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Mindfulness therapy as good as medication for chronic depression – study (reuters.com)
138 points by bsbechtel on Apr 26, 2015 | hide | past | web | favorite | 48 comments

Important note - the participants had already displayed relapses from medication based treatments, so they were already in a position where medication was not filling their needs.


I was unable to find the paper in Lancet's online system.

Erm, so the summary is that if medicine doesn't work for you then mindfulness therapy may work just as well as medicine?

TL;DR is that if medicine fails you, mindfulness is better than random chance of getting better

I couldn't find the paper, either. But I did find a different paper, which is on much the same topic, and which has multiple authors in common with the paper mentioned in this post:

"Mindfulness-Based Cognitive Therapy to Prevent Relapse in Recurrent Depression", Journal of Consulting and Clinical Psychology, v. 76 (6) (2008), pp. 966-978.

Link to PDF: https://www.radboudcentrumvoormindfulness.nl/media/Artikelen...

As far as I can tell that's pretty much what the book Feeling Good concluded many years ago: http://en.wikipedia.org/wiki/Feeling_Good:_The_New_Mood_Ther... , except at the time it was called Cognitive Behavioral Therapy. It's fascinating how the book dodges mentioning meditation as much as possible, but as you read it, you realize it's essentially proposing the same exact techniques of insight, just in a more clinical terminology.

CBT differs in two ways: First, it tends to be more reactive in that you typically analyse troublesome thoughts after-the-fact rather than in the present, as they happen. Second, it tends to be more ego-centric in that it tends to focus exclusively on your thoughts and needs, whereas mindfulness is more compassionate, both to yourself and to those you interact with. So, while there are similarities there are also important differences.

And while meditation is good for practicing mindfulness "in slow motion", you don't _need_ to meditate to be mindful.

>And while meditation is good for practicing mindfulness "in slow motion", you don't _need_ to meditate to be mindful.

Yes!! If you wake up and just don't feel like meditating that day, then don't! I view meditation as a tool that helps you reach deep into mindfulness, but meditating to meditate is missing the point. The goal you should have is to be mindful/present in the moment throughout the day.

MCBT is to CBT as C++ is to C... although don't take that analogy too far, as it certainly doesn't make it much more complex nor add a tonne of painful syntax ;)

Mindfulness-based CBT worked really well for myself, coupled with Suboxone which is being investigated as an anti-depressant itself. I haven't had an episode in two and half years, which is the longest stretch of saneness I've had since I was 16.

As others say, CBT is not MCBT.

The evidence for CBT is stronger than for MCBT, although they tend to be used for different people.

It's funny how this article is being spun by different sources.

Just the title being slightly different is enough to put a different interpretation on it. For example Reuters writes that "mindfulness is as good as medication".

But a Swedish doctors journal[2] writes "MBCT not better than pharmaceuticals".

And they both cite the same source[1].

[1]: http://www.thelancet.com/journals/lancet/article/PIIS0140-67... [2]: http://www.lakartidningen.se/Klinik-och-vetenskap/Nya-ron/20...

The article just publishing a press release.

"Treatment usually involves either medication, some form of psychotherapy or a combination of both. Yet many patients fail to get better and suffer recurring bouts of illness.

"MBCT was developed to help such people by teaching them skills to recognize and respond constructively to thoughts and feelings associated with relapse, aiming to prevent a downward spiral into depression."

This implird that MBCT is better than medication and/or psychotherapy, but later it says that it's just as (in)effective as medication, and also doesn't seem to realize that MBCT IS a form a psychotherapy.

"teaching them skills to recognize and respond constructively to thoughts and feelings associated with relapse, aiming to prevent a downward spiral into depression."

A lot of forms of psychotherapy do this. Some, do it explicitly, like CBT. Some do it implicitly, like psychoanalysis.

The important thing that the article leaves out (or that the study was unable to demonstrate) is how well it compares to other forms of psychotherapy in treating depression.

So in conclusion, what we know from this paper, is only, psychology should continue the course it's on: treat depression with a combination of medication and psychotherapy, and MBCT is a valid option.

