A Tool for Life? Mindfulness as self-help or safe uncertainty

Abstract

This article reports on a flexibly designed study evaluating the experience of participants with a range of health and life difficulties in a community-based mindfulness-training group. We describe the way we set up the group explicitly as a ‘facilitated self help’ group over 20 weeks in the environment of a community centre, with inclusive membership. We show similarities and differences in this approach with other mindfulness groups, in particular highlighting our desire to avoid presenting mindfulness as a “treatment”. A thematic analysis was applied to transcribed audio-recordings from multiple talk-based data sources. The analysis showed that participants found the group to be a safe and productive space in which to learn and consolidate a new skill. Participants also described both the group and mindfulness itself as, at times, an uncertain and difficult challenge, partly connected with what could be described as the slippery nature of mindfulness. Participants reported the positive impact of mindfulness in facilitating both enhanced appreciation of everyday life experiences, and greater resilience in the face of difficulties. In the concluding sections we explore the implications of this “slippery-ness” and of our approach both to the group itself and the research process, and ponder the uncertainties and paradoxes of mindfulness as a “tool for life”.

• Mental health and life difficulties
• mindfulness training
• facilitated self-help
• thematic analysis

IE: Um but it's a sort of … it's a sort of tool without being a tool if that's any any u- it's not it's not something that you it's not about questioning actually questioning what's going on so much as sort of accepting it and then saying well … you know, you know it's okay to okay for that to be there. (Mindfulness Interview 4:20:19)

Introduction: What is mindfulness?

Mindfulness is a term used to describe a practice of meditative awareness, as particularly developed in Buddhist meditative traditions (for example, see Tulku, 2004). Although practices of mindfulness draw on such arguably ancient traditions, it has been developed recently with a contemporary, secular, outlook to offer tools for developing non-judgmental, gentle awareness of what may be arising in the present moment of experience. A typical mindfulness practice would be to sit in silence for twenty minutes on a chair or cushion with the intention to rest some attention on the feeling of breathing in and out, while at the same time acknowledging other aspects of experience, such as thoughts and feelings. The aim of such a seemingly simple exercise is two-fold. First, in taking time out to sit in silence and bring attention to something like the breath, there is an opportunity for a degree of relaxation, or ‘slowing down’. Secondly there is a perhaps more counter-intuitive opportunity to simply notice-as non-judgementally and non-analytically as possible—the experiential flow of thoughts, feelings and sensations. In other words, there is an attempt to cultivate awareness of one's moment-by-moment experience—something Blatner (1997) describes as a “post-modern” meta skill.

Straight away in this two-fold description, one may appreciate why it could be said that mindfulness is ‘simple, but not easy’. The process of sitting and bringing some light attention to the process of breathing (or in other mindfulness practices it may be for example the process of walking, or eating), is not technically complicated and may feel a welcome relaxation. Alternatively, being invited simply to notice one's experience, can feel tremendously challenging. One can come up closer to previously less noticed streams of negative, painful, or fearful thought, or at the very least one can feel unsettled by noticing for perhaps the first time, how ‘all over the place’ our experience can be, veering in the space of a few moments, from wild fantasy, to profound sleepiness, for example. It is not something we may ever have done before, in such a direct way, and it can feel anything but relaxing at times. Thus, mindfulness could be said to be a more radical practice, of learning to be with both positive and painful experiential states, in the present, without loading this with strong expectations, of an outcome.

However, it does appear from the authors’ own experience that persistent mindfulness practice can lead to a significantly greater ability to tolerate and work with life difficulties of many kinds (Moss & O'Neill, 2003). We will turn to more formal evaluations below. However before we do this we want to note that for the present authors, the paradoxes of mindfulness leave us with a number of dilemmas and uncertainties, dilemmas that also played out in our research and clinical work with mindfulness in a range of ways. While we address these in more detail elsewhere (see Moss & Barnes, 2008) it became clear during the lifetime of the study that our participants were mirroring some of these uncertainties around mindfulness (as may already be evident in the opening quote above). Rather than “tidy this up” we became increasingly interested in the slipperiness of mindfulness, and the attendant challenges of honouring this quality in our research.

Notwithstanding such potential dilemmas, the question of the impact of practising mindfulness has now been, even in a relatively short while the focus of significant quantitative research, conceptual and empirical review and clinical questioning (see for example Baer, 2003). Perhaps not surprisingly, Baer concluded that many of the concepts associated with mindfulness (such as the cultivation of awareness and insight, wisdom and compassion) are difficult to operationalize and evaluate empirically and called for studies focusing on “a broader range of outcomes, such as subjective well-being and quality of life” (2003, p. 139).

