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Mindfulness has been suggested to be an important protective factor for emotional health. However, this effect might vary with regard to context. This study applied a novel statistical approach, quantile regression, in order to investigate the relation between trait mindfulness and residual depressive symptoms in individuals with a history of recurrent depression, while taking into account symptom severity and number of episodes as contextual factors. Rather than fitting to a single indicator of central tendency, quantile regression allows exploration of relations across the entire range of the response variable. Analysis of self-report data from 274 participants with a history of three or more previous episodes of depression showed that relatively higher levels of mindfulness were associated with relatively lower levels of residual depressive symptoms. This relationship was most pronounced near the upper end of the response distribution and moderated by the number of previous episodes of depression at the higher quantiles. The findings suggest that with lower levels of mindfulness, residual symptoms are less constrained and more likely to be influenced by other factors. Further, the limiting effect of mindfulness on residual symptoms is most salient in those with higher numbers of episodes.

Increased tendencies towards ruminative responses to negative mood and anxious worry are important vulnerability factors for relapse to depression. In this study, we investigated the trajectories of change in rumination and anxious worry over the course of an eight-week programme of mindfulness-based cognitive therapy (MBCT) for relapse prevention in patients with a history of recurrent depression. One hundred and four participants from the MBCT-arm of a randomized-controlled trial provided weekly ratings. Mixed linear models indicated that changes in rumination and worry over the course of the programme followed a general linear trend, with considerable variation around this trend as indicated by significant increases in model fit following inclusion of random slopes. Exploration of individual trajectories showed that, despite considerable fluctuation, there is little evidence to suggest that sudden gains are a common occurrence. The findings are in line with the general notion that, in MBCT, reductions in vulnerability are driven mainly through regular and consistent practice, and that sudden cognitive insights alone are unlikely to lead into lasting effects.

The environments and contexts in which individuals are embedded have a clear role in triggering and maintaining mental health difficulties. Adventure and wilderness therapies provide a radically different environment and way of experiencing oneself. Such a context may facilitate change and support recovery and growth. This thesis examines the application of such therapies for individuals with mental health difficulties. The first chapter reviews the evidence regarding sustained outcomes of adventure therapy for individuals with mental health and emotional disorders. Thirteen studies met the inclusion criteria, ten examining adolescents with mixed presentations and three focussing on adults with specific mental health conditions. There was evidence of significant follow-up outcomes (3–18 months) across the majority of clinical, behavioural, self-concept and quality of life measures. The promising findings, but generally ‘weak’ quality of these studies, call for further exploration of such approaches and more robust research designs. The second chapter employed ethnography to examine sail-training as an adjunctive intervention for individuals open to Early Intervention for Psychosis Services (EIPS). The voyages presented a radical contextual shift characterised by purpose, structure and routine, an intensive and inescapable social environment, the introduction of challenge and adversity and a novel and changing ocean environment. This context supported several positive processes including active engagement and, through this, the development of skills, finding of roles, growing confidence, social-connection, resilience, and a shift in outlook characterised by aspiration for change. Individuals also experienced challenges, struggles and, at times, resistance. The approach has positive implications for social and functional recovery, and these are discussed in relation to its unique features. Areas for future research are also explored. The final chapter discusses the broader implications of this research and introduces a process model developed during the empirical research. It concludes with the researcher’s personal reflections on the research process.