Zindel Segal

Meditation alters your grey matter, studies show

Move over cryptic crosswords and Sudoku, and make way for the ultimate mental workout. It’s called Mindfulness-Based Stress Reduction, or MBSR for short. Recent neuroscience research shows that novices using the method – developed at the University of Massachusetts Medical School in the 1970s – can get results in just eight weeks.

Brain-changing results, that is.

A 2010 study found that non-meditators who had eight weeks of MBSR training were more likely than a control group to access the brain region that provides a bodily sense of the “here and now” as opposed to the region associated with worry.

In other research published in January, brain scans of MBSR participants with no previous meditation experience showed increased grey-matter density in regions involved in learning and memory, emotion regulation, self-awareness and perspective taking.

Scientists don’t know whether changes in grey-matter density influence a person’s thought patterns or actions, notes Britta Hölzel, lead author of the second study and a research fellow at Massachusetts General Hospital. But she adds that decreased grey-matter concentration in the amygdala – the brain region that controls anxiety – was correlated to lower stress levels reported by participants. “This is actually a link [between] changes in the brain and behaviour.”

Previous studies suggest MBSR is a boon…

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for overall health. Research by Jon Kabat-Zinn, founder of the University of Massachusetts’ Stress Reduction Clinic, established the MBSR program as an effective medical intervention for chronic pain and stress-related illnesses such as high blood pressure. Scientists from the University of Wisconsin-Madison found that graduates of an MBSR course produced more antibodies after flu shots than did non-mediators, which indicated a stronger immune response. And in a 2010 study, researchers at the University of Toronto concluded that mindful meditation was as effective as antidepressants in preventing relapse from clinical depression.

Mindfulness meditation helps to reduce stress by providing insight, says Lucinda Sykes, a Toronto physician who has led MBSR courses since 1997. “Sometimes we’re having a stress response to situations that is actually more the result of our habits of perception and attitude rather than the circumstances themselves,” she explains.

But it may be premature to draw conclusions about the health benefits of MBSR, according to a meta-analysis of meditation research commissioned by the National Center for Complementary and Alternative Medicine in the United States. The report found that the majority of meditation studies published up to the year 2005 had methodological shortcomings.

Compared to some forms of meditation, however, MBSR is a highly systematic practice. The program consists of eight weekly group sessions and a full-day retreat. Participants commit to about 45 minutes a day of exercises that include gentle yoga, sitting meditation and a “body scan,” which involves directing attention to bodily sensations. Exercises at home are led by experts via CDs and participants are encouraged to contact program leaders in between sessions for extra coaching.

Unlike transcendental meditation and various chanting practices, MBSR is not based solely on focusing the mind, says Zindel Segal, a professor of psychiatry at the University of Toronto who developed Mindfulness-Based Cognitive Therapy to treat depression. Instead, mindfulness emphasizes awareness of thoughts, feelings, sounds and sensations from an internal observer’s perspective, without an attempt to judge or alter the experience. “You’re watching the moment by moment ebb and flow of emotions,” Dr. Segal says. “You’re not running away from them but you’re also not getting overwhelmed by them.”

Because it’s a specific method that takes practice, experts discourage beginners from trying MBSR without any guidance. “Most people are going to find it’s easier to do this with a group,” says Dr. Sykes, adding that MBSR alumni often begin a solo practice once they get the hang of it.

Dr. Segal cautions against attempting to “cannibalize” the MBSR program by experimenting with only one of the activities. Although the body scan, yoga and sitting meditation exercises are all designed to cultivate mindfulness, doing just one robs people of the chance to discover which practice is best suited to them, he says.

Dr. Hölzel says it’s unclear which exercises contributed to structural changes found in brain scans of MBSR participants, since the program was tested as a whole. “We cannot tease apart the specific effects of each of the components,” she says.

After the eight-week course is over, the recommended daily dose of MBSR depends on participants’ reasons for entering the program, Dr. Sykes says. Maintaining a new level of insight may be possible in just 10 or 15 minutes a day. But if the goal is to influence a biological variable, such as blood pressure, she says, “it’s likely that you’re going to get the best results if you practice 20 minutes, twice a day.”

Dr. Segal suggests it’s better to do mindfulness exercises for a few minutes each day than to be a weekend meditation warrior. A daily practice becomes woven into the fabric of life, he explains, whereas sporadic mindfulness “is not that fully integrated.”

