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Morita Therapy for depression (Morita Trial): an embedded qualitative study of acceptability
  1. Holly Victoria Rose Sugg,
  2. Julia Frost,
  3. David A Richards
  1. Medical School, University of Exeter, Exeter, UK
  1. Correspondence to Dr Holly Victoria Rose Sugg; h.v.s.sugg{at}


Objective To explore the views of UK-based recipients of Morita Therapy (MT) on the acceptability of MT.

Design Qualitative study nested within a pilot randomised controlled trial of MT (a Japanese psychological therapy largely unknown in the UK) versus treatment as usual, using post-treatment semistructured interviews analysed with a framework approach.

Setting and participants Participants who received MT as part of the Morita Trial, recruited for the trial from General Practice record searches in Devon, UK. Data from 16 participants were purposively sampled for analysis.

Results We identified five themes which, together, form a model of how different participants viewed and experienced MT. Overall, MT was perceived as acceptable by many participants who emphasised the value of the approach, often in comparison to other treatments they had tried. These participants highlighted how accepting and allowing difficulties as natural phenomena and shifting attention from symptoms to external factors had facilitated symptom reduction and a sense of empowerment. We found that how participants understood and related to the principles of MT, in light of their expectations of treatment, was significantly tied to the extent to which MT was perceived as acceptable. Our findings also highlighted the distinction between MT in principle and practice, with participants noting challenges of engaging with the process of therapy such as fear and discomfort around rest, needing sufficient support from the therapist and others, and the commitment of treatment.

Conclusions People in the UK can accept the premise of MT, and consider the approach beneficial and novel. Therefore, proceeding to a large-scale trial of MT is appropriate with minor modifications to our clinical protocol. Participants’ expectations and understandings of treatment play a key role in acceptability, and future research may investigate these potential moderators of acceptability in MT.

Trial registration numberC ISRCTN17544090; Pre-results.

  • Morita Therapy
  • depression
  • major depressive disorder
  • qualitative
  • acceptability

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  • Contributors DAR proposed the study; HVRS as chief investigator and study researcher designed the study with the involvement of DAR and JF; JF provided additional guidance and support in relation to the qualitative study; HVRS drafted the study protocol and materials and obtained National Health Service ethical approval and research and development governance assurance; HVRS and DAR developed the UK Morita Therapy outpatient protocol; DAR supervised the study therapists. HVRS, who had undergraduate and master’s degrees in the field of psychology as well as 7 years of experience in mental health research, was responsible for project management, data collection and analysis. HVRS managed the Morita Trial and conducted baseline assessments as part of her PhD and therefore had prior contact with all interviewees. HVRS received both in-house and external training in qualitative interviewing and analysis. JF supervised and conducted data analysis with HVRS. HVRS drafted the manuscript. All other authors contributed to editing of the final manuscript. All authors read and approved the final manuscript.

  • Funding The first author (HVRS) had a PhD fellowship award from the University of Exeter Medical School; DAR and JF are also funded by the University of Exeter Medical School and DAR, as a National Institute for Health Research Senior Investigator, receives additional support from the UK National Institute for Health Research South West Peninsula Collaboration for Leadership in Applied Health Research and Care. The AccEPT Clinic is funded by the National Health Service Northern, Eastern and Western Devon Clinical Commissioning Group and hosted by the University of Exeter’s Mood Disorders Centre. The Morita Trial was sponsored by the University of Exeter (contact details available on request). The sponsor and funding sources have had no role in the design of this study, nor during its execution, analyses, interpretation of data or submission of results.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.

  • Patient consent for publication Not required.