Building a Grounded Theory of Engagement in Mindfulness-Based Group Therapy for Distressing Voices

Abstract

Mindfulness based group therapy shows promise as a treatment for distressing voice-hearing.However, fostering engagement in groups can be challenging, and no theory of engagement in group therapy for distressing voices exists to guide practice or research. This study employed Grounded Theory Method to build a theory of engagement in mindfulness based groups for distressing voices. Ten service-users and three therapists were interviewed about their experiences of such groups. The model that emerged involves a recursive process of investing in change and continually evaluating its usefulness and safety. Barriers to engagement were often overcome, but sometimes compromised perceived safety, leading to dropout. For others, group participation led to rewards, some of which were integrated beyond group termination. Group engagement can be encouraged by establishing universality around voice-hearing early, reducing uncertainty, sharing difficulties with mindfulness practices and mapping group progress to create a cohering sense of collaboration on therapy tasks.

Home practice in mindfulness-based interventions for psychosis groups: a systematic review and qualitative study

“…Participants mostly described ‘everyday’ barriers to home practice, such as children being at home, or noise coming from the street. This fits with previous qualitative studies in psychosis which mention noisy home environments, or external interruptions, as barriers to home practice [ 18 , 35 ]. Furthermore, our participants reflected on the role of the ‘internal’ environment, given how mindfulness involves turning towards what is present; therefore it is challenging to practice when this involves coming into contact with unwanted emotional states, although arguably this is when mindfulness skills can be honed most effectively.…”

“…Similar themes were reported by McHale et al in terms of successful completion of home practice being contingent on the ‘right’ conditions (e.g. it being easier when feeling relaxed, and when the home environment was quiet vs. feeling agitated, and/or there being noise around at home) [ 35 ]. Some participants in an inpatient study spontaneously reported practising between sessions, and intending to carry this on at home after discharge as it had been beneficial for them: “well it’s just got me through so much, you know?…”

“…These additional qualitative papers, all conducted in the United Kingdom (UK), were conducted across a range of service settings, including an acute inpatient ward [ 30 ], an early intervention service [ 31 ], and community mental health services [ 32 – 35 ]. Three used grounded theory as the qualitative analytical approach [ 31 , 34 , 35 ], 2 used thematic analysis [ 30 , 33 ], and 1 used interpretative phenomenological analysis (IPA) [ 32 ]. A total of 17 studies were therefore included in this qualitative part of the review.…”

A service evaluation of a group mindfulness-based intervention for distressing voices: how do findings from a randomized controlled trial compare with routine clinical practice?

“…In order to maximize both benefits for patients and added value, patients need to attend group PBCT sessions regularly. However, some patients have to overcome many barriers and challenges when trying to complete the 12 sessions (McHale et al, 2018). A minimum effective dose of group PBCT, or therapy completion, is considered to be attendance to at least eight out of 12 sessions (Chadwick et al, 2016).…”

“I wanted to do more of the homework!”—Feasibility and acceptability of blending app‐based homework with group therapy for social cognition in psychosis

“…This lends support to the importance of maintaining face‐to face interactions alongside digital technology. The benefits of universality (i.e., recognizing that others share similar problems) is a finding consistently reported in the literature for psychosis‐spectrum clients (McHale et al, 2018; McLeod et al, 2007; Ngo Nkouth et al, 2010), and is one of the key therapeutic‐factors of group interventions posited by Yalom and Leszcz (2005). This supports group therapy as a delivery modality, conferring benefits that are unlikely to be gained from individual work.…”