Mindfulness exercises are compatible with spiritual traditions including Christianity and Judaism, notes Dr. Sykes. Although it’s based on a form of Buddhist meditation called Vipassana, MBSR is a secular program designed for health-care settings, she says.

“People don’t need to become Buddhist to nonetheless benefit from this practice.”

Get with the program

Eight-week workshops modelled after the Mindfulness-Based Stress Reduction program at the University of Massachusetts Medical School are held in cities across Canada:

Toronto: Meditation for Health, www.meditationforhealth.com

Vancouver: MBSR B.C., www.mbsrbc.ca

Ottawa: Ottawa Mindfulness, www.ottawamindfulness.ca

Montreal: Living Arts, www.living-arts.ca

For people who shy away from groups, the MBSR method is outlined in books that include CDs, such as Bob Stahl’s A Mindfulness-Based Stress Reduction Workbook and Zindel Segal’s The Mindful Way through Depression: Freeing Yourself from Chronic Unhappiness.

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Mindfulness meditation improves well-being, researchers report

Sit down. Close your eyes. Focus on your breath. Observe your thoughts objectively as if you were a scientist.

There, you’ve achieved it: mindfulness, a heightened awareness and acceptance of the present moment without judgment.

As simple as it seems, mindfulness, with its origins in the 2,500-year-old Buddhist practices of meditation and yoga, has become the latest buzzword in wellness, as study after study confirms its power to relieve anxiety and improve mood when combined with Western therapies.

Last month University of Toronto researchers reported in the Archives of General Psychiatry that mindfulness-based cognitive therapy, which mixes mindfulness meditation with cognitive behavioral therapy, is as effective as antidepressants for preventing relapses in depression.

Dr. Zindel Segal, head of the Cognitive Behaviour Therapy Clinic at the University of Toronto, and his colleagues gathered 84 participants who had all recuperated from at least two spells of depression.

Participants were then divided into three groups. One group underwent weekly group therapy. Another received an antidepressant. The third took a placebo.

Over the span of one and a half years, 70 percent of the participants who had taken the placebo had one or more relapses of depression. Only 30 percent of those who received the therapy or the antidepressant suffered from another relapse.

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Segal believes the therapy is so effective because it teaches patients how to observe and correct the destructive ways of thinking that typically lead to depression.

“People may get criticized at work or face rejection, but this therapy teaches skills,” he said. “They can watch those negative thoughts and feelings come and go in their mind without having to engage in them. Patients can then decide to take some action which is more adaptive.”

In Chicago hospitals and private practices, mindfulness-based therapies often cater to specific conditions. Integrative Health Partners in the Loop, for example, offers mindfulness classes for those suffering specifically from anxiety, depression, physical pain and compulsive overeating.

These therapies are offered not only in one-on-one sessions, but also in couples therapy and group classes.

Chicago writer Betsy Storm completed a mindfulness-based stress reduction class last summer at Rush University Medical Center. She has continued to meditate ever since because it improved her chronic sleep problems.

“I told somebody that it was one of the best things that happened to me in 2010—adding meditation in my life,” Storm said. “I feel more alert. I’m able to relax more.”

NorthShore Evanston Hospital and the Rehabilitation Institute of Chicago offer mindfulness programming as well. Researchers are conducting studies at various universities in the area including Rush, Loyola and Northwestern.

Dr. David Victorson, assistant professor in Northwestern’s the department of medical social sciences, studies the effects that mindfulness meditation has on patients in the early stages of prostate cancer. He also runs a nonprofit called True North Treks to bring young cancer survivors together on mindfulness wilderness trips.

Many of the area’s mindfulness professionals meet monthly for networking opportunities, and annually for a teacher’s retreat. The group, called The Chicago Area Mindfulness-Based Stress Reduction Teacher’s Sangha, has about 30 members, according to founder Holly Nelson-Johnson.

She said several of the group’s members were the first to bring mindfulness-based stress reduction therapy to Chicago in the mid-90s after training with the therapy’s founder Jon Kabat-Zinn. The group later opened the first mindfulness-based stress reduction clinic in Illinois at Cook County Hospital in 1996.

