Zindel Segal, PhD - University of Toronto Scarborough
In 2015 Sona Dimidjian and I published a paper in which we examined the prospects for a clinical science of mindfulness-based interventions (MBIs). We reported that the prospects looked good on the evidence front but were less promising on the public health front. Some might say that mindfulness-based treatments have cleared the hurdle of efficacy only to stumble over the hurdles of reach and impact. Maybe this is a natural developmental trajectory for a set of treatments that have only been around for 20-30 years. One could even argue that it makes sense to demonstrate that a given approach actually works before investing too greatly in its dissemination. But, this argument seems shaky when we consider that Kazdin & Blase made a similar point in 2011 regarding evidence-based interventions, such as BT and CBT, that have been around far longer than MBIs – strong on the data side but weak on delivery side.
I have experienced this phenomenon first hand in my own work with Mindfulness Based Cognitive Therapy (MBCT). With our treatment manual now having been in print for close to 16 years, with a yearly slate of training workshops being offered and with MBCT being listed as a first line prevention intervention in a number of national Depression Treatment guidelines, it is still hard for most people to find an MBCT therapist. This is perplexing. I also know that I am not alone in asking; what good is a well-supported intervention if it sits on the shelf and fails to make it into the hands of those who need it most? My response to this dilemma has been twofold.
One strategy has involved directly focusing on MBCT dissemination and quality by providing the public with a way to find MBCT therapists who have been trained to a recognized level of competence in this approach. Willem Kuyken and I have launched a freely available, searchable, standards-based international registry of MBCT therapists that will allow members of the public to find MBCT therapists who practice in their community. We have named this registry ACCESS MBCT www.accessmbct.com - you can search by either city or country and it will provide you with a list of registered MBCT therapists practicing in your area. Also, if you know the name of a provider and want to see if they are listed on the registry, you can search by name as well.
In this way, ACCESS MBCT serves a quality assurance function. All members of ACCESS MBCT will have to have been trained according to the steps outlined in the MBCT Training Pathway oxfordmindfulness.org/wp-content/uploads/2018/02/MBCT-Training-Pathway.pdf . Adopting this document to set our training threshold reflects the recognition that our field has evolved from the days when having a personal mindfulness practice, a clinical background and familiarity with the contents of Segal et al., 2002 would qualify one to teach MBCT. It is increasingly clear to me that MBCT is not preferentially defined according to its mindfulness or cognitive therapy axes, but rather from the integrative embodiment of these perspectives in the act of teaching. Not surprisingly, additional training experiences are required to develop this capacity and it is our intention that being a member of ACCESS MBCT will communicate this standard to the public. Deciding on this particular framework for ACCESS MBCT was achieved via broad consultation and feedback. We considered a variety of listing/registry models, with varying amounts of oversight and settled on a solution that relies on verifiable self-declarations provided by therapists/applicants interested in joining ACCESS MBCT. Please take a few minutes to check out the ACCESS MBCT website and watch the brief video of the Digital International Announcement for the Registry that was held at the end of 2017 - you may recognize a few familiar faces at www.accessmbct.com.
The second strategy to increase access to MBCT has been to digitize the in-person 8 week program and make it available online so that people could access it from the comfort of their own homes. The program is called Mindful Mood Balance (MMB) and takes a person through 8 separate sessions that present identical content to what folks attending the in-person groups are learning and practicing. While we have some preliminary data indicating that this program is effective in reducing residual depressive symptoms (Dimidjian et al., 2014), we are completing an RCT with 460 patients that will provide a more definitive evaluation. We have also adapted Mindful Mood Balance so that therapists interested in learning MBCT but who can’t find a group in their neighbourhood can complete the program online. MMBPro www.mindfulnoggin.com/mindful-mood-balance is now recognized as an acceptable format for both within the MBCT Training Pathway and is being used to supplement training programs in Canada, the US and the UK.
Needless to say, my graduate training never prepared me to address issues of dissemination and implementation, but it is increasingly clear that for our field to stay relevant in the provision of empirically supported treatments, these are pivotal issues that need to be addressed.
Dimidjian S, Beck A, Felder JN, Boggs JM, Gallop R, Segal ZV. Web-based Mindfulness-based Cognitive Therapy for reducing residual depressive symptoms: An open trial and quasi-experimental comparison to propensity score matched controls. Behav Res Ther. 2014 Dec;63:83-9.
Dimidjian S, Segal ZV. Prospects for a clinical science of mindfulness-based intervention. Am Psychol. 2015 Oct;70(7):593-620.
Kazdin AE, Blase SL. Rebooting Psychotherapy Research and Practice to Reduce the Burden of Mental Illness. Perspect Psychol Sci. 2011 Jan;6(1):21-37.
Published October 26, 2018