Perhaps surprisingly, qualitative studies that might take more interest in potentially richer narrative accounts of the experience of mindfulness have been few. One example is Mason and Hargreaves (2001) who used grounded theory to explore participants’ accounts of the therapeutic process following a course in mindfulness-based cognitive therapy for depression. We will return to this study to compare our findings later on.

Study aims

Given our discussion earlier about mindfulness and outcome, the purpose of our research was not simply to investigate “How efficacious is the intervention?” in terms of symptom reduction. Instead, we developed a more holistic aim to explore participants’ experiences of the training and the impact of working with mindfulness practices and ideas. We adopted a flexible qualitative research design (Robson, 2002) where decisions about data collection evolved during the lifetime of the group. As explored elsewhere (Moss & Barnes, 2008) we were also aware early on of bringing what could be described as both essentialist and constructionist paradigms to our exploration. In other words we were interested in participants’ accounts of what it was like to practice mindfulness as “straightforward accounts of an experience”; yet at the same time we were aware of the potential naivety in this view, if we didn't also recognise that accounts were also constructions in a particular interactional context. As briefly touched on in our introduction, there may be some unique challenges in constructing accounts of mindfulness, both in terms of what mindfulness is, and what impact it has had.

The mindfulness self-help group

Mindfulness has tended to date to be offered in the form of eight-week “treatment” or “therapy” group programmes such as in the approaches of mindfulness based stress reduction (MBSR) (Kabat-Zinn et al., 1992), and mindfulness based cognitive therapy (MBCT) (Williams, Teasdale, Segal & Soulsby, 2000). In the group we describe here, we offered instead a 20-week programme that in structure drew on the traditions mentioned above, but also differed in some areas. The group itself consisted of a 90 min session, which typically involved a mixture of a mindfulness experiential such as sitting quietly together developing awareness of breathing (as described earlier), or mindful walking practice or a “body scan”, and time for discussion within the group on how participants were finding working with mindfulness in daily life.

A key way in which our group was somewhat differently offered was to foreground the group as a facilitated self-help group, rather than as a treatment programme or therapy programme. At first glance, this may seem a minor semantic issue. However as social constructionism suggests, the language we use to describe something also has the power to shape our experience (Gergen, 1999) of that thing. For us using the term “self help” fitted with our understanding of mindfulness as not just another technique for reducing symptoms (Moss & O'Neill, 2003), but more as a perspective and a practice that could cultivate a way of being in the world, that could be helpful for a range of people and in a range of ways. While our reading of the mindfulness literature is that it invites a wholly non-reductive way of looking at ourselves, there are dangers that in making it palatable in health care and academically acceptable, mindfulness can be narrated as a treatment package, to treat disorder, or symptoms. For us, in comparison, one of the advantages of a self help discourse is that invites a less pathologizing and reductive context for introducing something like mindfulness and accords with an increasing ethic of service receiver expertise in designing their own sense of self care and recovery (Faulkner & Layzell, 2000; Faulkner & Thomas, 2002).

In other words, our decision to describe the group as a “facilitated self-help group” was deliberate, but obviously, we needed to do more than change the name of the group to situate what was being offered differently. We thus attended to two further issues in setting up the group: setting and participant inclusivity.

Setting

The group was held at a Quaker Centre outside statutory services that was accessible by public transport and was part of set of buildings regularly used by a range of community groups and day/evening classes. We felt this offered a space with associations with both a wide range of self-development classes for the public, and the specific associations of Quaker-ism with non-sectarian self-knowledge and spirituality. We recognized also some risks in this choice of venue, as a Quaker centre could still be perceived as a religious centre, and while we did not want to “bracket off” potential spiritual resonance's to mindfulness, we were clear that mindfulness need not be a specifically religious practice in any way.

Participants

The self-help group was set up as a research project and potential participants were made aware of this from the start. Rather than offer the group for a specific symptom, or difficulty, we wanted the group to be available for people with a wide range of needs, be they physical, emotional, severe or less so. The way in which people came to the group as participants was through contacts with local colleagues in mental (secondary, primary and non-statutory) and physical health care, where we advertised our intention of starting a group. Through meetings and staff workshops, we hoped to give more accurately a flavour of what mindfulness was, through colleagues being invited to experience mindfulness for themselves. Rather than focus on particular types of difficulty we asked colleagues to recommend the group to people who used their services that were interested at that point in self-help, were open to being in a group and whose life situation was not in immediate crisis.

