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Zindel V. Segal

University of Toronto, The Scarborough Hospital

43 papers in the library · 18,241 citations · publishing 1978-2026

Papers

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Outcomes of Mindful Mood Balance for Moms, online mindfulness-based cognitive therapy for perinatal depressive relapse prevention in the USA: a two-arm, single-blind, pragmatic randomised clinical trial

The Lancet Public Health October 20, 2026 Sona Dimidjian, Robert Gallop, Sherryl Hope Goodman et al. 1 citation

BACKGROUND: Effective and accessible approaches to prevent depressive relapse and reduce symptoms are crucial for addressing the major public health problem of depression among perinatal women. We aimed to evaluate the effectiveness of Mindful Mood Balance (MMB) for Moms plus usual care (hereafter MMB for Moms)-a web-based mindfulness-based cognitive therapy programme customised for perinatal...

A Critical Review and 10-Year Update on Prospects for a Clinical Science of Mindfulness-Based Intervention

Mindfulness July 7, 2026 Joseph J. Lévy, Sona Dimidjian, Zindel V. Segal

Abstract Objectives Over the past decade, research on mindfulness-based interventions (MBIs) has expanded exponentially. A decade ago, Dimidjian and Segal (2015) used the National Institutes of Health (NIH) Stage Model to assess the state of the science and identify key issues limiting public health impact. The present review provided a ten-year update on the field’s progress, applying the same...

DOI: 10.1007/s12671-026-02924-5 (opens in new tab) Full text (opens in new tab) Psycinfo Public health Psychological intervention Intervention counseling +14

Efficacy and Moderators of Mindfulness-Based Cognitive Therapy in Difficult-to-Treat Depression: A Systematic Review and Individual Participant Data Meta-Analysis

Psychotherapy and Psychosomatics June 12, 2026 Thorsten Barnhofer, Maria Niemi, Johannes Michalak et al. 1 citation

INTRODUCTION: Around a third of patients with major depressive disorder experience persistent symptoms despite usual treatments. Identifying scalable, psychological treatment options is critical to reduce the burden associated with difficult-to-treat depression (DTD). We examined the efficacy of mindfulness-based cognitive therapy (MBCT) compared with treatment as usual (TAU) and other active...

Efficacy and moderators of mindfulness-based cognitive therapy (MBCT) in 'Difficult to Treat' depression: protocol for a systematic review and individual participant data meta-analysis of randomised controlled trials.

BMJ Open December 8, 2025 Thorsten Barnhofer, Maria Niemi, Johannes Michalak et al.

Introduction: About 30% of depressed patients suffer from a protracted course in which the disorder continues to cause significant burden despite treatment efforts. While originally developed for relapse prevention, mindfulness-based cognitive therapy (MBCT) has increasingly been investigated in depressed patients with such 'difficult-to-treat' courses. This is a protocol for an individual...

Efficacy and Moderators of Mindfulness-Based Cognitive Therapy (MBCT) in ‘Difficult to Treat’ Depression: Protocol for a Systematic Review and Individual Patient Data Meta-Analysis of Randomised Controlled Trials

medRxiv June 9, 2025 Thorsten Barnhofer, Maria Niemi, Johannes Michalak et al. preprint

ABSTRACT: Introduction: About 30% of depressed patients suffer from a protracted course in which the disorder continues to cause significant burden despite treatment efforts. While originally developed for relapse prevention, Mindfulness-Based Cognitive Therapy (MBCT) has increasingly been investigated in depressed patients with such ‘difficult-to-treat’ courses. This is a protocol for an...

Mindfulness-Based Cognitive Therapy for Depression, Taking It Further (MBCT-D-TiF): An Assessment of an Intervention Development Study.

Global Advances in Integrative Medicine and Health 2025 Chelsea J Siwik, Jessica M. Harrison, Willem Kuyken et al.

Mindfulness-Based Cognitive Therapy (MBCT) reduces depression relapse, yet graduates have expressed a need for structured guidance post-program to maintain mindfulness practice and sustain benefits. To address this, we created MBCT for Depression-Taking it Further (MBCT-D-TiF). To refine and pilot test feasibility and acceptability of MBCT-D-TiF. We collected qualitative focus group data to...

