Skip to main content

Mindfulness-Based Compassionate Living (MBCL): a Qualitative Study into the Added Value of Compassion in Recurrent Depression



Mindfulness-based cognitive therapy (MBCT) has been found effective in reducing depressive symptoms in adults suffering from recurrent depression. However, sustained recovery after MBCT is modest and may require additional, sequential treatment. Basing such additions on known working mechanisms of MBCT, like increases in (self-)compassion, is likely to reap further benefits. Mindfulness-based compassionate living (MBCL) is designed as a follow-up to MBCT and has been shown effective in reducing depressive symptoms. It has a similar format to MBCT: eight weekly group sessions and additional home practice. MBCL has a more explicit focus on cultivating (self-)compassion in response to difficult experiences. Little is known about the potential experiential added value of MBCL after MBCT. The current study aims to fill this gap.


A grounded theory approach was used to analyze in-depth interviews, which were held post-intervention with a purposive sample of patients who participated in a randomized controlled trial of MBCL for recurrent depression.


Participants indicated that MBCL particularly had added value in terms of its immediate applicability in situations of deep suffering. Four themes emerged: (1) the container of kindness, (2) exposure to the difficult, (3) empowerment, and (4) common humanity.


This study shows that participants experienced an additional value of MBCL over and above MBCT. The results provide insight into the processes underlying the efficacy of MBCL in reducing depressive symptoms and may help address underlying mechanisms of vulnerability in this population as well as tap into mechanisms that enhance resilience.

This is a preview of subscription content, access via your institution.


  • Baldessarini, R. J., Lau, W. K., Sim, J., Sum, M. Y., & Sim, K. (2015). Duration of initial antidepressant treatment and subsequent relapse of major depression. Journal of Clinical Psychopharmacology, 35(1), 75–76.

    Article  Google Scholar 

  • Bauer, M., Whybrow, P. C., Angst, J., Versiani, M., & Möller, H. J. (2002). World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for biological treatment of unipolar depressive disorders, Part 1: Acute and continuation treatment of major depressive disorder. World Journal of Biological Psychiatry, 3(1), 5–43.

  • Beck, A. T. (1967). Depression: Clinical, experimental, and theoretical aspects. Harper & Row.

  • Beck, A. T., Shaw, R. A. J., Brian, F., & Emery, G. (1979). Cognitive therapy of depression. The Guilford Press.

    Google Scholar 

  • Boeije H. (2014). Analysis in qualitative research. Sage Publications.

  • Boland, R. J., Keller, M. B., & Bol, R. J. (2002). The course of depression. Guilford Press.

    Google Scholar 

  • Crane, R. S., Eames, C., Kuyken, W., Hastings, R. P., Williams, J. M. G., Bartley, T., Evans, A., Silverton, S., Soulsby, J. G., & Surawy, C. (2013). Development and validation of the mindfulness-based interventions–teaching assessment criteria (MBI: TAC). Assessment, 20(6), 681–688.

    Article  Google Scholar 

  • Cuijpers, P., Dekker, J., Hollon, S. D., & Andersson, G. (2009a). Adding psychotherapy to pharmacotherapy in the treatment of depressive disorders in adults: A meta-analysis. Database of Abstracts of Reviews of Effects (DARE): quality-assessed reviews. Centre for Reviews and Dissemination.

  • Cuijpers, P., Van Straten, A., Warmerdam, E., & Andersson, G. (2009b). Psychological treatment versus combined treatment of depression: A meta-analysis. Depression and Anxiety, 26, 279–288.

    Article  Google Scholar 

  • Feldman, C., & Kuyken, W. (2011). Compassion in the landscape of suffering. Contemporary Buddhism, 12(01), 143–155.

    Article  Google Scholar 

  • Feldman, C., & Kuyken, W. (2019). Mindfulnes: Ancient wisdom meets modern psychology. Guilford Publications.

    Google Scholar 

  • Ferrari, M., Hunt, C., Harrysunker, A., Abbott, M. J., Beath, A. P., & Einstein, D. A. (2019). Self-compassion interventions and psychosocial outcomes: A meta-analysis of RCTs. Mindfulness, 10(8), 1455–1473.

    Article  Google Scholar 

  • Forte, A., Baldessarini, R. J., Tondo, L., Vázquez, G. H., Pompili, M., & Girardi, P. (2015). Long-term morbidity in bipolar-I, bipolar-II, and unipolar major depressive disorders. Journal of Affective Disorders, 178, 71–78.

