It has long been theorised that there are two temporally distinct forms of self-reference: extended self-reference linking experiences across time, and momentary self-reference centred on the present. To characterise these two aspects of awareness, we used functional magnetic resonance imaging (fMRI) to examine monitoring of enduring traits (’narrative’ focus, NF) or momentary experience (’experiential’ focus, EF) in both novice participants and those having attended an 8 week course in mindfulness meditation, a program that trains individuals to develop focused attention on the present. In novices, EF yielded focal reductions in self-referential cortical midline regions (medial prefrontal cortex, mPFC) associated with NF. In trained participants, EF resulted in more marked and pervasive reductions in the mPFC, and increased engagement of a right lateralised network, comprising the lateral PFC and viscerosomatic areas such as the insula, secondary somatosensory cortex and inferior parietal lobule. Functional connectivity analyses further demonstrated a strong coupling between the right insula and the mPFC in novices that was uncoupled in the mindfulness group. These results suggest a fundamental neural dissociation between two distinct forms of self-awareness that are habitually integrated but can be dissociated through attentional training: the self across time and in the present moment.
Mindfulness-Based Cognitive Therapy (MBCT) is an evidence-based program that combines mindfulness and cognitive therapy techniques for working with stress, anxiety, depression, and other problems. Building Competence in Mindfulness-Based Cognitive Therapy provides the first transcript of an entire 8-week program. This intimate portrayal of the challenges and celebrations of actual clients give the reader an inside look at the processes that occur within these groups. The author also provides insights and practical suggestions for building personal and professional competence in delivering the MBCT protocol.
Mindfulness-Based Cognitive Therapy (MBCT) is an evidence-based program that combines mindfulness and cognitive therapy techniques for working with stress, anxiety, depression, and other problems. Building Competence in Mindfulness-Based Cognitive Therapy provides the first transcript of an entire 8-week program. This intimate portrayal of the challenges and celebrations of actual clients give the reader an inside look at the processes that occur within these groups. The author also provides insights and practical suggestions for building personal and professional competence in delivering the MBCT protocol.
Decentering is defined as the ability to observe one's thoughts and feelings as temporary, objective events in the mind, as opposed to reflections of the self that are necessarily true. The Experiences Questionnaire (EQ) was designed to measure both decentering and rumination but has not been empirically validated. The current study investigated the factor structure of the EQ in both undergraduate and clinical populations. A single, unifactorial decentering construct emerged using 2 undergraduate samples. The convergent and discriminant validity of this decentering factor was demonstrated in negative relationships with measures of depression symptoms, depressive rumination, experiential avoidance, and emotion regulation. Finally, the factor structure of the EQ was replicated in a clinical sample of individuals in remission from depression, and the decentering factor evidenced a negative relationship to concurrent levels of depression symptoms. Findings from this series of studies offer initial support for the EQ as a measure of decentering.
Metacognitive awareness is a cognitive set in which negative thoughts/feelings are experienced as mental events, rather than as the self. The authors hypothesized that (a) reduced metacognitive awareness would be associated with vulnerability to depression and (b) cognitive therapy (CT) and mindfulness-based CT (MBCT) would reduce depressive relapse by increasing metacognitive awareness. They found (a) accessibility of metacognitive sets to depressive cues was less in a vulnerable group (residually depressed patients) than in nondepressed controls; (b) accessibility of metacognitive sets predicted relapse in residually depressed patients; (c) where CT reduced relapse in residually depressed patients, it increased accessibility of metacognitive sets; and (d) where MBCT reduced relapse in recovered depressed patients, it increased accessibility of metacognitive sets. CT and MBCT may reduce relapse by changing relationships to negative thoughts rather than by changing belief in thought content.
The development of the Mindfulness‐Based Cognitive Therapy Adherence Scale (MBCT‐AS) is described. This 17‐item scale measures therapist adherence to the treatment protocol for Mindfulness‐Based Cognitive Therapy (MBCT), a treatment for the prevention of recurrence in Major Depressive Disorder. The MBCT‐AS assesses therapist behaviours specific to (MBCT) as well as therapy practices that MBCT shares with Cognitive Behaviour Therapy (CBT). To determine the utility of this scale, we compared delivery of group MBCT against group CBT, with independent ratings of taped sessions provided to measure adherence to MBCT and CBT for therapists in both groups. The results showed that: (a) raters can reliably use the MBCT‐AS; (b) MBCT therapists demonstrated adherence to the treatment protocol, as measured by the MBCT‐AS; and (c) MBCT is distinguishable from CBT on both the MBCT‐AS and a scale measuring adherence to CBT (CBT‐AS). These findings indicate that the MBCT‐AS may be a useful tool for ensuring the proper delivery of MBCT in future research, and may be helpful in determining the elements of MBCT that are unique to that treatment.