Mediators of change in online mindfulness-based cognitive therapy: A secondary analysis of a randomized trial of mindful mood balance.

Journal of Consulting and Clinical Psychology July 17, 2023 Sona Dimidjian, Robert Gallop, Joseph J. Lévy et al. 14 citations

OBJECTIVE: Digital delivery of mindfulness-based cognitive therapy through the Mindful Mood Balance (MMB) program is clinically effective (Segal et al., 2020); however, the mechanisms through which this program delivers its benefits have not been established. METHOD: This study investigates the differential impact of the MMB program paired with usual depression care (UDC) compared to UDC alone...

Preventing Depression Relapse: A Qualitative Study on the Need for Additional Structured Support Following Mindfulness-Based Cognitive Therapy.

Global Advances in Integrative Medicine and Health 2023 Chelsea J Siwik, Shelley R Adler, Patricia J Moran et al. 7 citations

Mindfulness-based cognitive therapy (MBCT) is an effective group intervention for reducing rates of depression relapse. However, about one-third of graduates experience relapse within 1 year of completing the course. The current study aimed to explore the need and strategies for additional support following the MBCT course. We conducted 4 focus groups via videoconferencing, two with MBCT...

DOI: 10.1177/27536130221144247 (opens in new tab) Full text (opens in new tab) Depression relapse Maintenance program Mindfulness-based cognitive therapy

Effectiveness and Cost-effectiveness of Online Brief Mindfulness-based Cognitive Therapy for the Improvement of Productivity in the Workplace: Study Protocol for a Randomized Controlled Trial.

JMIR Research Protocols June 13, 2022 Mitsuhiro Sado, Masashi Yamada, Akira Ninomiya et al.

Numerous studies have demonstrated the effectiveness of mindfulness-based programs (MBPs) among both clinical and nonclinical populations. These data document positive impacts in the workplace, including reducing perceived stress and burnout and increasing well-being. However, the effectiveness for productivity, which is of most interest to managers and administrators, is still unclear. In...

DOI: 10.2196/36012 (opens in new tab) Full text (opens in new tab) Burnout Cost-effectiveness Ehealth Employee +10

Impact of online Mindfulness-Based Cognitive Therapy on suicidal ideation: A secondary analysis of a randomized trial of Mindful Mood Balance.

Journal of Affective Disorders March 15, 2022 Sona Dimidjian, Julia Kaufman, Natalie Coleman et al.

To address the elevated prevalence of depression, suicide, and suicidal ideation, patients require increased access to effective interventions. Mindfulness-Based Cognitive Therapy has a strong evidence base in relapse prophylaxis and can be delivered digitally through Mindful Mood Balance (MMB). This study was a secondary analysis of the impact of MMB paired with usual depression care (UDC)...

Static and treatment-responsive brain biomarkers of depression relapse vulnerability following prophylactic psychotherapy: Evidence from a randomized control trial

NeuroImage: Clinical 2022 Norman A. S. Farb, Philip A. Desormeau, Adam K. Anderson et al. 15 citations

BACKGROUND: Neural reactivity to dysphoric mood induction indexes the tendency for distress to promote cognitive reactivity and sensory avoidance. Linking these responses to illness prognosis following recovery from Major Depressive Disorder informs our understanding of depression vulnerability and provides engagement targets for prophylactic interventions. METHODS: A prospective fMRI...

DOI: 10.1016/j.nicl.2022.102969 (opens in new tab) Anxiety Dysphoria Prefrontal cortex Biomarker +5

Mindfulness-based cognitive therapy vs. a health enhancement program for the treatment of late-life depression: Study protocol for a multi-site randomized controlled trial.

Frontiers in Aging Neuroscience 2022 Magnus Bein, Myriam Lesage, Elena Dikaios et al.

Late-life depression (LLD) affects up to 18% of older adults and has been linked to elevated dementia risk. Mindfulness-based cognitive therapy (MBCT) holds promise for treating symptoms of depression and ameliorating cognitive deficits in older adults. While preliminary findings are promising, a definitive RCT investigating its effects on late life depression and cognition have not yet been...