From the initial 14 people who expressed some interest in being in the group and who attended at least one of the first few sessions, the group matured into 8 regular attendees who stayed for the 20 weeks course (although missing some weeks).1 These participants brought with them a range of life struggles including severe and enduring obsessive difficulties, intrusive thoughts, attempted suicide, low mood and anxiety, relationship difficulties, prolonged physical pain, and carer stress. However, it feels misleading simply to list difficulties—a tendency itself linked with what we have described earlier as a “treatment-outcome” perspective. In fact, each member brought unique insight, resilience, support and wisdom to the group. As we report later the diversity of positions of group members raised issues for some at different times.

Research method

The backgrounds of our research team reflect the diverse domain within which mindfulness sits, they include Buddhism, Yoga, clinical psychology, cognitive behaviour therapy, social constructionist perspectives and an interest in talk-in-interaction.2 Our diversity is part of the context for this study as it could be said to have influenced both the way in which we set out to offer the group and the way in which we have gone about our analyses subsequently. As the group facilitators, Authors 1 and 2 were “insiders” to the research and as such aware of their investments in positive outcomes for the group participants. Author 3, therefore, was invited to join the research team as less invested “outsider” and to take a consulting role in research design and methodology.

Following ethical approval for the study, in order to evaluate more richly the experience of being in this particular group, and the impact of working with mindfulness practices and ideas, we agreed with the group members prior to the end of the 20 week course (at week 15) to audio-record one of the discussion slots (typically 20 min in length) that routinely took place in the group. A focused joint interview was also held as it were “between ourselves” immediately following the last session where the facilitators were invited to reflect upon their experiences of setting up and running the group by Author 3. We also agreed with all eight-group members to hold one-to-one focused research interviews at the original venue within approximately six weeks of the group finishing where they could tell us about their own experiences.

Research interviews were employed in our flexible design for a number of reasons: we were interested in the participants telling us about their experiences and the varied ways of making sense or accounting practices available to them. The interviews were relatively unstructured in so far as the researcher worked with a simple predetermined topic guide (see Table I) covering the major area of enquiry and the research questions whilst allowing room for departure to pursue novel topics introduced by the interviewee. In the pursuit of more detailed accounts of participants’ personal experiences and opinions, the topic guide encouraged open-ended questions and everyday naturalistic probes inviting interviewees to reflect on and relate their experiences at length. As the interviews were done face-to-face, the topic list and order could be modified for each encounter based upon the researcher's perception (via verbal and non-verbal cues) as to what seemed most appropriate.

Table I.  The focused research interview topic guide.

1.	Prior context of person
2.	What brought them to the group
3.	How they found the group experience
4.	How they found the practices
5.	How they would describe/define mindfulness
6.	Issues of impact and generalizability

All data were audio-recorded with the participants’ permissions and transcribed orthographically to enable them to act as a reliable record to which we could return to again and again. We felt that to have available an excerpt of “naturally occurring” group talk along with the facilitator and participant interview material would be helpful in terms of data triangulation (Denzin, 1970). We therefore had at our disposal multiple data sources taken from three different points in time—during the group, immediately after the final session and within six weeks of the group finishing. Rather than naively assuming that this would present a complete picture (Hammersley & Atkinson, 1983), we remained open to the sense of each account in the context in which it arose.

Analytical method

A thematic analysis suited the phenomenon in investigation and the aim of our study: to explore participants’ experiences of the training and the impact of working with mindfulness practices and ideas, as evidenced in their talk both during and after the group. Thematic analysis is a widely used method for identifying, analyzing and reporting themes and/or patterns within large datasets. Although used only as a tool within other currently better “branded” analytical traditions such as grounded theory (Strauss & Corbin, 1998); interpretative phenomenological analysis (Smith & Osborn, 2003); or narrative analysis (Riessman, 1993); thematic analysis also stands alone as a flexible qualitative analytical method in its own right essentially independent of theory and epistemology (Braun & Clarke, 2006), thus providing a fit with our flexible design. It can be applied to both research interview and naturally occurring talk data and fits with both a theoretical and a more inductive approach to data analysis. Being an independent approach, thematic analysis is compatible with both essentialist and constructionist paradigms. Therefore, it matches our dual analytical focus on themes, in participants’ views and feelings about their experience, and patterns in the varied ways of making sense or accounting practices available to them. Our choice, therefore, reflects our similarities as a team—thematic analysis is a shared generic skill—and our differences—thematic analysis has theoretical freedom in that it provides a tool that can be applied across different theoretical and epistemological positions (Boyatzis, 1998; Braun & Clark, 2006).

For the first stage of analysis, we all worked separately with three or four randomly assigned discrete “chunks” of data each, initially coding it around the six topics within our focused interview topic guide. We did this by listening to the recordings together with the transcripts. For this stage, our remit was to be inclusive with extracts rather than exclusive. We also agreed to retain fidelity to the interactional context by cutting and pasting whole relevant sequences from the transcripts, rather than isolating individual turns at talk, into word documents. We found that a number of extracts cut across a number of coding categories. We therefore decided that a copy of any such extracts should be included in each one.

