Mark A. Lau

Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy.

This study evaluated mindfulness-based cognitive therapy (MBCT), a group intervention designed to train recovered recurrently depressed patients to disengage from dysphoria-activated depressogenic thinking that may mediate relapse/recurrence. Recovered recurrently depressed patients (n = 145) were randomized to continue with treatment as usual or, in addition, to receive MBCT. Relapse/recurrence to major depression was assessed over a 60-week study period. For patients with 3 or more previous episodes of depression (77% of the sample), MBCT significantly reduced risk of relapse/recurrence. For patients with only 2 previous episodes, MBCT did not reduce relapse/recurrence. MBCT offers a promising cost-efficient psychological approach to preventing relapse/recurrence in recovered recurrently depressed patients.

Differences in Brain Glucose Metabolism Between Responders to CBT and Venlafaxine in a 16-Week Randomized Controlled Trial

OBJECTIVE Neuroimaging investigations reveal changes in glucose metabolism (fluorine-18-fluorodeoxyglucose positron emission tomography [PET]) associated with response to disparate antidepressant treatment modalities, including cognitive behavior therapy (CBT), antidepressant pharmacotherapies, and deep brain stimulation. Using a nonrandomized design, the authors previously compared changes following CBT or paroxetine in depressed patients. In this study, the authors report changes in fluorine-18-fluorodeoxyglucose PET in responders to CBT or venlafaxine during a randomized controlled trial. METHODS Subjects meeting DSM-IV-TR criteria for a major depressive episode and a diagnosis of a major depressive disorder received a fluorine-18-fluorodeoxyglucose PET scan before randomization and after 16 weeks of antidepressant treatment with either CBT (N=12) or venlafaxine (N=12). Modality-specific and modality-independent regional brain metabolic changes associated with response status were analyzed. RESULTS Response rates were comparable between the CBT (7/12) and venlafaxine (9/12) groups. Response to either treatment modality was associated with decreased glucose metabolism bilaterally in the orbitofrontal cortex and left medial prefrontal cortex, along with increased metabolism in the right occipital-temporal cortex. Changes in metabolism in the anterior and posterior parts of the subgenual cingulate cortex and the caudate differentiated CBT and venlafaxine responders. CONCLUSIONS Responders to either treatment modality demonstrated reduced metabolism in several prefrontal regions. Consistent with earlier reports, response to CBT was associated with a reciprocal modulation of cortical-limbic connectivity, while venlafaxine engaged additional cortical and striatal regions previously unreported in neuroimaging investigations.

Development and Preliminary Validation of a Trait Version of the Toronto Mindfulness Scale

After developing a trait version of the Toronto Mindfulness Scale (TMS), we evaluated its reliability, its convergent validity with six other trait mindfulness measures, and its construct validity in relation to prior meditation experience. A sample of nonmeditators (N = 218) and meditators (N = 243) with a wide range of meditation experience completed the Trait TMS and the six other mindfulness measures. Internal consistency reliability of the Trait TMS was comparable to that of the original State TMS. Significant positive correlations were found between both TMS factors and the other mindfulness measures; however, in general, the correlations for TMS Decenter were higher than for TMS Curiosity. Scores for TMS Decenter were shown to increase with meditation experience, but this was not the case for TMS Curiosity. The TMS Curiosity factor may assess a unique aspect of the mindfulness construct. Implications of these findings in relation to future mindfulness research are discussed.

Integrating Mindfulness Meditation With Cognitive and Behavioural Therapies: The Challenge of Combining Acceptance- and Change-Based Strategies

Recent innovations in psychological treatments have integrated mindfulness meditation techniques with traditional cognitive and behavioural therapies, challenging traditional cognitive and behavioural therapists to integrate acceptance- and change-based strategies. This article details how 2 treatments, mindfulness-based cognitive therapy and dialectical behaviour therapy, have met this challenge. We review the integration rationale underlying the 2 treatments, how the treatments combine strategies from each modality to accomplish treatment goals, implications for therapist training, and treatment effectiveness. In addition, we discuss the challenges of assessing the benefits of incorporating acceptance-based strategies. Both therapies have integrated acceptance-based mindfulness approaches with change-based cognitive and behavioural therapies to create efficacious treatments.

