Fifteen qualitative studies (190 participants; range three to 32) were included in the review. Three studies were graded A for quality, nine were graded B, one was graded C, and two were graded D.
Eight themes were identified:
Prior experiences and expectations: Participants often defined themselves in terms of their relationship with their mental health difficulties, or reported a lack of cohesive identity. Others denied the existence of problems. Many participants described an open-minded attitude to mindfulness before starting the course, but there was some scepticism and uncertainty about mindfulness.
Awareness: There was a recognition that habits were difficult to break, but that having an awareness of this was an important first step. Regular mindfulness practice generated a greater sense of symptom predictability and an understanding of how particular situations developed.
Relating differently to thoughts and feelings: Participants were able to prevent negative thoughts from developing into pervasive preoccupations. Participants also experienced a wide range of emotions and a reduction in the intensity of these was an important benefit.
Use of mindfulness techniques: Participants found certain practices were more personally relevant than others, for perceived benefits and for fitting in their daily lives. Participants found aspects of mindfulness challenging, but it was seen as an opportunity to learn new ways of managing their difficulties.
A sense of control and choice: A combination of increased awareness, practical skills, and a new relationship with experience, offered participants an increased sense of control and choice over their thoughts, feelings and behaviour.
Acceptance: Observing thoughts and emotions in a non-judgmental manner encouraged participants to accept these as part of their experience and to stop engaging with them in unhelpful ways. This was particularly difficult when participants felt positive towards some mood states. Disengaging from the struggle with distressing thoughts was also challenging, but participants found this gave them more control. Mindfulness gave participants space to stop evaluating themselves negatively with regard to their mental health difficulties.
Relationship with self and others: The attitude of acceptance fostered by mindfulness generated a shift in a participant’s sense of self.
Struggles: Practical issues, such as physical limitations and finding the time to practise, were highlighted as reasons for struggling to engage with mindfulness. Some participants had difficulty grasping the core concepts of mindfulness or felt overwhelmed by the new concepts. Many participants initially judged their practices as “good” or “bad” depending on how much they were able to control their thoughts and emotions.
The authors also reported a theme of the normalising and supportive process of the group.