Mindfulness-Based Cognitive Therapy (MBCT), a group psychotherapy developed by Zindel Segal, J. Mark Williams and John Teasdale, prevents depression relapse through a synthesis of mindfulness and cognitive therapy. The practice of mindfulness helps us to pay attention. It allows “emergent insight that is beyond thought but can be articulated through thought” (Jon Kabat-Zinn). This is a process that is compatible with cognitive therapy, which focuses on observing, describing and deconstructing thoughts and beliefs.

There are many techniques for cultivating mindfulness but mindfulness is not a technique. It helps people to become more aware of personal experience. As this awareness develops by a process of non-judgmental observation, a person can change the deeply grooved neural pathways of habitual ruminative thought and troublesome emotional reactions. MBCT emphasizes awareness of process and deemphasizes content, reducing the reinforcement of negative thoughts.

In the last quarter of the 20th Century, wide ranging studies of depression were conducted that showed: 1) depression is a wide-ranging mood disorder affecting a surprisingly highly percentage of people in the western world, 2) depression is highly likely to return after a first episode and comes back quickly, 3) the intervals between recurrences shorten over time. In the field of mental health, second and subsequent episodes are seen as a worsening of the first episode – relapses – rather than new episodes. When this concept of relapse began to be understood, anti-depressant medication began to be prescribed prophylactically to avoid relapse: to treat an acute episode (immediate treatment), to continue treatment (six months beyond the acute episode) and to maintain treatment (3-5 years beyond recovery. These are the current guidelines of the American Psychiatric Association.

These guidelines imply and assume that antidepressant medication, although suppressing symptoms, does not provide a long-term cure. Groundbreaking studies in the 1980’s indicated that medication in combination with interpersonal therapy was more beneficial to patients, in terms of relapse prevention, than the use of medication alone. These studies also showed links between specific skills taught to patients and the prevention of depression relapse. The more skills, the longer patients were able to stay well. Up until that time, a focus of depression treatment had been on the treatment of acute episodes rather than developing maintenance therapies. Important studies in the early 1990s showed that patients who started and stopped medication during and after an acute episode were significantly more likely to relapse than patients receiving cognitive therapy alone. The Seagal, Williams and Teasdale approach grew out of their study of the efficacy of cognitive behavioral as a maintenance approach.

As these important developments in the understanding of depression were taking place, mindfulness-based stress reduction (MBSR) was being developed, with great success, by Jon Kabat-Zinn at the University of Massachusetts. Participants in MBSR were finding significant relief of anxiety disorders and chronic pain. Segal, Williams and Teasdale have adapted the approaches of MBSR to their depression-relapse programs – group meetings, a high level of commitment to treatment, rigorous homework (up to an hour per day) and intensive training in mindfulness meditation.

Segal, Williams and Teasdale have found that MBCT is especially effective for relapse prevention in patients who have experienced three or more episodes of major depression prior to learning and practicing the MBCT skills. In this group, MBCT almost halved the relapse rates compared to conventional treatment. As they say in their book, “MBCT was able to help up to 12 patients in approximately the same time as it often takes to treat just one patient in conventional individual cognitive therapy for depression… we had achieved our aim of developing a new, cost-efficient way to reduce risk of relapse/recurrence of depression” in patients with three or more previous episodes of depression. Segal, et al hypothesize that their treatment is less efficient with people who have had two or fewer recurrences because MBCT treats autonomous relapse processes rather than teaching skills which are helpful in major life events. In other words, it may be that MBCT is more helpful in depression that is brought about by prolonged rumination rather than by major life events.