We subsequently agreed to condense the six original coding categories from the focused interview topic guide down into three broader categories. The three condensed categories were as follows: the group experience; participant descriptions of mindfulness; and talk about impact. We agreed that this second stage of analysis should involve listening and looking more closely within the shared documents containing findings from the first stage for any common themes, or patterns in the talk that might be of analytic interest. One common experience was that on listening to the recordings we felt there was a level of incompleteness to the initial transcripts, in that the orthographic rendition, missed details which might mislead our coding process. Therefore, we re-transcribed our chosen sequences in the second stage of analysis. We have not reproduced this detail in the examples below for ease of reading.

Our analytical focus was on both participant views and feelings about their experience and the varied ways of making sense or accounting practices available to them. Rather than simply treat the talk data as passively conveying meaning we also wished to consider the action-orientation of turns at talk thus combining the analysis of themes with the analysis of patterns of action. Where we refer to ‘themes’ we mean a distinct, recurring, and unifying quality, meaning or idea. Here our analytic focus is on language as a resource for studying something else, i.e. participants’ experiences. Where we refer to “patterns”, we mean a regular manner of reporting thoughts, actions or behaviour. Here our analytical focus is on language as a topic in its own right—this may focus on content or process.

Again, following this stage of analysis we documented and exchanged our new findings and met to discuss the experience and any difficulties or “noticings”. One such “process” noticing was that we became aware that whilst some of the patterns/themes were made relevant by direct questions from the interviewer or from the facilitators’ questions to participants in the group discussion, others were truly participants’ own concerns. We felt that both other-initiated and participants’ own concerns would be useful to present here for the purpose of this paper.

Results

The results of our thematic analysis are outlined in Table II. The sub-sections below give an account of our findings. Owing to space constraints, we cannot present all the relevant examples. Instead, we have selected extracts to represent what might be described as both “good” and “bad” feedback, all three data sources and as many different speakers as possible. The reader will see that in the extracts presented we have chosen to include talk by both the interviewer (IR) and the interviewees (IE) in order to stay more faithful to the local interactional context, and where needed, a brief summary of the sequential environment. Any participant names mentioned have been anonymized. A key to the simplified transcription conventions employed may be found in the Appendix.

Table II.  Table showing results of thematic analysis of mindfulness talk data.

Main categories	Themes	Sub-themes
1. The group experience	The group space	Safe and productive
		Uncertainties and tensions
	Difficulties with practice	Unfamiliarity of practices
		Slippery nature of concept
		Concentration difficulties
	Furthering resilience
2. Describing mindfulness	“Non-stick” quality of mind
	Non-judgemental stance
	Enhanced awareness of present moment
3. Impact and generalisability	Tolerance/acceptance/reduction of symptoms/worries
	Enhanced awareness/enjoyment of everyday life
	Practical everyday applications

Category 1: The group experience

Participants’ talk about how they found the mindfulness group oriented to a number concerns that were found across the datasets. We present these main concerns in our own terms as the following themes (in no particular order): the group space; difficulties with practice; and furthering resilience.

The group space

Many of the participants argued that the group offered a productive and safe space in which to learn and practice the mindfulness techniques, over time and, away from the distractions of everyday life. The pattern was that such accounts were reported mostly in response to a direct question from the interviewer (not shown) about how they had found the group. For an example, see Extract 1 below where the interviewee demonstrates in a positive way his acquisition of new knowledge:

IE: The mindfulness I enjoyed because it showed me for the first time the actual … disciplines of doing it. [IR: Mm] the different … the different ways. [IR: Yeah] even whether it's the sitting and breathing one or whether it's … um, the body scan, [IR: Mm,] or the walking or standing, [IR: Hm] So that was really brilliant. (Extract 1: Participant interview 6:6:273)

The acquisition of knowledge is one of the significant effects commonly reported by participants in self-help groups (Adamsen & Rasmussen, 2001). Similarly, the claims made in Extract 2 below, for the group space as providing time to learn new skills, are particularly representative of the participant interview data.

