Presentation by Stuart J. Eisendrath, MD, at the UCSF Depression Center's "Depression: Pathways to Resilience and Recovery" event on September 13, 2014.

1. Mindfulness-Based
Cognitive Therapy
for Depression
Stuart Eisendrath, MD
Director, UCSF Depression Center

2. Mindfulness
Mindfulness means paying attention, in a particular way; on
purpose, in the present moment and
non-judgmentally. – Kabat-Zinn, 1990
A nonevaluative awareness to one’s inner and outer environment.
A kind of non-elaborative, nonjudgmental, present-centered
awareness in which each thought, feeling, or sensation that arises
in the attentional field is acknowledged and accepted as it is. –
Bishop et al., 2004

3. Mindfulness Applications
• Stress reduction
• Chronic pain
• Psoriasis
• Eating
• Fibromyalgia
• Cancer
• Parenting/Childbirth
• Anxiety
• Depression
• Borderline personality
disorder
• Addiction
• Bipolar disorder

4. How Does Mindfulness Work
in Depression?
Focus on here and now
Selective attention
Decreased rumination
Increased decentering
Enhanced self compassion

5. MBCT Core Concepts
Thoughts and feelings are viewed as mental events and not as
concrete facts of reality.
Our minds are constant “thought generators”.
Our minds are not always our best friends.

6. 70
60
50
40
30
20
10
0
ONE YEAR FOLLOW-UP:
% FREE of RELAPSE/RECURRENCE (n= 73)
> 2 episodes
TAU %
MBCT %
Ma & Teasdale, 2004

7. MBCT vs. CBT
I am having the thought…..
Little emphasis on positive vs.
negative thoughts
Promotes an alternative way
of “being with” painful affect
and challenging circumstances
Noticing thoughts
Thought process focused
I am…..
 Rigorous attention to
identifying negative thoughts
and beliefs
Promotes new way of looking
at painful affect and
challenging circumstances
Answering back
Thought content focused

8. Experiential Practice # 1
Scenario A: Walking Down the Street

9. Experiential Practice # 2
The Body Scan

10. Clinical Characteristics
MBCT (N= 87) HEP (N=86)
Variable Mean SD Mean SD
Age at depression onset 18.8 10.9 21.7 13.2
Total number depressive episodes 3.6 2.6 3.5 2.4
Length of current depressive episode
84.4 119.5 78.5 93.5
(months)
HAM-D score 18.3 3.4 17.4 3.5
Single episode (%) 20.7 22.1
≥ 3 Lifetime episodes 62.2 58.0
Previous treatment for depression (%)
Hospitalization 16.1 18.6
Suicide attempt 19.0 20.5
Recruitment Source (%)
General Internal Medicine 34.5 36.1
Psychiatry Clinic 43.7 39.5
Community 24.4 24.4
Note. HAM-D = Hamilton Depression Rating Scale

11. Post-intervention Outcomes
23
37
24
25
50
40
30
20
10
0
Week 4 Week 8
MBCT
HEP
P = 0.008
% Reduction HAM-D
% Change
Treatment Response*
10.13
29.58
10.67
17.19
35
30
25
20
15
10
5
0
MBCT
HEP
P = 0.0293
Week 4 Week 8
% of Sample
*Response defined by ≥ 50% reduction in
Hamilton Depression Rating Scale (HAMD)
total score from baseline

12. Experiential Practice # 3
Attentional Focus

13. Experiential Practice # 5
Scenario A or B: Job Review

14. Mindfulness Mechanisms
Decentering: viewing thoughts as mental events and not facts: May
be key component of traditional CBT
Decreased rumination
Enhanced self-compassion
Enhanced mindfulness
Decreased avoidance

15. PARTICIPANT RESPONSE to
MBCT
“I’m gentler on myself.”
“I’m less critical.”
“I can talk back to myself more.”
“I notice people are more interesting.”
“I’m more mindful in my everyday life.”
“I handle stressful events better.”

16. MBCT Results in Increase in Activity in
MBCT Group: Activity in WM Task (Post - Pre Training)
HEP Group: Post – Pre Neural Activity WM Task
P = 0.05 uncorrected
Mathalon Lab
Attentional Control Areas

17. MBCT Shows Greater Changes Than HEP
Group in Parietal and Prefrontal Attention
Regions: Working Memory
Pre-Treatment (MBCT vs. HEP Group)
P = P = 0.05 uncorrected
Post-Treatment (MBCT vs. HEP Group)
P = 0.05 uncorrected

18. Experiential Practice # 4
3-Minute Breathing Space