Prevent Depression Relapse and Lessen Residual Symptoms with Mindfulness
By John M. de Castro, Ph.D.
“Through mindfulness, individuals start to see their thoughts as less powerful. These distorted thoughts – such as “I always make mistakes” or “I’m a horrible person” – start to hold less weight. We ‘experience’ thoughts and other sensations, but we aren’t carried away by them. We just watch them come and go.” – William Marchand
Clinically diagnosed depression is the most common mental illness, affecting over 6% of the population. Major depression can be quite debilitating. It is also generally episodic, coming and going. Some people only have a single episode but most have multiple reoccurrences of depression. Depression can be difficult to treat and usually treated with anti-depressive medication. But, of patients treated initially with drugs only about a third attained remission of the depression. After repeated and varied treatments including drugs, therapy, exercise etc. only about two thirds of patients attained remission. But, drugs often have troubling side effects and can lose effectiveness over time. In addition, many patients who achieve remission have relapses and recurrences of the depression. Even after remission some symptoms of depression may still be present (residual symptoms).
Being depressed and not responding to treatment or relapsing is a terribly difficult situation. The patients are suffering and nothing appears to work to relieve their intense depression. Suicide becomes a real possibility. So, it is imperative that other treatments be identified that can be applied when the typical treatments fail. Mindfulness training is another alternative treatment for depression. It has been shown to be an effective treatment for depression and is also effective for the prevention of its recurrence. Mindfulness-Based Cognitive Therapy (MBCT) was specifically developed to treat depression and has been found to reduce depression alone or in combination with anti-depressive drugs and can even be effective even in the cases where drugs fail,. MBCT involves mindfulness training, containing sitting and walking meditation and body scan, and cognitive therapy to alter how the patient relates to the thought processes that often underlie and exacerbate depression.
In today’s Research News article “Mindfulness Based Cognitive Therapy for Residual Depressive Symptoms and Relapse Prophylaxis.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4706736/
Segal and colleagues reviewed the recent published research literature on the effectiveness of MBCT for depression, remission, and residual symptoms. They indicate that the current research provides evidence that MBCT acts to alter neural structures that are involved in depressive symptoms including increased activations in the insula and prefrontal cortex, which are involved in interoceptive awareness and emotion regulation, processes deficient in depressed individuals. They also report that MBCT has been found to be as effective or perhaps more effective than antidepressant drugs in relieving depression, preventing relapse, and decreasing residual symptoms.
The published recent research suggests that MBCT might have its benefits for depression by lowering worry and rumination which are major contributors to depression. MBCT has also been shown to be effective for other mood disorders and for eating disorders, medically ill populations, such as cancer or diabetes, and pain management. In addition, these effects have been shown to occur regardless of whether MBCT is delivered in face-to-face group formats or individually on-line.
Hence, the research indicates that MBCT is a highly effective treatment of depression, relapse prevention, and residual symptoms, for other mood disorders, for medical diseases, and for pain. It has been shown to be safe with few if any adverse effects, and can be delivered with cost-effective on-line programs. Much of its effectiveness appears to be from cognitive changes, making the patient more mindful of the present moment and reconfiguring errant thought processes producing reductions in worry and rumination. Thus, a clear case is building that MBCT should be one of the primary treatments used especially for depression.
So, prevent depression relapse and lessen residual symptoms with mindfulness.
“mindfulness meditation “helps individuals step back from the ruminative thinking processes widely found to underlie a depressive episode.” – “Lara Fielding
CMCS – Center for Mindfulness and Contemplative Studies
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Study Summary
Segal, Z. V., & Walsh, K. M. (2016). Mindfulness Based Cognitive Therapy for Residual Depressive Symptoms and Relapse Prophylaxis. Current Opinion in Psychiatry, 29(1), 7–12. http://doi.org/10.1097/YCO.0000000000000216
Key Points
Data from multiple RCTs indicates that MBCT is effective in preventing relapse and reducing residual symptoms in patients with recurrent depression who are in clinical remission.
Studies of the mechanisms of change in MBCT point to reductions in rumination and increases in metacognitive awareness as being consistently associated with clinical benefits
In an effort to reduce barriers to care, MBCT has been adapted for online delivery – Mindful Mood Balance – with early data suggesting good patient engagement and outcomes.
Mindfulness meditation is associated with increased activations in the insula and prefrontal cortex, neurological changes that parallel behavioural changes in interoceptive awareness and emotion regulation.
Abstract
Purpose of review
This article reviews the recent evidence for mindfulness based cognitive therapy (MBCT) for patients with residual depressive symptoms or in remitted patients at increased risk for relapse.
Recent findings
Randomized controlled trials have shifted focus from comparing MBCT with treatment-as-usual to comparing MBCT against interventions. These studies have provided evidence for the efficacy of MBCT on par with maintenance antidepressant pharmacotherapy and leading to a relative reduction of risk on the order of 30–40%. Perhaps fuelled by these data, recent efforts have focused on extending MBCT to novel populations, such as acutely depressed patients, those diagnosed with health anxiety, social anxiety, fibromyalgia, or multiple chemical sensitivities as well migrating MBCT to online platforms so that it is more widely available. Neuroimaging studies of patients in structured therapies which feature mindfulness meditation, have reported findings that parallel behavioural changes, such as increased activation in brain regions subsuming self-focus and emotion regulation (prefrontal cortex) and interoceptive awareness (insula).
Summary
The current evidence base for MBCT is strongest for its application as a prophylactic intervention or for residual depressive symptoms, with early data suggesting additional indications outside the mood disorders. Future work will need to address dose-effect relationships between mindfulness practice and clinical benefits as well as establishing the rates of uptake for online MBCT so that its benefits can be compared to in-person groups. Additionally, validating current or novel neural markers of MBCT treatment response will allow for patient matching and optimization of treatment response.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4706736/