This book presents an innovative eight-session program that has been clinically proven to bolster recovery from depression and prevent relapse. Developed by leading scientist-practitioners, and solidly grounded in current psychological research, the approach integrates cognitive therapy principles and practice into a mindfulness framework. Clinicians from any background will find vital tools to help clients maintain gains made by prior treatment and to expand the envelope of care to remission and beyond. The focus of mindfulness-based cognitive therapy is teaching clients how to make a simple yet radical shift in their relationship to the thoughts, feelings, and bodily sensations that contribute to depressive relapse. This shift entails fostering a "decentered" relationship to experience, in which negative thoughts or feelings can be viewed as events in the mind, rather than as "self" or as necessarily true. Step-by-step guidelines are provided for conducting awareness exercises and cognitive interventions that help clients both gain awareness of mild states of sadness and prevent them from spiraling out of control. Illustrative transcripts and a wealth of reproducible materials, including session summaries and participant forms, enhance the clinical utility of the volume. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
This acclaimed work, now in a new edition, has introduced tens of thousands of clinicians to mindfulness-based cognitive therapy (MBCT) for depression, an 8-week program with proven effectiveness. Step by step, the authors explain the "whys" and "how-tos" of conducting mindfulness practices and cognitive interventions that have been shown to bolster recovery from depression and prevent relapse. Clinicians are also guided to practice mindfulness themselves, an essential prerequisite to teaching others. Forty-five reproducible handouts are included. Purchasers get access to a companion website featuring downloadable audio recordings of the guided mindfulness practices (meditations and mindful movement), plus all of the reproducibles, ready to download and print in a convenient 8 1/2" x 11" size. A separate website for use by clients features the audio recordings only. New to This Edition *Incorporates a decade's worth of developments in MBCT clinical practice and training. *Chapters on additional treatment components: the pre-course interview and optional full-day retreat. *Chapters on self-compassion, the inquiry process, and the three-minute breathing space. *Findings from multiple studies of MBCT's effectiveness and underlying mechanisms. Includes studies of adaptations for treating psychological and physical health problems other than depression. *Audio files of the guided mindfulness practices, narrated by the authors, on two separate Web pages--one for professionals, together with the reproducibles, and one just for clients. See also the authors' related titles for clients: The Mindful Way through Depression demonstrates these proven strategies in a self-help format, with in-depth stories and examples. The Mindful Way Workbook gives clients additional, explicit support for building their mindfulness practice, following the sequence of the MBCT program. Plus, for professionals: Mindfulness-Based Cognitive Therapy with People at Risk of Suicide extends and refines MBCT for clients with suicidal depression.
PURPOSE OF REVIEW:The article reviews the recent evidence for mindfulness-based cognitive therapy (MBCT) for patients with residual depressive symptoms or in remitted patients at increased risk for relapse.
RECENT FINDINGS:
Randomized controlled trials have shifted focus from comparing MBCT with treatment-as-usual to comparing MBCT against interventions. These studies have provided evidence for the efficacy of MBCT on par with maintenance antidepressant pharmacotherapy and leading to a relative reduction of risk on the order of 30-40%. Perhaps fuelled by these data, recent efforts have focused on extending MBCT to novel populations, such as acutely depressed patients, those diagnosed with health anxiety, social anxiety, fibromyalgia, or multiple chemical sensitivities as well migrating MBCT to online platforms so that it is more widely available. Neuroimaging studies of patients in structured therapies which feature mindfulness meditation, have reported findings that parallel behavioral changes, such as increased activation in brain regions subsuming self-focus and emotion regulation (prefrontal cortex) and interoceptive awareness (insula).
SUMMARY:
The current evidence base for MBCT is strongest for its application as a prophylactic intervention or for residual depressive symptoms, with early data suggesting additional indications outside the mood disorders. Future work will need to address dose-effect relationships between mindfulness practice and clinical benefits, as well as establishing the rates of uptake for online MBCT so that its benefits can be compared to in-person groups. Additionally, validating current or novel neural markers of MBCT treatment response will allow for patient matching and optimization of treatment response.
Previous research on depressed and suicidal patients and those with posttraumatic stress disorder has shown that patients' memory for the past is overgeneral (i.e., patients retrieve generic summaries of past events rather than specific events). This study investigated whether autobiographical memory could be affected by psychological treatment. Recovered depressed patients were randomly allocated to receive either treatment as usual or treatment designed to reduce risk of relapse. Whereas control patients showed no change in specificity of memories recalled in response to cue words, the treatment group showed a significantly reduced number of generic memories. Although such a memory deficit may arise from long-standing tendencies to encode and retrieve events generically, such a style is open to modification.
