Abstract
Mindfulness‐based cognitive therapy (MBCT) is an innovative evidence‐based intervention in mental and somatic health care. Gaining knowledge of therapeutic factors associated with treatment outcome can improve MBCT. This study focused on predictors of treatment outcome of MBCT for cancer patients and examined whether group cohesion, therapeutic alliance, and therapist competence predicted reduction of psychological distress after MBCT for cancer patients. Moreover, it was examined whether therapist competence facilitated therapeutic alliance or group cohesion. Multilevel analyses were conducted on a subsample of patients collected in a larger randomized controlled trial on individual internet‐based versus group‐based MBCT versus treatment as usual in distressed cancer patients. The current analyses included the 84 patients who completed group‐based MBCT out of 120 patients who were randomized to group‐based MBCT. Group cohesion and therapist competence did not predict reduction in psychological distress, whereas therapeutic alliance did. In addition, therapist competence did not predict therapeutic alliance but was associated with reduced group cohesion. Our findings revealed that therapeutic alliance significantly contributed to reduction of psychological distress in MBCT for cancer patients. Elaborating the clinical implications of the predictive significance of therapeutic alliance might be of added value to enhance the potential effect of MBCT.
Highlights
Mindfulness‐based interventions (MBIs) are innovative evidence‐based interventions in mental and somatic health care (Gotink et al, 2015; Informed consent was obtained from all individual participants included in the study.Kuyken et al, 2016)
For patients participating in the group‐based Mindfulness‐based cognitive therapy (MBCT) after treatment as usual (TAU), baseline scores on the Hospital Anxiety and Depression Scale (HADS) were replaced with end‐of‐waiting list scores as those were closer in time to the start of the treatment, in accordance with a previous study on the long‐term effect of (e)MBCT in cancer patient (Cillessen et al, 2018)
The present study investigated the association of group cohesion, therapeutic alliance, and therapist competence with reduction of psychological distress after MBCT for cancer patients
Summary
Mindfulness‐based interventions (MBIs) are innovative evidence‐based interventions in mental and somatic health care Other studies indicate specific therapeutic factors to predict outcome of particular psychotherapies, such as embodiment as a key element of therapist competence in MBIs (van Aalderen, Breukers, Reuzel, & Speckens, 2014). Therapeutic alliance predicts reduction in psychological distress after MBCT for cancer patients, whereas group cohesion and therapist competence did not. Group cohesion and therapeutic alliance are closely related constructs, contributing independently to treatment outcome. Conclusive evidence whether group cohesion, therapeutic alliance, and therapist competence predict treatment outcome is lacking. The aim of our explorative study was to examine the role of group cohesion, therapeutic alliance, and therapist competence on outcome of MBCT for distressed cancer patients. It was hypothesized that (a) group cohesion, therapeutic alliance, and therapist competence independently predict reduction of psychological distress, and (b) therapist competence is a precondition for developing both group cohesion and therapeutic alliance which, in turn, independently predict reduction of psychological distress
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