Clinical Psychology Science and Practice
January 1, 2004
Scott R. Bishop, Mark A. Lau, Shauna L. Shapiro et al.
6,266 citations
Mindfulness has attracted considerable interest as a way to reduce cognitive vulnerability to stress and emotional distress, but it has not been defined operationally. Recent consensus meetings produced a two-component model of mindfulness, specifying each component in terms of specific behaviors, experiential manifestations, and psychological processes. The paper addresses temporal stability and situational specificity, speculates on the conceptual and operational distinctiveness of mindfulness, and discusses implications for instrument development and measurement.
Journal of Consulting and Clinical Psychology
January 1, 2000
John D. Teasdale, Zindel V. Segal, James Williams et al.
2,613 citations
Mindfulness-based cognitive therapy (MBCT), a group intervention, trains recovered recurrently depressed patients to disengage from depressive thinking patterns that can trigger relapse. In a randomized trial with 145 recovered recurrently depressed patients, MBCT plus treatment as usual was compared to treatment as usual alone over 60 weeks. For patients with three or more previous depressive episodes (77% of the sample), MBCT significantly reduced the risk of relapse or recurrence. However, for patients with only two previous episodes, MBCT did not reduce relapse. MBCT offers a promising, cost-effective psychological approach to preventing relapse in recovered recurrently depressed patients.
Journal of Clinical Psychology
January 1, 2006
Mark A. Lau, Scott R. Bishop, Zindel V. Segal et al.
1,462 citations
A new self-report questionnaire, the Toronto Mindfulness Scale (TMS), measures the state of mindfulness. In two studies, the scale showed good internal consistency and two factors: Curiosity and Decentering. TMS scores increased with more mindfulness meditation experience. In a second study, participants in an 8-week mindfulness-based stress reduction program showed increased TMS scores after treatment, and Decentering scores predicted improvements in clinical outcomes. The TMS is a promising measure with good psychometric properties and predictive validity for treatment outcome.
Social Cognitive and Affective Neuroscience
August 13, 2007
Norman A. S. Farb, Zindel V. Segal, Helen S. Mayberg et al.
1,305 citations
Two distinct forms of self-awareness—one linking experiences across time (narrative focus) and one centered on the present moment (experiential focus)—rely on different brain networks and can be dissociated through mindfulness training. In novice participants, focusing on the present reduced activity in cortical midline regions (medial prefrontal cortex) associated with narrative self-reference. In participants who completed an 8-week mindfulness course, present-moment focus produced more extensive reductions in the medial prefrontal cortex and increased engagement of a right-lateralized network including the lateral prefrontal cortex, insula, and somatosensory areas. Functional connectivity showed strong coupling between the right insula and medial prefrontal cortex in novices that was absent in the mindfulness group, indicating attentional training can uncouple these normally integrated forms of self-awareness.
Journal of Consulting and Clinical Psychology
January 1, 2002
John D. Teasdale, Richard G. Moore, Hazel Hayhurst et al.
966 citations
Metacognitive awareness—experiencing negative thoughts and feelings as passing mental events rather than as reflections of the self—may protect against depression relapse. In a vulnerable group of residually depressed patients, reduced accessibility of this metacognitive set was linked to greater relapse risk. Cognitive therapy (CT) and mindfulness-based cognitive therapy (MBCT) both reduced relapse by increasing metacognitive awareness, not by altering belief in thought content. CT increased accessibility of metacognitive sets in residually depressed patients, and MBCT did so in recovered depressed patients. These therapies may work by changing how people relate to their thoughts.
JAMA Psychiatry
April 28, 2016
Willem Kuyken, Fiona C Warren, Rod S Taylor et al.
815 citations
For people with recurrent depression, mindfulness-based cognitive therapy (MBCT) reduces the risk of depressive relapse within a 60-week follow-up period compared with usual care or other active treatments, including antidepressants. A meta-analysis of individual patient data from 9 randomized trials involving 1258 patients (mean age 47.1 years, 75% female) found that those receiving MBCT had a 31% lower risk of relapse versus no MBCT (hazard ratio 0.69), and a 21% lower risk versus other active treatments (hazard ratio 0.79). Sociodemographic and psychiatric variables did not significantly modify the treatment effect, but greater severity of depressive symptoms before treatment was associated with a larger benefit from MBCT.
