2.4. Mind–Body Intervention

The mind–body intervention (MBI) was developed for the purpose of the present trial based on the Open and Calm (OC) intervention [18], based on the relaxation response approach [19] and further developed into a meta-theoretical model proposing four common factor mechanisms of change (open attention, calm processing, conscious participation, and personal understanding) across several types of MBIs. OC thus explicitly recommends technical adaptations for contextually relevant purposes. The present MBI was thus structured according to the OC-protocol (a bodily-mental-social thematic cycle week-by-week) and focused on the OC core strategies, but also included body scans and hatha yoga exercises from mindfulness-based stress reduction (MBSR) [20] as a way of re-entering the body with gentleness, which is often challenging for patients suffering from physical ailments. The MBI was delivered by two clinical psychologists (CGJ and ESB) who were either trained in one of the interventions (CGJ) or both interventions (ESB). The intervention was group-based with a planned maximum of 15 participants per group who applied three therapeutic components:

Contemplative practices, including (a) exercises designed to activate a relaxation response in the body as well as body awareness (b) mindfulness meditation, and (c) zen-meditation.

Psychoeducation, i.e., educational and informative lectures, materials and pen-and-paper exercises concerning (a) physical, psychological, and social health promotion, (b) stress prevention and resilience, and (c) disease-specific mechanisms (e.g., typical symptoms, possible developmental paths, possible risks and beneficial effects, and specific health-related advice).

Dialogue, including therapist–group dialogue as well as participant–participant dialogue. Participants were paired in smaller units (2 participants per unit) and were encouraged to continue dialogues and discussion outside of the treatment sessions. Moreover, each participant was offered 5 individual consultations with the therapist.

The total duration of the intervention was 20–26 weeks, which was divided into a high-intensive and a low-intensive phase with the purposes of establishing and maintaining treatment effects, respectively. The high-intensive phase lasted 9 weeks with weekly 3 h group meetings. Additionally, the high-intensive phase included two individual consultations with the therapist in weeks 2–3 and in weeks 7–9. The first individual consultation focused on the motivation and the individual relevance and adjustment of what was being taught in the group sessions. The second individual consultation focused on summarizing experiences and individual strategies for sustaining and maintaining training and its consecutive effects.

The subsequent 12 weeks of the low-intensive phase comprised one 2–3 h monthly group meeting and one monthly individual consultation (of which 2 were delivered per patient on average). The group meetings were structured according to the biopsychosocial model, where each group meeting worked with mental health and mind–body techniques, mainly from either a physical, psychological, or social angle. Patients in the control group received TAU and participated in the scheduled assessments in week 12 and 24.