Negative self-referential processing has fruitfully been studied in unipolar depressed patients, but remarkably less in patients with bipolar disorder (BD). This exploratory study examines the relation between task-based self-referential processing and depressive symptoms in BD and their possible importance to the working mechanism of mindfulness-based cognitive therapy (MBCT) for BD. The study population consisted of a subsample of patients with BD (n = 49) participating in an RCT of MBCT for BD, who were (...) assigned to MBCT + TAU (n = 23) or treatment as usual (TAU) (n = 26). Patients performed the self-referential encoding task (SRET), which measures (1) positive and (2) negative attributions to oneself as well as (3) negative self-referential memory bias, before and after MBCT + TAU or TAU. At baseline, all three SRET measures were significantly related to depressive symptoms in patients with BD. Moreover, repeated measures analyses of variance revealed that negative self-referential memory bias diminished over time in the MBCT + TAU group, compared with the TAU group. Given the preliminary nature of our findings, future research should explore the possibly mediating role of reducing negative self-referential memory bias in preventing and treating depressive symptoms in BD through MBCT. (shrink)

ObjectiveThis study aims to investigate the effectiveness of mindfulness-based cognitive therapy combined with medication therapy in preventing the recurrence of major depressive disorder in convalescent patients.MethodsA total of 130 patients with convalescent MDD were enrolled in this prospective study. Sixty-five patients were assigned to the experimental group and received medication therapy combined with MBCT, and 65 patients were assigned to the control group and treated with medication alone. The recurrence rate and related hormonal (...) changes were compared between the two groups.ResultsAfter 1 year of MBCT intervention, eight patients experienced recurrence in the experimental group, a recurrence rate of 12.31%, and 19 patients experienced recurrence in the control group, a recurrence rate of 29.23%. The Hamilton Depression Rating Scale and the World Health Organization Quality of Life Scale scores in both the experimental and the control groups were significantly improved after treatment. The difference in the HAM-D scores before and after treatment in the experimental group was 16.74 ± 4.54; this was significantly higher than that of the control group. The WHOQOL-BREF scores in the experimental group were significantly improved compared with those of the control group. The differences in the levels of corticotrophin-releasing hormone, adrenocorticotropic hormone, and cortisol before and after treatment in the experimental group and the control group were statistically significant. The difference in CRH before and after treatment in the experimental group was 16.8 ± 7.2, which was higher than that of the control group. The intervention with MBCT had a significant impact on the recurrence of MDD [β = 1.206, P = 0.039, 95% CI = 0.0790–1.229]. The difference in the HAM-D scores also had a significant impact on the recurrence of MDD.ConclusionCompared with medication therapy alone, the use of MBCT combined with medication therapy can effectively prevent the recurrence of MDD in convalescent patients. (shrink)

ABSTRACTMajor depressive disorder is a prevalent condition with high relapse rates. There is evidence that cognitive reactivity is an important vulnerability factor for the recurrence of depression. Mindfulness-based interventions are designed to reduce relapse rates, with cognitive reactivity as one of the proposed working mechanisms. In a randomised controlled trial we compared the effect of mindfulness-based cognitive therapy with treatment-as-usual on cognitive reactivity in recurrently depressed patients. Depressive symptoms, cognitive reactivity, (...) and mindfulness skills were assessed pre and post treatment. Patients in the MBCT group reported a significantly greater reduction in cognitive reactivity than those in the TAU group. The reduction of cognitive reactivity appeared to mediate the association between MBCT/TAU and decrease of depressive symptoms, using pre and post scores. The current study provides evidence that MBCT reduces cognitive reactivity and preliminar... (shrink)

Mindfulness-based interventions have proved effective in reducing various clinical symptoms and in improving general mental health and well-being. The investigation of the mechanisms of therapeutic change needs methods for assessment of mindfulness. Existing self-report measures have, however, been strongly criticized on various grounds, including distortion of the original concept, response bias, and other. We propose a psychophysiological method for the assessment of the mindfulness learned through time-limited mindfulness-based therapy by people who undergo meditation (...) training for the first time. We use the individual pre-post-therapy changes (dERPi) in the event-related brain potentials (ERPs) recorded in a passive meditation task as a measure of increased mindfulness. dERPi is computed through multivariate assessment of individual participant's ERPs. We tested the proposed method in a group of about 70 recurrently depressed participants, randomly assigned in 1.7:1 ratio to mindfulness-based cognitive therapy (MBCT) or cognitive therapy (CT). The therapy outcome was measured by the long-term change (dDS) relative to baseline in the depression symptoms (DS) assessed weekly, for 60 weeks, by an online self-report questionnaire. We found a strong, highly significant, negative correlation (r = -0.55) between dERPi (mean = 0.4) and dDS (mean = -0.7) in the MBCT group. Compared to this result, the relationship between dDS and the other (self-report) measures of mindfulness we used was substantially weaker and not significant. So was also the relationship between dERPi and dDS in the CT group. The interpretation of dERPi as a measure of increased mindfulness was further supported by positive correlations between dERPi and the other measures of mindfulness. In this study, we also replicated a previous result, namely, the increase (dLCNV) of the late contingent negative variation (LCNV) of the ERP in the MBCT group, but not in the control group (in this case, CT). We interpreted dLCNV as a measure of increased meditative concentration. The relationship between dLCNV and dDS was, however, very week, which suggests that concentration might be relatively unimportant for the therapeutic effect of mindfulness. The proposed psychophysiological method could become an important component of a "mindfulness test battery" together with self-report questionnaires and other newly developed instruments. (shrink)

