Mindfulness based cognitive therapy as maintenance treatment for unipolar major depression
- Zindel Segal, PhD, C.Psych
Zindel Segal, PhD, C.Psych
- Professor of Psychiatry
- University of Toronto
Mindfulness based cognitive therapy is a group program that is generally used to delay or prevent recurrence of major depression , but may also reduce depressive symptoms . The treatment combines the clinical application of mindfulness meditation with elements of cognitive-behavioral therapy, and was first developed in 2000 [3-5].
This topic reviews the use of mindfulness based cognitive therapy for the maintenance treatment of patients with recurrent unipolar major depression, as well as patients with acute episodes of unipolar major depression or with residual depressive symptoms. Choosing initial treatment for patients with unipolar depression and choosing treatment for resistant depression are discussed separately. (See "Unipolar major depression in adults: Choosing initial treatment" and "Unipolar depression in adults: Treatment of resistant depression".)
Mindfulness based cognitive therapy is indicated for:
●Maintenance treatment of euthymic patients who have suffered multiple episodes of unipolar major depression – The evidence suggests that the therapy is effective for patients with a history of at least three episodes; the therapy can be used alone or in conjunction with pharmacotherapy. Treatment guidelines from both the United Kingdom National Institute for Health and Clinical Excellence and the Canadian Network for Mood and Anxiety Treatments recommend mindfulness-based cognitive therapy for maintenance treatment of major depressive disorder. In addition, practice guidelines from the American Psychiatric Association suggest that mindfulness-based cognitive therapy can reduce recurrences of depression. (See 'Preventing recurrences' below.)
●Acute unipolar major depression. (See 'Acute major depression' below.)
- Segal ZV, Kennedy S, Gemar M, et al. Cognitive reactivity to sad mood provocation and the prediction of depressive relapse. Arch Gen Psychiatry 2006; 63:749.
- van Aalderen JR, Donders AR, Giommi F, et al. The efficacy of mindfulness-based cognitive therapy in recurrent depressed patients with and without a current depressive episode: a randomized controlled trial. Psychol Med 2012; 42:989.
- Williams, JM, Teasdale, JD, Segal, ZV, Kabat-Zinn, J. The mindful way through depression: Freeing yourself from chronic unhappiness, Guilford Press, New York 2007.
- Beck, AT, Rush, AJ, Shaw, BF, Emery, G. Cognitive therapy of depression, Guilford Press, New York 1979.
- Segal ZV, Williams JMG, Teasdale JD. Mindfulness Based Cognitive Therapy for Depression, Guilford Press, New York 2013.
- Parikh SV, Segal ZV, Grigoriadis S, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. II. Psychotherapy alone or in combination with antidepressant medication. J Affect Disord 2009; 117 Suppl 1:S15.
- Teasdale JD, Cox SG. Dysphoria: self-devaluative and affective components in recovered depressed patients and never depressed controls. Psychol Med 2001; 31:1311.
- Park RJ, Goodyer IM, Teasdale JD. Self-devaluative dysphoric experience and the prediction of persistent first-episode major depressive disorder in adolescents. Psychol Med 2005; 35:539.
- Watkins E, Teasdale JD. Rumination and overgeneral memory in depression: effects of self-focus and analytic thinking. J Abnorm Psychol 2001; 110:353.
- Williams JM, Kuyken W. Mindfulness-based cognitive therapy: a promising new approach to preventing depressive relapse. Br J Psychiatry 2012; 200:359.
- Teasdale JD, Moore RG, Hayhurst H, et al. Metacognitive awareness and prevention of relapse in depression: empirical evidence. J Consult Clin Psychol 2002; 70:275.
- Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. J Consult Clin Psychol 2010; 78:169.
- Frewen, PA, Dozois, DJ. Social, achievement, and control factors in personality vulnerability to depression. Cognit Ther Res 2006; 30:1.
- Arch JJ, Craske MG. Mechanisms of mindfulness: emotion regulation following a focused breathing induction. Behav Res Ther 2006; 44:1849.
- Chiesa A, Serretti A. Mindfulness based cognitive therapy for psychiatric disorders: a systematic review and meta-analysis. Psychiatry Res 2011; 187:441.
- Segal ZV, Walsh KM. Mindfulness-based cognitive therapy for residual depressive symptoms and relapse prophylaxis. Curr Opin Psychiatry 2016; 29:7.
- Chen F, Lv X, Fang J, et al. The effect of body-mind relaxation meditation induction on major depressive disorder: A resting-state fMRI study. J Affect Disord 2015; 183:75.
