Intersections in Innovation; mindfulness-based therapies as part of the well-being agenda by Kate Spiegelhalter


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Presentation by Kate Spiegelhalter at Sociology of Mental Health Study Group symposium: What does sociology need to contribute towards or against the wellbeing agenda? on 10 June 2013.

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Intersections in Innovation; mindfulness-based therapies as part of the well-being agenda by Kate Spiegelhalter

  1. 1. Intersections in Innovation; mindfulnessbased therapies as part of the well-being agenda Kate Spiegelhalter – current doctoral student, University of Sussex
  2. 2. Creative approaches to mental health: a critical analysis of the mindfulness agenda in Sussex
  3. 3. Rationale for PhD: 1) Mindfulness is an innovative therapy and subject of interest in Sussex. 2) It is debated whether mindfulness therapies are applicable to people experiencing psychosis (an often marginalised group). 3) Behavioural economics (‘nudge’) agenda is currently popular with an interesting evidence base. Collaboration with Sussex Partnership NHS Foundation Trust (SPFT) study; Mindfulness-based therapy groups for distressing voices (M4V): A pragmatic randomised controlled trial (RCT). 1. - M4V aims to evaluate the effectiveness of a new kind of ‘mindfulness- based group therapy’ & seeks to help people learn new ways of managing and living with distressing voices.
  4. 4. Research questions: Main question:Can mindfulness be used as a specific technique and made the focus of behavioural interventions in order to increase levels of well-being for people suffering from psychosis?Sub questions:1. What is mindfulness and who is promoting and working with it in the field of mental health? 2. How is mindfulness being used and engaged with in the field of psychosis, and specifically through on-going research in the area? 3. How is innovation being evaluated and what influences involvement, acceptability and usability after a formal intervention? 4. Could the mindfulness paradigm be built on by incorporating choice architecture to increase its value for users and practitioners? 5. What are the lessons for future mental health policy and practice, both within Sussex and nationally?
  5. 5. Relevant sociological literature Ethical and methodological issues
  6. 6. • Thaler & Sunstein book (2009) •‘Soft paternalism’ • Choice architecture • Current government ‘Behavioral Insights Team’/’nudge’ unit (BIT) • Problematic as health promotion strategy? • Medical sociologists would not necessarily dismiss the relevance of cultural/behavioural factors
  7. 7. Ideas for 'nudges' to apply:
  8. 8. UK Wellbeing agenda • Happiness Index launched 2011 • Wellbeing Commission 2012 • 'Mainstreaming' of CAM (mindfulness got own peer reviewed journal) • • • Supports retreat of government? Action on inequality needed on the base of data... (lip service?) Part of 'New Public Health' Sociological critiques of health promotion agenda and healthism
  9. 9. Healthism 'Health-related behaviour' •Increasing demand for •Development over medicalisation from lay past 40 years public e.g. ADHD, PTSD, (Armstrong 2009) CFS/ME •Project of the body: shift from medicine to health dominates every aspect of life (identity, emotion, behaviour, appearance) Healthisation/healthism/ health-facism? (Crawford • •Foucauldian theory •Idiom of ‘behavioural discourse’ •Rose: ‘bio-citizen’ (1999) •New modes of subjectivity
  10. 10. The Therapeutic Critique •‘Happiness gap’ despite increased life expectancy and relative material wellbeing •Low self esteem becomes the explanation for ’problem’ groups: teenagers, unemployed, elderly, mentally ill, lone parents, disabled etc. •“Society is much more comfortable dealing with poverty as a mental health problem rather than a social issue” (Furedi 2004:27)
  11. 11. Layard’s ‘Action for Happiness’
  12. 12. Accepting the void... - I believe that the very purpose of our life is to seek happiness. That is clear. Whether one believes in religion or not, whether one believes in this religion or that religion, we all are seeking something better in life. So, I think, the very motion of our life is towards happiness. His Holiness the Dalai Lama (Marut 2012: xv) But... Case for a parallel acceptance of the void of unknowing and selflessness. Sociological writing on happiness: (such as) Mauss, I., Gruber, J., Tamir, M. (2011) A Dark Side of Happiness? How, When, and Why Happiness Is Not Always Good. Perspectives on Psychological Science. Vol. 6 no. 3 222-233 • • • Mindfulness-based interventions (MBIs), with their roots in Buddhist philosophy, as a way to achieve this balance?
  13. 13. Intersections in innovation (and implementation) • Possibilities of implementation in Sussex as a case-study: feeding into the work of Bangor and Exeter (Implementation Toolkit) • Still in Kabat-Zinn's words: 'a pimple on an elephants back' in terms of popular awareness of MBCT as a therapeutic option, and the cost-effectiveness case being made in order to divert resources - Opportunity cost for the NHS, there Is no new funding • Progress made though, Bangor centre, PhD student there making a case, Crane and Kuyken upcoming implementation case-study. • Jury still out on nudge
  14. 14. What biomedicine/psychiatry/wellbeing agenda can learn from Buddhism Buddhist themes/teachings Current policy applications Links to MBCT/CBT Demystifying as a religion: No deity, creator, or supreme being. No-one to worship or concept of an immortal self. Similarity to focus on the practical aspects and thought patterns of CBT. Focus on Human Dysfunction: craving causes suffering, people experience life as unsatisfactory because it does not correspond to their expectations Focus on thought patterns, viewing thoughts as clouds in the sky/trains going through a station that one can choose to get onto or not. Anti-foundational, process perspective. World in constant flux, transformation and change. Phenomena have no independent essence of their own, they’re ‘empty’ of inherent substance or essence Role of social networks, people are not islands, interdependence Implications for wider policy
  15. 15. Thank you! /person/144720