Book Review
Mood Disorders 
Mindfulness-Based Cognitive Therapy for Depression. Zindel V Segal,
J Mark G Williams, John D Teasdale. New York: The Guilford Press; 2002. 351 p. US$38.00
Reviewer
rating*: Excellent
Review by: John I Telner, PhD, CPsych
Ottawa, Ontario
Many books have been written about the efficacy of cognitive-behavioural therapy (CBT) in the treatment of psychiatric disorders. Although CBT was initially developed as a treatment for depression, a plethora of research over the years has expounded its effectiveness for other psychiatric disorders. This book focuses on a new approach to preventing relapse in recovered depression patients.
It begins with a brief description of psychotherapy’s role in the prophylaxis of future depressive episodes. Although CBT and interpersonal therapy have been shown to be efficacious in treating depression, little research has been undertaken on preventing the development of new episodes in patients who have already experienced one depressive episode. This book devotes a full chapter to an attempt to develop a cognitive therapy variant that will address maintenance in patients who have recovered from an episode of depression. Drawing on previous studies, the authors indicate that, after cognitive therapy, the relapse rate is reduced to 20% to 25%. They argue that it would be advantageous to reduce the relapse rate even further. More important, finding what is protective in CBT might lead to a separate treatment for the prevention of relapse. As important, this new treatment could be applied to patients who have recovered from depression but have never received cognitive therapy.
A most interesting part of the book describes how the authors developed a relapse- prevention therapy based on a type of meditation called “mindfulness.” Their journey to discover a new approach begins with their examining the relation between thinking, mood, and depressive relapse. One author carried out some work on the effects of mood on thinking and came up with the “differential activation hypothesis,” whereby sad moods “reactivate thinking styles associated with previous sad moods” (p 29). Other researchers have also published studies looking at the causal relation between sad moods and dysfunctional attitudes. Finally, another author was able to show a relation between increases in dysfunctional beliefs following an experimental mood challenge and relapse over a 30-month period.
Hypothesizing how cognitive therapy could reduce relapse and recurrence of depression led the authors to arrive at a role for “decentering.” They suggest that, with much practice in cognitive therapy, patients began to see negative thoughts as “passing events in the mind that were neither necessarily valid reflections of reality nor central aspects of the self” (p 38). This led to them to link their interests in relapse prevention to the work of Jon Kabat-Zinn, who, at his stress-reduction clinic at the University of Massachusetts Medical Center, was teaching patients to employ the ancient practice of mindfulness meditation to deal with pain associated with various health problems. The authors describe in some detail how they adopted this practice to the problem of relapse in depression.
Part II of this book is basically a treatment manual that describes how to set up a mindfulness-based treatment program to prevent relapse in depression. It describes an 8- session program complete with handouts and homework assignments. The book’s final section examines this particular treatment’s clinical efficacy in preventing relapse and describes the results of a randomized controlled trial of mindfulness training. The results were very positive in terms of effectiveness. Interestingly, treatment was more successful for patients who had 3 or more previous episodes of depression, compared with those who had only 2 episodes. The authors attempt to attribute these unexpected differences in patients to the number of episodes.
This book should be read by all who practice cognitive therapy in the treatment of depression. The approach, which is very different from traditional CBT, can be seen as the next “wave” in widening the whole cognitive approach to treating psychiatric disorders. I found the first part of the book particularly enjoyable. It reads a bit like a detective story, in that it describes how the authors came to use mindfulness in their work with depression patients. The book is clearly written and attractively laid out. The authors are very well- published and well-known.
*Reviewer
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Good / Bon
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Not recommended / Pas recommandé
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