IE: It gave you a a good time to be shut off from everywhere else and to actually be doing it and that was all you were doing [IR: Yeah] Whereas at home … um with you know a slightly different practice but I felt that coming back to the group so often and so many times [IR: Mm] was … really important to really get a good feel of mindfulness [IR: Yeah] and how how to use it in our lives. (Extract 2: Participant interview 3:13:5)

There were also unsurprisingly a few uncertainties and tensions reported around being in the group that the facilitators and the participants oriented to in the interview context. These involved both the nature of groups in general and the diverse nature of this group in particular. For an example, see Extract 3 taken from the facilitator's interview below:

MW: We didn't focus in on … specific problems like people with depression [RB: Mm, yeah] this is a self help group and so each of the people that came had their own … um care coordinator or person that referred them to go back to with any … issues that may come [RB: Mm] up for them with a a regard to their own … um … problems um um … but they could bring any … issues regarding their mindfulness practice … to u- to the group [RB: Mm] and to us that was fine um … but I think there was a sort of uncertainty about … because of the w- this … huge mix of people that we had … as to how that would … actually work. (Extract 3: Facilitator interview: 3:4)

The diverse nature of the group was also something a number of the group participants raised themselves as a topic for discussion. Some thought the diverse nature of the group prevented them from forming strong bonds for example through sharing common experiences. See Extract 4 below where the interviewer has just asked about the interviewee‘s experience of participating in the group.

IE: Um … it was a we were like a really diverse group really? [IR: Right?] Um … which in some ways was great, … in other ways was quite difficult. Because we had people there that had … kind of fairly mild depression? [IR: Right] We had people that had chronic pain? We had people there with issues around self harm and depression and all sorts of things. [IR: Mm] um … and … I found it quite difficult for me because sometimes I'd feel quite emotional? … [IR: Okay?] An it [IR: Mm?] didn't feel particularly comfortable to be … like [IR: Mm.] that. (Extract 4: Participant interview 8:4:4)

Difficulties with practice

Although they reported favouring some practices over others, most of the group participants described their experience of being exposed to and guided through a range of practices as being a very positive one (e.g. Extract 1). However, as signalled in Extract 4 above, when asked how they found practicing within the group, a number of the participants expressed difficulties with the practices.

In keeping with our own appreciation of the paradoxes of mindfulness as briefly outlined in the introduction, some of the participants, likewise, described finding and the concept of mindfulness difficult to grasp as reported in Extract 5 below.

IE: I thought most of the time I I thought … ‘Have I got this idea? Have I not got it?’ [IR: Mm] … ‘Am I am I totally … missing the point?’ [IR: Yeah] (Laughs). (Extract 5: Participant interview 2:2:8)

Others found maintaining concentration the most difficult thing about the practices in general. Another pattern around reported difficulties highlighted the unfamiliar or strange nature of the practices themselves. For example, in Extract 6 below the interviewee humorously reports the initial strangeness of being introduced to the practices, but that by the end she was “finding it more helpful”.

IE: The first couple of weeks I was just like … ‘What on earth am I doing here?’ It was like well you know ‘It's too weird!’ [IR: Mm] You know, (Facilitator's) sat there working a singing bowl and they were sort of eating raisins for half an [IR: (Laughs)] HOUR and you're sort of thinking you know, ‘There's got to be more to it than this.’ um and then … by the end I was just, … you know finding it more helpful. (Extract 6: Participant interview 8:14:19)

Furthering resilience

This theme is linked to the previous “difficulties with practice” theme but all reports of furthering resilience, through mindfulness, in the face of difficulty, were offered by participants and facilitators themselves rather than made relevant by a direct question from the interviewer. It relates to participants’ reports of going through the process of building their own expertise and skills and the difficulties that arose for them through doing this.

In Extract 7, a group member, Graham, has just reported that he has had his best session that day. Prior to this, one of the facilitators (DM) has just asked him what he noticed that was different.

Gra: Sometimes I have this conflict when I'm trying to … be c- conscious of what's going on of of this lapsing into sort of … just letting go of it and disappearing and keep … struggling and coming back, which today it was it that that all that process and … much more natural … so I was much more in control of it it didn't seem you know when I had one where when it was disappearing it didn't matter and I could come back to it and I was a lot less sort of … if you like anxiety knocking around [DM: Yeah] I suppose, [DM: Right] and and tension [DM: Right] um … so I don't know it's just getting you you tune to it I suppose and used to AND OF SEEING IT AS SOMETHING that it's … all right to do. Rather [DM: Mm] than being something which is slightly … odd if you like [DM: Yeah] or unusual or artificial [DM: Mm] and um that today was really … [DM: Mm] you know it seemed to work. (Extract 7: Mindfulness self-help group: 7:25)

In his response, Graham describes an internal conflict that he sometimes has during his practice and how he noticed that he was less anxious that day about his concentration “disappearing”, as opposed to striving to being present and “noticing” what was going on in his mind. He reports that he felt more at ease with what he was doing and that it was working better than before. Such vocal demonstrations of new behaviour patterns were echoed in participants’ accounts of the impact their practice has had on their lives outside of the group, which we go on to explore later.

