a 2011 meta-analysis by Jacob Piet, PhD, and Esben Hougaard,
PhD, of the University of Aarhus in Denmark in Clinical
Psychology Review, MBCT was more effective in preventing
relapse among people with three or more episodes, reducing risk
by 43 percent versus 34 percent for participants overall.
In another study, Williams and colleagues found that
participants who had depression at earlier ages, or who had
more adversity or abuse in childhood, were more likely to benefit
from MBCT (Journal of Consulting and Clinical Psychology,
2014). Kuyken, who led the Lancet study, speculates that these
patients may be more motivated and invested in the treatment.
“They’ve been depressed more, they’ve had all these
unpleasant things happening to them and they’ve often tried
antidepressants and other kinds of therapy, so they’re willing to
meditate 40 minutes a day and to do something quite different
in terms of mindfulness practices like mindful movement,” he
says. “Those who do best are those ready to engage fully.”
While evidence suggests mindfulness works to help prevent
depression relapse, researchers don’t yet know how.
“It may be that mindfulness leads to an increase in self-
compassion and a decrease in experiential avoidance,” says
Stuart Eisendrath, MD, professor and head of the Depression
Center at the University of California, San Francisco. “It may
be selective attention — if you focus on your breath, you have
less bandwidth to ruminate. There are a lot of factors that are
operative and we’re just beginning to tease out and deconstruct
them. It’s like tasting a soup with 10 spices. Is there one main
ingredient or is the flavor a combination of things?”
For example, one characteristic of depression is a habit of
thinking negatively about experience, one’s self or the future.
Mindfulness trains people to be more aware of these thoughts
and to stand back and simply observe their thoughts passing
through their minds — ‘Oh, there I go again, calling myself an
idiot’ — instead of trying to control their emotions. Or, in the
case of people who have recovered from depression, blaming
themselves for feeling down again or worrying about a relapse.
MBCT’s emphasis on cultivating awareness and acceptance
of the present moment also seeks to harness ruminating and
mind wandering, both of which are implicated in depression,
says Stefan Hofmann, PhD, a Boston University professor whose
lab studies anxiety and related disorders.
“Why worry about the future and ruminate about the past?”
says Hofmann. “Live for the here and now. It’s comfortable. It’s
the joyful experience of being alive.”
Researchers also mention that the group aspect of MBCT
may help clients breach the wall of solitary shame and guilt that
depression can build.
“By practicing with others, people realize that the way
A benevolent therapy
their minds generate depressive and ruminative thoughts is
really no different from others, like that builder over there, or
my neighbor. These are just thoughts — not facts in my life,”
Among MBCT’s strengths is its lack of side effects, and that it
can be used as an adjunct therapy.
“For people with residual symptoms, or who have
treatment-resistant depression, MBCT can be sequenced with
antidepressant medication and with cognitive-behavioral
therapy to help prevent the recurrence of relapse,” Segal says.
Eisendrath is analyzing data from a large randomized trial
of people with treatment-resistant depression that compared
MBCT to an active control incorporating movement, music
therapy and nutritional advice.
“It was said people with active depression couldn’t
concentrate, but we didn’t find that at all. They practiced it
pretty actively. They’re often interested in getting treatment
other than more medications, too. [Mindfulness] may give
them a greater sense of self-efficacy,” he says.
Women at high risk of depression who may want to
• Segal, Z. V., Williams, J. M. G. & Teasdale, J. T. (2012).
“Mindfulness-Based Cognitive Therapy for Depression”
(2nd ed.). New York: The Guilford Press.
• Kabat-Zinn, J. (2013). “Full Catastrophe Living:
Using the Wisdom of Your Body and Mind to Face Stress,
Pain, and Illness” (Rev. updated ed.). Westminster, MD:
• Arkowitz, H. and Lilienfeld, S. (2014, September/
October). “Is Mindfulness Good Medicine?” Scientific
American, 5( 25), pp. 74–75. Retrieved from www.
• Khoury, B., Lecomte, T., Fortin, G., Masse, M.,
Therien, P., Bouchard, V., Chapleau, M. A., Paquin, K., &
Hofmann, S. G. (2013). Mindfulness-based therapy: A
comprehensive meta-analysis. Clinical Psychology Review,
• Semple, R. J., & Lee, J. (2011). “Mindfulness-based
cognitive therapy for anxious children: A manual for
treating childhood anxiety.” Oakland, CA: New Harbinger