Mindfulness-Based Cognitive Therapy prevents relapse into depression

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For people suffering from recurrent depression, one of the therapies increasingly available through the NHS is Mindfulness-Based Cognitive Therapy (MBCT). MBCT is a skills training programme that combines elements of Cognitive Behaviour Therapy (CBT) with mindfulness meditation to prevent relapse for those who have suffered from 3 or more episodes of depression.

The Oxford Mindfulness Centre (OMC) is part Oxford University’s Department of Psychiatry, established in 2008 to conduct clinical and neuroscience research on mindfulness. MBCT was designed by its Director Professor Mark Williams, together with John Teasdale and Zindel Segal, based on the work of Jon Kabat-Zinn who introduced Mindfulness-based Stress Reduction (MBSR) in 1979.

The OMC web site summarises the main results from research on MBCT as follows:

  • “In patients with three or more previous episodes of depression, MBCT reduces the recurrence rate over 12 months by 40-50% compared with usual care.
  • MBCT is as effective in reducing recurrence as antidepressants.
  • In the UK, the Government’s National Institute for Health and Clinical Excellence (NICE) has recommended MBCT for those with three or more episodes of depression in their Guidelines for Management of Depression (2004, 2009).”

MBCT comprises 2-hourly sessions delivered over 8 consecutive weeks in a group setting to between 9-15 people. Sessions combine practices such as the body scan, breathing meditation, simple yoga exercises and cognitive therapy; CDs are included for practice at home between classes.

What research says

Research studies[1] repeatedly show that for patients who have suffered 3 or more bouts of depression, MBCT, when used in conjunction with “treatment as usual” (TAU), halves the relapse rate over 12 months, compared to only “treatment as usual”. TAU can include antidepressant medication, counselling, psychotherapy, or other professional mental health support. The studies specifically address patients who are currently in remission after their last instance of depression.

Results of clinical trials also show that MBCT is as effective as anti-depressants in reducing the relapse rate of patients with 3 or more episodes of depression[2]. Moreover, MBCT appears to have the added benefit of improving positive emotions generally; patients in a clinical trial reported higher quality of life measures for both physical and psychological domains than if they only continued anti-depressant medication.

Further research needs to confirm if MBCT could be effective for currently depressed patients, its effectiveness in comparison to other specific psychological interventions, and importantly, which element of MBCT is actually helping to prevent relapse into depression. Although MBCT’s effectiveness for preventing relapse is widely accepted, what is still unknown is whether it is the mindfulness aspect that is creating this positive effect, or another element of the course such as group participation or therapist attention.

How does it work?

According to cognitive research, those who have suffered from depression already are particularly vulnerable to mood-related triggers that send them into an “auto-pilot” mode, inducing cycles of repetitive negative thinking and thereby causing relapse. This effect gets stronger the more bouts of depression one experiences. With MBCT, participants develop the ability to recognise and disengage from negative thought patterns and forge a new relationship to themselves and their surroundings.

MBCT uses those elements of CBT that “decentralise” thoughts, such as “thoughts are not facts” and “I am not my thoughts”. Unlike CBT, the emphasis is not on changing the content of thoughts; instead, mindfulness meditation focuses on changing the awareness of and relation to one’s thoughts. The section on mindfulness meditation here elaborates the principles of this practice.

As a result, participants discover what makes them vulnerable to downward mood spirals, explore ways of releasing themselves from “autopilot”, and discover a new way to relate to themselves and the world, noticing the present moment rather than living in the past or worrying about the future. Finally, MBCT teaches participants to accept themselves as they are rather than battling with themselves at these times.

An interesting corollary of the MBCT is that learning its practice and running the course can also improve the teacher’s wellbeing.  Several NHS organisations offer MBCT to its staff for its stress-reducing effect.

Relevant research

  • Williams JMG. and Kuyken W. (2012) Mindfulness-based cognitive therapy: a promising new approach to preventing depressive relapse Br. J. Psychiatry doi:10.1192/bjp.bp.111.104745
  • Segal ZVBieling PYoung T (2010) Antidepressant monotherapy vs sequential pharmacotherapy and mindfulness-based cognitive therapy, or placebo, for relapse prophylaxis in recurrent depression, Arch Gen Psychiatry 2010 Dec; 67(12): 1256–1264
  • Barnhofer, T., Crane, C., Hargus, E., et al. (2009) Mindfulness-Based Cognitive Therapy as a Treatment for Chronic Depression Behaviour Research & Therapy, 47, 366-373
  • Kuyken W, Byford S, Taylor RS et al. (2008) Mindfulness-based cognitive therapy to prevent relapse in recurrent depression, Journal of Consulting and Clinical Psychology, 2008 Dec; 76(6):966-78
  • Teasdale, J.D., Segal, Z.V., Williams, J.M.G., et al. (2000) Prevention of relapse/recurrence of major depression using Mindfulness-based Cognitive Therapy. Journal of Consulting and Clinical Psychology, 68, 615-23

Related sites

 


[1] Teasdale, J.D., Segal, Z.V., Williams, J.M.G., et al. (2000),  Ma, S.H., Teasdale, J.D. (2004)

[2] Segal ZV, Bieling P, Young T (2010), Kuyken W, Byford S, Taylor RS et al. (2008)

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