A Pilot Randomized Controlled Trial Among People Recovering from Mental Illness: A Tailored Mindfulness-Based Intervention versus Relaxation Training

Figures & data

short-legendFigure 1.

Table 1. An outline of the mindfulness-based intervention, the REMIND program 2.0, for people in mental health recovery.

Week/ Session	Theme	Content	In-session practices	Home practices and assignments
One	Introduction to mindfulness and self-compassion	Definitions: mindfulness and self-compassion Benefits of mindfulness and self-compassion: empirical evidence	Breathing and sitting postures Grounding Counting breaths Body scan	Practice grounding, counting breaths or body scan
Two	Mindfulness: attention and awareness	Definition of mindfulness Master your emotions The wandering mind: becoming aware of the innate autopilot mode Gathering the scattered mind: pause and rediscover the intentional mode	Grounding Revisit a past incident with the five-finger method Butterfly hug Set goals to practice mindfulness in everyday life	The five-finger method Mindful eating Rearrange schedule for mindfulness daily practices
Three	Mindfulness: just be with the thoughts	Thoughts are thoughts, not facts Noticing the thinking patterns Spaciousness: from reacting to responding, the wise mind What” and “How” mindfulness skill Mindfulness and the snow globe metaphor: stirred or settled Myths about emotions	Grounding The “thoughts and feelings” exercise Novel object (e.g., crystal) mindfulness practice and reflection	Practice of the “what” and “how” skills in any daily activities
Four	Being aware of self-compassion: loving-kindness for self and others	What is/is not self-compassion? Connecting mindfulness and self-compassion Common Humanity: imperfection Loving-kindness to self and others Understand the concept of “backdraft” and how to handle it	Grounding Distinction between treating family members/friends and oneself in difficult time. Self-care Loving kindness phrases Self-compassion break Your core values	Continue daily mindfulness and self-compassion practices Reflect on your self-compassionate behaviors in daily life
Five	Practicing self-compassion:self-compassionate motives and motivation	Self-compassion vs. self-criticism Transforming self-criticism through motives, encouragement and motivation generate from self-compassion	Grounding Transforming self-criticism: self-motivate with self-compassion Affectionate breathing Becoming aware of your traits and strengths	Continue daily mindfulness and self-compassion practices Compose sentences to wish yourself well
Six	Fostering self-compassion: self-compassionate motives and motivation	The root causes of suffering Causes of unnecessary suffering? Resistance and avoidance Blending mindfulness and self-compassion together for facing challenges, resistance and avoidance Self-compassion with five senses	Grounding Becoming aware of your experience of resistance and avoidance Reflection: energy giving and taking activities Smiling practice	Continue daily mindfulness and self-compassion practices Describe and reflect on your experience of a situation that you resisted or avoided
Seven	Practice being with difficulties: interweaving mindfulness and self-compassion	Your alarm systems and action plans Strategies for meeting with difficulties and emotional distress Let go and adapt Hidden value in difficulties	Grounding Remembered wellness Silver linings: learning from difficulties, struggles and challenges in life	Continue daily mindfulness and self-compassion practices Consider mindfulness and self-compassion practices for your daily life Describe your self-compassionate behaviors
Eight	Being aware and compassionate in each “present moment” in the future	Things that you feel negative and things that you feel grateful for Gratitude and self-appreciation Tips for maintaining daily practice	Grounding Reflections and discussions of previous weeks’ materials Gratitude and self-appreciation

Table 2. Demographic characteristics of participants in mindfulness-based intervention (MBI) and relaxation training (RT) at baseline.

Baseline Characteristics	MBI		RT
	n	%	n	%
Period of stay
Born in Hong Kong	11	78.6	12	85.7
7 years and above	3	21.4	2	14.3
Gender
Female	13	92.9	12	85.7
Male	1	7.1	2	14.3
Education level
Junior secondary	3	21.4	2	14.3
Senior secondary	5	35.7	8	57.1
Tertiary	6	42.9	4	28.6
Employment status
Unemployed	2	14.3	6	42.9
Full-time	4	28.6	2	14.3
Part-time	2	14.3	1	7.1
Homemaker	6	42.9	5	35.7
Income source
Salary	4	28.6	3	21.4
Family support	10	71.4	10	71.4
Government subsidies	0	0	1	7.1
Marital status
Single	2	14.3	5	35.7
Married	11	78.6	8	57.1
Divorced	1	7.1	1	7.1
Living arrangement
Alone	0	0	1	7.1
With Family	14	100	13	92.9
Housing type
Public housing	1	7.1	1	7.1
Private housing	13	92.9	13	92.9
Diagnosis
Depression	9	64.3	9	64.3
Anxiety	4	28.6	2	14.3
Psychotic disorders	1	7.1	3	21.4
Year of onset
Greater than 10 years	9	64.3	10	71.4
Within 10 years	5	35.7	4	28.6
Number of hospitalisations
None	14	100	14	100
Experience in mindfulness or meditation practice
No	3	21.4	5	35.7
Yes	11	78.6	9	64.3
Mindfulness or meditation practice habit
No	11	78.6	13	92.9
Yes, rarely	3	21.4	1	7.1

