Practice of therapy acquired regulatory skills and depressive relapse/recurrence prophylaxis following cognitive therapy or mindfulness based cognitive therapy.

Abstract

Background: To investigate whether usage of treatment-acquired regulatory skills is associated with prevention of depressive relapse/recurrence. Method: Remitted depressed outpatients entered a 24-month clinical follow up after either 8 weekly group sessions of cognitive therapy (CT; N ϭ 84) or mindfulnessbased cognitive therapy (MBCT; N ϭ 82). The primary outcome was symptom return meeting the criteria for major depression on Module A of the SCID. Results: Factor analysis identified three latent factors (53% of the variance): decentering (DC), distress tolerance (DT), and residual symptoms (RS), which were equivalent across CT and MBCT. Latent change score modeling of factor slopes over the follow up revealed positive slopes for DC (␤ ϭ .177), and for DT (␤ ϭ .259), but not for RS (␤ ϭ Ϫ.017), indicating posttreatment growth in DC and DT, but no change in RS. Cox regression indicated that DC slope was a significant predictor of relapse/recurrence prophylaxis, Hazard Ratio (HR) ϭ .232 90% Confidence Interval (CI) [.067, .806], controlling for past depressive episodes, treatment group, and medication. The practice of therapy-acquired regulatory skills had no direct effect on relapse/recurrence (␤ ϭ .028) but predicted relapse/recurrence through an indirect path (␤ ϭ Ϫ.125), such that greater practice of regulatory skills following treatment promoted increases in DC (␤ ϭ .462), which, in turn, predicted a reduced risk of relapse/recurrence over 24 months (␤ ϭ Ϫ.270). Conclusions: Preventing major depressive disorder relapse/recurrence may depend upon developing DC in addition to managing residual symptoms. Following the acquisition of therapy skills during maintenance psychotherapies, DC is strengthened by continued skill utilization beyond treatment termination. What is the public health significance of this article?People receiving maintenance psychotherapies for depression are expected to utilize emotion regulation skills past the point of active treatment but receive little guidance regarding which skills are most effective. Our data suggest that resilience to episode return depends upon the development of metacognitive skills for the regulation of distressing thoughts and emotions.

A neurobehavioral account for decentering as the salve for the distressed mind

“…Decentering represents a metacognitive capacity to observe items that arise in the mind (e.g., thoughts, feelings, memories) with healthy psychological distance, greater self-awareness and perspective-taking [15] and is thought to reflect three interrelated processes: metaawareness, disidentification from internal experience, and reduced reactivity to thought content [16]. Gains in decentering predict acute and enduring improvement in distress disorders following treatment with mindfulness-based interventions (MBIs) [17][18][19][20] as well as mindfulness enriched CBTs [21][22][23][24]. Theoretical accounts [16,25,26] and empirical findings [27,28] are beginning to reveal the neurobehavioral underpinnings of decentering and suggest MBIs lead to engagement and enduring alterations in large-scale neural networks associated with attention, executive control, and self-referential processing [29][30][31].…”

“…Theoretical accounts [16,25,26] and empirical findings [27,28] are beginning to reveal the neurobehavioral underpinnings of decentering and suggest MBIs lead to engagement and enduring alterations in large-scale neural networks associated with attention, executive control, and self-referential processing [29][30][31]. However, as the science of decentering continues to mature [32], more work is need to carefully elucidate how mindfulness acts on the distressed brain possibly via increases in decentering [20].…”

“…Establishing a mindfulness practice leads to increased capacity for decentering [17][18][19][20] as well as reliable and enduring alterations in the basal neural activity and connectivity, which may account for clinical improvement associated with MBIs [46,52,53]. Accumulating evidence offers indications for functional patterns of brain network configurations reflected in the proposed decentering components [16] that may contribute to the resolution of distress disorders [54,55].…”

Patient-Made Videos as a Tool of Self-Observation Enhancing Self-Reflection in Psychotherapy

“…patients learn to observe their experiences from "outside". Decentering seems to be the principal mechanism that correlates with the success of psychotherapeutic treatment of various disorders (Hayes-Skelton and Graham 2013;Segal et al 2019).…”

A neurobehavioral account for decentering as the salve for the distressed mind

“…Decentering represents a metacognitive capacity to observe items that arise in the mind (e.g., thoughts, feelings, memories) with healthy psychological distance, greater self-awareness and perspective-taking [15] and is thought to reflect three interrelated processes: metaawareness, disidentification from internal experience, and reduced reactivity to thought content [16]. Gains in decentering predict acute and enduring improvement in distress disorders following treatment with mindfulness-based interventions (MBIs) [17][18][19][20] as well as mindfulness enriched CBTs [21][22][23][24]. Theoretical accounts [16,25,26] and empirical findings [27,28] are beginning to reveal the neurobehavioral underpinnings of decentering and suggest MBIs lead to engagement and enduring alterations in large-scale neural networks associated with attention, executive control, and self-referential processing [29][30][31].…”