Mindfulness-Based Cognitive Therapy for Depression

In Mindfulness-Based Cognitive Therapy for Depression, Dr. Zindel V. Segal demonstrates a mind–body approach to helping clients who have experienced depression to prevent a relapse into depressive symptoms. Depression poses an ongoing challenge to staying well because certain thought patterns, usually involving rumination or self-criticism, often lead back to depression. By teaching clients mindfulness exercises, Dr. Segal helps them to recognize these thought patterns and, by being aware of them, to find healthy ways to work with and adapt to them.

In this group session, Dr. Segal talks with four clients who have experienced depression. He then leads them through a series of mindfulness exercises, followed by a discussion explaining the benefits of mindfulness practices as a way to avoid relapsing into depression.

Mindfulness-based cognitive therapy comes from spiritual traditions, but Dr. Segal's approach places less emphasis on spiritual practice and more on how these ancient wisdom traditions can be harnessed to enhance self-care. In essence, mindfulness is all about paying attention, whether the object of attention is one's breath, a raisin, or thoughts or emotions. Its application in cognitive therapy for depression is based on the Buddhist psychological view of the mind, which is that thoughts and emotions are objects that may be observed and that such observation leads to benefits such as being able to regulate affect more effectively.

By becoming mindful of thought patterns and emotions, clients who have experienced depression may be able to recognize the type of rumination or self-critical thoughts that lead them to become depressed before the thoughts spiral out of control. Mindfulness helps clients to work with and possibly accept these thinking patterns so as to work with the patterns more adaptively. Practicing mindfulness may help clients with depression work more wisely with feelings of helplessness and hopelessness, two other emotions that may lead to relapses in depression.

This approach was developed by Drs. Zindel V. Segal, Mark Williams, and John Teasdale and draws on a more generic approach to stress reduction that is used with general medical complaints. The approach has been proven effective in a randomized trial published in the Journal of Consulting and Clinical Psychology (Teasdale et al., 2000).

The approach involves an eight-session program. The sessions include groups of 10 to 12 clients. The first four sessions incorporate training in mindfulness skills, with an emphasis on practicing mindfulness at home. Mindfulness exercises range from sitting meditations to stretching, breathing, and walking. The last half of the treatment focuses on creating a personal "relapse prevention kit" that includes ways to recognize the warning signs of returning depression, cataloging support systems and drains on energy, and listing activities that bring clients pleasure.

Dr. Segal remarks that, unlike in some therapies, this approach requires the therapist to regularly take part in the therapeutic exercises: It is essential that anyone doing this work have their own mindfulness practice.

Zindel V. Segal, PhD, is the Morgan Firestone Chair in Psychotherapy in the Department of Psychiatry at the University of Toronto. He is a professor in the Departments of Psychiatry and Psychology and the director of the Cognitive Behaviour Therapy Unit at the Centre for Addiction and Mental Health.

Dr. Segal has studied and published widely on psychological treatments for depression for over 20 years. His most recent book Mindfulness-Based Cognitive Therapy for Depression advocates for the relevance of mindfulness and acceptance practices to therapeutics in psychiatry and mental health. He is a widely respected teacher and workshop leader whose insights drawn from both the clinical research literature and his personal mindfulness practice are much lauded by patients and practitioners.

• Brach, T. (2003). Radical acceptance. New York: Bantam Books.
• Kabat-Zinn, J. (1990). Full catastrophe living. New York: Dell.
• Kabat-Zinn, J. (1994). Wherever you go, there you are. New York: Hyperion Books.
• Ma, H., & Teasdale, J. D. (2004). Mindfulness-based cognitive therapy for depression: Replication and exploration of differential relapse prevention effects. Journal of Consulting and Clinical Psychology, 72, 31–40.
• Segal, Z., Williams, M., & Teasdale, J. (2002). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. New York: Guilford Press.
• Teasdale, J. T., Segal, Z. V., Williams, J. M. G., Ridgeway, V., Soulsby, J., & Lau, M. (2000). Prevention of relapse–recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 68, 615–623.

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APA Books

• Casebook for a Spiritual Strategy in Counseling and Psychotherapy
  Edited by P. Scott Richards and Allen E. Bergin
• Emotion-Focused Therapy for Depression
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• Essential Components of Cognitive–Behavior Therapy for Depression
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• A Spiritual Strategy for Counseling and Psychotherapy, Second Edition
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• Spiritually Oriented Psychotherapy
  Edited by Len Sperry and Edward P. Shafranske