I can see how this is effective. I remember reading that people with chronic depression have better memories and dwell on the past. Getting the person focused on the present could, theoretically, help alleviate painful memories. More studies need to be done. I'm all for natural, non-medicated, means of cures.

When mindfulness practice refers to "being present" it doesn't necessarily mean one only focuses on the current moment (although in certain circumstances this can be useful) -- rather, mindfulness is all about "going meta", moving outside your consciousness and looking at your thoughts and memories as they appear without allowing them to induce judgement or bias on your part: accepting how they make you feel, acknowledging those emotions, that you're human and they're perfectly normal, but then letting them go.

This way you can minimise their emotional effects so you can then theorise objectively on why you had a disturbing thought, and can then either make a note to modify your behaviour to avoid the situation that generated the thought or rationalise a mental solution to the issue at the core of the thought. You essentially become your own psychoanalyst.

Further, you can start to be "mindful" of others: acknowledging (consoling yourself with a little mental self-love is good here, "pet your inner monkey") and letting go of the feelings that resulted from their behaviours that upset you so that you can free yourself from the hurt and resentment they cause early, and allow yourself to explore an understanding as to why they acted the way that they did. Often (almost always) you can quickly establish some reasoning for their actions that don't involve unreasonable malice towards you, and thus you can dispose of thoughts that had they lingered would have festered and contributed further to your already 'sensitive' mental state.

So while it seems to an observer that early mindfulness practice is focussed on meditation and the literal present moment, its long-term concern is on giving the practitioner the ability to keep an eye on their "present" -- that is, their stream of consciousness -- so they can manage negative thoughts effectively and mitigate any potential damage they could cause, developing strategies to cope with them more easily and eventually moving to an automatic, unconscious response that instantly changes the malignant "Bob is mad at me, I must have done something horribly wrong" to the far more benign "Bob is mad at me, he must be having a bad day. I wonder why?"

I have chronic major depressive disorder. I don't think I have a better memory, maybe I have a predisposition to remember things that feel bad to me. Repeating the same loop in one's mind is not necessarily intelligent, nor does it indicate anything about memory, aside from the mind that clings continuously to a given idea.

but maybe you do have a better memory! which is why it is so difficult to forget things that feel bad. Leaving aside the question of intelligence, which is so many things that it isn't worth judging any individual by it, I would say your statement supports both the idea that memory is related to depression, and that focusing on the art of creation of new, positive memories, is a path to happiness, for people like you and me. As a person with a damn good memory, who once felt like you do, cheers!

AFAIK depression is associated with impaired memory [0][1], and sufferers tend to remember more negative experiences [2].

Also, memories are in effect changed by recall [3][4].

This combined with the cognitive distortions [5] linked to depression would seem to suggest even worse performance with regard to memory (i.e. looking for and finding fault that may not have been present, etc.)

BTW, "natural" is not really a useful distinction regarding this issue [6].

[0]: http://www.ncbi.nlm.nih.gov/pubmed/18266496

[1]: http://www.ncbi.nlm.nih.gov/pubmed/16571468

[2]: https://www.google.no/books?hl=en&lr=&id=TemvZpgA6uoC&oi=fnd...

[3]: http://www.northwestern.edu/newscenter/stories/2014/02/how-y...

[4]: http://www.jneurosci.org/content/32/35/12144.short

[5]: http://en.wikipedia.org/wiki/Cognitive_distortion#Main_types

[6]: http://en.wikipedia.org/wiki/Appeal_to_nature

Millions of dollars are made and will be made with the help of the statements starting from, or ending with the word: "study" (possibly preceded with the word "independent").

Study -> implies authority -> implies ability to manipulate.

research paper:

"Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): a randomised controlled trial"


"Mindfulness-based cognitive therapy - study"

Well, if drugs are only slightly better than placebo, and that's for the sickest patients maybe you shouldn't use it as a marker anymore? And that efficacy number is so low; it's wispered, and some clinicians after looking at the studies/metadata cannot even say drugs work over placebo in clinical depression.

