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Zindel V. Segal

University of Toronto, The Scarborough Hospital

34 papers in the library · 18,240 citations · publishing 1978-2026

Papers

Mindfulness‐based cognitive therapy for relapse prophylaxis in mood disorders

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

Mindfulness-based cognitive therapy (MBCT) helps prevent relapse in major depressive disorder by teaching formerly depressed patients to recognize and disengage from negative thoughts and feelings. In randomized controlled trials, MBCT outperformed treatment as usual and performed as well as maintenance antidepressant medication over two years, with relapse rates of 44% for MBCT versus 47% for antidepressants. Patients with three or more prior episodes benefit most. The program combines mindfulness meditation (body scan, sitting and walking meditations, yoga) with cognitive therapy techniques, including psychoeducation and relapse prevention planning. Online delivery (Mindful Mood Balance) may improve access. Benefits are linked to formal practice of 30–40 minutes rather than shorter informal practice.

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 January 1, 2023 Chelsea J Siwik, Shelley R Adler, Patricia J Moran et al. 7 citations

Mindfulness-based cognitive therapy (MBCT) reduces depression relapse, but about one-third of graduates relapse within a year. Focus groups with MBCT graduates and teachers revealed that the course is highly valued and sometimes life-changing. However, graduates struggle to maintain mindfulness practices and sustain benefits after the course ends, despite using community groups, apps, or retaking the course. One participant described finishing MBCT as feeling like "falling off a cliff." Both graduates and teachers strongly desired additional support, such as a maintenance program, to help sustain long-term benefits and reduce relapse risk.

Negative expectancy as a mediating variable in marihuana intoxication

Journal of Clinical Psychology October 1, 1978 Robert O. Pihl, Zindel V. Segal, Diane Shea 5 citations

Sixty experienced marijuana smokers took part in a study testing how a negative expectancy affects marijuana intoxication. Participants adjusted a fingertip shock to mild discomfort; only those in threat groups expected random shocks during sessions. Under marijuana, participants who anticipated shock reported feeling less intoxicated, found the environment less pleasant, yet had higher pulse rates than those not expecting shock. The findings suggest a cognitive component, particularly labeling, influences the level of intoxication.

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

For adults with difficult-to-treat depression—those who have not responded to prior treatments, have treatment-resistant depression, or have a chronic course—mindfulness-based cognitive therapy (MBCT) is likely superior to usual care, reducing depressive symptoms by a standardized mean difference of -0.40 at post-treatment and -0.41 at medium-term follow-up. There was a 92% and 85% probability, respectively, that these benefits exceeded a minimal important difference. However, MBCT did not show clear superiority over other active psychosocial interventions, and no robust moderators of outcome were identified across baseline severity, chronicity, or comorbidity.

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

A review of 1,226 empirical studies on mindfulness-based interventions (MBIs) published between 2014 and 2025 found that most research remains in early stages of development, with 41% classified as Stage 1, 54% as Stage 2 or 3, 3% as Stage 4, and 2% as Stage 5 of the NIH Stage Model. Compared to a prior review, later-stage studies modestly increased, and attention to mechanisms and real-world implementation expanded substantially. However, effectiveness, dissemination, and implementation studies remain rare. The authors argue that translating efficacy into large-scale public health impact will require coordinated research across all stages and integrating basic, clinical, and implementation science.

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 January 1, 2025 Chelsea J Siwik, Jessica M. Harrison, Willem Kuyken et al.

A maintenance program called MBCT-D-TiF, designed for graduates of Mindfulness-Based Cognitive Therapy (MBCT) who want structured guidance to sustain their mindfulness practice, was feasible and acceptable in a pilot test. In round one, 14 participants received the program; in round two, 20 were randomized to the program or a waitlist. Attendance was high: all weekly sessions and at least 75% of monthly sessions. Most participants rated weekly sessions (77.1%) and monthly sessions (66.7%) as very or extremely helpful. Qualitative themes included the group's role in social connection, support, and accountability; mental health benefits such as reduced impact of depression and anxiety; and a need for additional support to maintain home practice after weekly sessions ended.

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 January 1, 2022 Magnus Bein, Myriam Lesage, Elena Dikaios et al.

Late-life depression affects up to 18% of older adults and is linked to elevated dementia risk. Mindfulness-based cognitive therapy (MBCT) may help treat depressive symptoms and cognitive deficits in this population, but a definitive randomized controlled trial has not yet been conducted. This protocol describes a multi-site blinded trial comparing MBCT to an active control, a Health Enhancement Program, in 213 patients with late-life depression. Changes in depression severity, processing speed, executive functioning, and brain biomarkers will be assessed at baseline, post-intervention (8 weeks), and 26 weeks after baseline. The study will evaluate MBCT's potential to improve depression, cognitive impairments, and neurobiological markers.

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

Mindfulness meditation training reduces symptoms in medical and mental health disorders by engaging core cognitive processes that decrease ruminative and elaborative thinking, which perpetuate stress reactivity. The chapter defines mindfulness, reviews its theoretical basis, and outlines mindfulness-based interventions' structure and impact on stress and psychological health indices. It describes the mindfulness stress-buffering account (MSBA) as the dominant theoretical model explaining mindfulness's effects on stress-related disorders, highlighting how this framework can guide intervention science.

Therapeutic Mindfulness and Depression

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

Mindfulness-based cognitive therapy (MBCT) effectively prevents depressive relapse in people with recurrent unipolar depression, supported by systematic reviews, meta-analyses, and inclusion in treatment guidelines. Other mindfulness-based interventions, such as mindfulness-based stress reduction (MBSR), dialectical behavioral therapy, and acceptance and commitment therapy, are also used to treat depression in groups and individuals. This chapter examines these applications, the evidence base, and the mechanisms of action.