Relating Mindfully: A Qualitative Exploration of Changes in Relationships Through Mindfulness-Based Cognitive Therapy

Abstract

Mindfulness-based cognitive therapy (MBCT) was developed to reduce the risk of relapse for people suffering with chronic depression. The change processes identified to date focus on the individual level, e.g. “de-centering” or identifying less with thoughts. However, substantial research indicates that interpersonal processes play a major role in chronic depression and suggest that mindfulness practice is associated with more fulfilling interpersonal relationships. This study analyzed participants' experiences of MBCT and their relationships with others in-depth, through the use of qualitative methodology, specifically theoretical sampling of participants' interview data using grounded theory. The core construct that emerged from participants' accounts was “relating mindfully”. Findings show the interconnectedness of individual and interpersonal changes through MBCT, and are summarized in diagrammatic form. Participants described “relating mindfully” to their own experiences with consequential profound changes in their relationships with others. Specifically, participants were more aware of their tendency to react automatically to internal and external triggers (distressing interpersonal situations). This awareness allowed them space to mindfully respond to others rather than react in habitual (and often painful) ways. Relationships were enriched through profound and varied changes: Some participants were more able to “be with” others in distress rather than jumping to “fix” or avoid them. At other times, they were more able to enjoy and appreciate being with others due to their increased tendency to live in the present moment. Participants described improvements in communication, such as increased empathy and ability to see others' perspectives, arguments being more constructive as opposed to just frustrated, habitual rowing. These findings suggest the need for an expanded conceptualization of mindfulness, which acknowledges and encompasses these important relational change processes in addition to the individual psychological changes.

This is a preview of subscription content, log in to check access.

Fig. 1

References

  1. Allen, M., Bromley, A., Kuyken, W., & Sonnenberg, S. (2009). Participants' experiences of mindfulness-based cognitive therapy: “it changed me in just about every way possible”. Journal of Behavioural and Cognitive Psychotherapy, 37(4), 413–430.

    Article  Google Scholar 

  2. Allen, N., & Knight, W. (2006). Mindfulness, compassion for self and compassion for others: implications for understanding the psychopathology and treatment of depression. In P. Gilbert (Ed.), Compassion: conceptualisations, research and use in psychotherapy (pp. 239–263). East Sussex: Routledge.

    Google Scholar 

  3. Anderson, P., Beach, S., & Kaslow, N. (1999). Marital discord and depression: the potential of attachment theory to guide integrative clinical intervention. In T. Joyner & J. Coyne (Eds.), The interactional nature of depression—advances in interpersonal approaches (pp. 271–298). Washington: American Psychological Association.

    Google Scholar 

  4. Baer, R. (2003). Mindfulness training as a clinical intervention: a conceptual and empirical review. Clinical Psychology: Science and Practice, 10, 125–143.

    Google Scholar 

  5. Baer, R. (Ed.). (2006). Mindfulness-based treatment approaches: clinicians guide to evidence base and applications. London: Academic.

    Google Scholar 

  6. Ball, S., Otto, M., Pollack, M., & Rosenbaum, J. (1994). Predicting prospective episodes of depression in patients with panic disorder: a longitudinal study. Journal of Consulting and Clinical Psychology, 62, 359–365.

    PubMed  Article  Google Scholar 

  7. Barbato, A., & D'Avanzo, B. (2008). Efficacy of couple therapy as a treatment for depression: a meta-analysis. Psychiatric Quarterly, 79(2), 121–132.

    PubMed  Article  Google Scholar 

  8. Barnes, S., Brown, K., Krusemark, E., Campbell, W., & Rogge, R. (2007). The role of mindfulness in romantic relationship satisfaction and responses to relationship stress. Journal of Marital and Family Therapy, 33(4), 482–500.

    PubMed  Article  Google Scholar 

  9. Beck, A. (1976). Cognitive therapy and the emotional disorders. New York: International Universities Press.

    Google Scholar 

  10. Block-Lerner, J., Adair, C., Plumb, J., Rhatigan, D., & Orsillo, S. (2007). The case for mindfulness-based approaches in the cultivation of empathy: does non-judgmental, present moment awareness increase capacity for perspective taking and empathic concern? Journal of Marital and Family Therapy, 33(4), 501–516.

    PubMed  Article  Google Scholar 

  11. British Psychological Society. (2008). Psychological health and wellbeing: a new ethos and new service structure for mental health. A report on the working group on psychological health and well-being. Leicester: BPS.

  12. Brown, G., & Harris, T. (1978). Social origins of depression: a study of psychiatric disorder in women. New York: Free Press.

