Utility of MBCT in application to depression. To understand MBCT application to depression, it is crucial to understand how depressive thought patterns work. Eaves and Rush (1984) studied this topic in individuals experiencing unipolar, nonpsychotic depression at two individual points in time: when they were experiencing symptoms of depression and when they were in remission from their symptoms. The group was further subdivided based on types of depression in that individuals were divided into 11 individuals experiencing endogenous depression and 13 experiencing nonendogenous-based depression. The control group included in the study was comprised of 17 individuals who were not depressed. Overall, individuals who were experiencing symptoms of depression exhibited more dysfunctional attitudes, more attribution biases relating to depressive schemata, and more negative connotation in relation to automatic thoughts experienced. When individuals in the study were in depressive remission, there were levels of negative automatic thoughts exhibited that were equivalent to those in the control group. However, the negatively biased attitudes and attributes persisted in the endogenous and nonendogenous depressive groups. Attributional biases also correlated to levels of chronic depression, which is suggestive of biases of an attributional nature occurring as a result of long-term depression or inducing a higher quantity of time being spent in episodes of depression (Eaves & Rush, 1984). Hence, one can observe that for individuals who experience chronic, recurring depressive bouts, there can be a proclivity for these negative, attributions to arise again.
It seems that the depressive schemata remains intact for individuals even when their symptoms are in remission, which makes them vulnerable to perceiving the world from a depressive lens and reenacting symptoms even after they have been dormant. Raes, Dewulf, Van Heeringen, and Williams (2009) noted that this process is known as “cognitive reactivity,” which they described as the extent that dysphoric states of a mild nature can reactivate thinking patterns that are categorically negative. Raes et al. stated that this reactivation process plays a role in relapse of depression in individuals. Watkins and Teasdale (2004) further described that depression relates to ruminative thought processes in that specifically thoughts of a maladaptive nature or ones in which one focuses on one’s self assist in perpetuating depressive mood. However, self-focused attentive processes can also serve a useful function in that it permits individuals to generate alternative interpretations in relation to negative thoughts and feelings that they may be experiencing (Watkins & Teasdale, 2004).
Huffziger and Kuehner (2009) engaged in a study to further understand the effect of rumination in relation to proclivity to develop depression. Huffziger and Kuehner engaged in conducting this study under the notion that rumination is a cognitive factor of risk for the onset and maintenance of depression. As well, their study was conducted with the notion that mindfulness-based interventions have the ability to reduce risk of depression from recurring. This study was conducted through usage of inducing the subjects with short temporal periods of distraction, rumination, and self-focus of a mindful basis in relation to sad moods with a depressed patient populace. Their sample included 76 individuals who had been discharged from inpatient treatment 3.5 years before the study. The results of this study indicated that inducing self-focus of a mindful nature had beneficial effects in relation to dealing with negative moods. As well, patients who were categorically strong in habitual mindfulness had stronger reduction in their negative mood, particularly after inducing self-focus of a mindful nature. Hence, overall this study demonstrated that inducing self-focus of a mindful nature has the ability to reduce negative-based mood in depressive patients. Thus, again mindfulness was shown as being effective at mitigating depressive thought processes that are central contributors to depressive relapse. A limitation to Huffziger and Kuehner’s study, however, was that individuals had been discharged from treatment for 3.5 years, which may mean that their symptoms had reduced at this point. Namely, symptoms could have been so minimal that they may have regressed regardless of intervention.
As previously noted, Teasdale et al. (1995) described that attentional control training, the skills taught within the context of mindfulness meditation processes, are useful in serving a prophylactic effect against depression. MBCT has specifically been shown to be more effective in usage on individuals who have experienced three or more prior depressive episodes as compared to those who had experienced only two previous depressive episodes (Segal et al., 2013). Hence, it was found that more chronically depressed patients benefit more from MBCT programs (Segal et al., 2013). Understanding the utility of application of mindfulness to depression is important in that Segal et al. (2013) describe that an important implication of these findings is that MBCT can be useful for individuals experiencing an early onset of depression. Namely, many individuals within their study who had experienced three or more depressive episodes noted that it tended to start early in their life such as in their adolescence or early adulthood (Segal et al., 2013). Thus, Segal et al. (2013) hypothesized that usage of mindfulness-based interventions can be a way to mitigate against depressive episodes prior to their morphing into a more chronic form of depression consisting of three or more episodes.
