Mindfulness-Based Cognitive Therapy (MBCT; Segal et al., 2002) Segal, Z. V., Williams, M. G., & Teasdale, J. D. (2001). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. NY: Guilford.

Main tasks of CBT The following steps may shift in order at times, but mostly the following happens in CBT: Catch yourself whenever your mood shifts and catch your thoughts, whatever is going through your mind First task here: Realizing your thoughts Second task: Note it (in mind, on paper), Third task: Tackle them in sessions evaluating the thought in light of evidence, alternative options found to tackle difficult thoughts, rehearsed in therapy, then Fourth task: Apply these skills in everyday life All the while, teaching vigilance for long-term beliefs, attitudes, assumptions and look out for situations that will trigger them

Techniques of CBT Activity scheduling Rating mastery and pleasure Thought monitoring and challenging Cognitive rehearsal generating alternative options Noticing dealing with dysfunctional schemas/attitudes

What is the evidence Evidence supports that CT is at least effective as ADM in treating depression and CT Evidence shows that when ADM is discontinued, the rate of relapse was between 50-78 % Evidence shows that rate of recurrence for the CT group was about 20-36 %

What is the evidence? What is the mechanism of relapse? Difference between those who are never depressed and who are recovered: the DAS scores (the vulnerability)? The answer is: ? The reaction to sad mood: Evidence showed that the people with a previous history of depression reacted to sad mood induction with similar sadness levels but their cognitive response was exaggarated Differential activation hypothesis (Teasdale, 1988) or cognitive reactivity The more times depressed an individual had been, the easier pathways to relapse are activated by slighest negative event and sad moods Nolen-Hoeksema research: Ruminative mind For those who were once depressed:EVEN DAY TO DAY SADNESS COULD TRIGGER A SERIOUS VICIOUS CYCLE OF THINKING NEGATIVELY SPIRALING DOWN TO DEPRESSIVE ROUTE

Mindfulness-Based Cognitive Therapy (MBCT; Segal et al., 2002) Goal: Prevention of relapse of depression Relapse happens because: Cognitive reactivity to ordinary sad moods increases risk for relapse Depressive content in schemas is activated by sad moods The more times depressed an individual had been, the easier pathways to relapse are activated by slighest negative event and sad moods Ruminative mind: The way the mind of depressed individuals work

Mindfulness-Based Cognitive Therapy (MBCT; Segal et al., 2002) VICIOUS CYCLE: Relapse happens because previously depressed individuals react to ordinary sad moods with undesirable, negative thoughts and they catch themselves. What they do then is trying to avoid past patterns of thinking, behaving, and feeling  Increased rumination about the problematic states and further avoidance as a way to reach the desired state  Depression

Mindfulness-Based Cognitive Therapy (MBCT; Segal et al., 2002) Why CBT works in recovery and relapse? Reducing belief in depressive thoughts and dysfunctional attitudes – not much empirical evidence here! Alternative account: Maybe CBT teaches individuals implicitly and indirectly (via questioning the validity of content) to change their perspective on negative thoughts – called cognitive ‘distancing’ or ‘decentring’ Why then MBCT? Proposes different and perhaps more direct ways to change how individuals relate to their thoughts, in short alternative ways of ‘decentring’ as a way to prevent relapse The skills learned via MBCT can help individuals to stop the following from triggering depressive episodes via decreasing cognitive reactivity and ruminative thinking

Mindfulness and related skills in MBCT Being in the moment, Decentering from negative thoughts (also constructed by Marsha Linehan in DBT) This is not moving away from or fighting with thoughts This is moving away to look at thoughts more closely with a nonreactive attitude with kind awareness so to more clearly see what needs to be done acceptance/nonaversion, nonattachment, kind awareness, letting go, “being” rather than “doing,” Non-goal attainment, bringing awareness to the manifestation of a problem in the body.

The core skill Moving away from a focus on content of thinking to a focus on the process of thinking via the intentional use of attention and awareness, via choosing what we are going to attend to and how Changing from the default ‘doing’ mode to a ‘being’ mode

Modes of mind: Doing mode When the mind sees the things are different from what things are expected/ought/wished to be... So there is a discrepancy between desired vs. actual states If action can’t be taken in order to reduce this discrepancy/mismatch  a recurring sense of frustration, dissatisfaction etc… your mind is fixated at finding ways to correct this mismatch. This is an automatic, unintentional process

Modes of mind: Being mode Being mode is not motivated to achieve a goal (reverse is true for doing mode) “Accepting and allowing what is, without any immediate pressure to change it.” because there is no standard state to achieve… Doing mode: past and future oriented… Being mode: present-focus Thoughts are passing events as other objects of awareness.

Goal: Balancing Doing and Being Mode

Decentering: “I am not my thoughts” “Metacognitive awareness” Negative thoughts and feelings are experienced as transient mental events, rather than to define as what is called the “self.” (Teasdale et al., 2002) “The phenomena comtemplated are distinct from the mind contemplating them” (Goleman, 1980) Stepping back from any immediate perspective and perceiving the experience within a broader, more detached, context of awareness

MBCT- The Eight-Session Program Structure: Start with practice (choosing body scan, sitting meditations, or yoga stretches) Letting the dialogue flow, interwoven with stories or poetry Further practice

For therapists Experiential component Using MBCT along with personal experience, only intellectual knowledge will not suffice. Planning and preparation for sessions Be responsive and flexible to here-and-now needs Suspend judgment and invite participants do the same ‘Don’t try too hard-whatever comes up accept it, for that is what you are feeling right now.”

Structure Initial interview Classes Outline theme and curriculum for each 8 classes Class size: 12 for research, 30 or larger in Kabat-Zinn practice

Core Aims To help people who have suffered from depression in the past to learn skills to help prevent depression coming back To become more aware of bodily sensations, feelings, and thoughts, from moment to moment. To help participants develop a different way of relating to sensations, thoughts, and feelings To help them be able to choose the most skillful response to any unpleasant thoughts, feelings, or situations they meet

Sessions Sessions 1-4 Learning to pay attention Awareness of how little we pay attention Learn how to bring your focus back to a single focus, first with reference to your body, then the breath Learn to become aware of how this mind wandering can allow negative thoughts and feelings to occur

Sessions Sessions 5-8 Handling mood shifts Whenever negative thoughts or feelings arise, let them be there, before responding to them skillfully Skillful responding to negative affect or thoughts Bringing attention to their breathing for a minute or two (breathing space), Then expanding attention to the body and here-and-now (for instance, expand attention to the parts of the body that the thought or emotion affects, and use the breath to open and soften the sensations)

Core themes Core themes I Exploring how best to prevent the establishment and consolidation of patterns of negative thinking Core themes II Unhelpful automatic cognitive routines, motivated by escaping/avoiding depression or life situations: Automatic pilot (example experiences: Raisin exercise, body scan) Driven by an overriding wish to get rid of the negative mood Constant monitoring/comparison of present and desired states Reliance on verbal problem-solving skills

Other components of MBCT Core skill: letting go, be mindful Experiential learning Empowerment What is to be learned: Concentration Awareness/mindfulness Being in the moment Decentering Acceptance/nonaversion, nonattachment, kindly awareness Letting go Being rather than doing, non-goal attainment, no special state Bringing awareness to the manifestation of a problem in the body