Steps to Peace: Integrating Mindfulness, Relationship and Technique
Research type
Research Study
Full title
Steps to a Peace of Mind: Integrating Mindfulness, Therapeutic Relationship and Technique. Innovations in Practice in the Treatment of Eating Disorders.
IRAS ID
245662
Contact name
David Bishop
Contact email
Sponsor organisation
University of Bedfordshire, Institute of Applied Social Research
Duration of Study in the UK
2 years, 7 months, 13 days
Research summary
Steps to a Peace of Mind: Integrating mindful awareness, therapeutic relationship and technique. Exploring innovations in practice in the treatment of eating disorders.\n\nDespite the best current evidence-based practice, outcomes for people with eating disorders remain far from optimal. Between one half and one third of people do not fully recover and anorexia nervosa holds the highest mortality of any psychiatric disorder. \n\nHow might outcomes be enhanced?\n\nI work as a psychotherapist in an NHS Adult Eating Disorder Service. I am undertaking is a small, qualitative study of my own clinical practice, looking at innovative ways of working with people who have eating disorders and related mental health problems. \n\nOver recent years, I have been exploring different interventions such as mindfulness, mindful inquiry, (based on a self-help tool called The Work,) and a form of guided visualisation (based upon a process called The Journey Method). What is common to these techniques is the development of more mindful ways of being and working (both in the therapist and the client). This is very different to working at a cognitive, analytic or behavioural level. \n\nHaving incorporated these new ways of working, audit of my practice suggests that outcomes have significantly improved, with 60-90% (depending on chronicity of illness) of patients discharged clinically well.\n\nI would like to explore what may be making a difference. \n\nThe type of research I am doing is called relational ethnography, a form of autoethnography. This is a way of researching that will involve both describing and analysing experiences of change from within the therapeutic relationship. I would like to invite between three and five research participants from my clinical caseload to collaborate in the development of a rich, coherent, and analytical narrative account of new ways of working that have not previously been described in the field. \n
Lay Summary of Results:
Steps to a Peace of Mind: Integrating Mindfulness, Therapeutic Relationship and Technique. Innovations in Practice in the Treatment of Eating Disorders.
This qualitative research project emerged from my experience as a systemic psychotherapist working in the field of adult mental health and my particular interest in eating disorders.
The research was conducted as part of my professional doctorate in systemic practice as a therapist-researcher. The clinical research took place, with follow up, from 5 December 2018 – 16 September 2022 through the sponsor organisation, Midlands Partnership University NHS Foundation Trust.
Eating disorders effect around 1.25 million people in the UK, with 0.3% of the UK population living specifically with anorexia nervosa. NICE guidelines recommended treatments are effective for around 46% of clients with anorexia, with a further 30-35% experiencing only partial recovery and around 20% remaining ill with devastating life-long illness. Anorexia nervosa holds the highest mortality of any mental illness. As a therapist-researcher, my interest is exploring new ways of working with clients for whom evidence-based treatments have failed.
Informed by clinical research on the effectiveness of mindfulness in mental health, and theoretical research suggesting how mindfulness may help people overcome anorexia nervosa, I have been integrating mindfulness-informed ways of working in my clinical practice as a psychotherapist for many years. These include Mindfulness-Based Cognitive Therapy, Acceptance and Commitment Therapy, Inquiry-Based Stress Reduction, and The Journey Method (a focus of my previous research). Through integrating these approaches, I noticed clinical outcomes for clients improving beyond that expected according to existing research; for some, transformation would emerge.
As a therapist-researcher undertaking a professional doctorate, I was passionate to explore the questions; what factors may be making a difference for clients who are accessing this mindfulness-informed psychotherapy; and how might new understandings help inform possible new therapeutic approaches?
This was a qualitative research project with two case studies, semi-structured interviews, and reflective writing (relational ethnography). The intention was to write a thesis that would be accessible for both clients and therapists, in ‘steps’ (chapters), connecting theory, philosophy, and clinical practice, through narrative description of change for the research participants, Susie and John.
Susie was living with severe life-threatening anorexia nervosa (binge-purge subtype), alcohol dependence, complex post-traumatic stress disorder, anxiety, and panic attacks. She had taken multiple overdoses, twice requiring treatment in intensive care. She had had to retire on health grounds due to the severity of her illness. First line treatment for anorexia, specialist inpatient treatment, and psychodynamic psychotherapy had effected no change. Susie was not expected to survive.
John was living with severe enduring anorexia nervosa (restrictive subtype). First line treatments had failed, and John had required eight life-saving specialist eating disorder inpatient admissions, each 6-9 months duration, over a period of 30 years. John was too ill to work and was not expected to recover.
Through long term mindfulness-informed psychotherapy (each case study around 100 sessions), both Susie and John experienced personal transformation and achieved clinical remission from mental illness. Both were able to return to the workplace and were discharged from the eating disorder service. John has remained well. Susie has had several brief relapses but has responded well to further interventions.
