Skip to content

Mechanisms of sustained mindfulness practice in stroke survivors: A critical realist secondary analysis of the HEADS: UP intervention.

Naomi E. Clark, Ben Parkinson, Xu Wang, Bridget Davis, Lisa Kidd, Maggie Lawrence

Complementary Therapies in Clinical Practice December 23, 2025 DOI: 10.1016/j.ctcp.2025.102041 (opens in new tab)

Read Full Text
Relevant Not relevant

Study at a glance

AI-extracted from the abstract
Characteristics Secondary analysis of qualitative data from a randomized controlled trial Peer reviewed
Sample size 12
Population Stroke survivors who completed the HEADS: UP mindfulness-based intervention
Duration 6-month follow-up
Topics Anxiety Depression Meditation
Keywords Maintenance Secondary data analysis Stroke
Key findings Seven mechanisms—including believing in benefits, personal preferences, continued learning, social attitudes, togetherness, structured practice, and competing priorities—determined whether stroke survivors sustained mindfulness practice after completing the HEADS: UP intervention.

Abstract

Post-stroke anxiety and depression symptoms are common after stroke and can persist long-term. Despite this, there is a lack of long-term psychological support for post-stroke anxiety and depression. Mindfulness-based interventions are emerging as feasible, acceptable and potentially effective interventions for post-stroke anxiety and depression. Sustained use of mindfulness practice can help stroke survivors to self-manage their anxiety and depression in the long-term. However, stroke survivors' experiences of continued practice following a mindfulness-based intervention have yet to be explored. This study aims to identify mechanisms underpinning sustained mindfulness practice by stroke survivors following completion of an adapted, stroke-specific mindfulness-based intervention called HEADS: UP (Helping Ease Anxiety and Depression After Stroke). A secondary analysis of 6-month follow-up qualitative data from course participants (n = 12) in the HEADS: UP randomised controlled trial was analysed using critical realist thematic analysis. Seven mechanisms were identified as determining sustained mindfulness practice: 1) Believing continued practice brings benefits, 2) Personal preferences and accessibility, 3) Continued learning, 4) Attitudes of others and society, 5) Togetherness and connection, 6) Structuring and scaffolding practice, and 7) Competing priorities. The mechanisms provide explanations behind stroke survivors' experiences of sustained mindfulness practice following HEADS: UP. The findings highlighted the potential benefit of providing support following a mindfulness-based intervention to facilitate sustained practice. Awareness of the mechanisms could aid future intervention design and help clinical practitioners and stroke support professionals support continued mindfulness practice.

Comparable studies

Other randomized controlled trials on meditation, most cited first.

Study Year Design Participants
Alterations in Brain and Immune Function Produced by Mindfulness Meditation Healthy employees in a work environment 2003 Randomized controlled trial n = 41
Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Recovered recurrently depressed patients 2000 Randomized controlled trial n = 145
Open hearts build lives: Positive emotions, induced through loving-kindness meditation, build consequential personal resources. Working adults 2008 Randomized controlled trial n = 139
Short-term meditation training improves attention and self-regulation Undergraduate Chinese students 2007 Randomized controlled trial n = 40
Mindfulness-Based Cognitive Therapy for Depression: Replication and Exploration of Differential Relapse Prevention Effects. Recovered recurrently depressed patients 2004 Randomized controlled trial n = 73

Citations in the library

Cites 18

and 13 more in the library

Related reading

Explore topics

Anxiety Depression Meditation