Inhibitory deficits for negative information in persons with major depressive disorder.

BACKGROUND Within Becks cognitive model of depression, little is known about the mechanism(s) by which activated self-schemas result in the production of negative thoughts. Recent research has demonstrated that inhibitory dysfunction is present in depression, and this deficit is likely valence-specific. However, whether valence-specific inhibitory deficits are associated with increased negative cognition and whether such deficits are specific to depression per se remains unexamined. The authors posit the theory that inhibitory dysfunction may influence the degree to which activated self-schemas result in the production of depressive cognition. METHOD Individuals with major depressive disorder (MDD, n=43) versus healthy (n=36) and non-depressed anxious (n=32) controls were assessed on the Prose Distraction Task (PDT), a measure of cognitive inhibition, and the Stop-Signal Task (SST), a measure of motor response inhibition. These two tasks were modified in order to present emotionally valenced semantic stimuli (i.e. negative, neutral, positive). RESULTS Participants with MDD demonstrated performance impairments on the PDT, which were most pronounced for negatively valenced adjectives, relative to both control groups. Moreover, these impairments correlated with self-report measures of negative thinking and rumination. Conversely, the performance of the MDD participants did not differ from either control group on the SST. CONCLUSIONS Implications of these findings for understanding the mechanisms underlying the development and maintenance of depressive cognition are discussed.

Neurophysiological evidence of cognitive inhibition anomalies in persons with major depressive disorder

OBJECTIVE The neural correlates of inhibitory deficits for emotional semantic material in persons with major depressive disorder (MDD) were investigated. METHODS Individuals (n=15) with a diagnosis of MDD or MDD in partial remission, and healthy controls (n=14) underwent recording of event-related brain potentials (ERPs) while performing a computerized emotional Stroop task. RESULTS There were no group performance differences on the emotional Stroop task. However, the analysis of ERP waveforms revealed a larger negative wave peaking at about 170ms over the left than the right hemisphere only in controls; a negative displacement (N450) at parietal sites for positive and negative words only for persons with MDD; in both groups, processing negative and positive words was associated with a positive displacement that peaked at about 450ms and was larger over the left lateral frontal region; and, the N450 modulation correlated with negative automatic thinking and depressive symptoms. CONCLUSIONS The electrophysiological data reveal early changes in neural activity associated with word processing as well as valence-related changes in the N450 component at parietal sites in MDD. SIGNIFICANCE This valence-related increase in N450 amplitude at parietal sites may reflect an automatic capture of attention by words with emotional valence.

New Developments in Research on Mindfulness-Based Treatments: Introduction to the Special Issue

