Background: Studies of rumination suggest that self-focused attention is maladaptive and perpetuates depression. Conversely, self-focused attention can be adaptive, facilitating self-knowledge and the development of the alternative functional interpretations of negative thoughts and feelings on which cognitive therapy of depression depends. Increasing evidence suggests there are distinct varieties of self-focus, each with distinct functional properties. This study tested the prediction that in depressed patients brief inductions of analytical versus experiential self-focus would differentially affect overgeneral autobiographical memory, a phenomenon associated with poor clinical course. It was predicted that, relative to analytical self-focus, experiential self-focus would reduce overgeneral memory. Methods: 28 depressed patients either thought analytically about, or focused on their momentary experience of, identical symptom-focused induction items from [Cogn. Emotion 7 (1993) 561] rumination task. Participants completed the Autobiographical Memory Test [J. Abnorm. Psychol. 95 (1986) 144] before and after self-focus manipulations. Results: Experiential self-focus reduced overgeneral memory compared to analytical self-focus. Analytical and experiential self-focus did not differ in their effects on mood. Limitations: In the absence of a reference condition, only conclusions concerning the relative effects of analytical and experiential self-focus can be made. Conclusions: Results (1) support the differentiation of self-focus into distinct modes of self-attention with distinct functional effects in depression; (2) provide further evidence for the modifiability of overgeneral memory; and (3) provide further evidence for the dissociation of overgeneral memory and depressed mood. Clinically, results support the usefulness of training recovered depressed patients in adaptive experiential forms of self-awareness, as in mindfulness-based cognitive therapy.
IMPORTANCE:Relapse prevention in recurrent depression is a significant public health problem, and antidepressants are the current first-line treatment approach. Identifying an equally efficacious nonpharmacological intervention would be an important development.
OBJECTIVE:
To conduct a meta-analysis on individual patient data to examine the efficacy of mindfulness-based cognitive therapy (MBCT) compared with usual care and other active treatments, including antidepressants, in treating those with recurrent depression.
DATA SOURCES:
English-language studies published or accepted for publication in peer-reviewed journals identified from EMBASE, PubMed/Medline, PsycINFO, Web of Science, Scopus, and the Cochrane Controlled Trials Register from the first available year to November 22, 2014. Searches were conducted from November 2010 to November 2014.
STUDY SELECTION:
Randomized trials of manualized MBCT for relapse prevention in recurrent depression in full or partial remission that compared MBCT with at least 1 non-MBCT treatment, including usual care.
DATA EXTRACTION AND SYNTHESIS:
This was an update to a previous meta-analysis. We screened 2555 new records after removing duplicates. Abstracts were screened for full-text extraction (S.S.) and checked by another researcher (T.D.). There were no disagreements. Of the original 2555 studies, 766 were evaluated against full study inclusion criteria, and we acquired full text for 8. Of these, 4 studies were excluded, and the remaining 4 were combined with the 6 studies identified from the previous meta-analysis, yielding 10 studies for qualitative synthesis. Full patient data were not available for 1 of these studies, resulting in 9 studies with individual patient data, which were included in the quantitative synthesis.
RESULTS:
Of the 1258 patients included, the mean (SD) age was 47.1 (11.9) years, and 944 (75.0%) were female. A 2-stage random effects approach showed that patients receiving MBCT had a reduced risk of depressive relapse within a 60-week follow-up period compared with those who did not receive MBCT (hazard ratio, 0.69; 95% CI, 0.58-0.82). Furthermore, comparisons with active treatments suggest a reduced risk of depressive relapse within a 60-week follow-up period (hazard ratio, 0.79; 95% CI, 0.64-0.97). Using a 1-stage approach, sociodemographic (ie, age, sex, education, and relationship status) and psychiatric (ie, age at onset and number of previous episodes of depression) variables showed no statistically significant interaction with MBCT treatment. However, there was some evidence to suggest that a greater severity of depressive symptoms prior to treatment was associated with a larger effect of MBCT compared with other treatments.