Beyond clinical remission, what was striking for both Susie and John was the quality of subjective change. Susie and John described mindful phenomena of ‘peace, joy, love, serenity, forgiveness', and ‘enlightenment’ or ‘detachment’ from distressing thoughts and feelings.
I am humbled and deeply grateful for the courage and commitment of Susie and John in their healing journeys, and their contribution to this research. The experience of working together with Susie and John enabled new insights and understandings to emerge through reflective writing, developing new theories of change that I hope may offer a contribution to the field of mental health.
I was able to develop a new mindful model of change, or transformation, called fourth order change. This represents a development of the constructs of first order change (gradual, logical, incremental, behavioural change such as weight restoration), second order change (a transformation in sense of self, relationship or identity), and third order change (where transformation is connected to wider social, political, and cultural contexts such as social activism).
I developed a contribution to common factors theory, describing mindful presence as a fifth common factor – in addition to the established four common factors that combine to make a difference in psychotherapy; the client, the therapist, therapeutic relationship, and therapeutic techniques.
Other clients have since been inspired from reading the research in the format of the case studies and the thesis as a whole, available online (link below). I intend to write academic papers to disseminate these research findings further. Susie and John each received bound copies of the thesis.
Further research is necessary to develop this qualitative and theoretical research to explore if and how these ideas may be effective if integrated more widely into clinical practice, perhaps both with individuals and through group therapy.
https://gbr01.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftrack.pstmrk.it%2F3ts%2Fresearchportal.beds.ac.uk%252Fen%252FstudentTheses%252Fsteps-towards-peace-of-mind-integrating-mindful-presence-in-the-p-3%252F%2FNBTI%2FhA7GAQ%2FAQ%2F1481bea1-4534-4dc4-918b-60612dd4f62e%2F1%2FDCwyQkV8cM&data=05%7C02%7Cleedswest.rec%40hra.nhs.uk%7Caf2fb482dafa43e5d58908decaeeb758%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C639171323793454157%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=OEs5e%2FdjsYXyWO1l4PZ9WMiZuGYxu%2B2BqwmKIqePFCQ%3D&reserved=0
Has the registry been updated to include summary results?: No
If yes - please enter the URL to summary results:
If no – why not?: This was a small qualitative research project conducted as a therapist-researcher as part of a professional doctorate.
Did you follow your dissemination plan submitted in the IRAS application form (Q A51)?: Yes
If yes, describe or provide URLs to disseminated materials: The thesis is published and available at the University of Bedfordshire Library Open Repository:https://gbr01.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftrack.pstmrk.it%2F3ts%2Fresearchportal.beds.ac.uk%252Fen%252FstudentTheses%252Fsteps-towards-peace-of-mind-integrating-mindful-presence-in-the-p-3%252F%2FNBTI%2FhA7GAQ%2FAQ%2F1481bea1-4534-4dc4-918b-60612dd4f62e%2F1%2FDCwyQkV8cM&data=05%7C02%7Cleedswest.rec%40hra.nhs.uk%7Caf2fb482dafa43e5d58908decaeeb758%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C639171323793493084%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=vUSnND4XOhRodoeN3hVEKjggIn0%2FC0uDlptqJQgiYD8%3D&reserved=0
I have presented the research in workshop format to doctoral students and at conference.
I intend to publish journal articles related to the research over the coming year.
If pending, date when dissemination is expected:
If no, explain why you didn't follow it:
Have participants been informed of the results of the study?: Yes
If yes, describe and/or provide URLs to materials shared and how they were shared: The results were discussed with both participants who each received a bound copy of the thesis, which is also available at:https://gbr01.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftrack.pstmrk.it%2F3ts%2Fresearchportal.beds.ac.uk%252Fen%252FstudentTheses%252Fsteps-towards-peace-of-mind-integrating-mindful-presence-in-the-p-3%252F%2FNBTI%2FhA7GAQ%2FAQ%2F1481bea1-4534-4dc4-918b-60612dd4f62e%2F1%2FDCwyQkV8cM&data=05%7C02%7Cleedswest.rec%40hra.nhs.uk%7Caf2fb482dafa43e5d58908decaeeb758%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C639171323793515880%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=uXwXikEedhsQ%2FMsoREyMTbMK%2Fr%2BaDuuGaQF4DINA0qM%3D&reserved=0
If pending, date when feedback is expected:
If no, explain why they haven't:
Have you enabled sharing of study data with others?: Yes
If yes, describe or provide URLs to how it has been shared: I have shared the research with other clients. I have shared the research through teaching doctoral students, and the research informs my teaching medical students. I intend to publish academic articles over the coming year.
If no, explain why sharing hasn't been enabled:
Have you enabled sharing of tissue samples and associated data with others?: No
If yes, describe or provide a URL:
If no, explain why: N/AThis was a small qualitative study in the field of psychotherapy.
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Yorkshire & The Humber - Leeds West Research Ethics Committee
REC reference
18/YH/0333
Date of REC Opinion
10 Sep 2018
REC opinion
Further Information Favourable Opinion