Overall, the current research methodology achieved what I hoped it would. It allowed me to illuminate the phenomenon of engaging in MBIs whilst living with ME/CFS. As anticipated, findings have identified helpful and unhelpful aspects of the interventions, and given information about why these facets were found to be so. As hoped, the findings seem able to contribute to the development of future interventions as well as add to an evidence-base regarding ME/CFS and MBIs. As with all research the process has not been faultless. The following section discusses how the current study could be critiqued. Here, issues of clarity, sampling, and demographic information are discussed. Some of these are explored further when considering implications and options for future research.
One of the main critiques of the current study is the mismatch between the research question and the sampling process. Initially I hoped to consider a range of MBIs with the commonality which tied them together being that the interventions were all founded on mindfulness in some way. However, my most fruitful recruitment
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method was a round robin email sent by an organisation providing solely group- based interventions. As discussed in the Methodology section, I believe this worked out for the best as this initial aim may have generated a data set too diverse for deep and meaningful analysis. Instead, I was able to gain insight into common phenomena from a variety of angles. I decided not to change the term ‘mindfulness- based interventions’ to another, such as ‘mindfulness courses’, as I felt this would create inconsistency in my write-up. Recruitment materials and the information sheet would have referred to ‘mindfulness-based interventions’, whereas the write- up would have referred to a different term. I thought this might cause confusion, especially for my participants who expressed keen interest in reading the final product. Moreover, the term ‘mindfulness-based interventions’ still encompasses the courses participants spoke about and is therefore technically accurate.
Sampling in the current study is worthy of discussion too. The first point to consider links with the above discussion of clear communication. As mentioned in the Methodology section, presenting individual profiles would have compromised confidentiality due to volunteers approaching me after my recruitment talk in full view of the group. This is unfortunate, as I find individual profiles help connect readers with the accounts they are presented with. I believe readers are more able to empathise if they have a feel for a person and thus the participant’s lived experience becomes more alive. Being able to provide individual profiles would therefore have been more consistent with the aim of IPA and of the current study - to illuminate and communicate the experiences of participants. In hindsight, I would have provided contact details and asked interested individuals to contact me after the talk rather than at the venue.
The second point to consider is the exclusion of individuals who had experienced MBI for less than six weeks. As explained in the Methodology section, this was considered a positive and necessary step to ensure that participants had enough
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experience from which to provide detailed data about their interventions. It also meant that findings could be compared against a variety of other studies which have reported data from individuals with a similar level of attendance. However, requiring attendance for six weeks possibly means participants were interviewed who were all relatively committed to their MBIs. Even Harriet, who remained sceptical about the utility of mindfulness, attended all sessions and completed all the homework. Scepticism, cynicism, doubt, and the barriers these erected towards mindfulness and MBIs were found important facets of individuals’ experiences in the current study. It could be that I would have learned more about negative experiences of MBIs and barriers to engagement if I had interviewed individuals who attended fewer sessions.
The third point to consider regarding sampling is the growing body of literature critiquing the use of the Fukuda et al. (1994) diagnostic criteria. Researchers such as Brown, Jason, Evans and Flores (2013), Jason et al. (2012), Sullivan, Pedersen, Jacks and Evengard (2005), and Jason, Torres-Harding, Jurgens and Helgerson (2004) argue that what the literature commonly refers to as ME/CFS may not be one specific group. Rather ‘ME/CFS’ may be seen as an umbrella term which encapsulates different symptom clusters, aetiologies, and severities. It may be the case that the current sample consisted of individuals who could be categorised into different subsets. If this is the case, it might mean it is questionable to assume that the current sample is representative of one overarching condition. Perhaps instead, different participants are representative of different subsets. In light of this, it may be suggested that we cannot assume the current data is comparable against other research into ME/CFS. On the other hand, it could be argued that the potential of samples to represent different ‘conditions’ or ‘categories’ is only a problem if researchers are looking to generalise findings to wider populations. Here we would hope for the sample to be representative of a larger populace. We want to be
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confident that a certain percentage (usually 95-99%) of individuals would respond the same as those in our research. Obviously as IPA is conducted in small sample sizes, in this case eight participants, we are not looking to generalise from findings. Additionally, IPA prioritises experience, not correlates of diagnosis, at the forefront of the investigation. We are not looking to compare individuals based on their diagnoses. Rather, we are seeking to compare and elucidate experiences. Thus, the question of whether the current sample was made up of different subsets holds less importance than we might initially imagine.
