Is Online MBCT a Good Witch or a Bad Witch? – By Zindel Segal
Here is the thing about data, we collect them because we don’t know about outcomes in advance. And so I was somewhat surprsied when, having published our recent study of a digital version of MBCT that showed good outcomes in reducing residual depressive symptoms1, a number of folks expressed dismay about the findings.
My surprise gave rise to curiosity and I found myself wanting to understand how results that seemed to strengthen the reach of MBCT could be seen as undermining it – a good witch to some and possibly a bad witch to others.
Some of the doubts about the findings were expressed as:
- “If online MBCT does such a good job, will it take people away from the in person MBCT groups that I am offering?”
- “I have completed a number of steps on the MBCT training trajectory and wonder whether it is worth continuing if the same work can be delivered online?”
It is probably helpful to remember that these types of concerns were raised years ago when online treatments were first launched and continue today as chatbots and AI are seen as reducing the footprint of in-person therapies even further. This general apprehension is understandable since the psychotherapeutic paradigm has remained essentially unchanged for over 100 years – face to face, in person delivery. So why bother altering it? The answer is that mental health difficulties are a leading cause of global social burden…and yet, people with mental health problems worldwide have limited, if any, chance of accessing psychological help2.
Taking depression as a specific example. When John, Mark and I developed MBCT, we recognized that with prevlance rates hovering at 8% of the population, there would be little chance of narrowing the treatment seeking/treatment provision gap if MBCT was designed to be delivered one on one. The group format was one way of addressing this problem and an online digital version of MBCT extends that intention even further.
I do recognize that providing the rationale for digitizing MBCT may not fully alleviate concerns about poaching patients from one’s clinical practice. If we look at the evidence from online CBT, however, it seems that this has not been the case. In fact, the greater availability, visibility and marketing associated with online therapies has sensitized the public to seek help, driving referrals more generally. CBT as an evidence-based therapy of choice has not been eclipsed by its online doppelgangers.
More seriously though, adopting a binary view of the situation – favoring either in person or online delivery formats – may obscure real opportunities for linking one’s clinical practice to online tools that can enhance, support and sustain a person’s engagement with MBCT and the practice of mindfulness. It’s fair to say that in person MBCT will remain the gold standard sought by the public, but equally, will remain inaccessible to many. Online delivery of MBCT allows for innovations in care that could, for example, sequence in person with online versions of MBCT for maintenance, create online communities moderated by MBCT teachers for people who completed online MBCT or allow us to respond concretely to requests for treatment resources by people living far away. Even if we are never in the room with them, wouldn’t this be supporting our fundamental motivation for offering this work in the first place?
1. Outcomes of Online Mindfulness-Based Cognitive Therapy for Patients With Residual Depressive Symptoms: A Randomized Clinical Trial. Segal ZV, Dimidjian S, Beck A, et al., JAMA Psychiatry. 2020 Jan 29. doi: 10.1001/jamapsychiatry.2019.4693.
2. The digital revolution and its impact on mental health care. Bucci S, Schwannauer M, Berry N. Psychol Psychother. 2019 Jun;92(2):277-297. doi: 10.1111/papt.12222.
Author note – Zindel Segal, PhD is a CoFounder of Mindfulness Based Cognitive Therapy and Distinguished Professor of Psychology in Mood Disorders at the University of Toronto Scarborough.
Partner with Oxford Mindfulness to deliver online courses
Oxford Mindfulness has recently moved to also offering some of our courses online, recognising the restrictions imposed and environmental impact when we require participants and teachers to travel to a physical location.
For teachers interested in learning about the differences and skills required to teach courses online we are offering an Teaching Mindfulness Online Live – Masterclass for Mindfulness Teachers in March 2020.
We are also inviting teachers who would like to partner with Oxford Mindfulness to offer online courses to visit the partnership page and join our partnership programme. We have a high demand for online courses and would welcome partnership applications from suitably trained MBCT teachers who we can collaborate with to increase online accessibility, specifically to the Finding Peace in a Frantic World Programme.