Today, the group helps Chicagoans suffering from sleep deprivation, stress and anxiety. The Amsterdam-based Philips Center for Health and Well-Being recently found that Americans could use the help. In a global survey, the center found that about 49 percent of Americans reported they were too worried or stressed out to sleep.

For some, this figure may indicate that cultural values are responsible for the anxiety and stress that mindfulness-based therapies help to reduce.

“My two-year-old knows his alphabet, numbers and colors, all because of a computer,” said Vered Hankin, a mindfulness-based stress reduction therapist in Chicago. “That’s great, but you’ll learn all that eventually. But will you learn to tap into your intuition and creativity? Not if your TV or phone is always on. That’s important to remember in our society. After running around and information gathering, do we really know how to come back to the self?”

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Stressed out? Try mindfulness meditation (Toronto Globe & Mail)

Zindel Segal was in a Toronto bookstore a few weeks ago, when a title caught his eye. The book, The Mindful Investor, caused him a moment of shock and panic.

“I turned to someone and said, ‘This is the beginning of the end,’ ” recalls Dr. Segal, who heads the cognitive behaviour therapy clinic at Toronto’s Centre for Addiction and Mental Health.

The book, which purports to explain how a calm mind can help a person achieve financial security, is a sign that the concept of mindfulness is making a leap into mass popularity. But that doesn’t mean people actually understand it, he says.

Mindfulness is a technique for slowing down and examining one’s thought processes, and learning to be in the moment. Based on Buddhist principles, it became popular in the United States in the 1970s, and was taken up by celebs such as Meg Ryan and Goldie Hawn. Today, researchers are studying its benefits for everything from depression to stress.

In a multi-year study, whose results were published last month in the Archives of General Psychiatry, Dr. Segal and a group of colleagues found that mindfulness meditation – the term they use is “mindfulness-based cognitive therapy” – was just as effective as antidepressants when it came to preventing depression relapse.

Dr. Segal, who was one of the developers of the therapy, teaches it at CAMH in group treatment sessions with patients who have…

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recovered from depression and are “trying to stay well.”

“We’re seeing a demand as people feel that it’s more and more legitimate,” Dr. Segal says. He defines mindfulness meditation as “a way of training yourself to pay attention in the present moment without judgment [as] to what your experience is.”

Thanks to a similar U.K. study, which found the technique reduces the risk of depression relapse by 50 per cent, Britain’s National Institute for Clinical Excellence recommends mindfulness meditation in cases of chronic depression. The Mental Health Foundation, a U.K.-based charity, has recentlylaunched a campaign called Be Mindful, and offers an online program intended to make mindfulness more widely available.

“It’s growing exponentially almost, in terms of there now being an evidence base,” says Ed Halliwell, a British mindfulness teacher and co-author of The Mindfulness Manifesto: How Doing Less and Noticing More Can help Us Thrive in a Stressed-out World. While the field is still relatively new, some 300 to 400 studies are published each year, Mr. Halliwell estimates.

The studies show benefits for many conditions, including anxiety and stress. A study published last year in the journal Neurology found that mindfulness could be used to help people with multiple sclerosis.

And just as it is becoming more popular among researchers, it is also increasingly being sought out by busy professionals.

“Life these days is these days so full of stress … so I think this offers some way of simplifying our life,” says Marian Smith, founder of Mindful Living, a Vancouver-based clinic. Many clients, says Ms. Smith, are dealing with “the challenge of juggling full-time work, having a family, trying to make life meaningful to themselves and to be grounded.”

Doug MacLean, a mindfulness meditation instructor and owner of Practical Wellbeing in Calgary, says there has been an “explosion” in interest, in large part because of the research being published on the topic.

But some experts worry that some people may think all they need to do to solve their problems is close their eyes and pay attention to what’s going on in their heads.

“That can be a real danger, because people can go, ‘All I need to do is be mindful.’ And then perhaps they try meditation and discover it’s not easy – it’s simple, but it’s not easy – and then that can create another level of beating yourself up,” Mr. Halliwell says.

Dr. Segal says that people need to understand that mindfulness is much different than the popular idea of meditation.

“You think of the Beatles, you think of TM [transcendental meditation], you think of people achieving some kind of bliss state. And it’s really different from what people who are going through mindfulness-based cognitive therapy get,” he says. “If anything, what the meditation does is provide them with a way of staying grounded in the midst of very difficult emotions.”