Category 2: Describing mindfulness

During the interviews, all the group participants were asked to describe mindfulness in their own words. We did this, as we were curious about what could be called “local definitions” rather than a-contextual, formal definitions of mindfulness that can be found in the literature. We also felt that asking participants to define mindfulness was an acknowledgement that making sense of mindfulness was, given our discussion earlier in our introduction, a personal and uncertain process. Thus, rather than attempt an overall operationalized descriptor of mindfulness to orientate ourselves as researchers and our questions for participants, we wanted to leave the question of “what is mindfulness” as it were “up for grabs”.

As one might expect it did not come across as an easy process for many participants to define mindfulness, and they all reported this either directly by commenting on the difficulty of this task, indirectly by the level of “disfluencies” and repair work in their talk, or by using negative definitions of what they felt mindfulness was not. However, in the act of grappling linguistically with the slipperiness of mindfulness rich descriptions did emerge, for example in Extract 8 below:

IE: Um (Long pause) I suppose just about … um literally allowing thoughts to come into and out of your mind? … [IR: Right?] So um just like having a non-stick mind in a way so that you let a thought come in and you just let it go out again. … So you're not allowing your mind to focus on anything, but you're not telling it it can't [IR: Right] You're not sort of forcing yourself to think ‘I won't think, I won't think, I won't think!’ Because I was always rubbish at meditation because I had to kind of think … ‘Oh I've got not think!’, or ‘I've got to think about a candle!’ Or ‘I've got to think about something!’ and mindfulness isn't about that it's kind of about being with what's there, [IR: Yeah] Um (Long pause) but … not judging what's there? So you're not, … you're not putting pressure on yourself in that sense, [IR: Mm] you kind of just, … if you can it's about allowing thoughts to be neutral, [IR: Okay] and just about being very aware. … So … it might be you're aware of a change? Or [IR: Yeah] it might be something really nice, like you don't notice a tree or something lovely because you're so caught up with your thoughts or something, … an … But i- it's just being in the now I suppose, just whatever it is. (Extract 8: Participant interview 8:15:38)

A further example of a participant's definition of mindfulness may be seen in Extract 9 below, which also illustrates the challenging nature of the question in the response. It includes the extract that begins this paper, where something of the self-help ethos inherent in mindfulness training but also the paradoxical nature of mindfulness is described—it is a tool without being a tool.

IE: Um (Long pause) I think I think it's a sort of an acceptance of … um … I've got to relate it to the negative thinking [IR: Mm] because that's the main thing that I it's sort of an acceptance that that sort of stuff happens. That I've be- er I've b- built up these patterns from mm wherever but over a long period and that … you know starting to accept that as being that's how it is. But that's not necessarily that's how it … always has to be and I can have some sort of bearing on that … though [IR: Mm.] … Um it's difficult to say though exactly what because that sort of concept of mindfulness is it was quite difficult to sort of you know [IR: Yeah] … to sort of encapsulate really, I've delv- and we got stuck into this once or twice and it got it got a bit difficult [IR: Mm.] Um but it's a sort of … it's a sort of tool without being a tool if that's any any u- it's not it's not something that you it's not about questioning actually questioning what's going on so much as sort of accepting it an then saying well … you know, you know ‘It's okay to okay for that to be there’, [IR: Yeah] and maybe it won't be there in a while. (Extract 9: Participant interview 4:14:19)

This account demonstrates the interviewee integrating his definition of mindfulness into his own personal story. For example, he relates it to his own mental health difficulty (“I've got to relate it to the negative thinking”). Such experiential knowledge—“grounded in lived experience”—is arguably a defining characteristic of self-help groups (Borkman, 1999). We found that participants’ descriptions of mindfulness also come out unsolicited as it were in their accounts of the impact the training had had on their lives.

Category 3: Impact of mindfulness practice

Our analysis of participants’ accounts of the impact that working with mindfulness practices and ideas had on their lives resulted in three main themes (in no particular order). The first common finding was of reports of a reduction in the amount of distress, or a developed ability to tolerate or accept difficult feelings. Second, participants reported an enhanced awareness and enjoyment of every day things and life in general. Third, although a number of participants claimed they had had difficulties translating their group practice to their home environments, the majority reported actively applying the mindfulness skills learned in the group to situations in their everyday lives. Again, from a “process” level, we noted that these reports were mostly unsolicited participants’ concerns.

Positive Impact on Distress

In Extract 10 below, Eve describes being more aware generally and a calmer person because of her mindfulness training.

