Engagement, clinical outcomes and therapeutic process in online mindfulness for psychosis groups delivered in routine care

Objectives There is growing evidence for the benefit of mindfulness-based interventions (MBI) for people with psychosis. However, research is yet to evaluate the clinical benefit of delivering MBI groups online. We examine engagement, clinical outcomes, participant experience and therapeutic process of delivering therapy groups online in routine clinical practice. Methods The study used an uncontrolled pre-post design to examine engagement, therapeutic benefits (depression, anxiety, beliefs about voices) and group process in a 12-session online mindfulness group for individuals with a schizophrenia spectrum diagnosis with current distressing voices. Qualitative data on participant experience of online group therapy were analysed using Thematic Analysis. Results 17/21 participants (81%) completed one of three consecutively run therapy groups. For completers there were significant reductions pre-post in depression, anxiety, beliefs about voices and voice-related negative affect, with medium to large effect sizes. There were individuals showing reliable and clinically significant improvements in each clinical outcome, and none showing reliable or clinically significant deterioriation. Participants' rankings of the importance of different group therapeutic factors were very similar to those observed in face-to-face mindfulness for psychosis groups. Qualitative analysis of participant feedback identified three themes: 'experience of online delivery', 'therapeutic benefits' and 'feeling connected to people in the group'. Conclusions Findings in relation to therapy engagement, clinical benefits, participant experience and group process offer encouragement that online delivery of mindfulness for psychosis groups may be a useful addition to mental health services for people with distressing voices.