Hence, given these findings pertaining to symptoms, it is important to understand the underpinnings of depressive relapse and episodes to better understand utility of mindfulness applications as a mitigating force. Depressive relapse in individuals who have experienced three or more previous episodes of depression is thought to be connected to independent, automatic thought processes that come to be reactivated by sad moods (Segal et al., 2013). Kendler, Thornton, and Gardner (2000) noted that stress in the environment plays a less important role in inducing recurrence of symptoms when more episodes of depression have been experienced by an individual (as cited in Segal et al., 2013). Hence, internal processes such as thoughts are thought to be more of a contributing variable in this process. Ma and Teasdale (2004) also ascertained that relapses in individuals who have experienced less depressive symptoms tend to be affiliated with significant life events occurring. Individuals within this group also reported experiencing lower amounts of adversity to their childhood as well as a later onset of depression in life as compared to those who had experienced three or more depressive episodes (Ma & Teasdale, 2004). Ma and Teasdale found that, as compared to those who had experienced only two episodes of depression or had no history of depression, individuals who experienced three or more depressive episodes reported experiencing more adverse early life experiences (as cited in Segal et al., 2013). Ma and Teasdale advocated that the observations of these groups is representative of individuals in the greater populace as well in relation to depressive experience.
Overall, the results of the MBCT program indicated that participants who were in the 8-week program exhibited a lower likelihood of experiencing a depressive episode in the 12 months subsequent to their participation in the group (Segal et al., 2013). Raes et al. (2009) conducted a study in order to determine the relationship that exists between MBCT and cognitive reactivity. Two studies were conducted by these authors: one that used a cross-sectional design consisting of 164 individuals and a second study that consisted of comparing a group of 18 individuals who received MBCT treatment to 21 individuals on a waiting list (Raes et al., 2009). In the first study, a relationship was examined between naturally occurring mindfulness and cognitive reactivity. In the second study, a relationship was examined between MBCT treatment and cognitive reactivity (Raes et al., 2009). It was found overall that the trait of mindfulness has significant negative correlations to cognitive reactivity (Raes et al., 2009). Furthermore, Raes et al. found that MBCT reduces cognitive reactivity as mediated by a positive change in mindfulness-based skills. Thus, the results of this study indicated that mindfulness practices within MBCT mitigate against the occurrence of cognitive reactivity (Raes et al., 2009).
Teasdale et al. (2000) conducted a study on individuals who were currently recovered from recurrent bouts of depression. Teasdale et al.’s overall goal of this was to determine the efficacy of utilizing MBCT approaches to disengage individuals from the mood-related activation of depressive thinking in order to reduce risk of relapsing into depression. There were 145 participants in this study who were placed into groups of receiving treatment as usual or receiving their treatment as usual in addition to MBCT. Participants in this study were also required to have had experienced a minimum of two previous major depressive episodes. As well, all of the patients in this Teasdale et al. study also had experienced treatment with antidepressant medication and had been off of this medication for a minimum of 3 months prior to entering the trial. The relapse and recurrence to depression was measured over the course of a 60-week period (Teasdale et al., 2000).
Teasdale and his colleagues (2000) found that for 77% of the sample, who were individuals who had experienced three or more prior depressive episodes, MBCT was shown to strongly reduce risk of depressive relapse. However, for individuals who had experienced only two prior depressive episodes, MBCT did not have a considerable effect at reducing recurrence of depressive symptoms or relapse (Teasdale et al., 2000). The overall conclusion deduced from this study was that MBCT was something that offered an approach of psychological nature that was efficient in relation to cost for prevention of relapse of depressive episodes (Teasdale et al., 2000). Teasdale et al. further concluded that effects from usage of antidepressants were independent from the benefits exhibited from usage of MBCT. A limitation of this study is that the sample was predominantly comprised of individuals who had experienced three or more prior depressive episodes. This is potentially a biased sample in that MBCT tends to be more effective in individuals who have experienced three or more prior depressive episodes as compared to those who have experienced only two previous depressive episodes (Segal et al., 2013).
Ma and Teasdale (2004) carried out a study that was designed to procedurally replicate the study from 2000 conducted by Teasdale et al. (as cited in Segal et al., 2013). Individuals in this study were in remission from depressive episodes and were allotted to a group of either treatment as usual or treatment as usual in conjunction with MBCT (Ma & Teasdale, 2004). The results of the study indicated that MBCT facilitated a reduction in relapse from 78% to 36% in 55 individuals in the study who had experienced three or more previous episodes (Ma & Teasdale, 2004). However, in 18 patients in the study who had experienced only two recent episodes of depression, the reductions in relapse rates were 20—50% (Ma & Teasdale, 2004). The overall conclusion of this study was that MBCT was an efficient and effective way to prevent relapse in individuals recovered from depression who had experienced three or more depressive previous episodes (Ma & Teasdale, 2004). A potential limitation of this study is that the depression observed was speculated to relate to childhood experience. However, depression may have realistically been connected to genetic susceptibility of early age of onset. Ma and Teasdale (2004) also reported that a limitation of MBCT is that it exhibited a lack of efficiency on reducing depression in individuals who had experienced only two previous depressive episodes prior to entrance into the study (as cited in Segal et al., 2013).
