Mindfulness Training for Relapse Prevention?

In a symposium at the 1998 AABT convention entitled Attentional Control/Mindfulness Training for the Prevention of Relapse in Recurrent Affective Disorder Zindel Sagal, John Teasdale, and Mark Williams discussed a controlled clinical trial with individuals with a history of recurrent depression.

In introducing the study, Segal noted that the risk of eventual relapse is predicted by the extent to which an increase in depressed mood produces an increase in dysfunctional thinking. CBT appears to decrease the extent to which increases in depressed mood produce increases in dysfunctional thinking while antidepressant medication may not do this even when it provides effective treatment for the individual’s current episode of depression.

Williams described the intervention used in this study. It was a modified version John Cabott Zinn’s mindfulness-based stress-management approach. In included extensive practice in focusing attention on non-evaluative experience of the present. There were 8 weekly 2-hour sessions with an hour a day of homework (usually with tapes) between sessions and 4 maintainance sessions at monthly intervals. Training was administered in small-group sessions of up to 12 participants. It included exercises focusing attention on experience and attending to experience in detail, body awareness exercises, breathing exercises, etc. Group participants are taught to deal with their tendency to be judgemental by being aware and letting go and to deal with negative mood by being aware and accepting.Teasdale emphasized that the focus is on awareness rather than on change, on recognizing thoughts and disengaging from them rather than recognizing and challenging them.

Subjects in the study were 145 recovered depressed individuals with a history of recurrent depression who had previously been treated with antidepressants. They were randomly assiged to either mindfulness training or a waiting list & treatment as usual (TAU) as a control group. Following mindfulness training, Ss with more than two previous episodes of depression (77% of sample) had half the relapse rate as TAU Ss over a one-year follow-up. Subjects with two or fewer previous episodes of depression showed no benefit from mindfulness training.

This treatment required only a 5 hour per patient investment of professional time so it could easily be cost-effective. Both Zinn and the investigators think you need to practice mindfulness meditation yourself in order to teach it effectively.

Steve Hollon (the discussant) was initially skeptical about this approach but is impressed by the data. He drew paralells between mindfulness and commonly used CBT interventions such as “distancing”, Claire Weakes’ “floating”, etc. but he says that mindfulness seems to be more than that.

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