    Google Scholar 

  13. Brown, K., & Kasser, T. (2005). Are psychological and ecological wellbeing compatible? The role of values, mindfulness and lifestyle. Social Indicators Research, 74, 349–368.

    Article  Google Scholar 

  14. Brown, G., & Moran, P. (1994). Clinical and psychosocial origins of chronic depressive episodes: a community survey. The British Journal of Psychiatry, 165, 447–456.

    PubMed  Article  Google Scholar 

  15. Brown, K., & Ryan, R. (2003). The benefits of being present: mindfulness and its role in psychological wellbeing. Journal of Personality and Social Psychology, 84, 822–848.

    PubMed  Article  Google Scholar 

  16. Brown, K., Ryan, R., & Cresswell, J. (2007). Mindfulness: theoretical foundations and evidence for its salutary effects. Psychological Inquiry, 18(4), 211–237.

    Article  Google Scholar 

  17. Burpee, L., & Langer, E. (2005). Mindfulness and marital satisfaction. Journal of Adult Development, 12(1), 43–51.

    Article  Google Scholar 

  18. Burr, V. (1995). An introduction to social constructionism. London: Routledge.

    Google Scholar 

  19. Carson, J., Carson, K., Gil, K., & Baucom, D. (2004). Mindfulness-based relationship enhancement. Behaviour Therapy, 35(3), 471–494.

    Article  Google Scholar 

  20. Charmaz, K. (2006). Constructing grounded theory—a practical guide through qualitative analysis. London: Sage.

    Google Scholar 

  21. Childs, D. (2007). Mindfulness and the psychology of presence. Psychology and Psychotherapy: Theory, Research and Practice, 80(3), 367–376.

    Article  Google Scholar 

  22. Coffman, S., Dimidjian, S., & Baer, R. (2006). Mindfulness-based cognitive therapy for prevention of depressive relapse. In R. Baer (Ed.), Mindfulness-based treatment approaches: clinicians guide to evidence base and applications (pp. 31–50). London: Academic.

    Google Scholar 

  23. Conrad, P. (1990). The experience of illness: recent and new directions. Research in the Sociology of Health Care, 6, 1–31.

    Google Scholar 

  24. Medical Research Council. (2000). A framework for development and evaluation of RCTs for complex interventions to improve health. London: Medical Research Council.

    Google Scholar 

  25. Daley, S., Hammen, C., Burge, D., & Davila, J. (1997). Predictors of the duration of episodic stress: a longitudinal study of late adolescent women. Journal of Abnormal Psychology, 104, 592–600.

    Google Scholar 

  26. Davis, M. (1983). Measuring individual differences in empathy: evidence for a multidimensional approach. Journal of Personality and Social Psychology, 44(1), 113–126.

    Article  Google Scholar 

  27. Dekeyser, M., Raes, F., Leijssen, M., Leysen, S., & Dewulf, D. (2008). Mindfulness skills and interpersonal behavior. Personality and Individual Differences, 44(5), 1235–1245.

    Article  Google Scholar 

  28. Dey, I. (1999). Grounding grounded theory. San Diego: Academic.

    Google Scholar 

  29. Dey, I. (2004). Grounded theory. In C. Seale, G. Gobo, J. Gubrium, & D. Silverman (Eds.), Qualitative research practice (pp. 80–93). London: Sage.

    Google Scholar 

  30. Dimidjian, S., & Linehan, M. (2003). Defining an agenda for future research on the clinical applications of mindfulness practice. Clinical Psychology: Science and Practice, 10(2), 166–171.

    Google Scholar 

  31. Duan, C., & Hill, C. (1996). The current state of empathy research. Journal of Counselling Psychology, 43, 261–274.

    Article  Google Scholar 

  32. Dumas, J. (2005). Mindfulness-based parent training: strategies to lessen the grip of automaticity in families with disruptive children. Journal of Clinical Child and Adolescent Psychology, 34(4), 779–791.

    PubMed  Article  Google Scholar 

  33. Elliott, R. (2007). Change process research: realizing the promise. Paper presented at meeting of the Society for Psychotherapy Research, Madison, WI.

  34. Flick, U. (2006). An introduction to qualitative research. London: Sage.

    Google Scholar 

  35. Fonagy, P., & Target. (1997). Attachment and reflective function: their role in self organisation. Development and Psychopathology, 9, 679–700.

    PubMed  Article  Google Scholar 

  36. Fredrickson, B., Cohn, M., Coffey, K., Pek, J., & Finkel, S. (2008). Open hearts build lives: positive emotions, induced through loving-kindness meditation, build consequential personal resources. Journal of Personality and Social Psychology, 95(5), 1045–1062.

