How mindfulness reduces vulnerability to depression: A direct test of the impact on cognitive reactivity

by Michael D. Anestis, M.S.

We have spent a fairly significant amount of time discussing mindfulness on Psychotherapy Brown Bag.  Personally, I find the concept compelling, but more importantly, the efforts to test the utility of mindfulness have been impressive.  Today, I would like to present some newly published findings that expand upon those discussed in our recent article on the use of mindfulness-based cognitive therapy for depression.  In this new study, published in Behaviour Research and Therapy, Raes, Dewulf, Van Heeringen, and Williams (2009) presented data from two studies that directly tested the impact of mindfulness on cognitive reactivity (CR).

Let me begin with a description of CR - the degree to which mild negative moods activate thinking patterns known to result in depression.  Generally speaking, when we experience a negative mood, it knocks us on our heels for a moment, and then we recover.  Briefly, we may find ourselves brooding over the cause of this mood and stewing in our emotions, but then we distract ourselves or work towards a solution.  This, in part, is what keeps most individuals from experiencing depressive episodes.  For some individuals, however - those high in CR - a mild negative mood can set off a chain reaction of ruminative thoughts that spiral out of control, resulting in full blown depression.  As an example, imagine Sarah, who goes to a Starbucks to order a coffee and gets confused while making her order.  Rather than patiently waiting for her to correct herself, the man behind the counter laughs and says "you need more than a coffee, lady."  Sarah has low CR, so after a moment of embarrassment, she realizes that this man knows nothing about her and that his reaction is more a reflection of his lack of social skills than her own lack of worthiness or intelligence.  Now imagine Rachel, who has high CR.  The man behind the counter makes his snarky remark, which causes her to feel an immediate surge of embarrassment and shame.  This makes her think about past boyfriends who have talked to her in that same dismissive tone and how horrible it felt when they spoke to her that way.  Then she thinks about how deeply those moments affected her, how she withdrew from friends, ate unhealthily, and felt hopeless about ever deserving the respect of others.  Rachel leaves the store without completing her order, goes home, and spends the entire drive feeling as though she made a fool out of herself at the counter.

See how CR can be problematic?  Both Sarah and Rachel encountered the same nasty person behind the counter, but only one of them responded in a way that resulted in an overwhelming surge of negative affect that extended beyond the moment of that actual encounter.  This brings us back to the point of this article and the study that prompted it: how mindfulness can reduce CR and, as such, decrease vulnerability to depressive relapse.

For those of you who have not read our prior articles on mindfulness or other sources of information that provide a background on the nature of mindfulness, I highly recommend reading them before proceeding further with this article.  In case you choose not to do so, however, mindfulness can be thought of as a style of thinking that involves:

• Focusing only on the present moment
• Taking a non-judgmental stance - simply observing what is and accepting it without judgment
• Observing the presence of emotions as they emerge

Now, if this is your first encounter with a description of mindfulness, I suspect that it seems fairly abstract, and it is, but there is a mountain of data supporting its utility.  In this particular set of studies, Raes and colleagues (2009) wanted to test three central hypotheses:

• High levels of trait mindfulness in an undergraduate sample will predict low levels of CR
• Individuals who partook in mindfulness-based cognitive therapy (MBCT) would experience a decrease in CR
• Increases in mindfulness skills would mediate the relationship between MBCT participation and decreases in CR.

 

Each of these hypotheses was supported.  The first study, which utilized undergraduates, was cross-sectional in nature - meaning that there was only one time point.  With only one time point, researchers can not conclude whether one variable causes another, which is an obvious weakness, but such studies provide a valuable foundation upon which to build further work.  In this particular case, the authors were able to show that undergraduates who self-reported high levels of trait mindfulness also self-reported low levels of CR. 

In order to increase confidence in their interpretation of these findings, the authors also conducted a longitudinal study on a clinical sample.  Their sample was divided into two groups - individuals attending MBCT for depression and depressed individuals on a wait list.  Individuals in the MBCT condition were assessed for mindfulness skills and CR prior to their first session and after their final session.  Participants in the wait list condition were assessed at an equally spaced period of time.  The authors found that individuals in the MBCT condition improved on CR significantly more so than individuals in the wait list condition.  Perhaps more importantly, though, they found that increases in mindfulness skills over the course of therapy mediated that relationship.  In other words, they found that the relationship between MBCT and decreased CR was statistically explained by the fact that people in the MBCT condition improved their mindfulness skills.  As such, it wasn't simply being in a therapy that caused a reduction in CR, but specifically the increase in this particular set of skills.

So why do these skills seem to work?  Raes and colleague (2009) answered this very well with three quick points.  Mindfulness, they said, helps individuals to:

1. Recognize when their emotions are deteriorating early in that process
2. Observe this change in mood and the thoughts that accompany it
3. Switch to a non-reactive mindset and pursue active solutions to the problem rather than passively ruminating or avoiding the issue altogether

These studies were by no means perfect.  Few if any fit that description.  They do, however, make a strong effort to answer an important question: why does a particular approach appear successful in addressing a particular issue?  Rather than simply make assumptions or rely on intuition, the authors made an attempt to empirically validate the theory underlying MBCT and its impact on depression.  By understanding mechanisms of change like this, we can streamline treatments so as to emphasize the aspects of therapy with the highest impact and reduce unnecessary cost and time.

If you would like to learn more about mindfulness and mindfulness-based cognitive therapy, we recommend the following products, all of which are available through our online store:

Books:

• Mindfulness-Based Cognitive Therapy for Depression: A New Approach to Preventing Relapse

• Mindfulness-Based Treatment Approaches: Clinician's Guide to Evidence Base and Applications

• Peace Is Every Step: The Path of Mindfulness in Everyday Life

• The Miracle of Mindfulness

DVDs:

• This One Moment: Skills for Everyday Mindfulness

• Mindfulness & Meditation - Stress Reduction / Mindful Parenting

Mike Anestis is a doctoral candidate in the clinical psychology department at Florida State University