It has been more than 30 years since the Stress Reduction Clinic at the University of Massachusetts Medical School pioneered the introduction of mindfulness meditation into mainstream health care. In 1979, Jon Kabat-Zinn first offered an eight-session, group-based mindfulness-based stress reduction (MBSR; Kabat-Zinn, 1990) program teaching a secularized version of Buddhist mindfulness meditation practices to help reduce the suffering of individuals with intractable chronic pain. Since then, tens of thousands of individuals have participated in mindfulness-based programs across five continents (http://www.umassmed.edu/content. aspx?id = 41252). Moreover, the clinical scope of MBSR has broadened significantly to include treatment of a wide range of physical disorders and, by significantly contributing to the development of mindfulness-based psychological interventions, to several mental disorders as well. For example, variants of the MBSR program, such as mindfulness-based cognitive therapy (MBCT; Segal, Williams, & Teasdale, 2002), and other mindfulness-based treatments, such as dialectical behavior therapy (Linehan, 1993) and acceptance and commitment therapy (Hayes, Strosahl, & Wilson, 1999), have been specifically designed to help individuals suffering from psychological problems. Mindfulness related research has also increased dramatically. For example, more than 600 mindfulness-related manuscripts were published as of 2006 (Brown, Ryan, & Creswell, 2007). Furthermore, Shapiro (2009) notes that more than 260 mindfulness-based scientific articles have been published on mindfulness in the psychological literature. Initially, mindfulness research was focused primarily on evaluating the efficacy of mindfulness-based treatments in reducing physical and psychological symptoms. These efforts, summarized in several reviews (e.g., Baer, 2003; Bishop, 2002; Brown et al., 2007; Coelho, Canter, & Ernst, 2007; Grossman, Nieman, Schmidt, & Walach, 2004; Toneatto & Nguyen, 2007), have helped to confirm the value of mindfulness-based interventions for a wide range of disorders. Furthermore, in a few cases, the evidence has been sufficiently compelling to support the inclusion of mindfulness-based interventions in treatment guidelines. For example, MBCT is now recommended as a treatment for recurrent depression in the United Kingdoms National Institute for Clinical Excellence (NICE, 2004) guidelines. Approximately 10 years ago, the focus of mindfulness research began to expand to include an interest in investigating the mechanisms underlying mindfulness-based treatment outcomes and more recently to a focus on moderators of treatment response. This special issue focuses on new developments that make up the expanding envelope of mindfulness-based psychological research. Briefly, the articles in this issue include the description and validation of a trait version of the Toronto Mindfulness Scale (Lau et al., 2006), an exploration of the mechanisms underlying the association between increased mindfulness and psychological adjustment, an investigation of whether practicing mindfulness between sessions contributes to symptom improvement, a study of the neural mechanisms underlying increased mindfulness in social anxiety disorder (SAD), and finally an evaluation of whether attachment style moderates participant response to MBSR. The shift in focus from mindfulness treatment to process research was initially hampered by the lack of an operational mindfulness definition and a concomitant mindfulness assessment tool. This gap was subsequently closed with the development of several self-report mindfulness measures, including the Freiburg Mindfulness Inventory (FMI; Buchheld, Grossman, & Walach, 2001), the Mindful Attention Awareness Scale (MAAS; Brown & Ryan, 2003), the Kentucky Inventory of Mindfulness Skills (KIMS; Baer, Smith, & Allen, 2004), the Cognitive and Affective Mindfulness Scale-Revised (CAMS-R; Feldman, Hayes, Kumar, Greeson, & Laurenceau, 2007), the Southhampton Mindfulness Questionnaire (SMQ; Chadwick et al. …

Mindfulness-Based Cognitive Therapy as a Relapse Prevention Approach to Depression

Publisher Summary Mindfulness has been described as a nonelaborative, nonjudgmental, present-centered awareness in which each thought, feeling, or sensation that arises in the attentional field is acknowledged and accepted as it is. In mindfulness, thoughts and feelings are observed as events in the mind, without over-identifying with them, and without reacting to them in an automatic, habitual pattern of reactivity. Mindfulness-informed psychotherapy uses a theoretical framework informed by insights derived from both Buddhist and Western psychology, as well as the personal experience of therapists. Mindfulness-based psychotherapy explicitly educates patients in the practice of mindfulness. These treatments can vary in the degree to which they are based on mindfulness training. The mindfulness-based stress reduction is an intensive eight- to ten-week mindful ness training course that is based almost entirely on formal and informal mindfulness practices.

Evaluating the Mood State Dependence of Automatic Thoughts and Dysfunctional Attitudes in Remitted versus Never-Depressed Individuals

The cognitive model of depression specifies the role of schema-driven negative processing biases in the onset and maintenance of depression. Research has shown that cognitive reactivity, or the ease with which negative thinking patterns are activated by mild changes in negative mood, is related to relapse and recurrence. The goal of this study was to examine cognitive reactivity following a mood prime in individuals vulnerable to depression. Formerly (n = 28) and never (n = 36) depressed individuals were assessed on two measures of negative cognition, the Automatic Thoughts Questionnaire (ATQ) and Dysfunctional Attitudes Scale (DAS), before and after participating in a sad or neutral mood induction procedure (MIP). The negative mood induction resulted in increased belief in negative automatic thoughts across groups; however, only the formerly depressed participants assigned to this condition demonstrated increased DAS scores. Importantly, individuals who completed the neutral mood induction did not exhibit increases in negative cognition, providing evidence against the possibility that the MIP itself may lead to increases in negative cognition. These findings are discussed in relation to understanding the role of negative cognition and vulnerability to depression.