- Tang YY, Hölzel BK, Posner MI. The neuroscience of mindfulness meditation. Nat Rev Neurosci 2015; 16:213.
- Davidson RJ. Mindfulness-Based Cognitive Therapy and the Prevention of Depressive Relapse: Measures, Mechanisms, and Mediators. JAMA Psychiatry 2016; 73:547.
- Farb NA, Irving JA, Anderson AK, Segal ZV. A two-factor model of relapse/recurrence vulnerability in unipolar depression. J Abnorm Psychol 2015; 124:38.
- Fox KC, Nijeboer S, Dixon ML, et al. Is meditation associated with altered brain structure? A systematic review and meta-analysis of morphometric neuroimaging in meditation practitioners. Neurosci Biobehav Rev 2014; 43:48.
- Creswell JD, Taren AA, Lindsay EK, et al. Alterations in Resting-State Functional Connectivity Link Mindfulness Meditation With Reduced Interleukin-6: A Randomized Controlled Trial. Biol Psychiatry 2016; 80:53.
- Chiesa A, Calati R, Serretti A. Does mindfulness training improve cognitive abilities? A systematic review of neuropsychological findings. Clin Psychol Rev 2011; 31:449.
- Segal, Z, Williams, JM, Teasdale, JD. Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse, Guilford Press, New York 2002.
- Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001; 16:606.
- Kroenke, K, Spitzer, RL. The PHQ-9: a new depression and diagnostic severity measure. Psychiatric Annals 2002; 32:509.
- Grepmair L, Mitterlehner F, Loew T, et al. Promoting mindfulness in psychotherapists in training influences the treatment results of their patients: a randomized, double-blind, controlled study. Psychother Psychosom 2007; 76:332.
- Teasdale JD, Segal ZV, Williams JM, et al. Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. J Consult Clin Psychol 2000; 68:615.
- Ma SH, Teasdale JD. Mindfulness-based cognitive therapy for depression: replication and exploration of differential relapse prevention effects. J Consult Clin Psychol 2004; 72:31.
- Godfrin KA, van Heeringen C. The effects of mindfulness-based cognitive therapy on recurrence of depressive episodes, mental health and quality of life: A randomized controlled study. Behav Res Ther 2010; 48:738.
- Coffman SJ, Dimidjian S, Baer RA. Mindfulness-Based Cognitive Therapy for Prevention of Depressive Relapse. In: Mindfulness-Based Treatment Approaches: Clinician's Guide to Evidence Base and Applications, Baer RA. (Ed), Elsevier, Burlington, MA 2006. p.31.
- Dimidjian S, Beck A, Felder JN, et al. Web-based Mindfulness-based Cognitive Therapy for reducing residual depressive symptoms: An open trial and quasi-experimental comparison to propensity score matched controls. Behav Res Ther 2014; 63:83.
- Segal ZV, Bieling P, Young T, et al. Antidepressant monotherapy vs sequential pharmacotherapy and mindfulness-based cognitive therapy, or placebo, for relapse prophylaxis in recurrent depression. Arch Gen Psychiatry 2010; 67:1256.
- Kingston T, Dooley B, Bates A, et al. Mindfulness-based cognitive therapy for residual depressive symptoms. Psychol Psychother 2007; 80:193.
- Mueller TI, Leon AC, Keller MB, et al. Recurrence after recovery from major depressive disorder during 15 years of observational follow-up. Am J Psychiatry 1999; 156:1000.
- Depression: The treatment and management of depression in adults. NICE clinical guideline 90. Issued October, 2009. http://guidance.nice.org.uk/CG90/NICEGuidance/pdf/English (Accessed on March 30, 2011).
- Piet J, Hougaard E. The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: a systematic review and meta-analysis. Clin Psychol Rev 2011; 31:1032.
- Geschwind N, Peeters F, Huibers M, et al. Efficacy of mindfulness-based cognitive therapy in relation to prior history of depression: randomised controlled trial. Br J Psychiatry 2012; 201:320.
- Cuijpers P, Berking M, Andersson G, et al. A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. Can J Psychiatry 2013; 58:376.
- Goyal M, Singh S, Sibinga EM, et al. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Intern Med 2014; 174:357.
- Omidi A, Mohammadkhani P, Mohammadi A, Zargar F. Comparing mindfulness based cognitive therapy and traditional cognitive behavior therapy with treatments as usual on reduction of major depressive disorder symptoms. Iran Red Crescent Med J 2013; 15:142.
- Meadows GN, Shawyer F, Enticott JC, et al. Mindfulness-based cognitive therapy for recurrent depression: A translational research study with 2-year follow-up. Aust N Z J Psychiatry 2014; 48:743.