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Mindfulness therapy is no fad, experts say (LA Times)

There is solid evidence that mindfulness therapy, which combines elements of Buddhism and yoga, can relieve anxiety and improve mood.

Of all fields of medicine, psychology seems especially prone to fads. Freudian dream analysis, recovered memory therapy, eye movement desensitization for trauma — lots of once-hot psychological theories and treatments eventually fizzled.

Now along comes mindfulness therapy, a meditation-based treatment with foundations in Buddhism and yoga that’s taking off in private practices and university psychology departments across the country.

“Mindfulness has become a buzzword, especially with younger therapists,” said Stefan Hofmann, a professor of psychology at Boston University’s Center for Anxiety and Related Disorders.

Mindfulness therapy encourages patients to focus on their breathing and their body, to notice but not judge their thoughts and to generally…

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live in the moment. It may sound a bit squishy and New Agey to some, but Hofmann and other experts say mindfulness has something that discredited theories of the past never had: solid evidence that it can help.

“I was skeptical at first.” Hofmann said. “I wondered, ‘Why on Earth should this work?’ But it seems to work quite well.”

Hofmann and colleagues burnished the scientific credentials of mindfulness therapy with a review article in the April issue of the Journal of Consulting and Clinical Psychology. After combining results of 39 previous studies involving 1,140 patients, the researchers concluded that mindfulness therapy was effective for relieving anxiety and improving mood.

The treatment seemed to help ease the mental stress of people recovering from cancer and other serious illnesses, but it had the strongest benefits for people diagnosed with mood disorders, including generalized anxiety disorder and recurring depression.

Jordan Elliott, a 26-year-old marketer for a New York publishing company, said mindfulness training had helped pushed his once-disabling anxiety — about work, the weather, the meaning of life — into the background. “The anxiety is still there, but it’s not as bad as it was,” he said.

Elliott started getting one-on-one therapy four years ago at the American Institute for Cognitive Therapy in New York. It was hard at first, partly because he was skeptical of the technique and partly because he didn’t feel particularly mindful. “I was such a nervous wreck I could hardly sit still for three minutes,” he said.

Now he starts every day with a 10-minute meditation. He sits cross-legged in his apartment, TV and music off, and thinks about his breathing.

“When a negative thought pops off in my head, I say to myself, ‘There’s a thought. And feelings aren’t facts.’ ”

Elliott said he was taking Prozac before he started mindfulness therapy, but he no longer needed medication to keep his anxiety under control.

“It’s pretty clear that people can improve their health if they can encourage this practice in their lives,” said David Fresco, an associate professor of psychology at Kent State University in Ohio. “But we have to be careful not to move beyond the data too quickly.”

Fresco warns that mindfulness treatment is unlikely to help someone suffering from severe and ongoing depression. Those patients, he said, need a more active approach to recovery, perhaps including antidepressants and cognitive behavioral therapy, a type of counseling that encourages patients to question the validity of their negative thoughts.

Once recovery from depression begins, however, mindfulness therapy could provide a valuable defense against future episodes, said Zindel Segal, a professor of psychiatry at the University of Toronto who was one of the pioneers behind mindfulness-based cognitive therapy, or MBCT, a treatment that combines mindfulness with cognitive behavioral therapy.

In December, Segal and colleagues published a study in the Archives of General Psychiatry suggesting that the treatment was as effective as antidepressants for preventing relapses of depression.

The study involved 84 patients who had recovered from at least two bouts of major depression. The patients were broken up into three groups: One had eight weekly group sessions of the therapy, one took an antidepressant and one took a placebo. Over 18 months, about 70% of patients taking a placebo suffered at least one more episode of depression. By comparison, only about 30% of patients receiving therapy or taking an antidepressant had a setback.

Segal said mindfulness therapy could help patients avoid rumination, the process of endlessly chewing on incidents from the past. Rumination is a driving force behind depression, he said, and it just doesn’t mesh with mindful thinking. He also believes that by encouraging patients to focus on their current thoughts, mindfulness can discourage anxiety and worry — up to a point.

“If you’re having panic attacks in the mall, mindfulness therapy on its own isn’t going to be enough,” he said.

Segal adds that mindfulness treatment changes the relationship people have with their emotions, so much so that shifts in brain activity even show up in magnetic resonance imaging tests.