(sorry for being so dismissive--just tired of these "studies" that leave out the fact that so many drug/depression studies were poorly done, manipulated, cherry picked, didn't exclude early placebo responders, done in 3rd world countries for the cheapest price(no real oversight, lying, etc.), and we were essentially lied to---)

The ineffectiveness of drugs against depression is highly overstated--the average effectiveness is low, but the variance is high, and they tend to be more effective the more severe the depression. The meme of "drugs aren't actually effective against depression" isn't doing the people for whom do work any favors.

After reading the article and the comments here, I have mixed reactions to this.

As I have learned more about anti-depressants, I've come around to the opinion that they are no more effective than placebo at treating mental illness. The fact that mindfulness therapy is "as good as medication" tells me that mindfulness therapy isn't very useful either. What it does make me think is just the act of being treated helps. Awareness of mental illness and pushing people to seek any treatment then seems to be preferable to doing nothing at all.

I'd still hedge my bets and choose some form of therapy over messing with the chemical system in my brain. I personally have experience with CBT and have great results, but in addition to that there is Mindfulness-based Cognitive Therapy (MBCT) and other forms of clinical therapy designed to treat mental illness that someone can try if CBT doesn't work for them.

So, there was no third group, a group taken off meds and then put on no therapy whatsoever, to represent a baseline? Perhaps that would be unethical. I'm just curious how high the relapse rate would be in that group.

350 Million people with depression is a bigger number than I previously thought... I wonder if this technique (MCBT) could somewhat be implemented in a mobile app that assists/guides you during the day...

I'd personally take this with a grain of salt - if I recall correctly, the effectiveness of antidepressant medication is roughly equal to that of random chance.

Yeah.. high 40's percent relapse rate in the article.

Take what with a pinch of salt? That MCBT is about the same as meds for chronic recurrent depression? Because the paper appears to show that it is as effective. Or that it works at all? Well, they didn't have a group that they took off medication and who didn't do therapy so we don't know what the relapse rate would have been for that group. I suspect that t would be higher than 45%

You also should remember that the placebo effect does actually contribute a large part of the effect of antidepressants. The research just shows that antidepressants don't have much of an effect above and beyond placebo.

I see therapy as being more useful and reliable in the long term than a placebo.

> The research just shows that antidepressants don't have much of an effect above and beyond placebo

For mild depression. For moderate depression they're better. For severe depression they're better when you get the right one.

An evidence based therapy is always a good idea.

I just did a search and came across this meta-analysis, which confirms your statement:


Bad choice of words.. maybe "perspective" more than the suspicion that "grain of salt" implies, but the point being that meds aren't terribly effective anyways, so something that's nearly as effective of them is.. somewhat less impressive.

The studies can also take advantage of mean reversion and test patients that are experiencing uncommonly high levels of depression (eg, unresponsive to medication). Over time patients return to their usual level of depression (or whatever's being tested) and the treatment is deemed effective.

No, it cannot, the design is a a randomized controlled trial, the controls would also go back, what is measured is the difference.

Breathing as good as medication for life.

This isn't really news, though it speaks more to the limited use of the current psychiatric doping paradigm than the efficacy of mindfulness.


Things have different names in different languages and cultures all the time.

edit: and the concept is not so complex that it needs to also be imported from another culture.

"From shampoo to mindfulness meditation, Indic scholar Rajiv Malhotra on how western entrepreneurs are cashing in on eastern wisdom. "

Seriously? no, get out. If it's a good, healthy thing to do, you can't fault people for doing it. They don't have to also pay homage to its history.


Why would it matter where I might guess the word came from? Are you perceiving people's ignorance to the origins of English words as some sort of cultural disrespect?

Reading the youtube comments of the video GP posted casts a different light on this discussion.

I'm discerning that there's a lot of anger about western appropriation of Indian culture, which is, well, fine, and I definitely didn't really know about it before this. But...

"First of all, why do u use YOGA in ur name??????????????? This belongs 2 us Indians"

This is kinda infuriating.


I'm not trying to call you names. The poster above mentioned those comments so I took a look at them and was disappointed. Though, I was surprised to see that much anger about this from, well, as you said - inarticulate folk on the internet. I didn't realize it was a point of anger among any folk until today.


