Table 3 Overview of the trauma-specific mindfulness-based cognitive therapy reported in the Template for Intervention Description and Replication (TIDieR) checklist [57]

1. Brief name

Trauma-specific mindfulness-based cognitive therapy (TS-MBCT)

2. Why

The mindfulness-based cognitive therapy (MBCT) curriculum for depression relapse [22] adapted to address specific vulnerabilities of women affected by domestic violence and abuse. Adaptations were informed by trauma theory [5], the framework of mindfulness-based programmes (MBPs) fidelity [56] and our evidence synthesis.

3. What materials

Trauma-specific adaptations to the standard MBCT curriculum mapped on the coding system for modifications and adaptations of evidence-based interventions [30].

Tailoring/Tweaking/Refining:

- Refinement of assessment and orientation process, with a stronger focus on safety.

- Tailoring practice guidance to emphasise choice and support the process of recognising, responding to and working wisely with overwhelming experience and providing trauma-sensitive audio recordings for home practice

- Tweaking language and vocabulary on handouts.

Adding elements:

- Psycho-education on developing awareness of responses to overwhelm and inclusion of the Zones of Proximal Development Model [58]

- Movement practice for responding to overwhelm.

- Psycho-education on how the tone of negative inner dialogue relates to the experience of domestic violence and abuse.

- Psycho-education on the relationship between aversion and trauma and how patterns of reactivity maintain distress.

- Psycho- education on PTSD and inclusion of the Window of Tolerance Model [22]

- Difficult Communications Calendar (from Mindfulness-Based Stress Reduction).

- Sea of Reactions experiential exercise (from MBCT-Ca).

- Additional handouts to support learning and home practice.

Removing elements:

- Yoga–replaced with Qi Gong.

Shortening/condensing:

- Shorter practices.

Lengthening/extending:

- Offering a menu of home practices to choose from

- Attentional focus practice extended to include ‘impulses’, in addition to body sensations, thoughts and feelings.

- Extending the theme of acceptance to include acceptance of all internal experience, including flashbacks

Re-ordering elements:

- Awareness of patterns of aversion, reactivity and re-experiencing included from week 1, rather than week 4.

Repeating elements:

- Stronger and repeated emphasis on permission and making wise choices.

- Repeated emphasis that the attitude of acceptance in MBPs relates to acceptance of internal experiences and not to harmful behaviour from others

4. What procedures

Adaptations to MBCT procedures all relate to enhanced safety measures—both before and during the course.

In response to women’s suggestions, we developed coMforT app for supporting home practice.

Following advice from the study advisory group and professional stakeholders, we offered women a £20 shopping voucher and reimbursement of transport expenses and childcare for attending each session.

5. Who provided

Female mindfulness teacher (author SM) and teacher assistant.

SM has a Masters in Teaching mindfulness from Bangor University and a Certificate of Competence to Teach Mindfulness—she was assessed as proficient, following the completion of 5 years of training in 2013. SM is listed with BAMBA and meets the GPG for MBP teachers in the UK, which include developing and maintaining a personal mindfulness practice, attending annual retreats and completing required continuing professional development.

A master’s in psychology graduate assisted SM at group 1. A member of the coMforT advisory group assisted at group 2.

6. How

In person teacher-led delivery to a group of up to eight.

7. Where

Room in a community centre located in an urban area of high deprivation

8. When and how much

2-h session was delivered weekly over 8 weeks, though adaptations were made to how much home practice was expected—participants were offered a menu of practices of different lengths and encouraged to make choices about the amount of weekly home practice undertaken in response to their individual vulnerabilities.

9. Tailoring

Individual needs and vulnerabilities were met by offering individual meetings with the teacher, as well as phone and email support in between session where appropriate and with sensitivity to safety

10. Modifications

Modifications to practice guidance were made between groups 1 and 2 to deepen trauma-sensitivity in the language used.

11. How well planned

Recording sessions was not appropriate for this population. We co-developed an MBP fidelity tool with input from a member of the coMforT advisory group. She and a qualitative researcher attended the TS-MBCT group, completed the checklist for each session and collated the results.

12. How well actual

Due to funding restrictions, we did not access fidelity of the course in the feasibility trial. We plan to use the MBP fidelity tool in the full-size trial.