    PubMed Central  PubMed  Article  Google Scholar 

  37. Gilbert, P. (2009). Moving beyond cognitive behaviour therapy. The Psychologist, 22(5), 400–403.

    Google Scholar 

  38. Glaser, B., & Strauss, A. (1967). The discovery of grounded theory. Chicago: Aldine.

    Google Scholar 

  39. Hammen, C. (1991). Generation of stress in the course of unipolar depression. Journal of Abnormal Psychology, 100, 55–561.

    Article  Google Scholar 

  40. Hammen, C., Burge, D., Dale, S., Davila, J., Paley, B., & Rudolph, K. (1995). Interpersonal attachment cognitions and prediction of symptomatic responses to interpersonal stress. Journal of Personality and Social Psychology, 104, 436–443.

    Google Scholar 

  41. Henwood, K., & Pidgeon, N. (2003). Grounded theory in psychological research. In P. Camic, J. Rhodes, & L. Yardley (Eds.), Qualitative research in psychology: expanding perspectives in methodology and design (pp. 131–155). Washington: American Psychological Association.

    Google Scholar 

  42. Heppner, W., & Kernis, M. (2007). “Quiet ego” functioning: the complementary roles of mindfulness, authenticity, and secure high self esteem. Psychological Inquiry, 18(4), 248–251.

    Article  Google Scholar 

  43. Hofmann, S., Sawyer, A., Witt, A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. Journal of Consulting and Clinical Psychology, 78(2), 169–183.

    PubMed Central  PubMed  Article  Google Scholar 

  44. Hooley, J., & Teasdale, J. (1989). Predictors of relapse in unipolar depressives: expressed emotion, marital distress and perceived criticism. Journal of Abnormal Psychology, 98, 229–235.

    PubMed  Article  Google Scholar 

  45. Joiner, T. (2000). Depression's vicious spree: self- propagating and erosive processes in depression chronicity. Clinical Psychology: Science and Practice, 7(2), 203–218.

    Google Scholar 

  46. Joiner, T., & Coyne, J. (Eds.). (1999). The interactional nature of depression—advances in interpersonal approaches. Washington: American Psychological Association.

    Google Scholar 

  47. Joiner, T., Coyne, J., & Blalock, J. (1999). On the interpersonal nature of depression: overview and synthesis. In T. Joyner & J. Coyne (Eds.), The interactional nature of depression—advances in interpersonal approaches (pp. 3–20). Washington: American Psychological Association.

    Google Scholar 

  48. Jones, E., & Leff, J. (2000). Systemic couple therapy and depression. London: Karnac.

    Google Scholar 

  49. Judd, L. (1997). The clinical course of unipolar major depressive disorders. Archives of General Psychiatry, 54, 989–991.

    PubMed  Article  Google Scholar 

  50. Kabat-Zinn, J. (1990). Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness. New York: Dell Publishing.

    Google Scholar 

  51. Kabat-Zinn, J. (1993). Mindfulness meditation: health benefits of an ancient Buddhist practice. In D. Goleman & J. Garin (Eds.), Mind/body medicine. New York: Yonkers Consumer Reports.

    Google Scholar 

  52. Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: past, present and future. Clinical Psychology: Science and Practice, 10(2), 144–156.

    Google Scholar 

  53. Kabat-Zinn, J. (2005). Coming to our senses: healing ourselves and the world through mindfulness. New York: Hyperion.

    Google Scholar 

  54. Kabat-Zinn, M., & Kabat-Zinn, J. (1998). Everyday blessings: the inner work of mindful parenting. New York: Hyperion.

    Google Scholar 

  55. Kingston, T., Dooley, B., Bates, A., Lawlor, E., & Malone, K. (2007). Mindfulness-based cognitive therapy for residual symptoms. Psychology and Psychotherapy: Theory, Research and Practice, 80(2), 193–203.

    Article  Google Scholar 

  56. Klerman, G., Weissman, M., Rounsaville, B., & Chevron, E. (1984). Interpersonal therapy for depression. New York: Basic Books.

    Google Scholar 

  57. Kukyen, W., Sarah, B., Taylor, R., Watkins, E., Holden, E., White, K., Barrett, B., Byng, R., Evans, A., Mullan, E., & Teasdale, J. (2008). Mindfulness-based cognitive therapy to prevent relapse in recurrent depression. Journal of Consulting and Clinical Psychology, 76, 6.

    Google Scholar 

  58. Kvale, J. (1995). The social construction of validity. Qualitative Inquiry, 1(1), 19–40.

    Article  Google Scholar 

  59. Lara, M., Klein, D., & Kasch, K. (2000). Psychosocial predictors of the short-term course and outcome of major depression: a longitudinal study. Journal of Abnormal Psychology, 109(4), 644–650.