Social Cognitive and Affective Neuroscience
June 11, 2012
Norman A. S. Farb, Zindel V. Segal, Adam K. Anderson
566 citations
Graduates of an 8-week Mindfulness-Based Stress Reduction course, compared to a waitlisted control group, showed changes in brain activity during a task requiring attention to breathing sensations. Functional MRI revealed that mindfulness training predicted greater activity in the anterior insula, a brain region that integrates internal body sensations with external context. The training also predicted reduced activity in the dorsomedial prefrontal cortex and altered connectivity between that region and the posterior insula, the primary interoceptive cortex. Greater meditation practice was linked to more posterior insula activity and less reliance on visual brain regions during the task. These results suggest that mindfulness training produces plasticity in brain networks involved in sensing the body's internal state, similar to training-related changes seen in the external senses.
Current Directions in Psychological Science
December 1, 2013
Rimma Teper, Zindel V. Segal, Michael Inzlicht
557 citations
Mindfulness training improves emotion regulation by enhancing executive control, according to a proposed model. Present-moment awareness and nonjudgmental acceptance increase sensitivity to affective cues in experience, refining attunement to subtle emotional changes. This heightened openness signals the need for control, thereby improving executive control and ultimately emotion regulation. The model integrates new findings from executive control research to explain how mindfulness cultivates effective emotion regulation, addressing a gap in understanding the mechanisms behind its psychological benefits.
Emotion
February 1, 2010
Norman A. S. Farb, Adam K. Anderson, Helen S. Mayberg et al.
523 citations
Mindfulness training alters the brain's response to sadness, shifting activity from self-referential cortical midline regions toward right-lateralized visceral and somatosensory areas associated with body sensation. After eight weeks of mindfulness training, participants showed this distinct neural pattern during sadness provocation compared to waitlisted controls, even though both groups reported equivalent levels of sadness. The greater somatic brain response in the mindfulness group was linked to lower depression scores. Restoring balance between affective and sensory neural networks—supporting conceptual versus body-based emotion representations—may be one mechanism through which mindfulness reduces vulnerability to dysphoric reactivity.
Journal of Abnormal Psychology
January 1, 2000
James Williams, John D. Teasdale, Zindel V. Segal et al.
436 citations
Recovered depressed patients who received a psychological treatment designed to reduce relapse risk recalled fewer generic memories in response to cue words, while those receiving usual care showed no change. This suggests that overgeneral autobiographical memory, previously observed in depressed, suicidal, and PTSD patients, can be modified through treatment.
Clinical Psychology & Psychotherapy
March 1, 2002
Zindel V. Segal, John D. Teasdale, Jane Williams et al.
420 citations
A 17-item scale, the Mindfulness-Based Cognitive Therapy Adherence Scale (MBCT-AS), was developed to measure how closely therapists follow the MBCT protocol for preventing recurrence of major depressive disorder. The scale assesses behaviors specific to MBCT and those shared with cognitive behavior therapy (CBT). Independent ratings of recorded group sessions showed that raters could use the MBCT-AS reliably, MBCT therapists adhered to the protocol, and MBCT could be distinguished from CBT on both the MBCT-AS and a CBT adherence scale. The MBCT-AS may help ensure proper delivery of MBCT in future research and identify unique elements of the treatment.
The Canadian Journal of Psychiatry
February 1, 2012
Norman A. S. Farb, Adam K. Anderson, Zindel V. Segal
361 citations
Mindfulness training enhances focused attention through changes in the anterior cingulate cortex and lateral prefrontal cortex. In emotion regulation, these changes promote a nonconceptual sensory pathway as an alternative to cognitive reappraisal of negative emotion. The transition to nonconceptual awareness reduces evaluative processing supported by midline prefrontal structures, directing attention toward a limbic pathway for present-moment sensory awareness involving the thalamus, insula, and primary sensory regions. For people with affective disorders, mindfulness provides an alternative to cognitive control of negative emotion, directing attention to the transitory nature of experience. Limiting cognitive elaboration in favor of momentary awareness reduces automatic negative self-evaluation, increases tolerance for negative affect and pain, and helps engender self-compassion and empathy in people with chronic dysphoria.
Sleep
August 29, 2014
Jason C Ong, Rachel Manber, Zindel V. Segal et al.
