruggiero, K.J. and Eifert, G.H. (2003) Contemporary Behavioral Activation Treatments for Depression: Procedures, Principles, and Progress. Clinical Psychology Review, 23, 699-717.
http://dx.doi.org/10.1016/S0272-7358(03)00070-9 [6] Fjorback, L.O., Arendt, M., Ornbol, E., Fink, P. and Walach, H. (2011) Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy—A Systematic Review of Randomized Controlled Trails. Acta Psychiatrica Scandinavica, 124, 102-119.
http://dx.doi.org/10.1111/j.1600-0447.2011.01704.x [7] Beck, A.T. and Alford, B.A. (2009) Depression Causes and Treatment. University of Pennsylvania Press, Philadelphia. [8] Lau, M.A., Zindel, V., Segal, J. and Williams, M.G. (2004) Teasdale’s Differential Activation Hypothesis: Implications for Mechanisms of Depressive Relapse and Suicidal Behavior. Behavior Research and Therapy, 42, 1001-1017.
http://dx.doi.org/10.1016/j.brat.2004.03.003 [9] Segal, Z.V. and Ingram, R.E. (1994) Mood Priming and Construct Activation in Tests of Cognitive Vulnerability to Unipolar Depression. Clinical Psychology Review, 14, 663-695.
http://dx.doi.org/10.1016/0272-7358(94)90003-5 [10] Post, R.M. (1992) Transduction of Psychosocial Stress into the Neurobiology of Recurrent Affective Disorder. American Journal of Psychiatry, 149, 999-1010. [11] Post, R.M., Rubinow, D.R. and Ballenger, J.C. (1986) Conditioning and Sensitization in the Longitudinal Course of Affective Illness. British Journal of Psychiatry, 149, 191-201.
http://dx.doi.org/10.1192/bjp.149.2.191 [12] Ehnvall, A. and Agren, H. (2002) Patterns of Sensitization in the Course of Affective Illness. A Life-Charting Study of Treatment-Refractory Depressed Patients. Journal of Affective Disorders, 70, 67-75.
http://dx.doi.org/10.1016/S0165-0327(01)00328-7 [13] Nolen-Hoeksema, S. (2000) The Role of Rumination in Depressive Disorders and Mixed Anxiety/Depressive Symptoms. Journal of Abnormal Psychology, 109, 504-511.
http://dx.doi.org/10.1037/0021-843X.109.3.504 [14] Teasdale, J.D., Segal, Z.W., Williams, J.M., Ridgeway, V.A., Soulsby, J.M. and Lau, M.A. (2000) Prevention of Relapse/Recurrence in Major Depression by Mindfulness-Based Cognitive Therapy. Journal of Consulting and Clinical Psychology, 68, 615-623.
http://dx.doi.org/10.1037/0022-006X.68.4.615 [15] Ma, S.H. and Teasdale, J.D. (2004) Mindfulness-Based Cognitive Therapy for Depression: Replication and Exploration of Differential Relapse Prevention Effects. Journal of Consulting and Clinical Psychology, 72, 31-40.
http://dx.doi.org/10.1037/0022-006X.72.1.31 [16] Piet, J. and Hougaard, E. (2011) The Effect of Mindfulness-Based Cognitive Therapy for Prevention of Relapse in Recurrent Major Depressive Disorder: A Systematic Review and Meta-Analysis. Clinical Psychology Review, 31, 1032-1040.
http://dx.doi.org/10.1016/j.cpr.2011.05.002 [17] Chiesa, A. and Serretti, A. (2010) Mindfulness Based Cognitive Therapy for Psychiatric Disorders: A Systematic Review and Meta-Analysis. Psychiatry Research, 187, 441-453.
http://dx.doi.org/10.1016/j.psychres.2010.08.011 [18] Kuyken, W., Watkins, E., Holden, E., White, K., Taylor, R.S., Byford, S., Evans, A., Radford, S., Teasdale, J.D. and Dalgleish, T. (2010) How Does Mindfulness-Based Cognitive Therapy Work? Behavior Research and Therapy, 48, 1105-1112.
