Mindfulness Based Compassionate Living (MBCL): a qualitative study into the added value of compassion in recurrent depression

Objectives: 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. Methods: 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. Results: 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. Conclusion: 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.