CONCLUSIONS AND RELEVANCE:
Mindfulness-based cognitive therapy appears efficacious as a treatment for relapse prevention for those with recurrent depression, particularly those with more pronounced residual symptoms. Recommendations are made concerning how future trials can address remaining uncertainties and improve the rigor of the field.
Importance Relapse prevention in recurrent depression is a significant public health problem, and antidepressants are the current first-line treatment approach. Identifying an equally efficacious nonpharmacological intervention would be an important development.Objective To conduct a meta-analysis on individual patient data to examine the efficacy of mindfulness-based cognitive therapy (MBCT) compared with usual care and other active treatments, including antidepressants, in treating those with recurrent depression.
Data Sources English-language studies published or accepted for publication in peer-reviewed journals identified from EMBASE, PubMed/Medline, PsycINFO, Web of Science, Scopus, and the Cochrane Controlled Trials Register from the first available year to November 22, 2014. Searches were conducted from November 2010 to November 2014.
Study Selection Randomized trials of manualized MBCT for relapse prevention in recurrent depression in full or partial remission that compared MBCT with at least 1 non-MBCT treatment, including usual care.
Data Extraction and Synthesis This was an update to a previous meta-analysis. We screened 2555 new records after removing duplicates. Abstracts were screened for full-text extraction (S.S.) and checked by another researcher (T.D.). There were no disagreements. Of the original 2555 studies, 766 were evaluated against full study inclusion criteria, and we acquired full text for 8. Of these, 4 studies were excluded, and the remaining 4 were combined with the 6 studies identified from the previous meta-analysis, yielding 10 studies for qualitative synthesis. Full patient data were not available for 1 of these studies, resulting in 9 studies with individual patient data, which were included in the quantitative synthesis.
Results Of the 1258 patients included, the mean (SD) age was 47.1 (11.9) years, and 944 (75.0%) were female. A 2-stage random effects approach showed that patients receiving MBCT had a reduced risk of depressive relapse within a 60-week follow-up period compared with those who did not receive MBCT (hazard ratio, 0.69; 95% CI, 0.58-0.82). Furthermore, comparisons with active treatments suggest a reduced risk of depressive relapse within a 60-week follow-up period (hazard ratio, 0.79; 95% CI, 0.64-0.97). Using a 1-stage approach, sociodemographic (ie, age, sex, education, and relationship status) and psychiatric (ie, age at onset and number of previous episodes of depression) variables showed no statistically significant interaction with MBCT treatment. However, there was some evidence to suggest that a greater severity of depressive symptoms prior to treatment was associated with a larger effect of MBCT compared with other treatments.
Conclusions and Relevance Mindfulness-based cognitive therapy appears efficacious as a treatment for relapse prevention for those with recurrent depression, particularly those with more pronounced residual symptoms. Recommendations are made concerning how future trials can address remaining uncertainties and improve the rigor of the field.
There is encouraging evidence that structured psychological treatments for depression, in particular cognitive therapy, can reduce subsequent relapse after the period of initial treatment has been completed. However, there is a continuing need for prophylactic psychological approaches that can be administered to recovered patients in euthymic mood. An information-processing analysis of depressive maintenance and relapse is used to define the requirements for effective prevention, and to propose mechanisms through which cognitive therapy achieves its prophylactic effects. This analysis suggests that similar effects can be achieved using techniques of stress-reduction based on the skills of attentional control taught in mindfulness meditation. An information-processing analysis is presented of mindfulness and mindlessness, and of their relevance to preventing depressive relapse. This analysis provides the basis for the development of Attentional Control Training, a new approach to preventing relapse that integrates features of cognitive therapy and mindfulness training and is applicable to recovered depressed patients.
