Abstract
Mindfulness-based cognitive therapy (MBCT) groups are challenged by high attrition particularly in early sessions. This leads to disturbances in the composition of the groups and potential dissatisfaction. In order to support patients in their decision about participation and to accommodate the program to psychiatric patients, an adapted version of MBCT was developed with nine instead of 8 weekly units, reduced duration of some exercises, and patients invited to make an active decision about continuing with the program or leaving the group after an introductory phase of the first three sessions. 120 participants joined the program, 35 % decided to leave the program before the advanced stage started, and 50.8 % completed it. In a multiple logistic regression model, neither the degree of depression and mindfulness at onset nor sociodemographic variables could predict if participants would complete the program. The only significant predictor was the number of sessions attended in the introductory phase. In bivariate analyses, having participated in group therapies earlier strongly predicted if a person would complete sessions 1 to 3. The therapist’s assessment of the patient’s motivation and her/his predictions if the patient would leave the group preterm and if the patient would finalize the program regularly were also related to attrition. The modified version of MBCT has proved to be feasible and useful to stabilize the participants’ presence in the later sessions. Particular attention should be paid to patients who miss sessions in the introductory phase and for which the therapist recognizes low motivation or risk of dropping out.
This is a preview of subscription content, access via your institution.

References
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Arch Gen Psychiatry, 4, 561–571.
Bondolfi, G., Jermann, F., Van der Linden, M., Gex-Fabry, M., Bizzini, L., Rouget, B. W., et al. (2010). Depression relapse prophylaxis with mindfulness-based cognitive therapy: replication and extension in the Swiss health care system. Journal of Affective Disorders, 122(3), 224–231. doi:DOI10.1016/j.jad.2009.07.007.
Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84, 822–848.
Carmody, J., & Baer, R. A. (2009). How long does a mindfulness-based stress reduction program need to be? A review of class contact hours and effect sizes for psychological distress. Journal of Clinical Psychology, 65(6), 627–638. doi:10.1002/jclp.20555.
Chiesa, A., & Serretti, A. (2011). Mindfulness based cognitive therapy for psychiatric disorders: a systematic review and meta-analysis. Psychiatry Research, 187(3), 441–453. doi:DOI10.1016/j.psychres.2010.08.011.
Coelho, H. F., Canter, P. H., & Ernst, E. (2007). Mindfulness-based cognitive therapy: evaluating current evidence and informing future research. Journal of Consulting and Clinical Psychology, 75(6), 1000–1005. doi:10.1037/0022-006X.75.6.1000.
Crane, C., & Williams, J. M. (2010). Factors associated with attrition from mindfulness-based cognitive therapy in patients with a history of suicidal depression. Mindfulness (N Y), 1(1), 10–20. doi:10.1007/s12671-010-0003-8.
Dobkin, P. L., Irving, J. A., & Amar, S. (2012). For whom may participation in a mindfulness-based stress reduction program be contraindicated? Mindfulness, 3, 44–50. doi:10.1007/s12671-011-0079-9.
Eisendrath, S. J., Delucchi, K., Bitner, R., Fenimore, P., Smit, M., & McLane, M. (2008). Mindfulness-based cognitive therapy for treatment-resistant depression: a pilot study. Psychotherapy and Psychosomatics, 77(5), 319–320. doi:Doi10.1159/000142525.
Finucane, A., & Mercer, S. (2006). An exploratory mixed methods study of the acceptability and effectiveness of mindfulness-based cognitive therapy for patients with active depression and anxiety in primary care. BMC Psychiatry, 6(1), 14. doi:10.1186/1471-244X-6-14.
Fjorback, L. O., Arendt, M., Ornbol, E., Fink, P., & Walach, H. (2011). Mindfulness-based stress reduction and mindfulness-based cognitive therapy—a systematic review of randomized controlled trials. Acta Psychiatrica Scandinavica, 124(2), 102–119. doi:10.1111/j.1600-0447.2011.01704.x.
Godfrin, K. A., & van Heeringen, C. (2010). The effects of mindfulness-based cognitive therapy on recurrence of depressive episodes, mental health and quality of life: a randomized controlled study. Behaviour Research and Therapy, 48(8), 738–746. doi:10.1016/j.brat.2010.04.006.
Hänny, C. M., & Bader, K. (2008). Eine achtsamkeitsbasierte Therapie zur Verhütung von Rückfällen. InFo Neurologie & Psychiatrie, 6(3), 33–37.
Hautzinger, M., Keller, F., & Kühner, C. (2006). Beck depressions-inventar (BDI-II). Revision. Frankfurt/Main: Harcourt Test Services.
