The Acceptability and Effectiveness of Mindfulness-Based Cognitive Therapy in Adults with ...

201 Pages·2012·4.88 MB·English

The Acceptability and Effectiveness of Mindfulness-Based Cognitive Therapy in Adults with
Acquired Brain Injury

By

Anna Marson

B.A., McMaster University, 2007

A Thesis Submitted in Partial Fulfillment
of the Requirements for the Degree of

MASTER OF ARTS

in the Department of Educational Psychology and Leadership Studies

© Anna Marson, 2012
University of Victoria

All rights reserved. This thesis may not be reproduced in whole or in part, by photocopy or other
means, without the permission of the author.
ii

Supervisory Committee

The Acceptability and Effectiveness of Mindfulness-Based Cognitive Therapy in Adults with
Acquired Brain Injury

by

Anna Marson
B.A., McMaster University, 2007

Supervisory Committee

Dr. Susan Tasker, (Department of Educational Psychology and Leadership Studies)
Supervisor

Dr. John Walsh, (Department of Educational Psychology and Leadership Studies)
Departmental Member

Dr. Nancy Reeves, (Department of Educational Psychology and Leadership Studies)
Departmental Member
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ABSTRACT

Supervisory Committee

Dr. Susan Tasker, (Department of Educational Psychology and Leadership Studies)
Supervisor

Dr. John Walsh, (Department of Educational Psychology and Leadership Studies)
Departmental Member

Dr. Nancy Reeves, (Department of Educational Psychology and Leadership Studies)
Departmental Member

The evidence base for Mindfulness-Based Cognitive Therapy (MBCT) is growing, but there is a
lack of experimental validation among populations with acquired brain injuries (ABI). The
purpose of this study was to investigate the acceptability and effectiveness of MBCT in fostering
psychological recovery among adults with ABI. More specifically, this study was conducted to:
(a) extend Finucane and Mercer’s (2006) study by applying MBCT to another population (i.e.,
adults with ABI); (b) corroborate the Bedard et al. (2008) finding of MBCT’s effectiveness in
reducing depression in adults with TBI; (c) establish if empirical findings of the effectiveness of
MBCT on depression and anxiety in the general population and in primary care patients with
active symptoms of depression and anxiety extended to adults with ABI; and (d) explore the
effect of MBCT treatment on measures of locus of control, satisfaction with life, self-awareness,
and coping in adults with ABI. A mixed methods design was used and participants were
recruited from two community-based brain injury programs. The final sample comprised 12
adults with mild, moderate, and severe injuries. Interview and self-report measures were
administered pre- and post-treatment. Qualitative data were collected through semi-structured
focus groups following MBCT treatment. Depression, denial, and self-awareness among
participants showed statistically significant improvements and participants’ demonstrated
statistically significant increases in positive reframing and active coping. Focus group data
confirmed MBCT as an acceptable and effective approach for adults with ABI, and also speak to
implications for the use of MBCT in ABI populations specifically. The need for a larger
replication study with a control group is discussed.
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Table of Contents

Supervisory Committee ........................................................................................ ii

Abstract ................................................................................................................. iii

Table of Contents .................................................................................................. iv

List of Tables ........................................................................................................ vii

List of Figures ....................................................................................................... viii

Acknowledgements ............................................................................................... ix

Chapter 1: Introduction ..................................................................................... 1

1.1. Literature Review and Theoretical Background ............................................ 2

1.2. Mindfulness-Based Cognitive Therapy ......................................................... 2

1.2.1. Mindfulness-Based Cognitive Therapy ............................................... 2

1.2.2. What is Mindfulness Practice? ............................................................. 4

1.2.3. Attitudes of Mindfulness........................................................................ 6

1.2.4. Mechanisms of Mindfulness-Based Cognitive Therapy ...................... 9

1.2.5. Principles for the Clinical Application of Mindfulness-Based
Cognitive Therapy ......................................................................................... 9

1.2.6. Efficacy of Mindfulness-Based Cognitive Therapy ............................ 10

1.2.7. Applying Mindfulness-Based Cognitive Therapy to Acquired
Brain Injury .................................................................................................... 16

1.3. Brain Injury .................................................................................................... 17

1.3.1. Acquired Brain Injury and Recovery ................................................... 18

1.3.2. Psychosocial Changes and Impairments. ............................................. 20

1.3.3. Affective Response to Brain Injury: Implications for
Psychosocial Adjustment ............................................................................... 21
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1.3.4. Building the Case for Locus of Control and Coping as Targets
for Psychological Recovery in Acquired Brain Injury .................................. 25

1.3.5. Fostering Post Brain Injury Adjustment: Psychotherapeutic
Interventions .................................................................................................. 43

1.4. Applying Mindfulness-Based Cognitive Therapy to Acquired
Brain Injury. ................................................................................................... 52

1.4.1. Mindfulness-Based Cognitive Therapy in Acquired Brain Injury:
What Do We Know? ...................................................................................... 53

1.5. Research Rationale, Purpose, and Hypotheses .............................................. 54

1.5.1. Rationale .............................................................................................. 54

1.5.2. Purpose ................................................................................................. 58

1.5.3. Research Questions .............................................................................. 59

1.5.4. Hypotheses ........................................................................................... 59

Chapter 2: Method .............................................................................................. 62