DOI: 10.3389/fnagi.2022.976636 (opens in new tab) Full text (opens in new tab) Mindfulness Behavioral activation Cognitive function Executive function +3

Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy

The Oxford Handbook of Stress and Mental Health February 17, 2020 Philip A. Desormeau, Kathleen M. Walsh, Zindel V. Segal

Over the past two decades, investigations of mindfulness meditation have demonstrated considerable efficacy in reducing the symptom burden associated with a variety of medical and mental health disorders (Baer, 2003). This chapter reviews the theoretical basis for offering training in mindfulness meditation to these populations, and it outlines the structure of mindfulness-based interventions,...

Therapeutic Mindfulness and Depression

Depression October 1, 2019 Evan Collins, Zindel V. Segal

There is growing interest in mindfulness as a therapeutic intervention for a variety of physical and mental health conditions, including depression. A major contribution has been the growing evidence base of mindfulness-based cognitive therapy (MBCT) for prevention of depressive relapse in those with recurrent unipolar depression, as well as MBCT’s application to other mood disorders, special...

Prevention of relapse/recurrence in major depressive disorder with either mindfulness-based cognitive therapy or cognitive therapy.

Journal of Consulting and Clinical Psychology February 2018 Norman A. S. Farb, Adam K. Anderson, Arun Ravindran et al.

Both Mindfulness Based Cognitive Therapy (MBCT) and Cognitive Therapy (CT) enhance self-management of prodromal symptoms associated with depressive relapse, albeit through divergent therapeutic procedures. We evaluated rates of relapse in remitted depressed patients receiving MBCT and CT. Decentering and dysfunctional attitudes were assessed as treatment-specific process markers. Participants...

Mindfulness‐based cognitive therapy for relapse prophylaxis in mood disorders

World Psychiatry September 22, 2016 Zindel V. Segal, Lê-Anh Dinh-Williams 11 citations

Relapse and recurrence are common and debilitating aspects of major depressive disorder. Furthermore, the risk of developing a chronic course of illness increases with each successive episode and, even among patients who achieve clinical remission, residual depressive symptoms are commonly reported. Maintenance antidepressant monotherapy is effective as long as it is continued, yet in practice...

Efficacy of Mindfulness-Based Cognitive Therapy in Prevention of Depressive Relapse

JAMA Psychiatry April 28, 2016 Willem Kuyken, Fiona C Warren, Rod S. Taylor et al. 815 citations

IMPORTANCE: Relapse prevention in recurrent depression is a significant public health problem, and antidepressants are the current first-line treatment approach. Identifying an equally efficacious nonpharmacological intervention would be an important development. OBJECTIVE: To conduct a meta-analysis on individual patient data to examine the efficacy of mindfulness-based cognitive therapy...

DOI: 10.1001/jamapsychiatry.2016.0076 (opens in new tab) Full text (opens in new tab) Psycinfo Mindfulness-based cognitive therapy Medline Randomized controlled trial +4

A Randomized Controlled Trial of Mindfulness-Based Cognitive Therapy for Treatment-Resistant Depression

Psychotherapy and Psychosomatics 2016 Stuart J. Eisendrath, Erin P Gillung, Kevin L. Delucchi et al. 193 citations

BACKGROUND: Due to the clinical challenges of treatment-resistant depression (TRD), we evaluated the efficacy of mindfulness-based cognitive therapy (MBCT) relative to a structurally equivalent active comparison condition as adjuncts to treatment-as-usual (TAU) pharmacotherapy in TRD. METHODS: This single-site, randomized controlled trial compared 8-week courses of MBCT and the Health...

Mindfulness-based cognitive therapy for residual depressive symptoms and relapse prophylaxis

Current Opinion in Psychiatry December 11, 2015 Zindel V. Segal, Kathleen M. Walsh 64 citations

PURPOSE OF REVIEW: The article reviews the recent evidence for mindfulness-based cognitive therapy (MBCT) for patients with residual depressive symptoms or in remitted patients at increased risk for relapse. RECENT FINDINGS: Randomized controlled trials have shifted focus from comparing MBCT with treatment-as-usual to comparing MBCT against interventions. These studies have provided evidence...

DOI: 10.1097/yco.0000000000000216 (opens in new tab) Anxiety Mindfulness-based cognitive therapy Randomized controlled trial Psychological intervention +4

Prospects for a clinical science of mindfulness-based intervention.