Mindfulness-based cognitive therapy (MBCT) is an efficacious psychosocial intervention for recurrent depression (Kuyken et al., 2008; Ma & Teasdale, 2004; Teasdale et al., 2000). To date, no compelling research addresses MBCT's mechanisms of change. This study determines whether MBCT's treatment effects are mediated by enhancement of mindfulness and self-compassion across treatment, and/or by alterations in post-treatment cognitive reactivity. The study was embedded in a randomized controlled trial comparing MBCT with maintenance antidepressants (mADM) with 15-month follow-up (Kuyken et al., 2008). Mindfulness and self-compassion were assessed before and after MBCT treatment (or at equivalent time points in the mADM group). Post-treatment reactivity was assessed one month after the MBCT group sessions or at the equivalent time point in the mADM group. One hundred and twenty-three patients with ≥3 prior depressive episodes, and successfully treated with antidepressants, were randomized either to mADM or MBCT. The MBCT arm involved participation in MBCT, a group-based psychosocial intervention that teaches mindfulness skills, and discontinuation of ADM. The mADM arm involved maintenance on a therapeutic ADM dose for the duration of follow-up. Interviewer-administered outcome measures assessed depressive symptoms and relapse/recurrence across 15-month follow-up. Mindfulness and self-compassion were measured using self-report questionnaire. Cognitive reactivity was operationalized as change in depressive thinking during a laboratory mood induction. MBCT's effects were mediated by enhancement of mindfulness and self-compassion across treatment. MBCT also changed the nature of the relationship between post-treatment cognitive reactivity and outcome. Greater reactivity predicted worse outcome for mADM participants but this relationship was not evident in the MBCT group. MBCT's treatment effects are mediated by augmented self-compassion and mindfulness, along with a decoupling of the relationship between reactivity of depressive thinking and poor outcome. This decoupling is associated with the cultivation of self-compassion across treatment.
All over the world, research has shown that Mindfulness-Based Cognitive Therapy (MBCT) can halve the risk of future clinical depression in people who have already been depressed several times. Its effects seem comparable to antidepressant medications. But how?
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.
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.
Imaginez un programme en 8 semaines qui puisse vous libérer du stress, de l'anxiété, de la déprime ou de la dépression simplement en vous enseignant de nouvelles manières de répondre à vos propres pensées et sentiments… Ce programme existe : c'est la thérapie cognitive basée sur la pleine conscience. Depuis de nombreuses années, il a fait ses preuves partout dans le monde.Ce manuel de méditation anti-déprime a été conçu comme une véritable immersion dans le programme. Vous y trouverez des méditations à faire chez vous semaine après semaine, des questions de réflexion, des outils pour mesurer vos progrès… Grâce aux nombreux exercices enregistrés, vous pourrez vous entraîner et vous exercer à tout moment, afin de tirer au maximum parti du programme.
Un livre pour vous guider pas à pas sur le chemin du changement !
Imaginez un programme en 8 semaines qui puisse vous libérer du stress, de l'anxiété, de la déprime ou de la dépression simplement en vous enseignant de nouvelles manières de répondre à vos propres pensées et sentiments… Ce programme existe : c'est la thérapie cognitive basée sur la pleine conscience. Depuis de nombreuses années, il a fait ses preuves partout dans le monde.Ce manuel de méditation anti-déprime a été conçu comme une véritable immersion dans le programme. Vous y trouverez des méditations à faire chez vous semaine après semaine, des questions de réflexion, des outils pour mesurer vos progrès… Grâce aux nombreux exercices enregistrés, vous pourrez vous entraîner et vous exercer à tout moment, afin de tirer au maximum parti du programme.
Un livre pour vous guider pas à pas sur le chemin du changement !