    Article  Google Scholar 

  • Garland, E. L., Farb, N., Goldin, P., & Fredrickson, B. (2015). Mindfulness broadens awareness and builds eudaimonic meaning: A process model of mindful positive emotion regulation. Psychological Inquiry, 26(4), 293–314.

    Article  Google Scholar 

  • Germer, C. (2009). The mindful path to self-compassion: Freeing yourself from destructive thoughts and emotions. Guilford Press.

    Google Scholar 

  • Gilbert, P. (2009). Introducing compassion-focused therapy. Advances in Psychiatric Treatment, 15(3), 199–208.

    Article  Google Scholar 

  • Gilbert, P., McEwan, K., Catarino, F., Baiao, R., & Palmeira, L. (2013). Fears of happiness and compassion in relationship with depression, alexithymia, and attachment security in a depressed sample. British Journal of Clinical Psychology.

    Article  Google Scholar 

  • Gilbert, P., & Procter, S. (2006). Compassionate mind training for people with high shame and self-criticism: Overview and pilot study of a group therapy approach. Clinical Psychology & Psychotherapy, 13(6), 353–379.

    Article  Google Scholar 

  • Hardeveld, F., Spijker, J., De Graaf, R., Nolen, W., & Beekman, A. (2010). Prevalence and predictors of recurrence of major depressive disorder in the adult population. Acta Psychiatrica Scandinavica, 122(3), 184–191.

    Article  Google Scholar 

  • Judge, L., Cleghorn, A., McEwan, K., & Gilbert, P. (2012). An exploration of group-based compassion focused therapy for a heterogeneous range of clients presenting to a community mental health team. International Journal of Cognitive Therapy, 5(4), 420–429.

    Article  Google Scholar 

  • Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in everyday life. Hyperion.

    Google Scholar 

  • Kirby, J., Tellegen, C., & Steindl, S. (2015). Cultivating compassion: a systematic review and meta-analysis of compassion-based interventions. PROSPERO: International prospective register of systematic reviews

  • Kuyken, W., Warren, F. C., Taylor, R. S., Whalley, B., Crane, C., Bondolfi, G., Hayes, R., Huijbers, M., Ma, H., Schweizer, S., Segal, Z., Speckens, A., Teasdale, J. D., Van Heeringen, K., Williams, M., Byford, S., Byng, R., & Dalgliesh, T. (2016). Efficacy of mindfulness-based cognitive therapy in prevention of depressive relapse: An individual patient data meta-analysis from randomized trials. JAMA Psychiatry, 73(6), 565–574.

    Article  Google Scholar 

  • Kuyken, W., Watkins, E., Holden, E., White, K., Taylor, R. S., Byford, S., Evans, A., Sholto, R., Teasdale, J. D., & Dalgleish, T. (2010). How does mindfulness-based cognitive therapy work? Behaviour Research and Therapy, 48(11), 1105–1112.

    Article  PubMed  Google Scholar 

  • Mueller, T. I., Leon, A. C., Keller, M. B., Solomon, D. A., Endicott, J., Coryell, W., Warshaw, M., & Maser, J. D. (1999). Recurrence after recovery from major depressive disorder during 15 years of observational follow-up. American Journal of Psychiatry, 156(7), 1000–1006.

    Google Scholar 

  • Neff, K., & Germer, C. (2013). A pilot study and randomized controlled trial of the mindful self-compassion program. Journal of Clinical Psychology, 69(1), 28–44.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Rosen, G. M., & Davison, G. C. (2003). Psychology should list empirically supported principles of change (ESPs) and not credential trademarked therapies or other treatment packages. Behavior Modification, 27(3), 300–312.

    Article  Google Scholar 

  • Schuling, R., Huijbers, M. J., Van Ravesteijn, H., Donders, A., Kuyken, W., & Speckens, A. (2016). A parallel-group, randomized controlled trial into the of mindfulness-based compassionate living (MBCL) compared to treatment-as-usual in recurrent depression: Trial design and protocol. Contemporary Clinical Trials, 50, 77–83.

    Article  Google Scholar 

  • Schuling, R., Huijbers, M. J., Van Ravesteijn, H., Donders, A., Cillessen, L., Kuyken, W., & Speckens, A. (2020). Recovery from recurrent depression: Randomized controlled trial of the efficacy of mindfulness-based compassionate living compared with treatment-as-usual on depressive symptoms and its consolidation at longer term follow-up. Journal of Affective Disorders, 273, 265–273.

