Teacher Competence in Mindfulness-Based Cognitive Therapy for Depression and Its Relation to Treatment Outcome

Abstract

As mindfulness-based cognitive therapy (MBCT) becomes an increasingly mainstream approach for recurrent depression, there is a growing need for practitioners who are able to teach MBCT. The requirements for being competent as a mindfulness-based teacher include personal meditation practice and at least a year of additional professional training. This study is the first to investigate the relationship between MBCT teacher competence and several key dimensions of MBCT treatment outcomes. Patients with recurrent depression in remission (N = 241) participated in a multi-centre trial of MBCT, provided by 15 teachers. Teacher competence was assessed using the Mindfulness-Based Interventions: Teaching Assessment Criteria (MBI:TAC) based on two to four randomly selected video-recorded sessions of each of the 15 teachers, evaluated by 16 trained assessors. Results showed that teacher competence was not significantly associated with adherence (number of MBCT sessions attended), possible mechanisms of change (rumination, cognitive reactivity, mindfulness, and self-compassion), or key outcomes (depressive symptoms at post treatment and depressive relapse/recurrence during the 15-month follow-up). Thus, findings from the current study indicate no robust effects of teacher competence, as measured by the MBI:TAC, on possible mediators and outcome variables in MBCT for recurrent depression. Possible explanations are the standardized delivery of MBCT, the strong emphasis on self-reliance within the MBCT learning process, the importance of participant-related factors, the difficulties in assessing teacher competence, the absence of main treatment effects in terms of reducing depressive symptoms, and the relatively small selection of videotapes. Further work is required to systematically investigate these explanations.

Therapeutic alliance—not therapist competence or group cohesion—contributes to reduction of psychological distress in group‐based mindfulness‐based cognitive therapy for cancer patients

“…Therapist competence did not have a significant effect on reduction of psychological distress. This is in line with previous findings that did not show a relationship between therapist competence and treatment outcome in MBCT for recurrent depression (Huijbers et al, ). In addition, previous research in CBT also found little support for an association between competence and patient outcome (Branson et al, ).…”

Explaining variability in therapist adherence and patient depressive symptom improvement: The role of therapist interpersonal skills and patient engagement

“…It also corresponds with a recent trial showing that competence in delivering MBCT (including conveying course themes, guiding practice, embodiment of mindfulness, and relational skills) was not associated with posttreatment changes in depressive symptoms or with relapse and recurrence rates (Huijbers et al, 2017).…”

“…The finding that lower adherence was not predictive of poorer outcome in CBT and MBCT is consistent with a meta‐analysis finding no significant mean weighted association between therapist adherence and outcome of psychological treatments (Webb et al, ). It also corresponds with a recent trial showing that competence in delivering MBCT (including conveying course themes, guiding practice, embodiment of mindfulness, and relational skills) was not associated with posttreatment changes in depressive symptoms or with relapse and recurrence rates (Huijbers et al, ).…”

“…An explanation for the fact that neither therapist adherence nor therapists' interpersonal skills or patient's engagement predicted treatment outcome is that patients might have received sufficient “active ingredients” for the treatments to be effective (Huijbers et al, ). Both CBT and MBCT were provided according to standardized treatment manuals and included weekly homework assignments.…”

Mindfulness and progressive muscle relaxation as standardized session‐introduction in individual therapy: A randomized controlled trial

“…Possibly, this lack of mindfulness increase is attributable to the delivery of mindfulness exercises by inexperienced therapists. However, first studies found that therapists’ mindfulness competence and experience are not significantly associated with patient outcomes (Huijbers et al, ). Nevertheless, these results are only preliminary.…”