Video Transcript - Video with Dr. Segal - Show me the Evidence (Spring 2012, Volume 1, Issue 2; YouTube: Mindfulness-Based Cognitive Therapy)

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Preventing relapse episodes in patients suffering from chronic depression is a major challenge.

Antidepressant medication is usually the most reliable long-term treatment.

But long-term use of such medications isn't always an option.

Dr. Zindel Segal and his colleagues have developed mindfulness-based cognitive therapy (MBCT) as an alternative solution.

Dr. Zindel Segal
Centre for Addiction and Mental Health

The people that we've found really respond to mindfulness-based cognitive therapy are patients who have had multiple past episodes of depression. Now this is somewhat surprising, because in the past it has been the people who have had fewer episodes who have responded to psychotherapy, and patients who have had more episodes who have responded to an antidepressant.

MBCT combines traditional cognitive therapy sessions with "homework" in the form of meditation.

The "homework" helps reinforce learning from the therapy sessions.

Those are formal periods of mindfulness meditation where they may be asked to sit for 30–40 minutes, but there are also informal practices where people are asked to bring the same awareness into their everyday lives. If they're standing in line at the bank; if they're driving in their car; if they're finding themselves having a stressful conversation, to use the same emotion regulation skills and ability to watch their experience without being fully pulled into it. And as a result of that, they need to be training themselves on an ongoing basis.

MBCT trains patients to observe and label their emotions.

Brain imaging studies indicate that this training affects brain activity.

Following training in mindfulness, what we found was that the frontal regions were less active, and regions that were more active were the insula and operculum areas, which are more lateralized, and are specialized for processing interoceptive information. In other words, less thinking and more feeling of emotions. Less evaluating and problem solving of emotions.

Ongoing randomized controlled trials are evaluating MBCT's effectiveness in treating recurrent depression and other mental health issues.

There have also been extensions using the MBCT model for anxious children, for bipolar disorder, and I think that this is something which is going to continue as randomized trials allow us to see whether this treatment is quite beneficial.

The next challenge will be to improve access to MBCT.

I think a continuing challenge for MBCT is that the opportunity for patients to access this form of care is still relatively limited. And so dissemination and increasing access may require that this treatment be digitized and made available in online formats, so that patients, no matter where they are – living in remote communities or unable to access a mindfulness-based cognitive therapist – can still benefit from the program that we've put together.