Living to the fullest!

Abstract

Interventions that are easily available, attractive and feasible help to broaden the effect public mental health interventions can have on depression. In this thesis, a specific subset of Mindfulness-based Interventions (MBIs) as public mental health interventions for people with mild to moderate depressive symptoms is studied, namely a community-based Mindfulness Based Cognitive Therapy (MBCT) and a web-based Acceptance and Commitment Therapy (ACT) intervention. Our first goal was to study whether MBCT, originally developed to prevent the relapse of people diagnosed with recurrent depression, could be effective as a public mental health intervention for people who have depressive symptoms. The adaptation was, in large part, a reduction in mindfulness meditation exercises, from 45 minutes to 15 minutes a day. The study showed that the community-based MBCT was effective for people with depressive symptoms. Our second goal was to study whether web-based or online public mental health interventions based on mindfulness were effective. Although current public mental health interventions have been demonstrated to be effective, they seem to have low impact due to the stigma and a mismatch in acceptability to users. Ensuring availability of interventions on the Internet can enhance the impact of public mental health interventions and improve the quality of health care. In our meta-analysis, online MBIs as public mental health interventions showed a beneficial impact on mental health outcomes, suggesting that online MBIs have the potential to contribute to promoting mental health. Our third goal was to broaden the availability of online MBIs in a (cost-)effective way by developing a web-based intervention for adults with mild to moderate depressive symptoms. We developed the web-based intervention “Living to the Full”, based on ACT and mindfulness, using persuasive technologies to increase adherence. The web-based intervention proved to be superior over time in effectiveness compared to both the active and the waiting list control group. Psychological flexibility and mindfulness appeared to be the central therapeutic mechanisms in the web-based intervention, confirming theoretical framework of ACT. Furthermore, we found that, at least for the target group, there seems to be no reason to exclude people from web-based ACT.