- Kuyken W, Warren FC, Taylor RS, et al. Efficacy of Mindfulness-Based Cognitive Therapy in Prevention of Depressive Relapse: An Individual Patient Data Meta-analysis From Randomized Trials. JAMA Psychiatry 2016; 73:565.
- Crane C, Crane RS, Eames C, et al. The effects of amount of home meditation practice in Mindfulness Based Cognitive Therapy on hazard of relapse to depression in the Staying Well after Depression Trial. Behav Res Ther 2014; 63:17.
- Stangier U, Hilling C, Heidenreich T, et al. Maintenance cognitive-behavioral therapy and manualized psychoeducation in the treatment of recurrent depression: a multicenter prospective randomized controlled trial. Am J Psychiatry 2013; 170:624.
- Cuijpers P, van Straten A, Bohlmeijer E, et al. The effects of psychotherapy for adult depression are overestimated: a meta-analysis of study quality and effect size. Psychol Med 2010; 40:211.
- Cuijpers P, Smit F, Bohlmeijer E, et al. Efficacy of cognitive-behavioural therapy and other psychological treatments for adult depression: meta-analytic study of publication bias. Br J Psychiatry 2010; 196:173.
- Driessen E, Hollon SD, Bockting CL, et al. Does Publication Bias Inflate the Apparent Efficacy of Psychological Treatment for Major Depressive Disorder? A Systematic Review and Meta-Analysis of US National Institutes of Health-Funded Trials. PLoS One 2015; 10:e0137864.
- Kuyken W, Byford S, Taylor RS, et al. Mindfulness-based cognitive therapy to prevent relapse in recurrent depression. J Consult Clin Psychol 2008; 76:966.
- Bondolfi G, Jermann F, der Linden MV, et al. Depression relapse prophylaxis with Mindfulness-Based Cognitive Therapy: replication and extension in the Swiss health care system. J Affect Disord 2010; 122:224.
- Coelho HF, Canter PH, Ernst E. Mindfulness-based cognitive therapy: evaluating current evidence and informing future research. J Consult Clin Psychol 2007; 75:1000.
- Dimidjian S, Goodman SH, Felder JN, et al. Staying well during pregnancy and the postpartum: A pilot randomized trial of mindfulness-based cognitive therapy for the prevention of depressive relapse/recurrence. J Consult Clin Psychol 2016; 84:134.
- Huijbers MJ, Spinhoven P, Spijker J, et al. Discontinuation of antidepressant medication after mindfulness-based cognitive therapy for recurrent depression: randomised controlled non-inferiority trial. Br J Psychiatry 2016; 208:366.
- Huijbers MJ, Spinhoven P, Spijker J, et al. Adding mindfulness-based cognitive therapy to maintenance antidepressant medication for prevention of relapse/recurrence in major depressive disorder: Randomised controlled trial. J Affect Disord 2015; 187:54.
- Strauss C, Cavanagh K, Oliver A, Pettman D. Mindfulness-based interventions for people diagnosed with a current episode of an anxiety or depressive disorder: a meta-analysis of randomised controlled trials. PLoS One 2014; 9:e96110.
- Eisendrath SJ, Gillung E, Delucchi KL, et al. A Randomized Controlled Trial of Mindfulness-Based Cognitive Therapy for Treatment-Resistant Depression. Psychother Psychosom 2016; 85:99.
- Judd LL, Akiskal HS, Maser JD, et al. Major depressive disorder: a prospective study of residual subthreshold depressive symptoms as predictor of rapid relapse. J Affect Disord 1998; 50:97.
- Teasdale J, Williams M, Segal Z. The Mindful Way Workbook: A 8-Week Program to Free Yourself from Depression and Emotional Distress, The Guilford Press, New York 2014.
- Mindfulness-Based Cognitive Therapy http://www.mbct.com/ (Accessed on April 07, 2011).
- THEORETICAL FOUNDATION
- Neurobiology and neuropsychology
- DELIVERING MINDFULNESS BASED COGNITIVE THERAPY
- Clinician training
- Combined with pharmacotherapy
- Therapeutic interventions
- Managing clinical deterioration
- CONTINUING CARE
- EVIDENCE OF EFFICACY
- Preventing recurrences
- - Mindfulness based cognitive therapy alone compared with pharmacotherapy alone
- - Mindfulness based cognitive therapy plus treatment as usual compared with treatment as usual alone
- Mindfulness based cognitive therapy plus pharmacotherapy
- Acute major depression
- Resolving residual symptoms
- INFORMATION FOR PATIENTS