John D. Teasdale

How does cognitive therapy prevent depressive relapse and why should attentional control (mindfulness) training help

There is encouraging evidence that structured psychological treatments for depression, in particular cognitive therapy, can reduce subsequent relapse after the period of initial treatment has been completed. However, there is a continuing need for prophylactic psychological approaches that can be administered to recovered patients in euthymic mood. An information-processing analysis of depressive maintenance and relapse is used to define the requirements for effective prevention, and to propose mechanisms through which cognitive therapy achieves its prophylactic effects. This analysis suggests that similar effects can be achieved using techniques of stress-reduction based on the skills of attentional control taught in mindfulness meditation. An information-processing analysis is presented of mindfulness and mindlessness, and of their relevance to preventing depressive relapse. This analysis provides the basis for the development of Attentional Control Training, a new approach to preventing relapse that integrates features of cognitive therapy and mindfulness training and is applicable to recovered depressed patients.

Self-efficacy: Toward a unifying theory of behavioural change?

Abstract 1. 1. Bandura presents the concept of efficacy expectations ambiguously; at times they are discussed as if they include action-outcome expectations, at other times they are contrasted as distinct from these. 2. 2. It is helpful to keep action-outcome expectations and efficacy expectations conceptually distinct. Failure to do so does not allow consideration of the possibility that psychological treatments for phobias operate by modifying action-outcome expectations, without altering efficacy expectations. 3. 3. There is no firm experimental evidence to support Banduras contention that “psychological procedures, whatever their form, serve as means of creating and strengthening expectations of personal efficacy”, or to decide between alternative expectation accounts of the action of psychological treatments.

Negative thinking in depression: Cause, effect, or reciprocal relationship?

Abstract There is evidence consistent with the suggestion of the cognitive model of depression that certain negative cognitions can produce and maintain the state of depression. There is also good evidence that depressed mood affects the relative accessibility of positive and negative cognitions. Thus, negative cognitions appear to produce depression, and, conversely, depression increases the probability of just those cognitions which will cause further depression. This reciprocal relationship between depression and cognition may form the basis of a vicious cycle which will perpetuate and intensify depression. Bower has proposed an associative network theory to account for the effects of mood on memory. The implications of this model for cognitive models of depression are developed. It is suggested that an important dimension of cognitive vulnerability to depression may be the nature of the cognitions that become accessible in depressed mood.

Emotional processing, three modes of mind and the prevention of relapse in depression

Rachmans (1980) analysis [Rachman, S. (1980). Emotional processing. Behaviour Research and Therapy, 18, 51-60] of emotional processing is extended and applied to the prevention of relapse and recurrence in depression. It is proposed that effective emotional processing leads to changes in the ability of triggering cues to reactivate depressogenic processing cycles at times of potential relapse. Available evidence supports the usefulness of the probe methodology of the emotional processing framework as a way to investigate processes mediating relapse prevention by cognitive therapy. It is proposed that effective emotional processing involves creation of modified affect-related schematic mental models and that this occurs most effectively only within certain processing configurations or modes of mind. Within the Interacting Cognitive Subsystems (ICS) framework, three modes of processing emotional material can be distinguished: mindless emoting; conceptualising/doing and mindful experiencing/being. Only the last of these facilitates emotional processing; the second may prevent effective emotional processing and perpetuate depression by ruminative, conceptually dominated processing. This analysis suggests a further strategy to prevent relapse, in addition to modifying depressogenic schematic models, by teaching recovered depressed patients skills to switch processing modes by intentional redeployment of attention. Results of a recent trial of mindfulness-based cognitive therapy support the effectiveness of this novel alternative strategy.