“When your mind has a thought, such as, ‘My colleague just insulted me at the office,’ you can explore the consequences of that thought,” he said. “Thoughts have a less intense grip because you are an observer.”

Hofmann said most patients could pick up mindfulness fairly easily, but it’s not for everyone.

“It takes quite a bit of intelligence,” he said. “It’s good for people who like intellectual stimulation.”

In addition, children, older people (who tend to be more set in their ways) and rigid thinkers may have trouble understanding or embracing the treatment, he said.

Hofmann hopes that the ongoing flood of mindfulness studies will help clarify the benefits and limitations of the approach and ultimately shape the way that the therapy is offered in the real world.

“Some therapists embrace these new and sexy treatments without a lot of critical thinking because they sound cool,” he said.

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Conquering self-doubt with mindfulness-based therapies

The boss loves your work. Your spouse thinks you’re sexy. The kids—and even the cat—shower you with affection. But then there’s the Voice, the nagging presence in your head that tells you you’re a homely, heartless slacker.

Even people who appear supremely fit, highly successful and hyper-organized are sometimes riddled with debilitating doubts, fears and self-criticisms.

“Most people are struggling with difficult thoughts and feelings. But the show we put on for others says ‘I’ve got it handled,'” says Steven C. Hayes, a professor of psychology at University of Nevada-Reno. In reality, however, “there’s a big difference between what’s on the outside and what’s on the inside.”

Cognitive-behavioral therapy aims to help patients conquer their self doubts in two ways: Either by changing the behaviors that go along with it (I’m so fat—I need to get to the gym!) or by challenging the underlying thoughts, which are often distorted. (I’m 45-years old and I’m comparing myself to anorexic models. Get serious!)

Now, a third-wave of cognitive-behavioral therapy is catching on…

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in psychology and self-help circles. It holds that simply observing your critical thoughts without judging them is a more effective way to tame them than pressuring yourself to change or denying their validity.

” ‘Tame’ is an interesting word,” says Dr. Hayes, who pioneered one approach, called Acceptance and Commitment Therapy. “How would you go about taming a wild horse? You wouldn’t whip it back into a corner. You’d pat it on the nose and give it some carrots and eventually try to ride it.”

This new psychology movement centers on mindfulness—the increasing popular emphasis on paying attention to the present moment. One of its key tenets is that urging people to stop thinking negative thoughts only tightens their grip—”like struggling with quicksand,” Dr. Hayes says. But simply observing them like passing clouds can diffuse their emotional power, proponents say, and open up more options. (“Here’s that old fat feeling again. You know, this happens every time I look at fashion magazines. I am sure judging myself harshly. Do I want to go to the gym? Or I could go to a movie. Or I could stop reading magazines.”)

“Part of what mindfulness does is get to you to recognize that these critical thoughts are really stories you have created about yourself. They are not necessarily true, but they can have self-fulfilling consequences,” says Zindel V. Segal, a professor of psychiatry at the University of Toronto who devised Mindfulness-Based Cognitive Therapy to help depressed patients. “If you can get some distance from them, you can see that there are choices about how to respond.”

Mindfulness also involves paying attention to your breathing and other physical sensations while observing your thoughts so you have a tapestry of information to consider, says Dr. Segal. In fact, neuro-imaging studies have shown that when people consider problems mindfully, they use additional brain circuits beyond those that simply involve problem-solving.

Although some critics initially dismissed mindfulness-based therapies as vacuous and New Age-y, dozens of randomized-controlled trials in the past decade have shown that they can be effective in managing depression, panic disorders, social phobias, sleep problems and even borderline personality disorder.

A study of 160 patients with major depression, led by Dr. Segal and published in the Archives of General Psychiatry last month, found that mindfulness-based cognitive therapy was just as good at as antidepressants at warding off relapses of depression.

The National Institutes of Health is funding more than 50 research studies involving mindfulness treatments for psychological problems.

A growing number of therapists are also using mindfulness-based acceptance in their practices. Katherine Muller, associate director of the Center for Integrative Psychotherapy in Allentown, Pa., says she sometimes brings out a little plastic gnome to represent a patient’s negative feelings. “The idea is, ‘These feelings are going to come. What are you going to do about them?’ ” she says. “You don’t have to react to them at all. Just allowing them to exist takes away their power.”

She also finds that practicing mindfulness is more effective at easing her own fear of flying than being reminded about the safety statistics.

