A few weeks ago, MindSpace Clinic director Dr. Joe Flanders and assistant director Dr. Sarah Roberts gathered with dozens of psychologists, psychiatrists, and students at the Jewish General Hospital to spend the day with Dr. Zindel Segal. Segal is a researcher and cognitive psychologist at the University of Toronto and an expert on mindfulness in psychotherapy; he was in Montreal to give a training session on Mindfulness-Based Cognitive Therapy (MBCT).
What is MBCT?
MBCT is an eight-week group intervention designed to help individuals with recurrent depression prevent relapse following successful treatment. MBCT pairs traditional cognitive-behavioural therapy (CBT) approaches to depression with mindfulness interventions designed to prevent relapse. It is an adaptation of mindfulness-based stress reduction (MBSR) that focuses on the thoughts and feelings associated with depression, and allows individuals to prevent relapse by increasing their awareness of the precursors.
The cognitive hallmark of depression is a negative and pessimistic view of the self, the world, and the future. Segal conceptualizes this type of negative thinking as a symptom of depression, comparable to other symptoms such as decreased appetite or difficulty sleeping. According to Segal, repeated episodes of depression create a tight network of associated depressive thoughts, feelings, and sensations. The network is so strong that, in individuals who are vulnerable to depression, a minor shift in stress level or in emotion can trigger the entire network of negative thoughts and feelings, promoting relapse. The connections in the depressogenic network become tighter with each episode, explaining why individuals with more past depressive episodes are at greater risk for relapse.
How does mindfulness help?
Mindfulness-based interventions are designed to help individuals switch off autopilot. In the same way that many of us eat, walk, or engage in other daily activities automatically, we also have automatic and mindless responses to our thoughts and emotions.
MBCT teaches formerly-depressed individuals to uncouple their habitual responses to depression-triggering cues in favour of responses informed by a mindful perspective on the same thoughts. MBCT participants learn that thoughts are not facts, and can be conceptualized as a mere symptom of depression, similar to difficulty sleeping or poor appetite. They practice noticing and observing depressogenic thoughts with curiosity, kindness, and compassion; they may concurrently practice replacing depressive thoughts with realistic alternate thoughts, as in traditional CBT.
As in MBSR, MBCT participants are encouraged to develop general mindfulness skills by paying close attention to routine activities and to physical sensations in the body. Mindful attention to routine activities teaches MBCT participants an observer stance that they can use when rumination or depressive thinking occurs. Concurrently, mindfulness of body sensations provides immediate feedback about what’s going on in the individual’s environment; this practice allows MBCT participants to view their experience with curiosity, gaining and creating a more stable emotional platform that prevents them from being overwhelmed by their emotions.
MBCT is now being more broadly applied to treat bipolar disorder and many anxiety disorders, including panic and obsessive-compulsive disorder (OCD). In each case, the use of mindfulness involves developing non-judgmental awareness and acceptance of uncomfortable thoughts and feelings, freeing clients from the struggle to control and eliminate them. Participants in MBCT anxiety groups learn to notice anxious thoughts and behaviours, and respond differently.
How was MBCT developed?
MBCT was first developed in 1995 after Segal was asked to create a version of cognitive therapy designed specifically to help clients maintain gains after treatment for depression, and prevent relapse. Segal and colleagues Mark Williams and John Teasdale were referred to Jon Kabat-Zinn, founder of Mindfulness-Based Stress Reduction, an eight-week mindfulness program originally developed for chronic pain patients and other refractory patients at the University of Massachusetts Medical School. Segal and his colleagues met with Kabat-Zinn at the Center for Mindfulness at the University of Massachusetts. Although initially skeptical, Segal, Teasdale, and Williams embraced mindfulness and subsequently developed MBCT.
To date, MBCT has been evaluated in three randomized clinical trials–the gold-standard research study that compares individuals who receive MBCT with a control group that receives a different psychological or pharmacological treatment. The results of two of the studies demonstrated that MBCT protects individuals who’ve experienced multiple episodes of depression against relapse, reducing risk by up to 50% (references below).
This kind of evidence is more than enough to interest the MindSpace team of psychologists. “MBCT is a great option for clients with lingering symptoms of depression or anxiety after treatment, or recurrent episodes,” reported Dr. Flanders. “It’s important to realize that depression and anxiety aren’t one-off illnesses that you can treat once and for all. They’re more like chronic conditions that require regular maintenance.” Flanders added, “It’s not unlike the challenge of maintaining physical fitness over time. Mindfulness is a strategy clients can use to maintain mental fitness in the long term.”
“Our goal at the MindSpace Clinic is to offer the best evidence-based and cutting edge mindfulness interventions, so MBCT is a natural addition to our services,” reported Flanders. The MindSpace Clinic plans to offer MBCT groups in early 2015.
Bondolfi, Jermann, der Linden, Gex-Fabry, Bizzini, Rouget, Myers-Arrazola, Gonzalez, Segal, Aubry, & Bertschy (2010). Depression relapse prophylaxis with Mindfulness-Based Cognitive Therapy: replication and extension in the Swiss healthcare system. Journal of Affective Disorders, vol 122, p 224.
Segal, Z (2008) Finding Daylight. Psychotherapy Networker, Jan/Feb.
Teasdale, Segal, Williams, Ridgeway, Soulsby, & Lau (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, vol 68, p 615.