> I realize that people here don't have much of a reading on colonial and current Indology (why do you think the Germans called themselves "Aryans" ?), let alone general history, but there isn't much point talking about this to the ignorant (\pm arrogant).

That's because HN is an international crowd. As a European continental citizen I am much more aware of Aryanism than the current Indian recognition movement (I assume there seems to be one, right ?).

With that said I suggest you adopt a more diplomatic stance (because when all is said and done I believe that we are losing way too much information when `adopting/stealing` concepts from other societies and risk of making unintended mistakes when applying techniques without the full knowledge and body of experience that comes with it. And stealing/misattribution is bad and infuriating (to me). Thus I agree with you.)

edit: Which reminds me, fwiw: I had some intense debate with some 3rd generation migrants from turkey (who were at that time rediscovering their Islam heritage) in college about zero. I held the opinion it came from India but they stick to the `arab numbers`.

First of all, I see that you are in no position and in 'mindfulness' to ask someone to get-out.

As it doesn't matter for you, where the word comes from, why not acknowledge it? In fact why not acknowledge that it is really "vipAsanA" when someone has already taken effort to show that it is?

This shows that YOU are perceiving people's ignorance to the origins of English words as some sort of cultural superiority/respect which is kind-of linguistic racism.

"get out" is just an expression. Short for "get out of here", meaning "that's ridiculous". I regret using it.

I'll happily acknowledge where words come from. No one is denying the origin of these words. I just don't see how it matters. It's okay for something to have a different word in another language.

I object to your use of the phrase "it is really 'vipAsanA'". "It is really" implies there must be one true name for a thing, which isn't true. It can have different names to different people. That's fine. I mean - Certainly we do not use the Chinese word for "firework" just because they invented fireworks first. There is no moral obligation to pay homage to the inventor of something in its name.


But it is mine. Well, that's ambiguous. It depends on what 'it' and 'mine' mean.

Of course I don't think that the cultural tradition of meditation is mine (or 'ours', or whatever, for whatever group I'm pretending to speak for. 'Western' if you will.) But the behavior of meditating, or doing yoga, is mine if I'm doing it. It can be yours too. I don't have to cite anything for it to be mine.

That book in your link doesn't mention meditation because: 1) CBT is quote-unquote 'slightly different' (I don't know if this is true, but a commenter says it is) and 2) meditation, especially with all historical terminology you seem to be advocating for, has a non-scientific connotation to some people, so they deemed it beneficial to avoid talking about it. (I'm not saying it should have an unscientific connotation, I'm saying that it has ended up that way. I think you would agree? I also think this is lessening over time.)

I think there's no denying that it is unnecessary to bring any sort of religion, or a complicated and foreign naming scheme, into meditation in order to make it useful as a medical suggestion. A medical book on a medical therapy does not need to cite the historical details of the therapy. It should cite other medical books. A history book should cite history.

Perhaps the most popular book on vipassana style meditation in English is "Mindfulness in plain English", and uses the term "mindfulness" repeatedly. As does a large number of other English-language sources of information on Vipassana.

I'm pretty certain that the people who popularised it in the west generally do _not_ claim to have invented it.

Mindfulness is BETTER than drugging yourself because it enables you to not only hold the unskillful emotional state in mindful awareness and disperse it at will, but it also enables you to discover the unskillful patterns of thinking that give rise to this state to begin with.

With mindfulness you can completely eradicate these unskillful patterns of thinking from your life forever and replace them with more empowering patterns.

There is no better investment that you can make than to invest a little bit of your time learning how to be mindful. The rewards are extraordinary.

Here in the bay area a great class is offered at the Insight Meditation Center in Redwood city: http://www.insightmeditationcenter.org/programs/for-beginner...

As I read this comment I thought it was a shill piece and you proved me right with the link at the end. I was about to say that if you want to exploit the gullible here, do it less transparently but you more or less got it right.

As I read this comment I thought of a mind which habitually creates a reality of powerless victimhood so pervasive that it perceives bad intentions on the part of everyone and feels compelled to lash out at perceived threats that don't even exist. This is the product of an unskillful pattern of thinking. You can either go deeper into hell until you pop yourself or correct it.

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