    PubMed  Article  Google Scholar 

  60. Lara, M., Leader, J., & Klein. (1997). The association between social support and course of depression: is it confounded with personality? Journal of Abnormal Psychology, 106, 478–482.

    PubMed  Article  Google Scholar 

  61. Leary, M. (2004). The curse of the self: self awareness, egotism and the quality of human life. New York: Oxford University Press.

    Google Scholar 

  62. Long, E., Angera, J., Carter, S., Nakamoto, M., & Kalso, M. (1999). Understanding the one you love: a longitudinal assessment of an empathy training program for couples in romantic relationships. Family Relations, 48, 235–348.

    Article  Google Scholar 

  63. Ma, H. (2002). Prevention of relapse/recurrence in recurrent major depression by mindfulness-based cognitive therapy. (Unpublished doctoral dissertation). UK: University of Cambridge.

  64. Ma, S., & Teasdale, J. (2004). Mindfulness-based cognitive therapy for depression: replication and exploration of differential relapse prevention effects. Journal of Consulting and Clinical Psychology, 72, 31–40.

    PubMed  Article  Google Scholar 

  65. Mace, C. (2006). Long term impacts of mindfulness on psychological wellbeing: new findings from qualitative research. In A. Delle Fave (Ed.), Dimensions of wellbeing (pp. 255–269). Milan: Franco Angeli.

    Google Scholar 

  66. Mace, C. (2008). Mindfulness and mental health: therapy, theory and science. Sussex: Routledge.

    Google Scholar 

  67. Madill, A., Jordan, A., & Shirley, C. (2000). Objectivity and reliability in qualitative analysis: realist, contextualist and radical constructionist epistemologies. British Journal of Psychology, 91, 1–20.

    PubMed  Article  Google Scholar 

  68. Marshall, C., & Rossman, G. (2006). Designing qualitative research. London: Sage.

    Google Scholar 

  69. Mason, O., & Hargreaves, I. (2001). A qualitative study of mindfulness-based cognitive therapy for depression. The British Journal of Medical Psychology, 74, 197–212.

    Article  Google Scholar 

  70. Michal, M., Beutel, M., Jordan, J., Zimmerman, M., Wolters, S., & Heidenrich, T. (2007). Depersonalisation, mindfulness and childhood trauma. Journal of Nervous and Mental Diseases, 195(8), 693–696.

    Article  Google Scholar 

  71. Napoli, M. (2005). Mindfulness training for elementary school students: the attention academy. Journal of Applied School Psychology, 21(1), 99–125.

    Article  Google Scholar 

  72. National Institute for Clinical Excellence (NICE). (2004). Depression: management of depression in primary and secondary care (clinical guideline 23). London: NICE.

    Google Scholar 

  73. Nolen-Hoeksema, S. (1991). Responses to depression and their effects on the duration of depressive episodes. Journal of Abnormal Psychology, 100, 569–582.

    PubMed  Article  Google Scholar 

  74. Orford, J. (2008). Community psychology: challenges, controversies and emerging consensus. Chichester: Wiley.

    Google Scholar 

  75. Patton, M. (2002). Qualitative evaluation and research methods. London: Sage.

    Google Scholar 

  76. Pettit, J., & Joiner, T. (2006). Chronic depression—interpersonal sources, therapeutic solutions. Washington: American Psychological Association.

    Google Scholar 

  77. Pope, C., & Mays, N. (1995). Qualitative research—reaching the parts other methods cannot reach: an introduction to qualitative methods in health services. British Medical Journal, 311, 42–45.

    PubMed  Article  Google Scholar 

  78. Post, R. (1992). Transduction of psychosocial stress into the neurobiology of recurrent affective disorder. The American Journal of Psychiatry, 149, 999–1010.

    PubMed  Google Scholar 

  79. Scherer-Dickson, N. (2004). Current developments of meta-cognitive concepts and their clinical implications: mindfulness-based cognitive therapy for depression. Counselling Psychology Quarterly, 17(2), 223–234.

    Article  Google Scholar 

  80. Segal, Z., Gemar, M., & Williams, S. (1999). Differential cognitive response to a mood challenge following successful cognitive therapy or pharmacotherapy for unipolar depression. Journal of Abnormal Psychology, 108, 3–10.

    PubMed  Article  Google Scholar 

  81. Segal, Z., Truchon, C., Gemar, M., & Guirguis, M. (1995). A priming methodology for studying self-representation in major depressive disorder. Journal of Abnormal Psychology, 104, 205–213.