338 citations
Mindfulness meditation reduces chronic insomnia symptoms. In a three-arm trial, 54 adults with chronic insomnia were randomly assigned to mindfulness-based stress reduction (MBSR), mindfulness-based therapy for insomnia (MBTI), or self-monitoring (SM). Those receiving either meditation intervention showed significantly greater reductions in total wake time (43.75 vs 1.09 minutes), pre-sleep arousal (7.13 vs 0.16 points), and insomnia severity (4.56 vs 0.06 points) from baseline to post-treatment compared to SM. At 6-month follow-up, MBTI produced greater insomnia severity reductions than MBSR, with 50% remission and 78.6% response rates. Mindfulness meditation offers a viable treatment alternative for chronic insomnia.
Clinical Psychology & Psychotherapy
November 1, 2007
Nicole D. Anderson, Mark A. Lau, Zindel V. Segal et al.
326 citations
Healthy adults who completed an 8-week Mindfulness-Based Stress Reduction (MBSR) course reported greater improvements in emotional well-being and mindfulness compared to a wait-list control group, but showed no improvements in attentional control. Improvements in mindfulness after MBSR were correlated with better detection of objects in visual scenes, suggesting a link between mindfulness and non-directed attention.
American Psychologist
October 1, 2015
Sona Dimidjian, Zindel V. Segal
297 citations
Mindfulness-based interventions (MBIs) like mindfulness-based cognitive therapy and mindfulness-based stress reduction are widely studied, but their public health impact could be improved by embedding them in a broader clinical psychological science framework. Using the National Institutes of Health stage model, the authors identify gaps in the current evidence base and argue that continuing to produce similar studies without addressing these gaps will limit the relevance and reach of MBIs. Seven recommendations are offered to integrate core research questions, improve methodological quality, and strengthen links among stages of clinical translation to better address mental health needs.
Journal of Consulting and Clinical Psychology
March 12, 2012
Peter Bieling, Lance L. Hawley, Richard T. Bloch et al.
239 citations
Mindfulness-based cognitive therapy (MBCT) fosters metacognitive skills—specifically the ability to decenter from thoughts and feelings and to approach them with curiosity—that are not acquired through antidepressant medication alone. In a randomized trial, patients who discontinued antidepressants and received MBCT showed significant increases in decentering and wider experiences, while those who continued medication or switched to placebo did not. These skills predicted lower depression scores at 6-month follow-up. The findings suggest that MBCT's effectiveness for preventing depressive relapse may stem from cultivating a decentered, curious stance toward one's own mental events.
Clinical Psychology Science and Practice
January 1, 2003
John D. Teasdale, Zindel V. Segal, James Williams
215 citations
Mindfulness-based clinical interventions are generally effective, but applying mindfulness as a generic technique across different disorders without tailoring it to the specific factors maintaining each condition is cautioned against. The text raises six issues: mindfulness can be unhelpful in some contexts; effective mindfulness instruction includes a clear problem formulation shared with clients; there may be multiple dimensions of effectiveness underlying its apparent simplicity; mindfulness originated from a particular view of emotional suffering that implies broader changes beyond meditation; professionals should match mindfulness components to the targeted psychopathology; and mindfulness may affect processes common to different pathologies.
Psychotherapy and Psychosomatics
January 1, 2016
Stuart J. Eisendrath, Erin P Gillung, Kevin L. Delucchi et al.
193 citations
For adults with treatment-resistant depression, adding mindfulness-based cognitive therapy (MBCT) to usual pharmacotherapy produced a significantly greater reduction in depression severity (36.6% vs. 25.3% on the Hamilton Depression Rating Scale) and a higher rate of treatment responders (30.3% vs. 15.3%) after eight weeks, compared with an active control program of physical fitness, music therapy, and nutritional education. Remission rates did not differ significantly between groups (22.4% vs. 13.9%). Higher state anxiety, perceived stress, and personality disorder were associated with worse outcomes. MBCT appears to be a viable adjunctive treatment for treatment-resistant depression.
Journal of Medical Internet Research
March 24, 2014
Jennifer M. Boggs, Arne Beck, Jennifer N. Felder et al.
