New Developments re Mindfulness in CT

[James Pretzer]

I've come across three interesting studies regarding using mindfulness in CBT:

1. Helen Ma and John Teasdale (2004) have replicated Teasdale et al's initial findings regarding the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) for preventing relapse in recurrent depression and have extended those findings a bit. 75 patients currently in remission who met DSM criteria for recurrent major depression were randomly assigned to either continue treatment as usual (TAU) or receive TAU plus a MBCT group.
   
   As in the previous study, they found a very interesting result. MBCT cut the relapse rate in half for subjects with three or more previous episodes of depression. However, it did not reduce the relapse rate for subjects with two previous episodes. In fact, there was a non-significant trend for a higher rate of relapse when subjects with two episodes received MBCT.
   
   Interestingly, the difference in relapse rate for the MBCT group with three or more episodes of depression was primarily due to a reduction in the number or relapses which were not associated with negative life events. There was no significant difference in the rate of relapses associated with severe life events.
   
   Subjects with three or more episodes of depression reported an earlier onset of depression and reported more abuse and neglect during childhood. These findings are interpreted as suggesting that there are two sub-groups of individuals with recurrent depression who need different relapse prevention strategies.
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2. Another study may shed some light on the mechanism through which the preventive effects of MBCT occur. Ramel et al (2004) used a within-subjects design to examine the effects that an eight-week Mindfulness-Based Stress Reduction (MBSR) group had on previously-depressed participants. As hypothesized, they found that MBSR produces significant reductions in affective symptoms, dysfunctional attitudes, and rumination. The overall pattern of results suggested that reductions in rumination were responsible for decreases in affective symptoms and dysfunctional attitudes and not vice versa.
   
   While this single study with a small sample needs replication and methodological refinement, it does provide support for the idea that mindfulness training may be a useful way to decrease rumination.
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3. A very different use of mindfulness training in CBT is presented in Carson, et al's (2004) investigation of Mindfulness-Based Relationship Enhancement (MBRE). A sample of non-distressed couples were recruited. Half received MBRE (8 weekly 2.5 hour sessions and a day-long retreat modeled on MBSR but incorporating joint meditation and relationship enhancement components). The othes couples formed a waiting-list control group.
   
   MBRE resulted in improvement in couples' relationship satisfaction, autonomy, relatedness, closeness, acceptance of one another, and decreased relationship distress. Individuals also showed increases in optimism, spirituality, relaxation, and decreased psychological distress. Improvement was maintained at a three month follow-up. Those who practiced mindfulness more had better outcomes and greater practice on a given day was followed by several days of increased relationship happiness, increased stress coping efficacy, decreased relationship stress, and decreased overall stress.
   
   The authors note that their sample was largely white, well-educated, middle-class, and heterosexual so the generalizibility of these results may be limited. Also, note that this is an intervention for enhancing non-distressed relationships. It's applicability to distressed couples is not discussed.

Additional posts regarding mindfulness in CBT can be found in the Cognitive Therapy forum archives.

Carson, J. W., Carson, K. M., Gil, K. M. & Baucom, D. H. (2004). Mindfulness-based relationship enhancement. Behavior Therapy, 35, 471-494.

Ma, S. H. & Teasdale, J.D. (2004). Mindfulness-based cognitive therapy for depression: Replication and exploration of differential relapse prevention effects. Journal of Consulting and Clinical Psychology, 72, 31-40.

Ramel, W. Goldin, P. R., Carmona, P. E. & McQuaid, J. R. (2004). The effects of mindfulness meditation on cognitive processes and affect in patients with past depression. Cognitive Therapy and Research, 28, 433-455.

[James Pretzer]

Broderick (2005) has investigated the effect of mindfulness meditation on dysphoric mood in a non-clinical sample. When a dysphoric mood is present, rumination typically intensifies the dysphoric mood while distraction typically decreases the dysphoric mood. The author hypothesized that mindfulness meditation would be more effective than distraction in reducing negative affect.

A dysphoric mood was induced in 139 female and 38 male individuals who were then randomly assigned to a rumination, meditation, or distraction condition. as predicted, participants in the mindfulness meditation condition reported significantly lower levels of negative mood than those in either of the other two conditions. Meditators also recorded more positive thoughts and fewer negative thoughts on a thought-listing task but the difference between groups was not significant.

The author suggests that this provides evidence that mindfulness meditation interrupts the connection between a ruminative cognitive style and negative affect and may be useful in reducing the intensity and duration of depressive moods, preventing relapse into depression, and reducing the risk of developing depressive disorders in the first place.

Broderick, P. C. (2005). Mindfulness and coping with dysphoric mood: Contrasts with rumination and distraction. Cognitive Therapy and Research, 29, 501-510.