Mindfulness is Associated with Lower Functional Impairment and Avoidance in Major Depressive Disorder

Mindfulness is Associated with Lower Functional Impairment and Avoidance in Major Depressive Disorder


By John M. de Castro, Ph.D.


People at risk for depression are dealing with a lot of negative thoughts, feelings and beliefs about themselves and this can easily slide into a depressive relapse. MBCT helps them to recognize that’s happening, engage with it in a different way and respond to it with equanimity and compassion.” – Willem Kuyken


Clinically diagnosed depression is the most common mental illness, affecting over 6% of the population. Major depression can be quite debilitating, impairing the ability of the patients to effectively conduct their lives. 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 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 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. Behavioral activation involves engaging with what is going on in the present moment and is thought to help with depression while avoiding symptoms and ruminating tend to exacerbate the depression. There is little data, however, of the interplay of activation and mindfulness in patients with major depression.


In today’s Research News article “Roles of Trait Mindfulness in Behavioral Activation Mechanism for Patients With Major Depressive Disorder.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202344/), Takagaki and colleagues had adult patients with major depressive disorder complete questionnaires designed to measure behavioral activation for depression including subscales measuring activation, avoidance/rumination, work/school impairment, and social impairment; mindfulness including subscales measuring describe, observe, act with awareness, nonreactivity, and non-judging; depression; and disability.


They found that the greater the level of depression the greater the level of disability, avoidance/rumination, and mindful observing and the lower the levels of mindful describing, acting with awareness, nonreacting and non-judging. Similarly, they also found that the higher the levels of avoidance/rumination the greater the levels of depression, disability, and mindful observing and the lower the levels of mindful describing, acting with awareness, nonreacting and non-judging. Structural equation modelling revealed that mindful acting with awareness, nonreacting and non-judging was directly negatively related to avoidance/rumination which was in turn positively related to disability. In addition, mindful acting with awareness and nonreacting were directly negatively related to disability.


These results are correlative and caution must be taken in making causal inferences. Nevertheless, the results suggest that the degree of disability/impairment in patients with major depressive disorder is directly and indirectly associated with mindfulness with avoidance/rumination as an intermediary. That is, avoidance of a negative aversive state and engagement in rumination rather than active problem-solving to some extent mediates the association of mindfulness with lower levels of impairment in life. Hence, mindfulness is related to the patient’s ability to better conduct their life and it does so directly and indirectly by being associated with less avoidance of psychological pain and less rumination.


So, mindfulness is associated with lower functional impairment and avoidance in major depressive disorder.


Mindfulness training can “generate positive emotions by cultivating self-compassion and self-confidence through an upward spiral process, although behavioral activation is action oriented while mindfulness emphasizes the acceptance and awareness of present moment emotions, thoughts, and bodily sensations, the two can be complementary.” _ Amanda MacMillan


CMCS – Center for Mindfulness and Contemplative Studies


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Study Summary


Takagaki, K., Ito, M., Takebayashi, Y., Nakajima, S., & Horikoshi, M. (2020). Roles of Trait Mindfulness in Behavioral Activation Mechanism for Patients With Major Depressive Disorder. Frontiers in psychology, 11, 845. https://doi.org/10.3389/fpsyg.2020.00845



Behavioral activation and mindfulness have both been shown to engender improvement of functional impairment in patients with major depressive disorder. In behavioral activation, the practice of engaging with the direct experience of the present moment is central, especially when targeting avoidance. Consequently, mindfulness affects changes of avoidance in behavioral activation. This study was designed to assess exploratory relations among trait mindfulness, avoidance, and functional impairment in behavioral activation mechanism for depression. For 1042 participants with depression only or for depression with anxiety disorders, we used structural equation modeling to examine relations among trait mindfulness, avoidance, and functional impairment. Trait mindfulness non-reactivity, non-judging, and acting with awareness had a direct negative effect on avoidance. Trait mindfulness non-reactivity, trait non-judging, and trait acting with awareness had indirect negative effects on functional impairment. Results show that each trait mindfulness facet exhibited a distinct pattern of relations with avoidance and impairment.