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1 Japanese Journal of Mindfulness, 2017, Vol. 2, No. 2 Special Issue: Mindfulness-Based Cognitive Therapy Research Report Evaluation of Group Program Based on Mindfulness-Based Cognitive Therapy in Psychiatric Hospital Outpatient Online first published: April 3, 2018 Received: April 1, 2017 Accepted: March 8, 2018 Hironori Yanagisawa Inuyama Hospital Takashi Fujita TS Cognitive Behavior Therapy Center Mitaka Mindfulness Lab, Inuyama Hospital Yuko Mizuno Clinic Adachi, Inuyama Hospital Kanako Adachi Inuyama Hospital Katsumi Yoshino Inuyama Hospital Satoru Takazawa Inuyama Hospital Abstract Limited research has been conducted at psychiatric hospitals in Japan on group therapy that employs mindfulness. In this study, a group therapy program that employed mindfulness-based cognitive therapy was developed and implemented at Psychiatric Hospital A. Patients who consulted at the outpatient clinic were targeted. The program included eight weekly two-hour sessions and a follow-up session. Given the study s location, exclusion criteria were relaxed, and patients with a wide variety of complaints participated in the program. Seven courses of the program were conducted in which a total of 31 patients participated. Their diagnoses included depression, anxiety disorder, bromyalgia, and schizophrenia. The majority of participants were also undergoing diagnosis of multiple mental illness complications. A comparison of the results of the questionnaire scale before and after the program showed an improvement in mindfulness, depression and quality of life. Furthermore, the needs and problems of mindfulness in psychiatric clinical practice obtained from participants impressions, and aspects of practice in psychiatric hospitals were examined. It is expected that the findings of the study will result in further expansion of the practice of mindfulness. Keywords: mindfulness, psychiatric hospital, group therapy Correspondence concerning this article should be sent to: Hironori Yanagisawa, Inuyama Hospital, 10, Ooguro, Tounoji, Inuyama-shi, Aichi, , Japan ( shinri@okeikai.or.jp).
2 TS A QOL shinri@okeikai.or.jp
3 Yanagisawa et al.: Evaluation of group program in psychiatric hospital outpatient Kabat-Zinn, 2003 Kabat-Zinn 1982 Fjorback, Arendt, Ørnbøl, Fink, & Walach, 2011 Ledesma & Kumano, 2009 Ashcroft, Barrow, Lee, & MacKinnon, 2012 Vøllestad, Sivertsen, & Nielsen, 2011 Biegel, Brown, Shapiro, & Schubert, Mindfulness-based Cognitive Therapy: MBCT; Segal, Williams, & Teasdale, Mindfulness-Based Stress-Reduction: MBSR; Kabat-Zinn RCT Randomized Controlled Trial APA presidential task force on evidence-based practice, 2006 A MBCT A B
4 = SD = MBCT MBCT Table 1 4. MBCT MBCT 8 Jon Kabat-Zinn 3 MBCT 4 3 MBCT
5 Yanagisawa et al.: Evaluation of group program in psychiatric hospital outpatient Table 1 プログラムで使用されたセッションタイトルと各セッションで実施した独自の工夫 バックするために 定期的に心理尺度を用いた質問紙 を求めた 得点が高いほど抑うつが高いことを示して 調査を行い 終了時アンケートを実施した 心理尺度は いる 以下に挙げる 3 種類であり プログラム開始時 5 セッ ションの開始時 8 セッションの開始時 プログラム終 了後 4 週後のフォローアップ時に以下の心理尺度を用い た質問紙調査を行った なお 以下の尺度の内 1 及び 2 の尺度は全てのクールで用いた 一方 3 の尺度は 第 3 クール以降から追加した また終了時アンケートは このプログラムで得られ 3 生活の質の測定 日本語版 WHO/QOL26 田崎 中根 1997 以下 QOL26 と略記 を使用した QOL26 は主観的な QOL Quality of Life を測定する 26 項目からなる自記式質 問紙であり 各項目について 5 件法で回答を求めた 得 点が高いほど QOL が高いことを示している たこと という質問に自由記述で答えさせた 結 果 1 マインドフルネスの測定 Five Facet Mindfulness Questionnaire の日本語版 Sugiura, Sato, Ito, & Murakami, 2012 以下 FFMQ と略記 を使用した FFMQ はそれぞれ Observing 観 察 Describing 描写 Acting with awareness 意識した行動 Nonjudging 判断しないこと 1. 