Eve: But I mean it's it's helped a lot from a- at the beginning it was very hard for me I thought ‘Oh God … you know here we go!’, because it dredged up a lot of lot of … things that I thought I'd buried a long time ago and you know still sometimes now it's still, you know, th- there are days where it still drags it up but … you know, it's it's I am much more aware now and I'm much more … calmer and think ‘Well … yeah, … that's alright, that can go.’. … You know … it's … knowing what what's right for you. [DM: Mm] You know, if you can … hang on to it or if you can just just let it go. (Extract 10: Mindfulness self-help group: 5:14)

Eve uses two contrasting reported thoughts (Barnes & Moss, 2007) to evidence and demonstrate this change from “Oh God you know here we go!” at the beginning of the training to it's general application in her everyday life, “Well, yeah that's alright, that can go”.

In Extract 11 below, the interviewee confirms that she has noticed an increased level of tolerance regarding her thoughts of self-harming.

IE: Um … I found that really frightening to start with? [IR: Yeh?] Because it was like you know ‘If I … if I sit with these feelings … then what's [IR: Mm] the outcome going to be?’ I suppose. [IR: Mm] Um … and interestingly … it does seem to have … taken a lot of … power out of my self harm thoughts actually [IR: Right] Being able to … tolerate them … [IR: Mm] without … um either burning myself or distracting myself … [IR: Right] is er is a lot easier [IR: Amazing] than I thin- I would have thought.

IR: And is that a factor that … helps you … to do it more in a sense that sort of knowledge that … you can see some evidence [IE: (Swallows) Yeah] that it that it makes a difference to use?

IE: Yeah definitely [IR: Right] Um I think, … I think probably my … ability to sort of … tolerate being emotional and … and upset … has … has increased. Um yeah. (Extract 11: Participant interview 8:13:5)

Such accounts resonate with the dominant treatment-outcome perspective on mental health interventions. Perhaps such accounts orient to what the participants think we want to hear—note the interviewer's candidate suggestion above that the interviewee can “see some evidence that it makes a difference”. However many of the participants’ claims, regarding the impact of the training group were couched in different kinds of perspectives on change including spiritual and social transformations.

Enhanced awareness/enjoyment of everyday life

During and after the group intervention, many of the participants reported an enhanced general awareness of everyday things ranging from their minds “slowing down”, to noticing birdsong and other aspects of nature such as seasonal changes more acutely. See Extract 12 below for one such example.

IE: And I mean one forgets a lot during the day but it has also helped me appreciate … um … where I am. [IR: Mm] every um change in the seasons … Spring this time took a lot longer to come. You know usually it sort of comes and hits you in the face at about May time? [IR: Yeah] ‘God everything's green!’ … But now I notice the change in the trees [IR: Yeah.] every day and I am much more awar- mentally a much happier … [IR: Ah] person by being aware of things more and … taking them in more and appreciating things more made me much more appreciative … of … where I am and what I do. (Extract 12: Participant interview 3:23:7)

Mindfulness entering everyday life

Although a number of the participants reported that they were not doing regular formal practice since the group finishing, many of them reported using the skills they had learned to work with their life difficulties more creatively. See our final example, Extract 13 below.

IE: And now ah oh it's just it's just great you know I can sit in the car whereas I would be like ‘Beep, beep, beep!’ [IR: Mm] you know, ‘Get out the way!’ you know now after what (Facilitator) said he said do you know I sit in the car and ‘I can't go nowhere’, [IR: Yeh] you know, where can you go? [IR: (Laughs)] and I thought ‘God that's so true.’ You know and every time I'm sat in a queue I just think right what'd what would (Facilitator) say ‘It's okay, [IR: Yeh] get there when we get there’, you know and I mean even my kids have noticed how calm I am and and it's just great [IR: Mm] you know I see things a lot lot clearer now you know. (Extract 13: Participant interview 5:3:22)

Summary of findings

We can summarize the material above in relation to our dual analytic focus mentioned earlier, namely both participant views and feelings about their experience and the varied ways of making sense or accounting practices available to them. The participants experienced the group as a safe and productive space in which to learn and consolidate new skills away from the distractions of everyday life. For some, the group was also an uncertain and difficult space. This may partly be due to the diverse and specific nature of this group in particular as a self-help, rather than therapy group and being made up from with people with a wide range of difficulties (for example as commented on in Extract 4 above). A number of the participants also reported experiencing difficulties with making sense of the concept of mindfulness itself.

In terms of mindfulness itself we have been struck by the positive impact mindfulness is described as having for all participants, but also how this positivity is narrated within a tone that expresses uncertainty and paradox. As one participant put it (with a humorous delivery)—“Have I got this idea? Have I not got it? … Am I am I totally … missing the point?” Rather than see such accounts as a sign of a problem of lack of clarity, we prefer to see this as reflecting what might be called mindfulness' positive refusal to be summed up.

Discussion

Mindfulness up close?

