An evaluation of large group cognitive behaviour therapy with mindfulness (CBTm) classes

Abstract

Background Ensuring equitable and timely access to Cognitive Behaviour Therapy (CBT) is challenging within Canada’s service delivery model. The current study aims to determine acceptability and effectiveness of 4-session, large, Cognitive Behaviour Therapy with Mindfulness (CBTm) classes. Methods A retrospective chart review of adult outpatients ( n = 523) who attended CBTm classes from 2015 to 2016. Classes were administered in a tertiary mental health clinic in Winnipeg, Canada and averaged 24 clients per session. Primary outcomes were (a) acceptability of the classes and retention rates and (b) changes in anxiety and depressive symptoms using Generalized Anxiety Disorder 7-item (GAD-7) and Patient Health Questionnaire 9-item (PHQ-9) scales. Results Clients found classes useful and > 90% expressed a desire to attend future sessions. The dropout rate was 37.5%. A mixed-effects linear regression demonstrated classes improved anxiety symptoms (GAD-7 score change per class = − 0.52 [95%CI, − 0.74 to − 0.30], P < 0.001) and depressive symptoms (PHQ-9 score change per class = − 0.65 [95%CI, − 0.89 to − 0.40], P < 0.001). Secondary analysis found reduction in scores between baseline and follow-up to be 2.40 and 1.98 for the GAD-7 and PHQ-9, respectively. Effect sizes were small for all analyses. Conclusions This study offers preliminary evidence suggesting CBTm classes are an acceptable strategy to facilitate access and to engage and maintain clients’ interest in pursuing CBT. Clients attending CBTm classes experienced improvements in anxiety and depressive symptoms. Symptom improvement was not clinically significant. Study limitations, such as a lack of control group, should be addressed in future research.

Canadian psychological practice: Development of low intensity/high volume initiatives in public healthcare.

“…Strategies used to try and mitigate this challenge include being mindful of terminology (e.g., ensuring large group interventions are referred to as “classes” rather than groups) and providing clear information about what can reasonably be expected from different levels of intervention. Conversely, there have been concerns that fiscal realities may increasingly put pressure on psychologists to replace higher-intensity interventions with lower intensity ones, which would be both unfair and counterproductive, given the rather modest effect sizes associated with many LI-HV interventions as revealed in Thakur et al (2019).…”

Web-Based Mindfulness Meditation as an Adjunct to Internet-Delivered Cognitive Behavioral Therapy for Public Safety Personnel: Mixed Methods Feasibility Evaluation Study

“…Unlike the previous versions of the PSP Wellbeing Course, the version used in this study included a downloadable, guided, audio mindfulness meditation for each of the 5 lessons of the intervention and psychoeducational material on mindfulness meditations before the first meditation. Each lesson included a different type of mindfulness meditation designed to complement the CBT skills taught in that lesson and was based on evidence of successful implementation in other programs [ 22 , 36 - 39 ]:…”

“…Each mindfulness meditation was audio-recorded by a voice actor and was designed to be approximately 10 minutes long, consistent with previous recommendations [ 39 - 41 ]. Each mindfulness meditation was accompanied by a text script that clients could read in lieu of the audio.…”

“…Unlike the previous versions of the PSP Wellbeing Course, the version used in this study included a downloadable, guided, audio mindfulness meditation for each of the 5 lessons of the intervention and psychoeducational material on mindfulness meditations before the first meditation. Each lesson included a different type of mindfulness meditation designed to complement the CBT skills taught in that lesson and was based on evidence of successful implementation in other programs [22,[36][37][38][39]: Each mindfulness meditation was audio-recorded by a voice actor and was designed to be approximately 10 minutes long, consistent with previous recommendations [39][40][41]. Each mindfulness meditation was accompanied by a text script that clients could read in lieu of the audio.…”

“…Furthermore, previous studies on PSP and mindfulness appear to focus on the intervention as a whole (ie, the impact of the intervention and mindfulness combined) and have not considered the independent impact of mindfulness on outcomes. It should be noted that the extant research suggests that mindfulness can have positive effects when practiced for 10 minutes daily, but shorter periods can also be associated with benefits [39][40][41]. Evidence also suggests that the quality of mindfulness meditation may be more important than the amount of mindfulness meditation practiced [61].…”