While Mindfulness-Based Interventions (MBIs) have been shown to be effective for a range of patient populations and outcomes, a question remains as to the role of common therapeutic factors, as opposed to the specific effects of mindfulness practice, in contributing to patient improvements. This project used a mixed-method design to investigate the contribution of specific (mindfulness practice-related) and common (instructor and group related) therapeutic factors to client improvements within an MBI. Participants with mild-severe depression (N= 104; (...) 73% female,Mage = 40.28) participated in an 8-week MBI. Specific therapeutic factors (formal out-of-class meditation minutes and informal mindfulness practice frequency) and social common factors (instructor and group ratings) were entered into multilevel growth curve models to predict changes in depression, anxiety, stress, and mindfulness at six timepoints from baseline to 3-month follow-up. Qualitative interviews with participants provided rich descriptions of how instructor and group related factors played a role in therapeutic trajectories. Findings indicated that instructor ratings predicted changes in depression and stress, group ratings predicted changes in stress and self-reported mindfulness, and formal meditation predicted changes in anxiety and stress, while informal mindfulness practice did not predict client improvements. Social common factors were stronger predictors of improvements in depression, stress, and self-reported mindfulness than specific mindfulness practice-related factors. Qualitative data supported the importance of relationships with instructor and group members, involving bonding, expressing feelings, and instilling hope. Our findings dispel the myth that MBI outcomes are exclusively the result of mindfulness meditation practice, and suggest that social common factors may account for much of the effects of these interventions. Further research on meditation should take into consideration the effects of social context and other common therapeutic factors. (shrink)

This paper argues that a neopragmatist approach can allow for normativity to be integrated into a thoroughly naturalist account of mental disorder. A recognition of the malleability of norm-governed social practices reveals language, rationality, and mind to be open-ended, fluid processes that resist characterization in terms of fixed mechanistic structures. This, we will argue, foregrounds the import of vocabularies in determining the structure and content of mindedness. Specifically, the broader role that our discursive practices play in generating minds means that (...) the conditions contemporary psychiatric practice seeks to treat are themselves partly constituted by the vocabularies of treatment adopted. We then offer some positive proposals about how mindfulness based cognitive therapy (MBCT) may be enhanced once we replace representational approaches to mind with a vocabulary that explicitly articulates the inherent fluidity of self. To do this we draw on insights from mindfulness’s contextual home, namely Buddhism, and elaborate on the significance this tradition places on the doctrine of “not-self” (_anātman_) as a necessary framework for successful mindfulness practice– a framework that neatly slots into the neopragmatist understanding of mind and self as dynamic and socially constituted. (shrink)

In this article I examine an important episode in the growth of ‘mindfulness’ as a biomedical modality in Britain: the formation and establishment of Mindfulness-Based Cognitive Therapy (MBCT) by John Teasdale and his colleagues Mark Williams and Zindel Segal. My study, focusing on Teasdale’s contribution, combines ethnographic, oral historical and archival research to understand how mindfulness was disseminated or, to use a term sometimes used by mindfulness practitioners themselves, ‘transmitted’. Drawing on theoretical (...) support from Max Weber, Michel Foucault and Gilles Deleuze, I argue that transmission had a very specific form within the Buddhistic milieu that Teasdale occupied and within which he developed MBCT. To ‘transmit’ mindfulness was to transmit an experiential essence; a type of subjectivity that was seen as perennial, universal and radically distinct from its historical context. In tracing the recurring metaphysical, metaphorical and visual tropes of mindfulness and its transmission, I attempt to understand how Teasdale was embedded in both local and global networks of discourse and practice, and how his life and work contributed and depended upon an assemblage whose elements (institutional, technical, conceptual, textual) straddled empiricist psychology and religious mysticism. I also examine how authority, experience and knowledge were closely interwoven in the birth of British mindfulness, coming together to form an affectively compelling ‘diagram’ that shaped the way mindfulness was practiced and disseminated. In doing so, I aim to open up the possibility of studying the history of the human sciences from a new perspective: one which places an emphasis on the emotional impetus generated by metaphysical assumptions. (shrink)