参加率及びドロップアウト 全 7 クールの各クールの平均参加人数は 4.7 名で あった 各クールのフォローアップセッションも含めた全 9 回 Nonreactivity 反応しないこと の 5 因子 39 項目か のセッションの内 欠席なくプログラムを完遂したのは らなる自記式質問紙であり 各項目について 5 件法で回 答を求めた 得点が高いほどマインドフルネスが高いこ 14 名であった また 欠席が 1 回の者は 3 名 欠席が 2 回の者は 5 名 欠席が 3 回の者は 2 名 欠席が 4 回の者 とを示している は 1 名 欠席が 5 回以上の者は 6 名であった 欠席が 5 回以上の者をドロップアウト者と判断した その結果ド 2 抑うつの測定 The Center for Epidemiologic Studies Depression Scale の日本語版 島 鹿野 北村 浅井 1985 以下 ロップアウト率は 19% であった ドロップアウトの主な理由は 生活環境の変化等から 参加が困難になった 3 名 初回に参加した時点で 自 CES-D と略記 を使用した CES-D は 20 項目からな 分には合わない と判断しそれ以降を欠席した 2 名 る自記式質問紙であり 各項目について 4 件法で回答 不明 1 名 であった
6 QOL26 3. Table 2 t FFMQ 5% t(24) = 2.19, p <.05 FFMQ Describing 1% t(24) = 2.94, p <.01 Nonreactivity 5% t(24) = 2.61, p <.05 CES-D 1% t(24) = 2.95, p <.01 QOL-26 5% t(20) = 2.19, p < Table 3 MBCT A 7 A MBCT FFMQ Describing Nonreactivity QOL MBCT MBCT Teasdale Table 2 t
7 Yanagisawa et al.: Evaluation of group program in psychiatric hospital outpatient Table 3 et al., 2000 Chiesa & Serretti, 2011 MBCT MBCT % 1
8 1 1 APA presidential task force on evidence-based practice. (2006). Evidence-based practice in psychology. American Psychologist, 61, Ashcroft, K., Barrow, F., Lee, R., & MacKinnon, K. (2012). Mindfulness groups for early psychosis: A qualitative study. Psychology and Psychotherapy: Theory, Research and Practice, 85, Biegel, G. M., Brown, K. W., Shapiro, S. L., & Schubert, C. M. (2009). Mindfulness-based stress reduction for the treatment of adolescent psychiatric outpatients: A randomized clinical trial. Journal of Consulting and Clinical Psychology, 77, Chiesa, A., & Serretti, A. (2011). Mindfulness based cognitive therapy for psychiatric disorders: A systematic review and meta-analysis. Psychiatry Research, 187, Fjorback, L. O., Arendt, M., Ørnbøl, E., Fink, P., & Walach, H. (2011). Mindfulness-based stress reduction and mindfulness-based cognitive therapy: A systematic review of randomized controlled trials. Acta Psychiatrica Scandinavica, 124, Monthly Book Medical Rehabilitation, 138, Kabat-Zinn, J. (1982). An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: Theoretical considerations and preliminary results. General Hospital Psychiatry, 4, Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. Delacorte Press. J 2007 Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice, 10, Ledesma, D., & Kumano, H. (2009). Mindfulnessbased stress reduction and cancer: A metaanalysis. Psycho-Oncology, 18, Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. New York: Guilford Press., Z. V., J. M. G., J. D Sugiura, Y., Sato, A., Ito, Y., & Murakami, H. (2012). Development and validation of the Japanese version of the Five Facet Mindfulness Questionnaire. Mindfulness, 3, WHO/QOL-26 Teasdale, J. D., Segal, Z. V., Williams, J. M. G., Ridgeway, V. A., Soulsby. J. M., & Lau, M. A. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 68, Vøllestad, J., Sivertsen, B., & Nielsen, G. H. (2011). Mindfulness-based stress reduction for patients with anxiety disorders: Evaluation in a randomized controlled trial. Behaviour Research and
9 Yanagisawa et al.: Evaluation of group program in psychiatric hospital outpatient Therapy, 49,
Japanese Journal of Mindfulness, 2017, Vol. 2, No. 2 Special Issue: Mindfulness-Based Cognitive Therapy Practice News pp Learning of Mindfulnes
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