Previous research on depressed and suicidal patients and those with posttraumatic stress disorder has shown that patients' memory for the past is overgeneral (i.e., patients retrieve generic summaries of past events rather than specific events). This study investigated whether autobiographical memory could be affected by psychological treatment. Recovered depressed patients were randomly allocated to receive either treatment as usual or treatment designed to reduce risk of relapse. Whereas control patients showed no change in specificity of memories recalled in response to cue words, the treatment group showed a significantly reduced number of generic memories. Although such a memory deficit may arise from long-standing tendencies to encode and retrieve events generically, such a style is open to modification.
Previous research on depressed and suicidal patients and those with posttraumatic stress disorder has shown that patients' memory for the past is overgeneral (i.e., patients retrieve generic summaries of past events rather than specific events). This study investigated whether autobiographical memory could be affected by psychological treatment. Recovered depressed patients were randomly allocated to receive either treatment as usual or treatment designed to reduce risk of relapse. Whereas control patients showed no change in specificity of memories recalled in response to cue words, the treatment group showed a significantly reduced number of generic memories. Although such a memory deficit may arise from long-standing tendencies to encode and retrieve events generically, such a style is open to modification.
This study was designed to test the hypothesis that mindfulness involves sustained attention, attention switching, inhibition of elaborative processing and non-directed attention. Healthy adults were tested before and after random assignment to an 8-weekMindfulness-Based Stress Reduction (MBSR) course (n = 39) or a wait-list control (n = 33). Testing included measures of sustained attention, attention switching, Stroop interference (as a measure of inhibition of laborative processing), detection of objects in consistent or inconsistent scenes (as a measure of non-directed attention), as well as self-report measures of emotional well-being and mindfulness. Participation in the MBSR course was associated with significantly greater improvements in emotional well-being and mindfulness, but no improvements in attentional control relative to the control group. However, improvements in mindfulness after
MBSR were correlated with improvements in object detection. We
discuss the implications of these results as they relate to the role of attention in mindfulness.
Evidence suggests mindfulness‐based clinical interventions are effective. Accepting this, we caution against assuming that mindfulness can be applied as a generic technique across a range of disorders without formulating how the approach addresses the factors maintaining the disorder in question. Six specific issues are raised: mindfulness has been found to be unhelpful in some contexts; where mindfulness has been found to be effective, instructors have derived and shared with clients a clear problem formulation; there may be many dimensions of effectiveness underlying the apparent simplicity of mindfulness; mindfulness was developed within a particular “view” of emotional suffering that implies wider changes that go beyond meditation practice alone; professionals need to match the different components of mindfulness with the psychopathology being targeted; nonetheless, mindfulness may affect processes common to different pathologies.
Evidence suggests mindfulness-based clinical interventions are effective. Accepting this, we caution against assuming that mindfulness can be applied as a generic technique across a range of disorders (as suggested by R. Baer, see record 2003-03824-001) without formulating how the approach addresses the factors maintaining the disorder in question. Six specific issues are raised: mindfulness has been found to be unhelpful in some contexts; where mindfulness has been found to be effective, instructors have derived and shared with clients a clear problem formulation; there may be many dimensions of effectiveness underlying the apparent simplicity of mindfulness; mindfulness was developed within a particular "view" of emotional suffering that implies wider changes that go beyond meditation practice alone; professionals need to match the different components of mindfulness with the psychopathology being targeted; nonetheless, mindfulness may affect processes common to different pathologies. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Recovery from emotional challenge and increased tolerance of negative affect are both hallmarks of mental health. Mindfulness training (MT) has been shown to facilitate these outcomes, yet little is known about its mechanisms of action. The present study employed functional MRI (fMRI) to compare neural reactivity to sadness provocation in participants completing 8 weeks of MT and waitlisted controls. Sadness resulted in widespread recruitment of regions associated with self-referential processes along the cortical midline. Despite equivalent self-reported sadness, MT participants demonstrated a distinct neural response, with greater right-lateralized recruitment, including visceral and somatosensory areas associated with body sensation. The greater somatic recruitment observed in the MT group during evoked sadness was associated with decreased depression scores. Restoring balance between affective and sensory neural networks—supporting conceptual and body based representations of emotion—could be one path through which mindfulness reduces vulnerability to dysphoric reactivity.
