Alcohol-related aggression: New therapies may result from Ohio State study
While considerable strides have been made in treating depression, the incidences of relapse and recurrent depression are still significant public health concerns in the United States. Studies show that approximately one in six men and one in four women will experience depression in their lifetimes. About 50% of those who recover from depression will relapse at least once, and the odds of relapse increase to approximately 80% in those with two or more episodes. Researchers maintain that recurrent depression causes significant personal and public health consequences, as well as an impact on our society and economy.
Sophie Lazarus, PhD, clinical assistant professor of Psychiatry and Behavioral Health in The Ohio State University College of Medicine, addressed this concern by establishing a relapse prevention program using the evidence-based intervention mindfulness-based cognitive therapy (MBCT). She’s certified to teach MBCT through the University of California San Diego Mindfulness-Based Professional Training Institute.
“We focus not only on the treatment of acute depression, but on relapse prevention,” Dr. Lazarus says. “The burden of depression is really high, and this is highly impacted by the number of patients who experience a recurrence. Even once recovered, people with a history of depression are especially vulnerable during periods of sadness or difficulty to the return of old, depression-related thinking. Unfortunately, once someone has experienced an episode of depression, patterns of negative thinking, avoidant behaviors and increasing low mood are reinstated very easily. This program works to help patients decouple low moods from depressive thinking to create new ways of responding to low mood.”
The efficacy of MBCT
Mindfulness-based cognitive therapy combines the tenets of cognitive therapy with mindfulness practices like meditation and present-moment awareness.
A study at Cambridge in 2000 evaluated patients with recurrent depression who were referred for and had undergone treatment as usual for depression maintenance and compared them to those who also received MBCT. For patients with three or more previous depressive episodes, 37% of those receiving MBCT experienced a recurrence of depression over 60 weeks compared to 66% among those who received only treatment as usual.
A 2019 Oxford University meta-analysis found even clearer evidence that MBCT was associated with a significant reduction in the risk of relapse/recurrence over 60 weeks compared with other active treatments, including antidepressant medications. The analysis suggested that MBCT has a larger effect on patients whose risk of depressive relapse/recurrence is more significant because they show higher levels of depression symptoms at baseline.
How MBCT works
MBCT is the practice of increasing patients’ present-moment awareness and understanding of depressive mood states while learning to respond to them in more helpful ways. Patients also develop the ability to see the connection between low mood and downward spirals of negative thinking and unhelpful behavior that increase vulnerability to future episodes of depression. MBCT helps patients to acknowledge and skillfully respond to difficult experiences so that they can maintain contact with what’s most important in their lives. This helps patients develop a new, more accepting and nonjudgmental way of relating to whatever feelings and thoughts arise.
“Mindfulness brings greater distance to depressive thoughts,” Dr. Lazarus says. “While cognitive therapy alone helps patients change unhelpful patterns of thinking, mindfulness shifts how patients relate to those negative thoughts. With mindfulness, it’s not about changing thoughts. It’s about developing more acceptance and ‘letting be.’ When patients do this, they can let the experience pass without adding more fuel to the fire.”
MBCT at Ohio State
Ohio State’s clinical MBCT program is eight weeks of group therapy that includes mindfulness meditation, facilitated group discussion and exercises to better understand and prevent future episodes of depression. By the end of the eight weeks, patients create a relapse prevention plan that includes their personal early warning signs of depression and an action plan for addressing low mood before it takes hold. There is also a half-day retreat near the end of the eight weeks for immersive mindfulness work. Each group has eight to 12 patients. Returning patients can attend quarterly retreat days for follow-up support. About 25% have returned for those retreats.
“The goals of our program are for patients to understand and be aware of the patterns that might signal that depression is threatening, increase their ability to bring awareness to and be present for those pivotal moments and access their own wisdom and choice to respond wisely and care for themselves. We focus on people not just getting well but staying well,” Dr. Lazarus says.
Patients best suited for MBCT have a history of recurrent depression but are no longer in an acute episode. Patients who’ve benefitted from therapy or medication and are doing relatively well are in a good position to focus on relapse prevention.
Since Dr. Lazarus started the MBCT program at Ohio State, the program has treated more than 120 patients. Those patients have experienced a 30% reduction in depressive symptoms and a 35% reduction in anxiety symptoms over the eight-week group. In addition, “We’ve also seen significant increases in mindfulness, self-compassion and flourishing in our patients,” Dr. Lazarus says.
Her team is currently gathering data from past and present patients to measure the long-term effects of the treatment. Dr. Lazarus obtained additional funding to grow the program by adding another qualified teacher to the team and establishing an internship rotation for clinical psychology trainees focused on mindfulness-based approaches. News of the program has also reached the community, with 25% of the program’s referrals now coming from outside the Ohio State medical community.
MBCT in the United States
The UK National Institute for Health and Care Excellence endorses MBCT as an effective treatment for the prevention of depressive relapse, and the treatment is highly integrated into a health care system. However, the implementation of MBCT in the U.S. has lagged. Dr. Lazarus is one of only 27 certified MBCT providers in the country. That’s why funding for growing her program and awareness of the efficacy of MBCT are so essential. Please visit the MBCT website for more information.