Note. N = 28 (n = 14 for each group). Participants in the MBI group were on average 54.64 years old (SD = 10.93). Participants in the RT group were on average 55.79 years old (SD = 10.90). Participant demographic characteristics did not differ by group.

Table 3. Means, standard deviations and between-subject analyses of variance in quantitative outcomes at baseline (T0), post-intervention (T1) and follow-up (T2).

Measure	MBI		RT		Δ			ANOVA
	M	SD	M	SD	M	SE	Effect	F ratio	ηp^2
Personal recovery
T0	78.14	10.88	83.50	12.79	5.36	4.49	G	18.97***	.42
T1	102.29	7.33	80.57	10.71	21.72	3.47	T	24.35***	.48
T2	102.07	8.54	75.21	8.66	26.86	3.25	G x T	60.39***	.70
Mindfulness
T0	50.43	10.41	51.71	7.83	1.28	3.48	G	53.41***	.67
T1	74.07	5.84	48.64	6.89	25.43	2.41	T	41.60***	.62
T2	73.43	6.37	44.29	5.82	29.14	2.31	G x T	99.57***	.79
Self-compassion
T0	69.14	10.81	75.86	12.81	6.72	4.48	G	31.00***	.54
T1	103.21	5.00	74.93	12.56	28.28	3.61	T	78.25***	.75
T2	102.57	6.42	66.29	10.18	36.28	3.22	G x T	140.01***	.84
Resilience
T0	56.00	13.58	57.50	10.70	1.50	4.62	G	15.59***	.38
T1	71.43	8.92	56.50	10.55	14.93	3.69	T	11.67***	.31
T2	71.07	8.63	45.14	6.36	25.93	2.87	G x T	37.82***	.59
Depression
T0	14.00	2.08	11.79	1.19	2.21	0.64	G	39.19***	.60
T1	6.00	1.36	10.29	1.07	4.29	0.46	T	236.02***	.90
T2	5.71	1.07	11.93	1.21	6.22	0.43	G x T	174.35***	.87
Anxiety
T0	8.71	0.83	8.64	1.01	0.07	0.35	G	.75	.03
T1	4.50	1.16	5.21	1.63	0.71	0.54	T	212.08***	.89
T2	4.00	1.18	4.50	2.03	0.50	0.63	G x T	1.52	.06
Stress
T0	13.86	0.95	13.00	8.8	0.86	2.37	G	.46	.02
T1	6.14	1.41	6.30	1.33	0.16	0.52	T	303.52***	.92
T2	6.79	2.16	6.50	2.47	0.29	0.88	G x T	1.17	.04
Positive mood
T0	24.29	2.70	24.43	4.16	0.14	1.33	G	15.35***	.37
T1	32.86	3.21	27.00	4.13	5.86	1.40	T	49.37***	.66
T2	30.50	2.53	22.79	3.77	7.71	1.21	G x T	26.54***	.51
Negative mood
T0	29.93	5.78	29.57	5.40	0.36	2.11	G	13.56***	.34
T1	19.36	3.97	26.29	5.17	6.93	1.74	T	69.00***	.73
T2	19.43	3.55	31.50	4.67	12.07	1.57	G x T	55.02***	.68
Quality of life
T0	2.93	0.48	2.93	0.48	0	0.18	G	7.74*	.23
T1	4.21	0.58	3.79	0.43	0.42	0.19	T	72.40***	.74
T2	4.14	0.54	3.29	0.47	0.85	0.19	G x T	10.80**	.29
General health
T0	2.93	0.83	2.79	0.89	0.14	0.33	G	4.54*	.15
T1	3.79	0.58	3.43	0.76	0.36	0.26	T	18.33***	.41
T2	3.86	0.54	3.00	0.39	0.86	0.18	G x T	4.01*	.13

Note. N = 28 (n= 14 for each group). MBI= Mindfulness-based intervention; RT = Relaxation training control group. G = group; T = time; Δ = difference. *p < .05; **p < .01; ***p < .001.

Table 4. Means, standard deviations and within-subject analyses of variance in quantitative outcomes at baseline (T0), post-intervention (T1) and follow-up (T2).