On one flight, she says, “all my cognitive skills were going right out the window.” Then another psychologist suggested focusing on the tray table rather than fighting her fears. “It helped me center my head and get a grip,” she says. “It gave me a chance to watch the movie and talk to the person next to me, rather than focus on how the plane might go down in a fiery ball.”

Psychologist Dennis Tirch, director of the New York Center for Mindfulness, Acceptance and Compassion-Focused Therapies, uses this formula to help even people with profound developmental disabilities take control of their emotions: “Feel your soles of your feet. Feel yourself breathe. Label your emotions and make space for your thoughts.”

Extending some compassion for yourself is also an important part of the new mindfulness therapies, Dr. Tirch says. “I can’t tell you how many clients I have who are just beating themselves up about things” says Dr. Tirch. “Give yourself a break—not so you can curl up in bed and stay home, but so you can interact better with the world.”

Kindness and accepting your thoughts nonjudgmentally doesn’t mean having to settle for the status quo, proponents say. Rather than be paralyzed by negative thoughts, you can opt to change your situation—get to the gym or work harder—but with a clearer set of options based on what really matters.

Some critics note that such advice doesn’t sound so different from standard cognitive-behavioral therapy or being kind to the “inner child” of earlier psychotherapy approaches. And some experts say that still more scientific data are needed to evaluate its effectiveness, particularly now that it’s being applied to such a wide array of disorders.

It’s also not clear yet who might benefit most from mindfully accepting their thoughts rather than reasoning with them. For example, Dr. Tirch thinks that it’s still important to convince someone with severe agoraphobia that a piano won’t fall on their head if they leave the house.

Yet Marsha Linehan, a professor of psychology at the University of Washington, found that the acceptance therapy she developed in the 1990s enabled suicidal patients and those with borderline personality disorder to accept their feelings and get help while trying to challenge them would only have created more bad feelings.

“It’s the nonjudgmental part that trips most people up,” says Dr. Linehan. “Most of us think that if we are judgmental enough, things will change. But judgment makes it harder to change.” She adds: “What happens in mindfulness over the long haul is that you finally accept that you’ve seen this soap opera before and you can turn off the TV.”

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Mindfulness therapy beats drugs in preventing depression relapse

Mindfulness therapy — in the form known as mindfulness-based cognitive therapy (MBCT)– demonstrates greater efficacy than antidepressant medications for the prevention of a depression relapse, according to new data.

MBCT combines the use of tried-and-true cognitive-behavioral therapy (CBT) techniques with greater focus on self-awareness and self-reflection.

In the current study, the researchers describe how they implemented mindfulness-based therapy: “This is accomplished through daily homework exercises featuring (1) guided (taped) awareness exercises directed at increasing moment-by-moment nonjudgmental awareness of bodily sensations, thoughts, and feelings; (2) accepting difficulties with a stance of self-compassion; and (3) developing an ‘action plan’ composed of strategies for responding to early warning signs of relapse/recurrence.”

Researchers led by Zindel Segal, Ph.D., of the Centre for Addiction and Mental Health in Canada, studied 160 adults who met major depressive disorder criteria and had at least two previous episodes of depression.

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After eight months of treatment, 84 — over half — achieved remission from depression. Patients in remission were then randomly assigned to one of three treatment groups: 28 continued taking their medication; 30 had their medication slowly replaced by placebo; and 26 tapered their medication and then received MBCT.

The mindfulness therapy group had the lowest relapse rate at the 18-month followup — 38 percent, compared with 46 percent who were on maintenance antidepressant medication, an 8 percent difference. The placebo group had the worst depression relapse rate of 60 percent.

The researchers further examined and categorized people in the study according to whether they were considered stable or unstable remitters. About half (51 percent) of patients were classified as unstable remitters — individuals who had symptom “flurries” or intermittently higher scores on depression rating scales despite having a low enough average score to qualify for remission. The other half (49 percent) were stable remitters with consistently low scores.

Among unstable remitters, those taking maintenance medication or undergoing cognitive behavioral therapy were about 73 percent less likely to relapse than those taking placebo. Among stable remitters, there were no differences between the three groups.

“Our data highlight the importance of maintaining at least one active long-term treatment in recurrently depressed patients whose remission is unstable,” the authors wrote.