The fourth point to consider regarding sampling refers to the motivations of those who volunteered for the study. Rozmovits and Zeibland (2004) espoused in their research that it was inevitable that participants who took part in their interviews differed in a particular way from other similar individuals. Rozmovtis and Zeibland (2004) noted that their participants were willing to tell the story of their illness to benefit others. Nelson (2010) echoes a similar sentiment in her research, noting that individuals may be drawn to volunteer due to a particularly positive experience or a particularly difficult one. In this sense, research may not represent the views of those who had fairly middling experiences. Consistent with Willig’s (2008) advice, I asked each participant about their motivation for volunteering. As anticipated by Rozmovtis and Zeibland (2004), and Nelson (2010), three participants said they wanted to volunteer because they wished to espouse positive accounts of mindfulness and MBIs. For example, Nadia said she found the mindfulness course really helpful and wanted to “promote [mindfulness] as a technique” (line 17). One participant, Harriet, explained she wanted to ensure that negative experiences were represented in my dataset too. She said, “I thought you might be very pro- mindfulness or something and I hadn’t had a brilliant experience” (21-26).
Since only three out of eight participants espoused particularly positive or negative accounts, it could be suggested that the current findings do describe the views of
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those who had more middling experiences. Certainly, when we consider other reasons participants gave for volunteering we can see that having a particularly positive or negative experience was not at the forefront of many accounts. No individuals gave just one reason for volunteering. Indeed, six said they wanted to volunteer because they felt ME/CFS was poorly understood and research in the area scarce. For five participants, this was the motivation they mentioned first, which perhaps indicates it was the one most important to them. Participants noted a range of other reasons for volunteering too. These included being interested in the area (two participants) and desiring to help me (one participant). Other reasons given were that the interview was an opportunity to explain their experience (one participant) and believing that talking about their experiences would help them (two participants). It seems that individuals in the current study volunteered for a variety of reasons. Thus, their accounts may not be meaningfully different from others with more middling experiences.
A brief criticism of the current study can be made relating to the demographic information gathered. Information collected did include the severity of participants’ symptoms, both at the time the data was gathered and in general. However, perhaps a more useful piece of information would have detailed the severity of symptoms at the time of the course. We know ME/CFS to be a fluctuating illness (Arroll & Senior, 2008) and cannot therefore conclude that the general measure of severity would be representative of the time participants’ courses ran. Indeed, Caroline, Daniel, Irv, and Lucy all described their symptoms at interview as being much better than at the time of the course. Knowing at what level of severity participants would have classified their illnesses at the time of their MBIs may have added an extra layer to our understanding of their experiences. It may also have provided an avenue for me to explore during interviews.
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Another criticism of the current study pertains to ethics. As discussed in the Methodology section, researchers such as Willig (2013; 2012), Kvale (2003, as cited in Willig, 2012), and Latour (2000, as cited in Willig, 2012), argue that it is important for participants to be able to object to what is said about them. I would suggest that being able to object to interpretations is particularly important in the area of ME/CFS. Historically, ME/CFS patient populations have objected to research findings published about their condition. Rather than this leading to opening a dialogue between researchers and people with ME/CFS, it seems to have created more of a battle in some circles. As mentioned earlier, a rift seems to exist between psychologists and some individuals and groups with ME/CFS. Again, as discussed earlier, this battle stance might mean individuals are restricted from accessing treatment options which could be helpful to them. In light of the above, it seems it would have been more ethical if I had engaged in ‘member checking’ whereby interpretations are taken back to participants and amended as appropriate. Not only might this have ensured that participants’ experiences were less likely to be misrepresented, but it may also have communicated that psychologists are willing to listen and desire to give people with ME/CFS a voice. Unfortunately, due to the limited time for this research, I was unable to do this. However, I would advocate member checking whenever possible in research conducted within the ME/CFS field.