Reframing sad thoughts

Mind-based therapy created to fight depression
Daily meditation is used to stop negative thinking
Sep. 8, 2006, ROBIN HARVEY, LIFE WRITER, Toronto Star

Sandra, a Toronto woman in her early 40s, has a problem with recurrent depression. For four years, she tried "almost every approach there was" to stop it. "Nothing worked for long," she says. "I'd take medication, they'd say increase the dose, then I'd get worse."

Then she heard of a study at Toronto's Centre for Addiction and Mental Health (CAMH) run by psychologist Zindel Segal, who was testing a program of therapy that has shown promise in patients who frequently relapse into depression.

Called mindfulness-based cognitive therapy, it was developed to help people with depression and is being tested at CAMH with a $2.5 million grant from the National Institutes of Health in the U.S. The therapy involves eight weeks of meditation, relaxation, breathing and concentration exercises to reframe patients' response to thoughts — especially negative ones — with daily homework and feedback.

For Sandra (not her real name), it has been a lifeline. "When I was on medications, I had to deal with all kinds of side effects," Sandra says. "This has helped stop that negative thinking. A couple of weeks ago, I started to see the signs that would have got me going into depression. I used the tools with breathing and meditations and was able to turn things around."

The study, which is to involve close to 300 people, is half way into its five-year mandate and still needs scores of volunteers. To qualify a person has to have had a diagnosed depression. Then they are treated for four to six months with medication before they are weaned off and taught the mindfulness program.

The study will follow them for 18 months to see if it helps reduce relapses. A 2004 study found brain scans of people who received cognitive behaviour therapy, (which does not involve the same degree of meditation and attentional focus as Segal's current work) showed similar changes as those who had taken medication for depression and recovered.

The changes were found in the frontal and limbic regions, areas that regulate worry and emotion. Normally a person is urged to stay on medication after their first major depression for eight weeks to six months or more. But due to side effects such as agitation, sexual dysfunction and weight gain among others and human nature — people who feel well do not want to take medication — it has always been difficult to get many patients to comply with long-term medication treatment. But even if patients take a full course of medication many will become depressed again within two to five years, or less.

In July, Segal, also a psychiatry professor, and a team from CAMH published results in the Archives of General Psychiatry of a study of 300 people with major depression, ages 18 to 65 who received cognitive training.

It found that those who were more likely to become depressed again seem to have a sensitivity to negative thinking patterns, and could respond to cognitive training. It was the first study ever to follow patients who had been successfully treated for depression and then link their degree of sensitivity to negative thinking patterns to their relapse risk. This prompted a theory that formerly depressed people's brains may become vulnerable to mindsets make them prone to relapse. The current study hopes to expand on that research.

Segal's newest work on brain scans show training in mindfulness-based cognitive therapy appears to increase activity in brain regions linked to body awareness and decreased activity in those linked to worry and rumination. This suggests the newer technique may give people more control over how they react, rather than respond automatically to worry or fear.

This could be due to leftover effects from depression itself or early childhood stresses and trauma or both. The cognitive therapy helps them identify this vulnerability and teaches them how to avoid letting the negativity have a strong impact on them. It trains them in styles of thinking and awareness that make them more resistant, he says.

"We side-step the question of whether the negative thought causes depression or depression causes negative thought because we don't need to know," he says. "But we know there are important changes that leave them vulnerable to future relapse." The vulnerability is like a "well-worn groove" in the mind where sadness and stress can trigger the spiral into depression where thought go on "automatic pilot" he says.

Another participant in the study, a therapist who has experienced depression, says the daily exercises have changed her emotional stability. "I find it amazing that with practice you can develop a different relationship with your thinking and affect your emotions," says the woman in her 30s. "This has helped me and I hope to be able to use it with my patients, too."

The mind, thinking and emotions are just a set of chemical and electrical reactions, Segal says. Using both together makes sense and training people in their thinking is a logical way to approach problems with mood.

Segal says, for everyone — even those not depressed — by being mindful of your thinking and mood and avoiding the "automatic pilot" approach to life in general, it is possible to radically improve your life experience.

Call 1-866-317-8884 or email depressionstudy@camh.net if you'd like to participate.