Patients with a history of major depressive disorder who completed a program of mindfulness-based cognitive therapy (MBCT) were more likely than controls to see improvements in their ability to self-reassure, a new analysis finds. Patients were randomly assigned either to a waitlist control group or to receive eight two-hour weekly group sessions where participants learned how habitual modes of negative thinking, feeling and behaving could contribute to depressive relapse, and how to be mindful of bodily sensations, emotions and thoughts, according to the report published in Counselling & Psychotherapy Research. Participants in the intervention showed significant improvements in the ability to reassure themselves, and reduction in feelings of inadequacy. Improvements in self-reassurance also predicted risk of depression relapse in the two years following the intervention. "Depression is a huge public health challenge," said the study's lead author, Elisabeth Schanche, an associate professor in the department of clinical psychology at the University of Bergen in Norway. "A clinical feature of depression is a negative view of oneself and highly self-critical attitudes," Schanche said in an email. "Our study indicates that the ability to relate to oneself in a kind and supportive manner can protect from depression." The program used by Schanche and her colleagues teaches patients to be more conscious of thought patterns that can predispose them to depression. "MBCT helps people develop non-judgmental awareness through mindfulness practice," Schanche said. "Through various exercises they learn to relate to their thoughts and feelings in ways that make them less caught up in negative experiences. It is a practice of pausing and allowing for less habitual and more helpful responses in various situations. For someone struggling with recurrent depression the ability to pause and respond in ways that involves being more supportive and kind towards oneself can be of great importance." The tools learned in the program may help quiet critical thoughts and thus stave off future depression. "Being able to support and reassure oneself in difficult situations can be thought of as a skill that regulates our own emotions," Schanche said. "Self-reassurance as a skill can be strengthened through practice. When we practice relating to ourselves in a kind and supportive manner, this self-support is more available to us when we need it the most." To explore whether MBCT could help in turning down the volume on the part of the self that constantly criticizes and turning up the inner voice that provides reassurance, the researchers recruited 56 individuals with recurrent depressive disorder who were in remission at the time the research was performed. Participants were randomly assigned to receive MBCT without charge or to be placed on a waiting list for the therapy. The participants were evaluated with the Forms of Self-Criticizing and Reassuring Scale (FSCRS) before starting the program and at multiple points for two years after treatment. The study team found a significant medium effect of mindfulness training on the participants' tendency to dwell on mistakes and sense of personal inadequacy and a significant medium to large effect on the participants' ability to self-reassure. By the two-year point, 9 out of 26 participants who completed the program had a depression relapse. "These are some very interesting findings," said Jon Weingarden, a psychologist and senior program director at the UPMC Western Psychiatric Hospital in Pittsburgh. "But you have to keep in mind this is not a comparison to an active treatment. It showed that some fared better in some capacities than those who were not getting treatment. This is all we know." While the treatment doesn't stop the negative thoughts from coming, it can give people a little bit of distance from them, Weingarden said. "The theory is that it doesn't change the thoughts but rather the mindfulness of those thoughts," Weingarden said. "When we jot down a thought we're distancing ourselves from it so even if it doesn't change it's a little less close." Weingarden looks forward to future studies that would compare MBCT to other proven therapies. "This is an incremental step," he said. "But I'd be surprised if they didn't have good outcomes in what would be the next step." —Linda Carroll Source
