Mindfulness based cognitive therapy in depression
Book chapters
Segal et al. | Chapter 1-21
Depression Casts a Long Shadow
Segal et al. | Chapter 1
Depression = a disorder of mood with high prevalence rates and a high chance of relapse.
Relapse
= the worsening of a previously controlled episode that has not yet run its course. Continuation and
maintenance treatment can be used to prevent relapse.
Recurrence = a new episode of depression.
Types of treatment
Treatment can occur at different points in time:
o Acute treatment = treatment during an episode.
o Continuation treatment = treatment for 6 months after the recovery period.
o Maintenance treatment = treatment extended for as long as 3 to 5 years after recovery.
Therapy instead of medication
Because some people can’t or won’t take medication, therapy based treatments were developed. In the beginning
the focus was on acute treatment, but maintenance versions are just as important.
Why Do People Who Have Recovered from Depression Relapse?
Segal et al. | Chapter 2
Vulnerability to depression
People who are more vulnerable to depression seem to have more cognitive reactivity and a ruminative
response style to negative moods.
Differential activation hypothesis
= a hypothesis that states that sad moods are likely to reactivate (dysfunctional) thinking styles associated with
previous sad moods. It was found that when never-depressed individuals reported feeling sad, their attitudes
changed relatively little. When formerly depressed patients reported feeling sad, they were more likely to
endorse dysfunctional attitudes.
Cognitive reactivity
= the tendency to react to small changes in mood with large changes in negative thinking. Patients who had
undergone cognitive therapy showed less reactivity: their dysfunctional attitudes shifted less in response to the
mood.
Rumination
= a response style to low mood by acting in ways that focusses attention on oneself. Another, non-ruminative
response style is doing things that takes one’s mind away from themselves. People who tend to use this style are
more likely to experience more short-lived depressed moods.
Cognitive therapy
CT addresses negative thought patterns and leads to implicit changes in how people relate to them.
Cognitive therapy
The main idea of cognitive therapy is that negative thinking can be the cause of depression and, even if it isn’t,
such thinking can maintain the episode once it has started. It was found that the patients that relapsed or needed
further treatment was substantially reduced if cognitive therapy (alone) was used as acute treatment.
1
, Mindfulness based cognitive therapy in depression
How does CT reduce relapse?
When CT produced significantly better long-term outcomes than pharmacotherapy, there was no difference on
measures of dysfunctional thinking between the two. Thus, the level of dysfunctional attitudes, didn’t seem to be
the issue.
It was found that CT led to implicit changes in patients’ relationships to their negative thoughts and
feelings. As a results of repeatedly identifying negative thoughts as they arose and standing back from them to
evaluate the accuracy of their content, patients often made a shift in their perspective on negative thoughts and
feelings. They switched to a perspective where the thoughts and feelings could be seen as passing events in the
mind that were neither valid reflections of reality nor central aspects of the self (= decentering).
Decentering
= stepping back from thoughts and emotions and relating to them less literally, as mental events rather than the
truth. This appeared to be central in CT, instead of being one of many things.
Developing Mindfulness-Based Cognitive Therapy
Segal et al. | Chapter 3
Mindfulness = paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally.
Mindfulness based stress reduction (MBSR)
= a program in which people receive extensive practice in learning to bring their attention back to the present
whenever they notice that it diverted to streams of thought, worries, or general lack of awareness.
Advantages of MBSR
o Patients learn generic skills of attentional control, so they are not limited to the presence of negative
thoughts and feelings. Thus, they can be used as maintenance therapy, when the patient isn’t depressed at
the moment.
o The techniques used (focusing on breathing, yoga) can be chosen to do in spare time.
Attentional control training (ACT)
= maintenance training with the aim of combining mindfulness and cognitive approaches to enable patients to
increase their awareness. This training didn’t prove to be effective, because patients were looking for help in
dealing with unwanted emotions early in the program, before they had time to learn the skills of decentering that
were seen as crucial.
From ACT to mindfulness-based cognitive therapy (MBCT)
Upon further research it was found that the big difference between ACT and MBSR was that in the latter, all
teachers had their own mindfulness practice and basic understanding and orientation. It also seemed as if the
understanding of decentering was too specific, yet not specific enough:
o It referred mainly to thoughts, but in MBSR it was the whole mind-body state.
o The meaning of decentering in the mindfulness approach is one of welcoming and allowing, not ignoring.
Doing and Being
Segal et al. | Chapter 4
Working of relapse
At times of lowering mood:
o there is reactivation of patterns of negative thinking similar to the thought patterns that were active during
previous episodes of low mood/depression.
The patterns work around a particular view of depressive experience, within which:
o the self is felt to be inadequate, worthless and blameworthy;
o and negative thoughts are seen as an accurate reflection of reality.
Working of rumination
Even though rumination is a problem for depression, the mind keeps the habit of ruminating. A probable cause is
that rumination is seen as a way to achieve the goal of preventing or reducing low mood/depression: we want to
figure out why these states of mind are produced. However, by ruminating we actually worsen them.