Hosmer, D. W., & Lemeshow, S. (2000). Applied logistic regression (2nd ed.). New York: Wiley.
International Business Machines Corp. (2011). SPSS 19.0.0 for Windows. Armonk, New York: International Business Machines Corp.
Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain and illness. New York: Delacourt.
Kenny, M. A., & Williams, J. M. (2007). Treatment-resistant depressed patients show a good response to mindfulness-based cognitive therapy. Behaviour Research and Therapy, 45(3), 617–625. doi:10.1016/j.brat.2006.04.008.
Kingston, T., Dooley, B., Bates, A., Lawlor, E., & Malone, K. (2007). Mindfulness-based cognitive therapy for residual depressive symptoms. Psychology and Psychotherapy, 80(Pt 2), 193–203. doi:10.1348/147608306X116016[doi].
Klainin-Yobas, P., Cho, M. A., & Creedy, D. (2012). Efficacy of mindfulness-based interventions on depressive symptoms among people with mental disorders: a meta-analysis. International Journal of Nursing Studies, 49(1), 109–121. doi:10.1016/j.ijnurstu.2011.08.014.
Langdon, S., Jones, F. W., Hutton, J., & Holttum, S. (2011). A grounded-theory study of mindfulness practice following mindfulness-based cognitive therapy. Mindfulness, 2(4), 270–281. doi:10.1007/s12671-011-0070-5.
Ma, S. H., & Teasdale, J. D. (2004). Mindfulness-based cognitive therapy for depression: replication and exploration of differential relapse prevention effects. Journal of Consulting and Clinical Psychology, 72(1), 31–40. doi:10.1037/0022-006X.72.1.31.
Michalak, J., Heidenreich, T., Ströhle, G., & Nachtigall, C. (2008). Die deutsche Version der Mindful Attention and Awareness Scale (MAAS). Psychometrische Befunde zu einem Achtsamkeitsfragebogen. Zeitschrift für Klinische Psychologie und Psychotherapie, 37, 200–208. doi:10.1026/1616-3443.37.3.200.
Nolen-Hoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008). Rethinking rumination. Perspectives on Psychological Science, 3(5), 400–424. doi:10.1111/j.1745-6924.2008.00088.x.
Piet, J., & Hougaard, E. (2011). The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: a systematic review and meta-analysis. Clinical Psychology Review, 31(6), 1032–1040. doi:10.1016/j.cpr.2011.05.002.
Sears, S. R., Kraus, S., Carlough, K., & Treat, E. (2011). Perceived benefits and doubts of participants in a weekly meditation study. Mindfulness, 2, 167–174. doi:10.1007/s12671-011-0055-4.
Segal, Z. V., Williams, J. M. G., & Teasdale, J. V. (2002). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. New York: Guilford.
Teasdale, J. D., Segal, Z. V., Williams, J. M., Ridgeway, V. A., Soulsby, J. M., & Lau, M. A. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 68(4), 615–623.
Walach, H., Buchheld, N., Buttenmüller, V., Kleinknecht, N., & Schmidt, S. (2006). Measuring mindfulness—the Freiburg mindfulness inventory (FMI). Personality and Individual Differences, 40(8), 1543–1555. doi:10.1016/j.paid.2005.11.025.
Walach, H., Rose, N., Buttenmüller, V., Kleinknecht, N., Grossmann, P., & Schmidt, S. (2009). Empirische Erfassung der Achtsamkeit – Die Konstruktion des Freiburger Fragebogens zur Achtsamkeit (FFA) und weitere Validierungsstudien. In T. Heidenreich & J. Michalak (Eds.), Achtsamkeit und Akzeptanz in der Psychotherapie. Ein Handbuch. Tübingen: dgvt-Verlag.
Williams, J. M., Alatiq, Y., Crane, C., Barnhofer, T., Fennell, M. J., Duggan, D. S., et al. (2008). Mindfulness-based cognitive therapy (MBCT) in bipolar disorder: preliminary evaluation of immediate effects on between-episode functioning. Journal of Affective Disorders, 107(1–3), 275–279. doi:10.1016/j.jad.2007.08.022.
Acknowledgments
We would like to thank the participants who have given their time to take part in interviews and complete the questionnaires, the interviewers, and cotherapists Eliane Pflugshaupt, Peter Würsch, Grit Lexow, and Marina Elsaesser for their help with carrying out the groups and data collection, and the two anonymous reviewers for their very helpful comments on an earlier version of this paper.
Conflicts of Interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Herdt, J., Bührlen, B., Bader, K. et al. Participation in an Adapted Version of MBCT in Psychiatric Care. Mindfulness 3, 218–226 (2012). https://doi.org/10.1007/s12671-012-0120-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12671-012-0120-7