Objective To examine whether meta-cognitive psychological skills, acquired in MBCT are also present in patients receiving medication treatments for prevention of depressive relapse and whether these skills mediate MBCT's effectiveness. Method This study, embedded within a randomized efficacy trial of MBCT, was the first to examine changes in mindfulness and decentering during 6-8 months of antidepressant treatment and then during an 18 month maintenance phase where patients either discontinued medication and received MBCT, continued on antidepressants, or were switched to a placebo. A total of 84 patients (mean age 44, 58% female) were randomized to one of these three prevention conditions. In addition to symptom variables, changes in mindfulness, rumination and decentering were assessed during the phases of the study. Results Pharmacological treatment of acute depression was associated with reductions in Rumination and increased Wider Experiences. During the maintenance phase, only patients receiving MBCT showed significant increases in the ability to monitor and observe thoughts and feelings as measured by the Wider Experiences (p<.01) and Decentering (p<.01) subscales of the Experiences Questionnaire and Toronto Mindfulness Scale. In addition, changes in Wider Experiences (p<.05) and Curiosity (p<.01) predicted lower HRSD scores at 6 months follow up. Conclusions An increased capacity for decentering and curiousity may be fostered during MBCT, and underlie its effectiveness. With practice, patients can learn to counter habitual avoidance tendencies and to regulate dysphoric affect in ways that support recovery.

The authors examined the longitudinal relationship of patient-rated perfectionism, clinician-rated depression, and observer-rated therapeutic alliance using the latent difference score (LDS) analytic framework. Outpatients involved in the Treatment for Depression Collaborative Research Program completed measures of perfectionism and depression at 5 occasions throughout treatment, with therapeutic alliance measured early in therapy. First, LDS analyses of perfectionism and depression established longitudinal change models. Further LDS analyses revealed significant longitudinal interrelationships, in which perfectionism predicted the subsequent rate of depression change, consistent with a personality vulnerability model of depression. In the final LDS model, the strength of the therapeutic alliance significantly predicted longitudinal perfectionism change, and perfectionism significantly predicted the rate of depression change throughout therapy. These results clarify the patterns of growth and change for these indicators throughout depression treatment, demonstrating an alternative method for evaluating longitudinal dynamics in therapy.

The authors integrate explorations by Blatt and colleagues of contributions of patient personality, therapeutic relationship, and change in mental representation to sustained therapeutic change. A pretreatment personality characteristic, self-critical perfectionism, a negative self-schema, significantly interfered with therapeutic progress in manual-directed, brief outpatient treatment for depression. The therapeutic relationship, however, facilitated changes in this negative self-representation, leading to sustained therapeutic change. The authors also explored change in the content and structural organization of representations of self and significant others in long-term, intensive inpatient treatment. A detailed clinical example elaborates the processes through which the therapeutic relationship facilitates changes in the thematic content and cognitive structural organization of patients' interpersonal schemas that appear to be the basis for sustained therapeutic gain.

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This is the first study to directly compare relapse prophylaxis following MBCT and CT directly. The lack of group differences in time to relapse supports the view that both interventions are equally effective and that increases in decentering achieved via either treatment are associated with greater protection. These findings lend credence to Teasdale et al.'s (2002) contention that, even though they may be taught through dissimilar methods, CT and MBCT help participants develop similar metacognitive skills for the regulation of distressing thoughts and emotions. (PsycINFO Database Record

Strength of character, Dysfunctional attitude, Predisposition, Well-being, Major depression, Recovery,

Implications of these findings for understanding the mechanisms underlying the development and maintenance of depressive cognition are discussed.