“For those unwilling or unable to tolerate maintenance antidepressant treatment, mindfulness-based cognitive therapy offers equal protection from relapse during an 18-month period.”

It is unclear exactly how mindfulness-based therapy works, but it may change neural pathways to support patterns that lead to recovery instead of to deeper depression, they note.

“Relapse and recurrence after recovery from major depressive disorder are common and debilitating outcomes that carry enormous personal, familial and societal costs,” the authors wrote as background information in the article.

The current standard for preventing relapse is maintenance therapy with a single antidepressant. This regimen is generally effective if patients take their medications, but as many as 40 percent of them do not.

“Alternatives to long-term antidepressant monotherapy, especially those that address mood outcomes in a broader context of well-being, may appeal to patients wary of continued intervention,” the authors said.

The study appears in the December issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

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Warding off depression: ‘mindfulness’ therapy works as well as drugs

Meditating daily and being mindful of life events that make you happy or sad may be as effective as taking medication to prevent a relapse of depression, a new study suggests.

By undergoing what is called mindfulness-based cognitive therapy, people can learn how to meditate and pay attention to emotional triggers, said study researcher Zindel V. Segal, of the Centre for Addiction and Mental Health in Canada.

“When you do that, you gain better control over cognitive emotions that can trigger relapse without you being aware of it,” Segal told MyHealthNewsDaily.

Antidepressants provide chemicals that impact brain regions involved in depression. Research shows that only about 40 percent of people in remission for depression adhere to their medication regimen, Segal said.

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The new finding suggests that mindfulness therapy could be used as a substitute for or addition to medication, Segal said. However, “if someone is on an antidepressant, coming off needs to be decision made with a health care professional,” he said.

The study was published in the December issue of the journal Archives of General Psychiatry.

Effects of reflection

Researchers studied 84 people ages 18 to 65 who had taken medication to treat their depression over an eight-month period, and were in remission. The researchers divided them into three groups: one continued taking medication, one underwent mindfulness-based cognitive therapy and one had their medication slowly replaced by a placebo.

“All of these patients received treatment through a hospital, so this is something that was conducted with mental health professionals keeping track of them continuously to detect possible relapse,” Segal said.

After 18 months, 38 percent of people who’d learned to meditate had relapsed, according to the study. Forty-six percent of people in the medication group relapsed, and 60 percent in the placebo group relapsed.

Because of the way the results were analyzed statistically, researchers could not conclude whether the difference between the meditation and the medication groups was due to chance, Segal said. But they could show the improvements in both of those groups over those taking the placebo was not due to chance.

The mindfulness therapy consisted of eight weeks of group training sessions, during which patients learned how to monitor their thinking patterns. They were taught to change their automatic reactions to triggers for sadness, and instead use those times as an opportunity to reflect on their feelings, Segal said. They were also taught to come up with an action plan with strategies for coping with early signs of relapse.

After the training sessions, the patients were required to set aside about 40 minutes a day for meditation and mindfulness exercises, he said.

“If you had depression triggers,” Segal said, you might turn your attention instead to the fact that “you enjoy eating your food, and that you walk outside and it’s a bright sunny day.”

Seeing results

Mindfulness-based cognitive therapy can be a good alternative to medication for multiple reasons, Segal said. Although the therapy sessions cost money, the maintenance after those sessions — daily meditation and being mindful of depression triggers — doesn’t cost a dime, he said. Maintenance medication, on the other hand, is an ongoing expense.

Pregnant women and people who don’t like the side effects or don’t want to constantly be on medication may also want an alternative to maintenance antidepressants, said Elizabeth Robinson, an assistant psychiatry professor at the University of Michigan, who was not involved in the study.

By teaching someone a new skill, they have something they can carry over with them, “whether they continue taking medication or not,” she said. Robinson teaches mindfulness-based cognitive therapy classes in Michigan and sees results in her students first-hand.

“What you see with people is they take a different look, their perspective on their personal experience shifts,” she said.

Beyond dealing with depression, meditation can help people find different ways of navigating relationships, Robinson said.

Mindfulness-based cognitive therapy is only available in large cities or places with large medical presences. Segal is researching ways to make the therapy available to people in remote communities, possibly over the Internet.

Pass it on: The study suggests that health care providers could provide information about meditation as an option to their patients who don’t want to continue taking antidepressants to prevent relapse.

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