2
Book chapters
Segal et al. | Chapter 1-21
Depression Casts a Long Shadow
Segal et al. | Chapter 1
Depression = a disorder of mood with high prevalence rates and a high chance of relapse.
Relapse
= the worsening of a previously controlled episode that has not yet run its course. Continuation and
maintenance treatment can be used to prevent relapse.
Recurrence = a new episode of depression.
Types of treatment
Treatment can occur at different points in time:
o Acute treatment = treatment during an episode.
o Continuation treatment = treatment for 6 months after the recovery period.
o Maintenance treatment = treatment extended for as long as 3 to 5 years after recovery.
Therapy instead of medication
Because some people can’t or won’t take medication, therapy based treatments were developed. In the beginning
the focus was on acute treatment, but maintenance versions are just as important.
Why Do People Who Have Recovered from Depression Relapse?
Segal et al. | Chapter 2
Vulnerability to depression
People who are more vulnerable to depression seem to have more cognitive reactivity and a ruminative
response style to negative moods.
Differential activation hypothesis
= a hypothesis that states that sad moods are likely to reactivate (dysfunctional) thinking styles associated with
previous sad moods. It was found that when never-depressed individuals reported feeling sad, their attitudes
changed relatively little. When formerly depressed patients reported feeling sad, they were more likely to
endorse dysfunctional attitudes.
Cognitive reactivity
= the tendency to react to small changes in mood with large changes in negative thinking. Patients who had
undergone cognitive therapy showed less reactivity: their dysfunctional attitudes shifted less in response to the
mood.
Rumination
= a response style to low mood by acting in ways that focusses attention on oneself. Another, non-ruminative
response style is doing things that takes one’s mind away from themselves. People who tend to use this style are
more likely to experience more short-lived depressed moods.
Cognitive therapy
CT addresses negative thought patterns and leads to implicit changes in how people relate to them.
Cognitive therapy
The main idea of cognitive therapy is that negative thinking can be the cause of depression and, even if it isn’t,
such thinking can maintain the episode once it has started. It was found that the patients that relapsed or needed
further treatment was substantially reduced if cognitive therapy (alone) was used as acute treatment.
1
, Mindfulness based cognitive therapy in depression
How does CT reduce relapse?
When CT produced significantly better long-term outcomes than pharmacotherapy, there was no difference on
measures of dysfunctional thinking between the two. Thus, the level of dysfunctional attitudes, didn’t seem to be
the issue.
It was found that CT led to implicit changes in patients’ relationships to their negative thoughts and
feelings. As a results of repeatedly identifying negative thoughts as they arose and standing back from them to
evaluate the accuracy of their content, patients often made a shift in their perspective on negative thoughts and
feelings. They switched to a perspective where the thoughts and feelings could be seen as passing events in the
mind that were neither valid reflections of reality nor central aspects of the self (= decentering).
Decentering
= stepping back from thoughts and emotions and relating to them less literally, as mental events rather than the
truth. This appeared to be central in CT, instead of being one of many things.
Developing Mindfulness-Based Cognitive Therapy
Segal et al. | Chapter 3
Mindfulness = paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally.
Mindfulness based stress reduction (MBSR)
= a program in which people receive extensive practice in learning to bring their attention back to the present
whenever they notice that it diverted to streams of thought, worries, or general lack of awareness.
Advantages of MBSR
o Patients learn generic skills of attentional control, so they are not limited to the presence of negative
thoughts and feelings. Thus, they can be used as maintenance therapy, when the patient isn’t depressed at
the moment.
o The techniques used (focusing on breathing, yoga) can be chosen to do in spare time.
Attentional control training (ACT)
= maintenance training with the aim of combining mindfulness and cognitive approaches to enable patients to
increase their awareness. This training didn’t prove to be effective, because patients were looking for help in
dealing with unwanted emotions early in the program, before they had time to learn the skills of decentering that
were seen as crucial.
From ACT to mindfulness-based cognitive therapy (MBCT)
Upon further research it was found that the big difference between ACT and MBSR was that in the latter, all
teachers had their own mindfulness practice and basic understanding and orientation. It also seemed as if the
understanding of decentering was too specific, yet not specific enough:
o It referred mainly to thoughts, but in MBSR it was the whole mind-body state.
o The meaning of decentering in the mindfulness approach is one of welcoming and allowing, not ignoring.
Doing and Being
Segal et al. | Chapter 4
Working of relapse
At times of lowering mood:
o there is reactivation of patterns of negative thinking similar to the thought patterns that were active during
previous episodes of low mood/depression.
The patterns work around a particular view of depressive experience, within which:
o the self is felt to be inadequate, worthless and blameworthy;
o and negative thoughts are seen as an accurate reflection of reality.
Working of rumination
Even though rumination is a problem for depression, the mind keeps the habit of ruminating. A probable cause is
that rumination is seen as a way to achieve the goal of preventing or reducing low mood/depression: we want to
figure out why these states of mind are produced. However, by ruminating we actually worsen them.
2
