Mindfulness-Based Cognitive Therapy for Depression
Review by Andrea B. Stone, M.D., Psychiatric Services, Sept 6, 2005
Title: Mindfulness-Based Cognitive Therapy for Depression: A New Approach to Preventing Relapse
Author: Zindel V. Segal, Mark G. Williams, and John D. Teasdale; New York, Guilford Press, 2001, 351 pages, $38
New York, USA -- Mindfulness-Based Cognitive Therapy for Depression: A New Approach to Preventing Relapse is both a book and a manual for the prevention of depressive relapse among individuals who have recovered from an episode of major depression.
The book is divided into three sections. Part 1 identifies the scope of the problem of depression and depressive relapses. The authors detail how they came to incorporate mindfulness—the core of Buddhist meditative practices—into their vision of cognitive therapy. Marsha Linehan provided them with a model in dialectical behavior therapy and led them to Jon Kabat-Zinn's work at the University of Massachusetts. He had developed a group treatment around mindfulness practice for people with chronic pain. Kabat-Zinn's definition of mindfulness—"paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally"—forms the conceptual foundation of their treatment (1).
Part 2 is a manual for providing mindfulness-based cognitive therapy (MBCT) for the prevention of depressive relapse. It is an eight-session group treatment. Each chapter covers one session in great detail, including transcripts to use during the session. These chapters include sample discussions, patient handouts, and homework sheets (which come complete with the publisher's permission to use them).
Sessions 1 through 4 focus on learning the fundamental concepts and skills of mindfulness practice: paying attention, focusing one's mind, and understanding the connection between wandering thoughts and negative thoughts. This last skill may be critical to the prevention of depressive relapse.
Sessions 5 through 8 teach people how to deal with mood shifts in a mindful way. The role of acceptance in mindfulness practice is introduced in session 5. Participants learn how to notice thoughts and their impact on physical and emotional experiences, accept these thoughts and experiences, and use this information to develop a different relationship to thoughts, feelings, and bodily sensations: "The core skill that the MBCT program aims to teach is the ability ... to recognize and disengage from mind states characterized by self-perpetuating patterns of ruminative, negative thoughts.... In order to do this, participants have to learn how to disengage from one mode of mind and enter another, incompatible mode of mind.... This involves moving from a focus on content to a focus on process."
Part 3 reports on a randomized controlled trial of the treatment and a discussion of the findings. The trial included 145 patients who had experienced at least two previous episodes of major depression and had recovered. The two conditions were treatment as usual or eight sessions of MBCT. The participants were followed for 60 weeks. Participants with a history of three or more episodes of depression showed a statistically significant response to MBCT. In fact, the more previous episodes, the greater the response.
Mindfulness-Based Cognitive Therapy for Depression is both readable and practical. An effective, brief group treatment for preventing depressive relapse is welcome news for patients, clinicians, and managed care companies alike.
Dr. Stone is affiliated with the University of Massachusetts Medical School in Worcester and with the Carson Center for Human Services in Westfield, Massachusetts.
1. Kabat-Zinn J: Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life. New York, Hyperion, 1994