Recovery from emotional challenge and increased tolerance of negative affect are both hallmarks of mental health. Mindfulness training (MT) has been shown to facilitate these outcomes, yet little is known about its mechanisms of action. The present study employed functional MRI (fMRI) to compare neural reactivity to sadness provocation in participants completing 8 weeks of MT and waitlisted controls. Sadness resulted in widespread recruitment of regions associated with self-referential processes along the cortical midline. Despite equivalent self-reported sadness, MT participants demonstrated a distinct neural response, with greater right-lateralized recruitment, including visceral and somatosensory areas associated with body sensation. The greater somatic recruitment observed in the MT group during evoked sadness was associated with decreased depression scores. Restoring balance between affective and sensory neural networks—supporting conceptual and body based representations of emotion—could be one path through which mindfulness reduces vulnerability to dysphoric reactivity.
Recovery from emotional challenge and increased tolerance of negative affect are both hallmarks of mental health. Mindfulness training (MT) has been shown to facilitate these outcomes, yet little is known about its mechanisms of action. The present study employed functional MRI (fMRI) to compare neural reactivity to sadness provocation in participants completing 8 weeks of MT and waitlisted controls. Sadness resulted in widespread recruitment of regions associated with self-referential processes along the cortical midline. Despite equivalent self-reported sadness, MT participants demonstrated a distinct neural response, with greater right-lateralized recruitment, including visceral and somatosensory areas associated with body sensation. The greater somatic recruitment observed in the MT group during evoked sadness was associated with decreased depression scores. Restoring balance between affective and sensory neural networks—supporting conceptual and body based representations of emotion—could be one path through which mindfulness reduces vulnerability to dysphoric reactivity.
Recent reports indicate that depression is the most common psychological disorder in the US, affecting as many as 17 million Americans. This book integrates the spiritual practice of mindfulness with psychological techniques for changing negative thoughts and behaviors into a powerful and proven-effective program for coping with this serious and distressing condition.Current statistics suggest that as many as 17 million Americans suffer from depression; further research states that less than 25 percent of these receive adequate treatment for the disorder. In clinical trials, treatment approaches that incorporate spirituality with psychology have proven to be dramatically effective at countering depression. This book is co-written by a leading specialist in the treatment of depression and a clinical nurse who, as a Zen practitioner trained with Charlotte Joko Beck and Jon Kabat-Zinn.
A concept grounded in the practice of certain forms of Buddhism, mindfulness is the conscious, uninvolved awareness of the present moment. Western psychologists have recently learned that this state of mind is particularly conducive to the accomplishment of cognitive behavioral therapy, or CBT: an active mode of psychological treatment that attempts to recognize and counter negative thoughts and behaviors before they lead to debilitating symptoms like depression. As statistics confirm again and again that depression is the single most common psychological problem affecting Americans, the refinement of psychotherapy through the integration of spirituality-based techniques has generated considerable interest among psychology professionals. This approachable and easy-to-use book makes these powerful techniques available to the general public.
The book is built around a compelling series of specific, step-by-step interventions that provide readers with an understanding of the thoughts that lead to depression. They learn how to find the motivation to confront depressive feelings. By sitting with painful emotions and allowing them to pass, you will find that you can reduce the frequency of depressive episodes. Using meditation practices for observation and awareness, develop the ability to recognize cognitive, physiological, and environmental triggers that can lead to aggravated periods of the disorder. When you change how you approach your day-to-day life, your daily activities, the choices you make, and the way you cope with life's ups and downs you strengthen the skills you need to move beyond depression and develop lasting peace of mind.
Recent reports indicate that depression is the most common psychological disorder in the US, affecting as many as 17 million Americans. This book integrates the spiritual practice of mindfulness with psychological techniques for changing negative thoughts and behaviors into a powerful and proven-effective program for coping with this serious and distressing condition.Current statistics suggest that as many as 17 million Americans suffer from depression; further research states that less than 25 percent of these receive adequate treatment for the disorder. In clinical trials, treatment approaches that incorporate spirituality with psychology have proven to be dramatically effective at countering depression. This book is co-written by a leading specialist in the treatment of depression and a clinical nurse who, as a Zen practitioner trained with Charlotte Joko Beck and Jon Kabat-Zinn.
A concept grounded in the practice of certain forms of Buddhism, mindfulness is the conscious, uninvolved awareness of the present moment. Western psychologists have recently learned that this state of mind is particularly conducive to the accomplishment of cognitive behavioral therapy, or CBT: an active mode of psychological treatment that attempts to recognize and counter negative thoughts and behaviors before they lead to debilitating symptoms like depression. As statistics confirm again and again that depression is the single most common psychological problem affecting Americans, the refinement of psychotherapy through the integration of spirituality-based techniques has generated considerable interest among psychology professionals. This approachable and easy-to-use book makes these powerful techniques available to the general public.