73 citations
A Web-based program called Mindful Mood Balance (MMB), which delivers the core concepts of mindfulness-based cognitive therapy (MBCT), is a viable way to treat residual depressive symptoms and prevent relapse. In exit interviews with 38 participants who had a current PHQ-9 score of 12 or less and at least one prior major depressive episode, four main themes emerged: Web content, Web-based group process, home practice, and concept comprehension. Participants noted advantages such as flexibility, reduced cost, and less time commitment, as well as obstacles like time challenges for home practice and a need for more support. They endorsed developing affect regulation skills. High satisfaction suggests MMB can increase access to evidence-based psychological treatments for sub-threshold unipolar depression.
Australian & New Zealand Journal of Psychiatry
March 4, 2014
Graham Meadows, Frances Shawyer, Joanne Enticott et al.
66 citations
Mindfulness-based cognitive therapy (MBCT) plus active monitoring reduced the average number of days with major depression over two years to 65, compared to 112 for active monitoring alone. Proportionally fewer MBCT participants experienced relapse in both the first and second year (odds ratio 0.45). The difference in time to first depressive episode was not statistically significant, though trends favored MBCT. MBCT was most effective for people receiving specialist care and for those taking antidepressant or mood stabilizer medication. The findings support MBCT's effectiveness in routine practice, with effects less strong than in prior efficacy studies but still appreciable.
Current Opinion in Psychiatry
December 11, 2015
Zindel V. Segal, Kathleen M. Walsh
64 citations
Mindfulness-based cognitive therapy (MBCT) reduces the risk of depressive relapse by about 30-40% compared to usual care, performing as well as maintenance antidepressant medication. Recent trials compare MBCT against active interventions rather than treatment-as-usual, and researchers are extending it to new conditions such as acute depression, health anxiety, social anxiety, fibromyalgia, and multiple chemical sensitivities, as well as adapting it for online delivery. Neuroimaging studies show that mindfulness-based therapies increase activity in brain regions involved in self-focus, emotion regulation (prefrontal cortex), and interoceptive awareness (insula). The strongest evidence supports MBCT for preventing relapse or treating residual depressive symptoms, with early data suggesting broader uses.
Journal of Clinical Psychology
January 26, 2012
Jennifer N. Felder, Sona Dimidjian, Zindel V. Segal
55 citations
Therapeutic collaboration between psychotherapist and group participants in mindfulness-based cognitive therapy (MBCT) is described as central to two components: inquiry and leading mindfulness practices. During inquiry, the therapist asks questions about the participant's moment-to-moment experience of the practice, conducted with curious, open, and warm attitudes. Collaboration is also maintained through co-participation in mindfulness practices. A case illustration is provided, and recommendations for clinical practice are offered.
Contemporary Buddhism
May 1, 2011
Melanie Fennell, Zindel V. Segal
31 citations
Mindfulness-based cognitive therapy combines mindfulness meditation, rooted in Buddhist thought, with Western cognitive and clinical science. This article examines points of congruence and difference between these two traditions and concludes that, despite initial appearances, the partnership is fruitful and likely to endure.
NeuroImage Clinical
January 1, 2022
Norman A. S. Farb, Philip A. Desormeau, Adam K. Anderson et al.
15 citations
Neural reactivity to sad mood—specifically deactivation in somatosensory brain regions—was a stable marker of depression relapse risk in remitted patients, regardless of whether they received Cognitive Therapy or Mindfulness-Based Cognitive Therapy. In contrast, reduced activation in the left lateral prefrontal cortex after treatment predicted lower relapse risk, suggesting that therapy may work by dampening cognitive control processes and enhancing sensory integration. The findings point to two distinct factors in depression vulnerability: an enduring sensory deactivation pattern that signals relapse risk, and a modifiable prefrontal response that can be targeted by prophylactic interventions.
Journal of Consulting and Clinical Psychology
July 17, 2023
Sona Dimidjian, Robert Gallop, Joseph J. Lévy et al.
14 citations
The Mindful Mood Balance (MMB) program, a digitally delivered version of mindfulness-based cognitive therapy, combined with usual depression care, produced greater improvements in decentering, mindfulness, and rumination than usual care alone among adults with residual depressive symptoms. Changes in these three processes each predicted a lower likelihood of depressive relapse. The findings indicate that the program's benefits operate through the same mechanisms as in-person mindfulness-based cognitive therapy and that these mechanisms can be engaged through digital delivery.