title: Web-based intervention in mindfulness meditation for reducing residual depressive symptoms and relapse prophylaxis: a qualitative study.
abstract: BACKGROUND
  Mindful Mood Balance (MMB) is a Web-based intervention designed to treat residual depressive symptoms and prevent relapse. MMB was designed to deliver the core concepts of mindfulness-based cognitive therapy (MBCT), a group treatment, which, despite its strong evidence base, faces a number of dissemination challenges.
  
  
  OBJECTIVE
  The present study is a qualitative investigation of participants' experiences with MMB.
  
  
  METHODS
  Qualitative content analysis was conducted via 38 exit interviews with MMB participants. Study inclusion required a current PHQ-9 (Patient Health Questionnaire) score ≤12 and lifetime history ≥1 major depressive episode. Feedback was obtained on specific website components, program content, and administration as well as skills learned.
  
  
  RESULTS
  Codes were assigned to interview responses and organized into four main themes: MBCT Web content, MBCT Web-based group process, home practice, and evidence of concept comprehension. Within these four areas, participants highlighted the advantages and obstacles of translating and delivering MBCT in a Web-based format. Adding increased support was suggested for troubleshooting session content as well as managing time challenges for completing home mindfulness practice. Participants endorsed developing affect regulation skills and identified several advantages to Web-based delivery including flexibility, reduced cost, and time commitment.
  
  
  CONCLUSIONS
  These findings support the viability of providing MBCT online and are consistent with prior qualitative accounts derived from in-person MBCT groups. While there is certainly room for innovation in the domains of program support and engagement, the high levels of participant satisfaction indicated that MMB can significantly increase access to evidence-based psychological treatments for sub-threshold symptoms of unipolar affective disorder.
authors.affiliation: Jennifer.m.boggs@kp.org.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Boggs
authors.forename: Arne
authors.initials: A
authors.lastname: Beck
authors.forename: Jennifer N
authors.initials: JN
authors.lastname: Felder
authors.forename: Sona
authors.initials: S
authors.lastname: Dimidjian
authors.forename: Christina A
authors.initials: CA
authors.lastname: Metcalf
authors.forename: Zindel V
authors.initials: ZV
authors.lastname: Segal
mesh_terms: D000328:Adult; D003863:Depression / Q000628:therapy*; D003865:Major Depressive Disorder / Q000628:therapy; D005260:Female; D006801:Humans; D020407:Internet; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D064866:Mindfulness; D011615:Psychotherapy, Group; D036301:Qualitative Research; D055502:Secondary Prevention; D017216:Telemedicine
keywords: Internet-based depression; Web-based depression; depression relapse prevention; mindfulness-based cognitive therapy; online depression; online psychological treatment; qualitative methods; residual depression symptoms