Le livre que vous tenez entre les mains est consacré aux techniques de méditation en pleine conscience. Associant tradition orientale et thérapie cognitive, ces techniques, scientifiquement validées, ont fait la preuve de leur efficacité. Non seulement elles aident à guérir et à prévenir la maladie dépressive, mais elles permettent, pratiquées régulièrement, de retrouver le goût simple de la vie. Lisez, pratiquez et jugez par vous-même ! « Ce guide lucide, à la fois rigoureux dans sa démarche scientifique et éclairant dans son approche pratique, offre une planche de salut pour retrouver la liberté intérieure, la joie de vivre et l'ouverture au monde, et pour éviter de sombrer à nouveau dans un gouffre sans lumière. » Matthieu Ricard. « Révolutionnaire... Un guide vraiment utile pour atteindre l'équilibre émotionnel. Je recommande au plus haut point ce livre et le CD qui l'accompagne. »Daniel Goleman, auteur de L'Intelligence émotionnelle. Mark Williams est professeur de psychologie clinique à l'Université d'Oxford en Grande-Bretagne. John Teasdale, chercheur, travaille au département de psychiatrie de l'Université d'Oxford et à l'unité de neurosciences de l'Université de Cambridge, en Grande-Bretagne. Zindel Segal, psychothérapeute, dirige l'unité de thérapie cognitivo-comportementale au centre Addiction et Santé mentale de Toronto, au Canada. Jon Kabat-Zinn est professeur émérite de médecine à l'Université du Massachusetts, aux États-Unis.
Le livre que vous tenez entre les mains est consacré aux techniques de méditation en pleine conscience. Associant tradition orientale et thérapie cognitive, ces techniques, scientifiquement validées, ont fait la preuve de leur efficacité. Non seulement elles aident à guérir et à prévenir la maladie dépressive, mais elles permettent, pratiquées régulièrement, de retrouver le goût simple de la vie. Lisez, pratiquez et jugez par vous-même ! « Ce guide lucide, à la fois rigoureux dans sa démarche scientifique et éclairant dans son approche pratique, offre une planche de salut pour retrouver la liberté intérieure, la joie de vivre et l'ouverture au monde, et pour éviter de sombrer à nouveau dans un gouffre sans lumière. » Matthieu Ricard. « Révolutionnaire... Un guide vraiment utile pour atteindre l'équilibre émotionnel. Je recommande au plus haut point ce livre et le CD qui l'accompagne. »Daniel Goleman, auteur de L'Intelligence émotionnelle. Mark Williams est professeur de psychologie clinique à l'Université d'Oxford en Grande-Bretagne. John Teasdale, chercheur, travaille au département de psychiatrie de l'Université d'Oxford et à l'unité de neurosciences de l'Université de Cambridge, en Grande-Bretagne. Zindel Segal, psychothérapeute, dirige l'unité de thérapie cognitivo-comportementale au centre Addiction et Santé mentale de Toronto, au Canada. Jon Kabat-Zinn est professeur émérite de médecine à l'Université du Massachusetts, aux États-Unis.
Zotero Collections:
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.
PsycNET
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 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.
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.
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.
<p>This book presents an innovative eight-session program designed to prevent relapse in clients who have recovered from depression.</p>
Zotero Collections:
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)
<p>Recovered recurrently depressed patients were randomized to treatment as usual (TAU) or TAU plus mindfulness-based cognitive therapy (MBCT). Replicating previous findings, MBCT reduced relapse from 78% to 36% in 55 patients with 3 or more previous episodes; but in 18 patients with only 2 (recent) episodes corresponding figures were 20% and 50%. MBCT was most effective in preventing relapses not preceded by life events. Relapses were more often associated with significant life events in the 2-episode group. This group also reported less childhood adversity and later first depression onset than the 3-or-more-episode group, suggesting that these groups represented distinct populations. MBCT is an effective and efficient way to prevent relapse/recurrence in recovered depressed patients with 3 or more previous episodes.</p>
Zotero Collections:
Recovered recurrently depressed patients were randomized to treatment as usual (TAU) or TAU plus mindfulness-based cognitive therapy (MBCT). Replicating previous findings, MBCT reduced relapse from 78% to 36% in 55 patients with 3 or more previous episodes; but in 18 patients with only 2 (recent) episodes corresponding figures were 20% and 50%. MBCT was most effective in preventing relapses not preceded by life events. Relapses were more often associated with significant life events in the 2-episode group. This group also reported less childhood adversity and later first depression onset than the 3-or-more-episode group, suggesting that these groups represented distinct populations. MBCT is an effective and efficient way to prevent relapse/recurrence in recovered depressed patients with 3 or more previous episodes.
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.
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