http://dx.doi.org/10.1016/j.brat.2010.08.003 [19] Brown, K.W. and Ryan, R.M. (2003) The Benefits of Being Present: Mindfulness and Its Role in Psychological Well-Being. Journal of Personality and Social Psychology, 84, 822-848.
http://dx.doi.org/10.1037/0022-3514.84.4.822 [20] Bengtsson, L. and Odéhn, E. (2010) Experiences of Group Treatments Behavioral Activation and Mindfulness-Based Cognitive Therapy for Intractable Depression. Goteborg University, Goteborg. [21] Finucane, A. and Mercer, S.W. (2006) An Exploratory Mixed Methods Study of the Acceptability and Effectiveness of Mindfulness-Based Cognitive Therapy for Patients with Active Depression and Anxiety in Primary Care. BMC Psychiatry, 6, 14.
http://dx.doi.org/10.1186/1471-244X-6-14 [22] Allen, M., Bromley, A., Kuyken, W. and Sonnenberg, S.J. (2009) Participants’ Experiences of Mindfulness-Based Cognitive Therapy: “It Changed Me in Just about Every Way Possible”. Behavioural and Cognitive Psychotherapy, 37, 413-430.
http://dx.doi.org/10.1017/S135246580999004X [23] Bailie, C., Kuyken, W. and Sonnenberg, S. (2012) The Experience of Parents in Mindfulness-Based Cognitive Therapy. Clinical Child Psychology and Psychiatry, 17, 103-119.
http://dx.doi.org/10.1177/1359104510392296 [24] Hertenstein, E., Rose, N., Voderholzer, U., Heidenreich, T., Nissen, C., Thiel, N., Herbst, N. and Kulz, A.K. (2012) Mindfulness-Based Cognitive Therapy in Obsessive-Compulsive Disorder—A Qualitative Study Concerning Patients’ Experience. BMC Psychiatry, 12, 185.
http://dx.doi.org/10.1186/1471-244X-12-185 [25] Mason, O. and Hargreaves, I. (2001) A Qualitative Study of Mindfulness-Based Cognitive Therapy for Depression. British Journal of Medical Psychology, 74, 197-212.
http://dx.doi.org/10.1348/000711201160911 [26] Karlsson, G. (1993) Psychological Qualitative Research from a Phenomenological Perspective. Alqvist & Wiksell International, Stockholm. [27] Edebol, H., Bood, S.A. and Norlander, T. (2008) Chronic Whiplash Associated Disorders and Their Treatment Using Flotation-REST (Restricted Environmental Stimulation Technique). Qualitative Health Research, 18, 480-488.
http://dx.doi.org/10.1177/1049732308315109 [28] Niklasson, M., Niklasson, I. and Norlander, T. (2010) Sensorimotor Therapy: Physical and Psychological Regressions Contributes to an Improved Kinesthetic and Vestibular Capacity in Children and Adolescents with Motor Difficulties and Concentration Problems. Social Behavior and Personality, 38, 327-346.
http://dx.doi.org/10.2224/sbp.2010.38.3.327 [29] Nordén, T., Eriksson, A., Kjellgren, A. and Norlander, T. (2012) Involving Clients and Their Relatives and Friends in the Psychiatric Care: Case Managers’ Experiences of Training in Resource Group Assertive Community Treatment. PsyCh Journal, 1, 15-27.
http://dx.doi.org/10.1002/pchj.1 [30] Nyklicek, I. (2010) Mindfulness, Emotion Regulation and Well-Being. In: Nyklícek, I., Vingerhoets, A. and Zeelenberg, M., Eds., Emotion Regulation and Well-Being, Springer Science and Business Media, New York, 101-118. [31] Branstrom, R., Kvillemo, P., Brandberg, Y. and Moskowitz, J.T. (2010) Self-Report Mindfulnes as a Mediator of Psychological Well-Being in a Stress Reduction Intervention for Cancer Patients. A Randomized Study. Annals of Behavioral Medicine, 39, 151-161.
