Reduce Depression in Vindictive/Self‐Centered Depressed Patients with Mindfulness
By John M. de Castro, Ph.D.
“there are a handful of key areas — including depression, chronic pain, and anxiety — in which well-designed, well-run studies have shown benefits for patients engaging in a mindfulness meditation program, with effects similar to other existing treatments.” – Alvin Powell
Clinically diagnosed depression is the most common mental illness, affecting over 6% of the population. Major depression can be quite debilitating. Depression can be difficult to treat and is 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 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 relieve the suffering. Mindfulness training is an alternative treatment for depression. It has been shown to be an effective treatment for depression and its recurrence and even in the cases where drugs fail. Mindfulness-Based Cognitive Therapy (MBCT) was specifically developed to treat depression. MBCT involves mindfulness training, containing sitting, walking and body scan meditations, and cognitive therapy that attempts to teach patients to distinguish between thoughts, emotions, physical sensations, and behaviors, and to recognize irrational thinking styles and how they affect behavior. MBCT has been found to be effective in treating depression. Problematic interpersonal styles, such as submissive and hostile styles are characteristics of patients with chronic depression. It is possible that MBCT has differential effectiveness for depression, in patient’s with certain interpersonal problems and not others.
In today’s Research News article “Patients’ interpersonal problems as moderators of depression outcomes in a randomized controlled trial comparing mindfulness-based cognitive therapy and a group version of the cognitive-behavioral analysis system of psychotherapy in chronic depression.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7318258/) Probst and colleagues recruited participants with a current, long-term, at least 2 years, major depressive disorder. They all received their treatment as usual. They were randomly assigned to receive either no additional treatment, or to receive 8 weeks, once a week, for 2.5 hours group sessions of either Mindfulness-Based Cognitive Therapy (MBCT), or cognitive behavioral analysis system of psychotherapy (CBASP). They were measured before and after treatment and 6 months later for depression, interpersonal problems including domineering/controlling; vindictive/self‐centered; cold/distant; socially inhibited/avoidant; nonassertive; overly accommodating/exploitable; self‐sacrificing/overly nurturant; and intrusive/needy.
They found that both treatments significantly reduced depression levels. But patients who were high in vindictive/self‐centered interpersonal problems benefited more (had a greater reductions in depression) from Mindfulness-Based Cognitive Therapy (MBCT), than from cognitive behavioral analysis system of psychotherapy (CBASP). Conversely, patients who were high in nonassertive interpersonal problems benefited more (had a greater reductions in depression) from cognitive behavioral analysis system of psychotherapy (CBASP) than from MBCT.
Vindictive/self‐centered individuals are frequently egocentric and hostile in dealing with others. Mindfulness training has been shown to produce decentering and lower hostility. So, it makes sense that Mindfulness-Based Cognitive Therapy (MBCT) would be particularly effective with these patients. On the other hand, nonassertive patients have difficulty expressing their needs to others and cognitive behavioral analysis appears to work better for them.
There are a number of different types of therapy for depression. So, the results of the present study are very useful. They suggest that knowing the particular interpersonal problems a patient has can help to select the form of therapy that will be maximally beneficial for them. Mindfulness-Based Cognitive Therapy (MBCT) appears to work best for vindictive/self‐centered depressed patients reducing their egocentricity and hostility.
So, reduce depression in vindictive/self‐centered depressed patients with mindfulness.
“Mindfulness-based cognitive therapy is a group program that is generally used to delay or prevent recurrence of major depression, but can also ameliorate acute depressive syndromes and symptoms.” – Zindel Segal
CMCS – Center for Mindfulness and Contemplative Studies
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Probst, T., Schramm, E., Heidenreich, T., Klein, J. P., & Michalak, J. (2020). Patients’ interpersonal problems as moderators of depression outcomes in a randomized controlled trial comparing mindfulness-based cognitive therapy and a group version of the cognitive-behavioral analysis system of psychotherapy in chronic depression. Journal of clinical psychology, 76(7), 1241–1254. https://doi.org/10.1002/jclp.22931
Interpersonal problems were examined as moderators of depression outcomes between mindfulness‐based cognitive therapy (MBCT) and cognitive behavioral analysis system of psychotherapy (CBASP) in patients with chronic depression.
Patients received treatment‐as‐usual and, in addition, were randomized to 8‐weeks of MBCT (n = 34) or 8‐weeks of CBASP (n = 34). MBCT and CBASP were given in a group format. The Hamilton depression rating scale (HAM‐D) was the primary and the Beck Depression Inventory (BDI‐II) the secondary outcome. The subscales of the Inventory of interpersonal problems (IIP‐32) were moderators. Multilevel models were performed.
Higher scores on the “vindictive/self‐centered” subscale were associated with a better outcome in MBCT than in CBASP (HAM‐D: p < .01; BDI‐II: p < .01). Higher scores on the “nonassertive” subscale were associated with a better outcome in CBASP than in MBCT (HAM‐D: p < .01; BDI‐II: p < .01).
If these results can be replicated in larger trials, MBCT should be preferred to CBASP in chronically depressed patients being vindictive/self‐centered, whereas CBASP should be preferred to MBCT in chronically depressed patients being nonassertive.