A naturalistic pilot study 53 Discussion Interpretation As the primary objectives of this pilot study concerned the feasibility of implementing the IMR training program on a broader scale, we measured the following: 1.) whether the institute had succeeded in recruiting sufficient participants for the planned six IMR groups, 2.) clients’ and clinicians’ satisfaction with IMR, and 3.) the effectiveness of the program. That the institute could recruit 81 IMR participants to the pilot study from the 167 people assessed for eligibility means that we exceeded our feasibility criterion of 60. This suggests that a good number of clients is interested in this treatment. It also supports the feasibility of getting sufficient participants for the RCT, although recruiting for an RCT is probably harder than recruiting for a pilot study with no control group. The satisfaction of the completers interviewed and of all clinicians was very good. However, as we measured this only at follow-up, we could not measure change over time, and as we did not interview people who dropped out, we know only that 49% of all participants were satisfied with IMR. IMR was effective for completers on the IMR-scale clinician version, with a large effect-size d = 0.84, and on the RMQ, with a medium effect size (d = 0.52), but there was no significant improvement on the IMR-scale client version (d = 0.41). However, a limitation of this pilot study is our deviation from the original protocol: due to a sudden reduction in the research team, we could not conduct follow-up measurements or interview the non-completers; neither did we have a control group. We nevertheless conclude that our institute appears to have a sufficiently firm support base for implementing IMR on a broader scale, and that this contributes to the feasibility of an RCT. The secondary objectives of the pilot study were to implement IMR with satisfactory fidelity, to create a sufficient infrastructure for the trainers’ education and supervision, to explore program duration, and to explore dropout. With regard to the RCT, we see it as an advantage that, due probably to sufficient trainer education and supervision, the institute successfully established six IMR groups in this pilot period whose average total fidelity score on the IMR Fidelity Scale was 4.0. Therefore our feasibility criterion of ≥ 4.0 was met. We also see it as very useful that our item scores helped us identify the aspects of implementation of IMR that the institute must improve to achieve total scores ≥ 4.0 for all groups.
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