http://dx.doi.org/10.1007/s12160-010-9168-6 [32] Rosenkranz, M.A., Davidson, R.J., MacCoon, D.G., Sheridan, J.F., Kalin, N.H. and Lutz, A. (2013) A Comparison of Mindfulness-Based Stress Reduction and an Active Control in Modulation of Neurogenic Inflammation. Brain, Behavior, and Immunity, 27, 174-184.
http://dx.doi.org/10.1016/j.bbi.2012.10.013 [33] Marmarosh, C., Holtz, A. and Schottenbauer, M. (2005) Group Cohesiveness, Group-Derived Collective Self-Esteem, Group-Derived Hope, and the Well-Being of Group Therapy Members. Group Dynamics: Theory, Research, and Practice, 9, 32-44.
http://dx.doi.org/10.1037/1089-2699.9.1.32 [34] Chambers, R., Gullone, E. and Allen, N.B. (2009) Mindful Emotion Regulation: An Integrative Review. Clinical Psychology Review, 29, 560-572.
http://dx.doi.org/10.1016/j.cpr.2009.06.005 [35] Baer, R.A. (2003) Mindfulness Training as a Clinical Intervention: A Conceptual and Empirical Review. Clinical Psychology: Science and Practice, 10, 125-143.
http://dx.doi.org/10.1093/clipsy.bpg015 [36] Nydahl, O. (2008) The Way Things Are. O Books, London. [37] Blackledge, J.T. and Hayes, S.C. (2001) Emotion Regulation in Acceptance and Commitment Therapy. Journal of Clinical Psychology, 57, 243-255.
http://dx.doi.org/10.1002/1097-4679(200102)57:2<243::AID-JCLP9>3.0.CO;2-X [38] Teasdale, J.D. (1999) Metacognition, Mindfulness and the Modification of Mood Disorders. Clinical Psychology and Psychotherapy, 6, 146-155.
http://dx.doi.org/10.1002/(SICI)1099-0879(199905)6:2<146::AID-CPP195>3.0.CO;2-E [39] Shapiro, S.L., Carlson, L.E., Astin, J.A. and Freedman, B. (2006) Mechanisms of Mindfulness. Journal of Clinical Psychology, 62, 373-386.
http://dx.doi.org/10.1002/jclp.20237 [40] Wells, A. (2009) Metacognitive Therapy for Anxiety and Depression. The Guilford Press, New York. [41] Hayes, S.C., Luoma, J., Bond, F., Masuda, A. and Lillis, J. (2006) Acceptance and Commitment Therapy: Model, Processes, and Outcomes. Behavior Research and Therapy, 44, 1-25.
http://dx.doi.org/10.1016/j.brat.2005.06.006 [42] Feldman, C. and Kuyken, W. (2011) Compassion in the Landscape of Suffering. Contemporary Buddhism: An Interdisciplinary Journal, 12, 143-155.
http://dx.doi.org/10.1080/14639947.2011.564831 [43] Leary, M.R., Tate, E.B., Allen, A.B. and Hancock, J. (2007) Self-Compassion and Reactions to Unpleasant Self-Relevant Events: The Implications of Treating Oneself Kindly. Journal of Personality and Social Psychology, 92, 887-904.
http://dx.doi.org/10.1037/0022-3514.92.5.887 [44] Gilbert, P. (2009) The Compassionate Mind. Constable, London. [45] Trungpa, C. (1973) Cutting through Spiritual Materialism. Shambhala Publications, Boston. [46] Lutz, A., Brefczynski-Lewis, J., Johnstone, T. and Davidson, R.J. (2008) Regulation of the Neural Circuitry of Emotion by Compassion Mediation: Effects of Meditative Expertise. PLoS ONE, 3, el897. [47] Slagter, H.A., Lutz, A., Greischer, L.L., Francis, A.D., Nieuwenhuis, S., Davis, J.M. and Davidson, R.J. (2007) Mental Training Affects Distribution of Limited Brain Resources. PLoS Biology, 5, e138.
http://dx.doi.org/10.1371/journal.pbio.0050138