MRC Cognition and Brain Sciences Unit

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A new treatment for depression: mindfulness-based cognitive therapy

It is increasingly recognised that major depression is often a life-long, recurring disorder - although the symptoms of each episode can be successfully treated in many cases, it is very likely that an individual, having experienced one episode, will go on to have further episodes, and the chance of further recurrences increases with every episode experienced. Antidepressant drugs reduce the risk of relapse and recurrence, but their benefits depend on patients continuing to take their medication for extended periods, which many are unwilling to do. Unlike medication, psychological treatments, such as cognitive therapy (CT), have preventive effects that last long after active treatment has been completed. However, CT, given on a one-to-one basis, is demanding of expensive, skilled professional resources, and there are simply not enough cognitive therapists available to meet the enormous scale of the problem of depression.

For these reasons, in 1992, John Teasdale, -a member of Emotion Group till Sept 2004 and has now retired - with Mark Williams from the University of Wales, and Zindel Segal from the University of Toronto, began to develop a radically new approach to prevention of relapse and recurrence in depression. This was based on Teasdale's earlier theoretical analysis of the process of relapse. This proposed that patients with a history of depression were at risk of relapse because, even though they might be well over the symptoms of past episodes, periods of mild depressed mood could reactivate old patterns of negative ruminative thought, setting up vicious spirals that could intensify depression and lead on to relapse. It followed that the key task in preventing relapse was to give patients the means to prevent this reactivation of negative thinking patterns at times of potential relapse. Conventional CT did this by training individual patients, when they were acutely depressed, to focus on the content of their negative thinking and question their belief in that negative content. By contrast, the Mindfulness-Based Cognitive Therapy (MBCT) programme, developed by Teasdale and colleagues on the basis of a novel analysis of the effectiveness of CT, teaches groups of recovered depressed patients how to relate differently to their negative thoughts and feelings, without focusing on changing belief in thought content. Specifically, MBCT teaches patients how to switch out of an automatic, habitual, ruminative mode of mind in which they identify with their negative thoughts and feelings, to a more mindful, intentional mode, in which thoughts and feelings are seen from a wider perspective as simply events passing through the mind. This is done in a programme of group meetings, with daily homework exercises between meetings.

A multicentre clinical trial evaluating MBCT in a group of 145 recovered depressed patients showed that, for patients with three or more previous episodes of depression, MBCT approximately halved relapse rates (37% vs. 66%) compared to treatment-as-usual (Teasdale, J.D. et al., Journal of Consulting and Clinical Psychology, 2000, 68, 615-623). This was the first demonstration that a group-based psychological intervention administered in recovery could affect the future course of major depression. In a second clinical trial in Cambridge , Helen Ma and John Teasdale confirmed these positive results, showing that, for a similar group of patients, relapse rates could be reduced from 78% to 36%, for an average investment of less than 3 hours of professional contact time per patient. In both trials, the detailed pattern of results was consistent with the theoretical basis of MBCT.

The success of MBCT offers a new way to prevent relapse and recurrence in major depression, and also opens up new ways to develop cognitive therapy more generally.