2.1. Sample Characteristics ................................................................................... 62

2.1.2. Exclusion Criteria ................................................................................ 62

2.2. Research Design and Experimental Procedures ............................................ 65

2.3. Treatment: Mindfulness-Based Cognitive Therapy ....................................... 68

2.3.1. Modifications to the MBCT Program .................................................. 69

2.3.2. Facilitation of the MBCT Program ...................................................... 69

2.4. Measures ........................................................................................................ 70

2.4.1. Demographic and Background Information ........................................ 70

2.4.2. Time 1 and Time 2 Measures ............................................................... 71

2.5. Reliability of SADI Scoring and Focus Group Transcribing ......................... 82

2.6. Data Analyses ................................................................................................ 83
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2.6.1. Quantitative Analyses .......................................................................... 83

2.6.2. Qualitative Analyses ............................................................................ 84

Chapter 3: Results ............................................................................................... 87

3.1. Relations among Demographic Variables and Study Variables:
Within-Subject Analyses ............................................................................... 87

3.2. Hypothesis Testing ......................................................................................... 87

3.3. Qualitative Analyses Assessing Acceptability and Effectiveness of
MBCT in Adults with ABI ........................................................................... 95

3.3.1. Acceptability of MBCT Treatment in Adults with ABI ...................... 96

3.3.2. Effectiveness of MBCT Treatment in Adults with ABI ...................... 98

Chapter 4: Discussion ......................................................................................... 102

4.1. Summary of Findings ..................................................................................... 103

4.1.1. Acceptability of MBCT Treatment in Adults with ABI ...................... 103

4.1.2. Effectiveness of MBCT Treatment in Adults with ABI ...................... 106

4.2. Facilitator Commentary and Take-Home Messages ...................................... 124

4.3. Limitations of the Research ........................................................................... 126

4.4. Implications for Counselling .......................................................................... 131

4.5. Conclusion ..................................................................................................... 132

References ............................................................................................................. 135

Appendices ............................................................................................................ 163
vii

List of Tables

Table Page

Table 1. Demographic Variables for Completers and Dropouts .......................... 154

Table 2. Study Variables for Completers and Dropouts ....................................... 157

Tables 3 & 4. Hypothesis 1 & Hypothesis 2 ......................................................... 159

Table 5. Hypothesis 3 ........................................................................................... 160

Table 6. Hypothesis 4 ........................................................................................... 161
viii

List of Figures

Figure Page

Figure 1. A Graphic Representation of the Verbatim
Transcription from the Focus Groups ................................................................... 162
ix

Acknowledgments

In thinking about writing this acknowledgement, I realized what an all-encompassing
journey this has been for me, which has extended into personal and professional aspects of my
life. It has been an immensely rewarding and challenging undertaking, and I am deeply grateful
to those individuals who have made this study possible.
I would like to recognize Dr. Nancy Reeves for her thoughtful and constructive feedback
throughout this process; I have greatly appreciated your attention to detail and your overall
contributions to this work.
I would like to sincerely thank Dr. John Walsh for his enthusiasm and commitment to this
work. Your unwavering patience and willingness to help did not go unnoticed. Thank you for
your investment in my learning, and particularly, your guidance during the data analysis phase of
research. You enabled me to retain statistical ideologies, and in turn I was able to apply them to
my research in a meaningful way. Your words of encouragement have meant a great deal to me.
Enormous gratitude goes to my supervisor, Dr. Susan Tasker. You have been an
invaluable mentor to me. I owe you much gratitude for fostering my continued work with
MBCT, an approach that truly encapsulates my personal and professional philosophies. Your
confidence in my abilities as a facilitator and team leader has made this study possible, and
allowed for immeasurable personal growth. You have always been so generous in your
willingness to impart knowledge. Thank you for all the opportunities you provided; I have
learned such a great deal from my work with you.
I would like to acknowledge my exceptional research team, Ali Dohadwala and Laura
Forseth. Your degree of competence, diligence, and professionalism directly contributed to the
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success of this work. Your optimism and enthusiasm were infectious and refreshing during my
own moments of frustration. I truly could not have completed this study without you.
A special thanks to Nick Meikle, who selflessly volunteered his time to assist with data
collection. It was a pleasure working with you Nick; your assistance was greatly valued.
My appreciation is extended to the staff at The Cridge, particularly Geoff Sing, Janelle
Breese Biagioni, Tori Woodford, and Mark Fournier, for allowing me the opportunity to conduct
this research within their organization. Thank you for your unfaltering helpfulness and faith in
the study. Special thanks are also extended to Barbara Erickson, Max Uhlemann, Nicole Nelson,
and the staff at VBIS. Thank you for being so accommodating.
Certainly, I would like to express my tremendous gratitude to the twelve individuals who
participated in this study. It was an honour to get to know each of you and witness your
determination and growth. Thank you for allowing my research team and me to share such a
special experience with you. It was profoundly inspiring and moving to hear of your insights
about mindfulness. I have taken so much away from our work together.
Thanks to my family for your unyielding love, support, and appreciation for my work.
Your encouragement has allowed me to follow the endeavours I truly believe in. Thank you from
my heart.
I would like to extend my gratitude to Matthew Woodford for his assistance throughout
the study. I am so glad I could share this experience with you. Thank you for your reassuring
words. It means so much to have your respect and admiration.
Also, I truly appreciated the support and understanding I received from my colleagues
during the challenging and celebratory moments.