We hope the extracts above give a flavour of the kinds and range of talk, in our dataset. Given we had at our disposal three different data sources, we feel we were able to draw on a rich vein of material and think our findings mirror that richness. We intend our close renditions of talk to retain fidelity to the interactional context and the words, turns of phrase, pauses etc of our participants. Using close levels of transcription have perhaps a paradoxical effect—they both reveal the discontinuous, sometimes fragmentary nature of talk, when seen ‘up close’, but also allow us to be more intimate with the “voice” of the participant. As we have discussed elsewhere (Moss & Barnes, 2008), this paradox mirrors the experience of mindfulness—a practice that could be called a “close reading” of moment-by-moment experience.

However, we are also aware of the dangers of over-using the notion of the “voice of the participant”. Rather than take a view that methods such as research interviews can access stable “beliefs” inside participants, we are aware from perspectives such as social constructionism that what we “capture” in any recording is a conversation constructed in that context. For example, what might we have heard about mindfulness if we had asked participants to keep a video diary throughout their time in the group?4 We also could have done more to help co-construct with participants the way we made sense of the transcript material by way of respondent validation (see Corcoran, Mewse & Babiker, 2007).

We do though argue that a research approach that foregrounds participants’ own accounts is in keeping with the ethos of the group itself. In terms of links with other qualitative studies, although we are not aware of any published investigations of self-help mindfulness training in a mixed group reporting on qualitative outcomes, such as subjective well-being and quality of life, our findings do have some resonance with a study in the UK by Mason and Hargreaves (2001). The authors used grounded theory to explore seven course participants’ accounts of the therapeutic process following training in mindfulness-based cognitive therapy for depression. Notably our findings do appear to match the following categories reported in this study: “Initial negative experiences”, “Coming to terms” and “Bringing it into everyday”.

In terms of the relationship between our study and quantitative outcome studies, it is harder to draw conclusions because of the differing paradigms of research approaches. In particular, as a self-help group, which did not use diagnostic inclusion criteria and did not evaluate the effectiveness of mindfulness on specific symptoms, it is difficult to place our research findings alongside such research. While we recognize the value of quantitative studies that have used (e.g. Kabat-Zinn et al., 1992) diagnostic criteria and symptom rating scales to assess the effectiveness of mindfulness, not least as a way of promoting what otherwise might be seen as “fringe” approach, we would argue that there is some danger in only researching mindfulness through such a lens (for a more general discussion of this issue see Faulkner & Thomas, 2002). Here we find a resonance between the language of the clinic and the language of research. In other words if one constructs a clinical space that is described as a ‘treatment programme’ one is perhaps more likely to construct particular forms of research that ‘fit’ with such a discourse.

“Have I got it?”—mindfulness as safe uncertainty

We would suggest finally, from our study, following Mason (1993) that mindfulness may be described as a practice of “safe uncertainty” and that this phrase may best express what elsewhere we have described as the “slippery” nature of mindfulness. Although it may sound simple to ask oneself to “stay in the present moment”, the present moment is always flowing away, constantly changing and what we find in the moment is not always what we want or expect. This can cut through “safe certainties” onto which we may cling. Yet at the same time allowing oneself to “let go” in this way may paradoxically help foster a sense of grounded-ness that can come with non-judgmentally noticing and accepting. Traditions of mindfulness suggest that this “letting go” is a life long practice, rather than a time-limited technique one uses with a goal in mind. This paradox—this “tool without being a tool”—we thus suggest, could be a tool for life.

Acknowledgements

The authors would like to acknowledge Nick Booth, Head of Plymouth Psychotherapy Services, Plymouth Teaching PCT, for supporting the project.

Notes

1. We did attempt to explore with those who dropped out of the group, their reasons for leaving. Feedback from one person was of being disappointed that mindfulness did not appear to be something that would offer help quickly enough. Other participants either did not offer feedback, or were no longer attending other health care services and, therefore, were difficult to access.

2. Talk-in-interaction is the object of study in conversation analysis (CA), a well-established cross-disciplinary research programme with its foundations in the sociological tradition of ethnomethodology. For an account of the history of CA, see Heritage (1984).

3. The data tags such as the one here, “Participant interview 6:6:27”, are to inform the reader that this extract has been taken from the sixth participant interview and that the first line may be found on page six, line 27 of the original transcript.

4. In fact, we had wanted to include a video diary method, but lacked the necessary resources.

Appendix

Transcription symbols simplified from Jefferson (2004)

Table

…	Short pause
word	Emphasis
WORD	Especially loud
wo-	Cut off
(Laughs)	Transcriber's comments
.	Falling intonation at the end of an utterance
?	Rising intonation at the end of an utterance
,	Weaker rise in intonation at the end of an utterance