    PubMed  Article  Google Scholar 

  82. Segal, Z., Williams, J., & Teasdale, J. (2002). Mindfulness based cognitive therapy for depression: a new approach to preventing relapse. London: Guildford press.

    Google Scholar 

  83. Shapiro, S., Schwartz, G., & Bonner, G. (1998). Effects of mindfulness-based stress reduction on medical and pre-medical students. Journal of Behavioural Medicine, 21, 581–599.

    Article  Google Scholar 

  84. Shaver, P., Lavy, S., Saron, C., & Mikulincer, M. (2007). Social foundations of the capacity for mindfulness: an attachment perspective. Psychological Inquiry, 18(4), 264–271.

    Article  Google Scholar 

  85. Singh, N., Lancioni, G., Winton, A., Fisher, N., Wahler, R., McAleavey, K., Singh, J., & Sabaawi, M. (2006). Mindful parenting decreases aggression, non-compliance and self-injury in children with autism. Journal of Emotional and Behavioural Disorders, 14(3), 169–177.

    Article  Google Scholar 

  86. Singh, N., Lancioni, G., Winton, A., Singh, J., Curtis, J., Wahler, R., & McAleavey, K. (2007). Mindful parenting decreases aggression and increases social behaviour in children with developmental disabilities. Behaviour Modification, 31(6), 749–771.

    Article  Google Scholar 

  87. Smith, A., Graham, L., & Senthinathan, S. (2007). Mindfulness-based cognitive therapy for recurring depression in older people: a qualitative study. Aging & Mental Health, 11(3), 346–357.

    Article  Google Scholar 

  88. Strauss, A., & Corbin, J. (1990). Basics of qualitative research. London: Sage.

    Google Scholar 

  89. Teasdale, J. (1988). Cognitive vulnerability to persistent depression. Cognition and Emotion, 2, 247–274.

    Article  Google Scholar 

  90. Teasdale, J., & Barnard, P. (1993). Affect, cognition and change. Hove: Erlbaum.

    Google Scholar 

  91. Teasdale, J., Moore, R., Hayhurst, H., Pope, M., Williams, S., & Segal, Z. (2002). Meta-cognitive awareness and prevention of relapse in depression: empirical evidence. Journal of Consulting and Clinical Psychology, 70(2), 275–287.

    PubMed  Article  Google Scholar 

  92. Teasdale, J., Segal, Z., & Williams, J. (1995). How does cognitive therapy prevent depressive relapse and why should attentional control (mindfulness training) help? Behaviour Research and Therapy, 33, 25–39.

    PubMed  Article  Google Scholar 

  93. Teasdale, J., Segal, Z., & Williams, J. (2003). Mindfulness training and problem formulation. Clinical Psychology: Science and Practice, 10, 157–160.

    Google Scholar 

  94. Teasdale, J., Segal, Z., Williams, J., Ridgeway, V., Soulsby, J., & Lau, M. (2000). Prevention of relapse-recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 68, 615–623.

    PubMed  Article  Google Scholar 

  95. Wachs, K., & Cordova, J. (2007). Mindful relating: exploring mindfulness and emotion repertoires in intimate relationships. Journal of Marital and Family Therapy, 33(4), 464–481.

    PubMed  Article  Google Scholar 

  96. Wall, R. (2005). Tai chi and mindfulness-based stress reduction in a Boston public middle school. Journal of Pediatric Health Care, 19(4), 230–237.

    PubMed  Article  Google Scholar 

  97. Weissman, M., & Markowitz, J. (1998). An overview of interpersonal psychotherapy. In J. Markowitz (Ed.), Interpersonal psychotherapy (pp. 1–33). Washington: American Psychiatric.

    Google Scholar 

  98. Weissman, M., Markowitz, J., & Klerman, G. (2007). Clinician's quick guide to interpersonal psychotherapy. New York: Oxford University Press.

    Google Scholar 

  99. Willig, C. (2001). Introducing qualitative research in psychology—adventures in theory and method. Buckingham: Open University.

    Google Scholar 

Download references

Acknowledgments

The authors thank all the participants, and to Alison Evans, MBCT instructor and field collaborator, for their insight, kindness and generosity.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Joanne L. N. Bihari.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Bihari, J.L.N., Mullan, E.G. Relating Mindfully: A Qualitative Exploration of Changes in Relationships Through Mindfulness-Based Cognitive Therapy. Mindfulness 5, 46–59 (2014). https://doi.org/10.1007/s12671-012-0146-x

Download citation

Keywords

  • Mindfulness-based cognitive therapy
  • MBCT
  • Mindfulness
  • Relationships
  • Interpersonal
  • Qualitative