How Psychological Change Unfolds During Online Mindfulness-Based Cognitive Therapy: A Convergent Mixed-Methods Study of Daily Processes in Depression

Abstract

Background: Online Mindfulness-Based Cognitive Therapy (MBCT) offers a scalable approach to treating depression, yet high attrition and sustained engagement remain persistent challenges, particularly for individuals with active symptoms. This convergent mixed-methods study aimed to explore how individuals with current depressive symptoms experience and navigate digital mindfulness practice, and how these subjective experiences translate into daily trajectories of psychological change across different delivery formats

Methods: The study combined intensive longitudinal methods via structured daily diaries with in-depth qualitative interviews. Quantitative data were drawn from the daily diaries of 137 participants (yielding 1628 person-day observations) and analysed using hierarchical linear modelling (HLM). Qualitative data were collected through semi-structured interviews with 15 participants following a six-week online MBCT programme and analysed using Reflexive Thematic Analysis (RTA). Participants were enrolled in either a live group synchronous or guided asynchronous online format.

Results: Quantitatively, daily diaries revealed reliable within-person improvements in depressogenic adjustment, negative affect, and rumination, alongside increases in mindfulness and self-compassion. However, these changes were accompanied by substantial between-person variability, indicating highly individual rates of daily change. These statistical fluctuations were deeply mirrored in the qualitative data, where participants described practice not as a smooth trajectory, but as uneven, effortful practice. Three themes were constructed: the effort invested in establishing rhythms and routines ( Learning to Live Inside the Practice ); navigating relational experiences ranging from shared humanity to digital quiet ( Feeling With Others, Feeling Into Silence ); and experiencing subtle shifts in relating to one's thoughts and emotions ( Expanding Inner Latitude ). Crucially, delivery format did not moderate improvements in primary depressive symptoms; however, asynchronous participants demonstrated significantly faster daily gains in self-compassion and mindful responding.

Conclusions: The qualitative and quantitative strands converged in characterising participation in an online MBCT as an active, self-directed process. The findings support a process-oriented account of online MBCT in which symptom improvement is relatively consistent across delivery formats, whereas the development of mindfulness and self-compassion follows more individualized trajectories, with asynchronous delivery associated with faster gains in these skills.