Differential effects of induced mood on the recall of positive, negative and neutral words

Previous investigations have consistently found differential effects of induced moods on the accessibility of personal memories differing in hedonic tone. Findings for effects of retrieval mood on recall of verbal material have been less consistent. This study examined the effect of induced mood on the recall of previously learned personality trait words. Trait words were presented in normal mood and recall tested in elated or depressed mood. More positive words were recalled in elated than in depressed mood. Conversely, more negative words were recalled in depressed than in elated mood. There was no effect of mood on the recall of neutral words. Subjects in whom the mood induction procedures had failed to affect mood substantially did not show differential word recall. Differential effects of retrieval mood on recall of verbal material can be shown, but the nature of the material may be important. It may be necessary for the material to have been differentially associated with mood states in the subjectss life experience. This suggestion is discussed within Bowers (1981) associative network theory of mood and memory, and the implications for models of depression are considered.

Cognitive therapy for depression: Individual differences and the process of change

Changes in depression over the first weeks of therapy were examined in detail in patients taking part in a trial of cognitive-behavioral therapy for depression (CBT). Within 2 weeks of starting treatment, marked differences were apparent between CBT and comparison patients and, within CBT, some patients showed a very rapid response to treatment. Such rapid responders had significantly better long-term outcome than those responding more slowly. Compared to the latter, rapid responders more strongly endorsed the cognitive conceptualization of depression initially offered, reported a more positive response to initial homework assignments, and, prior to treatment, scored higher on a measure of “depression about depression.” These results support the importance of providing an acceptable rationale for treatment, followed by homework assignments that empirically validate the rationale offered. Implications for the practice of CBT for depression are discussed. It is suggested that the process of change may well be different in rapid and slow responders, and that the delivery system of CBT should be modified to take account of these differences.

Effects of induced elation-depression on the accessibility of memories of happy and unhappy experiences.

Abstract Elated and depressed moods were induced in student volunteers on separate occasions. On each occasion they retrieved past real-life experiences associated to stimulus words presented. Subjects subsequently rated the experiences for happiness-unhappiness and pleasantness-unpleasantness on a third occasion in a neutral mood state. Extremely unhappy memories were significantly more likely to be retrieved in the depressed mood than in the elated mood. Extremely happy memories were significantly more likely to be retrieved in the elated mood than in the depressed mood. Measures of latency of retrieval showed a significant interaction between mood state and type of memory. The results confirm the generality of previous findings in suggesting an effect of mood state on the accessibility of different types of cognition. The results are considered in relation to mood as a context in contextual-specific encoding and retrieval, and in relation to models and treatment of clinical conditions.

Psychological treatments for depression: how do they work?

Abstract There is good evidence that psychological treatments can be effective in reducing depression. However, effective treatments often differ considerably in the procedures they include and in their underlying rationales. Thus, the nature of their central effective therapeutic processes is unclear. It is proposed that ‘depression about depression’, arising from a reciprocal relationship between cognitive processing and the depressed state, is frequently an important factor maintaining depression. It is suggested that effective treatments operate, at least in part, by modifying this factor. Evidence from a trial of cognitive therapy consistent with this hypothesis is presented.

A home-based treatment program for agoraphobia

Previous work with agoraphobic patients indicates that, in addition to showing a limited response to behavioral treatments so far developed, improvement occurs only during treatment contact, and no further gains are made during the follow-up. A home-treatment program was developed with the intention of providing an on-going alternative within the patients own environment for the instructions and reinforcement normally given by the therapist. The program was used with 12 married women, all but one of whom made behavioral gains. In comparison with the clinic-based treatments used earlier, the home program produced at least equivalent change with a reduced expenditure of therapist time, and most patients went on to make further gains during the follow-up period.

Immediate effects on depression of cognitive therapy interventions

The immediate effects on depression of exploring versus modifying depressive thoughts were compared in chronic moderately to severely depressed patients receiving cognitive behavioral therapy (CBT). Using a withinsubject design, it was found that periods of “cognitive” CBT consistently produced more change in belief in identified depressive thoughts than did similar periods devoted to exploring and obtaining more information relevant to the thoughts. The greater change in belief resulting from “cognitive” CBT was consistently accompanied by greater reduction in self-rated depressed mood than was obtained in the Thought Exploration condition. Differences in the effects of the two conditions on a measure of speech rate were not consistent. The results support a central prediction of the cognitive model of depression and suggest the specific therapeutic effectiveness of “cognitive” CBT techniques.