The book is built around a compelling series of specific, step-by-step interventions that provide readers with an understanding of the thoughts that lead to depression. They learn how to find the motivation to confront depressive feelings. By sitting with painful emotions and allowing them to pass, you will find that you can reduce the frequency of depressive episodes. Using meditation practices for observation and awareness, develop the ability to recognize cognitive, physiological, and environmental triggers that can lead to aggravated periods of the disorder. When you change how you approach your day-to-day life, your daily activities, the choices you make, and the way you cope with life's ups and downs you strengthen the skills you need to move beyond depression and develop lasting peace of mind.
Objective: Both Mindfulness Based Cognitive Therapy (MBCT) and Cognitive Therapy (CT) enhance self-management of prodromal symptoms associated with depressive relapse, albeit through divergent therapeutic procedures. We evaluated rates of relapse in remitted depressed patients receiving MBCT and CT. Decentering and dysfunctional attitudes were assessed as treatment-specific process markers. Method: Participants in remission from Major Depressive Disorder (MDD; N = 166) were randomized to 8 weeks of either MBCT (N = 82) or CT (N = 84) and were followed for 24 months, with process markers measured every 3 months. Attendance in both treatments was high (6.3/8 session) and treatment fidelity and competence were evaluated. Relapse was defined as a return of symptoms meeting the criteria for major depression on Module A of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID). Results: Intention-to-treat analyses indicated no differences between MBCT and CT in either rates of relapse to MDD or time to relapse across 24 months of follow up. Both groups experienced significant increases in decentering and participants in CT reported greater reductions in dysfunctional attitudes. Within both treatments, participants who relapsed evidenced lower decentering scores than those who stayed well over the follow up. Conclusions: This is the first study to directly compare relapse prophylaxis following MBCT and CT directly. The lack of group differences in time to relapse supports the view that both interventions are equally effective and that increases in decentering achieved via either treatment are associated with greater protection. These findings lend credence to Teasdale et al.’s (2002) contention that, even though they may be taught through dissimilar methods, CT and MBCT help participants develop similar metacognitive skills for the regulation of distressing thoughts and emotions.
Objective: Both Mindfulness Based Cognitive Therapy (MBCT) and Cognitive Therapy (CT) enhance self-management of prodromal symptoms associated with depressive relapse, albeit through divergent therapeutic procedures. We evaluated rates of relapse in remitted depressed patients receiving MBCT and CT. Decentering and dysfunctional attitudes were assessed as treatment-specific process markers. Method: Participants in remission from Major Depressive Disorder (MDD; N = 166) were randomized to 8 weeks of either MBCT (N = 82) or CT (N = 84) and were followed for 24 months, with process markers measured every 3 months. Attendance in both treatments was high (6.3/8 session) and treatment fidelity and competence were evaluated. Relapse was defined as a return of symptoms meeting the criteria for major depression on Module A of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID). Results: Intention-to-treat analyses indicated no differences between MBCT and CT in either rates of relapse to MDD or time to relapse across 24 months of follow up. Both groups experienced significant increases in decentering and participants in CT reported greater reductions in dysfunctional attitudes. Within both treatments, participants who relapsed evidenced lower decentering scores than those who stayed well over the follow up. Conclusions: This is the first study to directly compare relapse prophylaxis following MBCT and CT directly. The lack of group differences in time to relapse supports the view that both interventions are equally effective and that increases in decentering achieved via either treatment are associated with greater protection. These findings lend credence to Teasdale et al.’s (2002) contention that, even though they may be taught through dissimilar methods, CT and MBCT help participants develop similar metacognitive skills for the regulation of distressing thoughts and emotions.
Mindfulness-based interventions (MBIs) are at a pivotal point in their future development. Spurred on by an ever-increasing number of studies and breadth of clinical application, the value of such approaches may appear self-evident. We contend, however, that the public health impact of MBIs can be enhanced significantly by situating this work in a broader framework of clinical psychological science. Utilizing the National Institutes of Health stage model (Onken, Carroll, Shoham, Cuthbert, & Riddle, 2014), we map the evidence base for mindfulness-based cognitive therapy and mindfulness-based stress reduction as exemplars of MBIs. From this perspective, we suggest that important gaps in the current evidence base become apparent and, furthermore, that generating more of the same types of studies without addressing such gaps will limit the relevance and reach of these interventions. We offer a set of 7 recommendations that promote an integrated approach to core research questions, enhanced methodological quality of individual studies, and increased logical links among stages of clinical translation in order to increase the potential of MBIs to impact positively the mental health needs of individuals and communities.
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