American Psychologist October 1, 2015 Sona Dimidjian, Zindel V. Segal 297 citations

Mindfulness-based interventions (MBIs) are at a pivotal point in their future development. Spurred on by an ever-increasing number of studies and breadth of clinical application, the value of such approaches may appear self-evident. We contend, however, that the public health impact of MBIs can be enhanced significantly by situating this work in a broader framework of clinical psychological...

DOI: 10.1037/a0039589 (opens in new tab) Mindfulness Psychological intervention Relevance law Perspective graphical +6

Web-based Mindfulness-based Cognitive Therapy for reducing residual depressive symptoms: An open trial and quasi-experimental comparison to propensity score matched controls.

Behaviour Research and Therapy December 2014 Sona Dimidjian, Arne Beck, Jennifer N. Felder et al.

Mindfulness-based Cognitive Therapy (MBCT) has been shown to effectively prevent relapse and reduce residual depressive symptoms (RDS), yet it faces barriers to dissemination. The present study examined Mindful Mood Balance (MMB), the first web-based approach to deliver the core content of MBCT. Of the 107 recurrently depressed individuals screened, 100 elected to enroll in the study and...

DOI: 10.1016/j.brat.2014.09.004 (opens in new tab) Full text (opens in new tab) Major depressive disorder Dissemination Mindfulness-based cognitive therapy Residual depressive symptoms +1

PS2-43: Internet Delivered Mindfulness-based Cognitive Therapy for Reducing Residual Depressive Symptoms: An Open Trial and Quasi-experimental Comparison to Propensity Matched Controls

Clinical medicine & research September 1, 2014 Arne Beck, Sona Dimidjian, Jennifer M. Boggs et al.

Background/Aims: The persistence of residual depressive symptoms (RDS) among patients in clinical remission predicts a negative prognosis and is considered an important target for adjunctive treatment. Mindfulness-Based Cognitive Therapy (MBCT) is effective in reducing RDS. Delivered in 8 in-person group sessions, MBCT teaches disengagement from depression-related ruminative thought patterns to...

A Randomized Controlled Trial of Mindfulness Meditation for Chronic Insomnia

Sleep August 29, 2014 Jason C Ong, Rachel Manber, Zindel V. Segal et al. 338 citations

STUDY OBJECTIVES: To evaluate the efficacy of mindfulness meditation for the treatment of chronic insomnia. DESIGN: Three-arm, single-site, randomized controlled trial. SETTING: Academic medical center. PARTICIPANTS: Fifty-four adults with chronic insomnia. INTERVENTIONS: Participants were randomized to either mindfulness-based stress reduction (MBSR), mindfulness-based therapy for insomnia...

DOI: 10.5665/sleep.4010 (opens in new tab) Full text (opens in new tab) Meditation Actigraphy Randomized controlled trial Mindfulness-based stress reduction +4

Impact of mindfulness-based cognitive therapy on health care utilization: a population-based controlled comparison.

Journal of Psychosomatic Research August 2014 Paul Kurdyak, Alice Newman, Zindel V. Segal

Elevated rates of mood and anxiety disorders among high utilizers of health care have been suggested as one driver of increased service use. We compared the impact of Mindfulness Based Cognitive Therapy (MBCT), a structured group treatment, on the rates of health care utilization with matched control participants receiving non-MBCT group therapy. Using Ontario health administrative data, we...

DOI: 10.1016/j.jpsychores.2014.06.009 (opens in new tab) Full text (opens in new tab) Health service utilization Mindfulness-based cognitive therapy Primary care

Web-Based Intervention in Mindfulness Meditation for Reducing Residual Depressive Symptoms and Relapse Prophylaxis: A Qualitative Study

Journal of Medical Internet Research March 24, 2014 Jennifer M. Boggs, Arne Beck, Jennifer N. Felder et al. 73 citations

BACKGROUND: Mindful Mood Balance (MMB) is a Web-based intervention designed to treat residual depressive symptoms and prevent relapse. MMB was designed to deliver the core concepts of mindfulness-based cognitive therapy (MBCT), a group treatment, which, despite its strong evidence base, faces a number of dissemination challenges. OBJECTIVE: The present study is a qualitative investigation of...

DOI: 10.2196/jmir.3129 (opens in new tab) Intervention counseling Psychotherapist Mindfulness meditation Web application +4