Measure	MBI		ANOVA		RT		ANOVA
	M	SD	F ratio	ηp^2	M	SD	F ratio	ηp^2
Personal recovery
Δ T0-T1	24.14***	11.59	60.14***	.82	−2.93	7.03	10.01**	.44
Δ T1-T2	−0.21	4.34			−5.36**	5.30
Δ T0-T2	23.93***	10.75			−8.29**	8.41
Mindfulness
Δ T0-T1	23.64***	9.12	97.18***	.88	−3.07	5.98	15.47***	.54
Δ T1-T2	−0.64	3.32			−4.36***	2.95
Δ T0-T2	23.00***	7.91			−7.43***	5.58
Self-compassion
Δ T0-T1	34.07***	9.54	171.83***	.93	−0.93	5.41	18.27***	.58
Δ T1-T2	−0.64	3.25			−8.64***	6.78
Δ T0-T2	33.43***	9.17			−9.57***	7.27
Resilience
Δ T0-T1	15.43***	9.76	30.56***	.70	−1.00**	6.14	18.84***	.59
Δ T1-T2	−0.36	2.95			−11.36	9.61
Δ T0-T2	15.07***	10.45			−12.36***	8.94
Depression
Δ T0-T1	−8.00***	1.52	242.27***	.95	−1.50***	0.52	40.33***	.76
Δ T1-T2	−0.29	1.14			−1.64***	0.93
Δ T0-T2	−8.29***	2.02			0.14	0.77
Anxiety
Δ T0-T1	−4.21***	0.89	199.45***	.94	−3.43***	1.45	65.32***	.83
Δ T1-T2	−0.50	1.02			−0.71	1.27
Δ T0-T2	−4.71***	0.99			−4.14***	1.61
Stress
Δ T0-T1	−7.71***	1.27	206.26***	.94	−6.71***	1.20	114.64***	.90
Δ T1-T2	0.64	1.34			0.21	2.22
Δ T0-T2	−7.07***	2.02			−6.50***	2.07
Positive mood
Δ T0-T1	8.57***	3.96	53.93***	.81	2.57**	2.65	16.59***	.56
Δ T1-T2	−2.36***	1.82			−4.21***	2.83
Δ T0-T2	6.21***	3.40			−1.64*	2.79
Negative mood
Δ T0-T1	−10.57***	4.07	86.73***	.87	−3.29***	1.94	24.63***	.66
Δ T1-T2	0.71	1.33			5.21	3.17
Δ T0-T2	−10.50***	4.18			1.93*	3.15
Quality of life
Δ T0-T1	1.29***	0.61	56.21***	.83	0.86***	0.36	24.02***	.65
Δ T1-T2	−0.07	0.27			−0.50**	0.52
Δ T0-T2	1.21***	0.58			0.36*	0.50
General health
Δ T0-T1	0.86**	0.77	16.59***	.56	0.64**	0.74	6.16**	.32
Δ T1-T2	0.07	0.62			−0.43**	0.51
Δ T0-T2	0.93***	0.62			0.21	0.80

Note. N = 28 (n= 14 for each group). MBI= Mindfulness-based intervention; RT = Relaxation training control group. G = group; T = time; Δ = difference. *p < .05; **p < .01; ***p < .001.

Table 5. Main themes and subthemes at post-intervention and one-month follow-up interviews with the mindfulness-based intervention participants.

Main Themes		Subthemes
Post-intervention
Theme 1	Misconceptions about mindfulness from previous experience
Theme 2	Cultural relevance	(i) Content: language and context (ii) Sharing: social inclusion and collective intelligence (iii) Religion: consideration and incorporations
Theme 3	Integrate knowledge from REMIND 2.0 for everyday living	(i) Facilitating factors (ii) Difficult but challenging factors
Theme 4	Perceived benefits of REMIND 2.0 on personal recovery	(i) Transformation of self and intrapersonal relationship (ii) From emotion regulation to symptomsattenuation (iii) Transformation in interpersonal relationships (iv) Mindful compassionate hope for future
One-month Follow-up
Theme 1	Recollection of REMIND 2.0 content with personal experience
Theme 2	Living everyday with mindfulness and self-compassion	(i) Reinforcing factors (ii) Challenging yet possible
Theme 3	Continued to thrive through the personal recovery journey	(i) Self and intrapersonal relationship (ii) Emotion and symptom regulation (iii) Interpersonal relationships (iv) Hopes, goals and plans

Data availability statement

Participants in this study were assured that their sensitive and personal information would be kept confidential. Raw research data would not be publicly accessible, and individual data was aggregated and summarized.