    Article  Google Scholar 

  • Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2012). Mindfulness-based cognitive therapy for depression. Guilford Press.

    Google Scholar 

  • Sim, K., Lau, W. K., Sim, J., Sum, M. Y., & Baldessarini, R. J. (2016). Prevention of relapse and recurrence in adults with major depressive disorder Systematic review and meta-analyses of controlled trials. International Journal of Neuropsychopharmacology, 19(2), pyv076.

    Article  Google Scholar 

  • Strauss, C., Cavanagh, K., Oliver, A., & Pettman, D. (2014). Mindfulness-based interventions for people diagnosed with a current episode of an anxiety or depressive disorder: A meta-analysis of randomised controlled trials. PLoS One, 9(4), e96110.

    Article  PubMed  PubMed Central  Google Scholar 

  • Strauss, C., Taylor, B. L., Gu, J., Kuyken, W., Baer, R., Jones, F., & Cavanagh, K. (2016). What is compassion and how can we measure it? A review of definitions and measures. Clinical Psychology Review, 47, 15–27.

    Article  Google Scholar 

  • Undurraga, J., & Baldessarini, R. (2012). A 30-year meta-analytic review of antidepressant efficacy in acute major depression. Neuropsychopharmacology, 37, 851–864.

    Article  Google Scholar 

  • Van Aalderen, J., Donders, A. R. T., Giommi, F., Spinhoven, P., Barendregt, H. P., & Speckens, A. (2012). The efficacy of mindfulness-based cognitive therapy in recurrent depressed patients with and without a current depressive episode: A randomized controlled trial. Psychological Medicine, 42(05), 989–1001.

    Article  Google Scholar 

  • Van den Brink, E., & Koster, F. (2015). Mindfulness-based compassionate living: A new training programme to deepen mindfulness with heartfulness. Routledge.

    Book  Google Scholar 

  • Van der Velden, A. M., Kuyken, W., Wattar, U., Crane, C., Pallesen, K. J., Dahlgaard, J., Fjorback, L. O., & Piet, J. (2015). A systematic review of mechanisms of change in mindfulness-based cognitive therapy in the treatment of recurrent major depressive disorder. Clinical Psychology Review, 37, 26–39.

    Article  Google Scholar 

  • Vos, T., Abajobir, A.A., Abate, K.H., Abbafati, C., Abbas, K.M., Abd-Allah, F., Abdulkader, R.S., Abdulle, A.M., Abebo, T.A., Abera, S.F., Aboyans, V., Abu-Raddad, L.J., Ackerman, I.N., Adamu, A.A., Adetokunboh, O., Afarideh, M., Afshin, A., Agarwal, S.K., Aggarwal, R., ... & Murray, C.J.L. (2017). Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet, 390(10100), 1211-1259

  • Wittchen, H. U., Jacobi, F., Rehm, J., Gustavsson, A., Svensson, M., Jönsson, B., Olesen, J., Allgulander, C., Alonso, J., Faravelli, C., Fratiglioni, L., Jennum, P., Lieb, R., Maercker, A., Van Os, J., Preisig, M., Salvador-Carulla, L., Simon, R., & Steinhausen, H. C. (2011). The size and burden of mental disorders and other disorders of the brain in Europe 2010. European Neuropsychopharmacology, 21(9), 655–679.

    Article  Google Scholar 

Download references


The authors would like to thank all patients who participated in this study and Rosalie van Woezik, Indah Kuiper, and Heidi Willemse for their help with transcribing the interviews.


This study was partly financed by the Meditation Awareness and Peace research fund under auspices of the Triodos Foundation. Neither of these parties influenced design or execution of this study.

Author information

Authors and Affiliations



RS: designed and executed the study, conducted data analyses, and wrote the paper. MH: conducted data analyses and edited the paper. HR: collaborated with the design, conducted data analyses, and co-authored the paper. WK: gave input for study aims and discussion and edited the paper. AS: collaborated with the design and data analysis and edited the paper.

Corresponding author

Correspondence to Rhoda Schuling.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Early stages of analysis were presented at the CMPR Chester 2017, ICM Amsterdam 2018, and Compassion in Connection at Omega Institute 2018.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schuling, R., Huijbers, M.J., van Ravesteijn, H. et al. Mindfulness-Based Compassionate Living (MBCL): a Qualitative Study into the Added Value of Compassion in Recurrent Depression. Mindfulness 12, 2196–2206 (2021).

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: