Excel At Life--Dedicated to the Pursuit of Excellence in Life, Relationships, Sports and Career
CBT Jealousy Depression Relationships Conflict Self-efficacy Happiness Goal-setting Motivation Wellness Sport Psych

Popular Articles

Crazy-Makers: Dealing with Passive-Aggressive People

Why Are People Mean? Don't Take It Personally!

When You Have Been Betrayed

Struggling to Forgive: An Inability to Grieve

Happy Habits: 50 Suggestions

The Secret of Happiness: Let It Find You (But Make the Effort)

Excellence vs. Perfection

Depression is Not Sadness

20 Steps to Better Self-Esteem

7 Rules and 8 Methods for Responding to Passive-aggressive People

What to Do When Your Jealousy Threatens to Destroy Your Marriage

Happiness is An Attitude

Guide to How to Set Achieveable Goals

Catastrophe? Or Inconvenience?

Popular Audios

Panic Assistance

Motivational Audios

Mindfulness Training

Rational Thinking

Relaxation for Children

Loving Kindness Meditation

Self-Esteem Exercise

Lies You Were Told

Choosing Happiness

Audio Version of Article: Crazy-Makers: Passive-Aggressive People

Audio Version of Article: Why Are People Mean? Don't Take It Personally!

Audio Version of Article: Happiness Is An Attitude

All Audio Articles

PsychNotes Index

More PsychNotes: Mindfulness and Relaxation Methods

October 27, 2015       

Mindfulness Practice and Relapse Prevention When Using Anti-depressants
by Monica A. Frank, PhD

It has long been shown that discontinuing anti-depressants has a high relapse rate. However, when mindfulness training results in greater emotional tolerance, not only does the relapse rate decline but improvement continues. Learning how to decenter from mindfulness training increases curiosity and the tolerance of thoughts and feelings because they are viewed as temporary events in the mind (Bieling, et al., 2012).

Previous research that examined patients treated with anti-depressants and then randomly placed in groups to either continue with the anti-depressants, receive a placebo, or discontinue anti-depressants to receive Mindfulness-Based Cognitive Therapy (MBCT) found no difference between those who remained on the medication and those who stopped medication and were trained in mindfulness techniques (Segal, 2010).

However, additional research examining the same patients showed that when mindfulness training results in greater emotional tolerance it continues to reduce depression after medication is stopped. Those patients who learned how to decenter from the mindfulness training and increased their ability to observe thoughts and feelings with greater tolerance had lower levels of depression six months after medication was discontinued than those who remained on the anti-depressants (Bieling, et al., 2012).

What does this mean for you? Just learning how to be mindful isn't enough to affect levels of depression when discontinuing medication. It is necessary to get to the point in your mindfulness practice where you can observe your thoughts and feelings from an emotional distance. In other words, when you feel bad, you can recognize you are having a bad day without the judgment: “This is terrible! I can't stand it! I've got to get it to stop” or “I'm so weak. What's wrong with me?” Instead of the judgment and demands to get rid of the depression you can examine it from a more objective perspective: “I'm having a bad day. What do I need to do to best take care of myself?”

This research shows that not only can anti-depressants be discontinued but when you learn to tolerate emotions and approach events with curiosity rather than dread you can continue to improve. As I indicate in my Understanding Mindfulness audios (free to download or read transcripts), step 1 teaches mindful awareness, step 2 teaches mindful awareness with discomfort, and it is not until step 3 that you start learning to develop emotional tolerance. However, these steps build upon one another and you need to take the time to learn each step before you can reduce depression through mindfulness training.

It is the tolerance of emotional discomfort that helps reduce the depressive symptoms. Think of it this way. Imagine that we scale your depression from 1 to 10 and the uncontrollable, physical part of the depression is a 5. But then you also have negative thoughts about your inability to tolerate the depression. Now the depression might be a 7. And then you also have judgmental thoughts about your inability to control the depression. Now the depression might be a 9. This shows that part of the depression is the illness itself but the other part is how your thinking may contribute to increasing the symptoms (this same process is also implicated in other illnesses such as heart disease).

Therefore, mindfulness training increasing emotional tolerance may not rid you of the depression entirely because depression is physically based. However, it can decrease the part of the depression that is due to the intolerance of the symptoms. As a result, the depression becomes more manageable and interferes less with your life.

Bieling, P.J., Hawley, L.L., Bloch, R.T., Corcoran, K.M., Levitan, R.D., Young, L.T., MacQueen, G.M. And Segal, Z.V. (2012). Treatment-Specific Changes in Decentering Following Mindfulness-Based Cognitive Therapy Versus Antidepressant Medication or Placebo for Prevention of Depressive Relapse. Journal of Consulting and Clinical Psychology, 80, 365–372. DOI: 10.1037/a0027483

Segal, Z. V., Bieling, P. J., Young, T., MacQueen, G., Cooke, R., Martin, L., Block, R. and Levitan, R. D. (2010). Antidepressant monotherapy versus sequential pharmacotherapy and mindfulness-based cognitive therapy, or placebo, for relapse prophylaxis in recurrent depression. Archives of General Psychiatry, 67, 1256–1264. DOI:10.1001/archgenpsychiatry.2010.168

More PsychNotes
Mindfulness and Relaxation Methods

Mindfulness Practice and Relapse Prevention When Using Anti-depressants
The Mindful Journey
The Benefits of Mindfully Washing Dishes
The Difference Between Mindful Focus and a Mindful Attitude
Mindfulness Training Shows Promise for Attention-Deficit Hyperactivity Disorder
Mindfulness and Managing Chronic Pain
How We Might Stop Bullying: Kindness Curriculum for Preschoolers
Practicing Loving-Kindness May Elicit Resentments
How Mindfulness Can Reduce Risk for Alzheimer's and Heart Disease
Mindful Attention to Unhealthy Foods Improves Food Choices
Want an Easy and Uplifting Health Practice? Laughing Qigong
Mindful Dating: How Does Mindfulness Affect Satisfaction in Relationships?
10 Everyday Frustrations and a Mindful Attitude
What is the Difference Between Mindful Acceptance and Emotional Suppression?
Mindful Attention Reduces Anger for Those With Borderline Personality Disorder
The Paradox of the Mindful Attitude
The Key to Mindful Breathing for Sleep
Addiction to Emotions and Mindfulness Practice
Mindfulness Practice is Not Focusing, It is Re-Focusing
How Much Should You Practice Mindfulness?
For Fun--Try Being Mindful About the Weather
What Could Be More Mindful Than a Cat Watching Bird Videos?
Wisdom Doesn't Come In Sound Bites
Qigong Can Reduce Depression
Demands vs. Mindfulness for Enhancing Performance
Acceptance as the Basis for Wisdom?
“I want to feel good NOW!”
The 20-Minute a Day Miracle
Be the Best You Can Be: On Mindfulness and Performance
Being Mindful of Emotions Decreases Intensity
Massage: Effects on Anxiety, Depression, and Pain
Mindfulness and Flow in the Workplace
Mindfulness May Prevent Relapse
Is Mindfulness-Based Therapy Effective?
Qi Gong Exercise Shown to Improve Mood
Mindfulness Skills Can Improve Relationships

Kindle Books by
Dr. Monica Frank

Recent Articles

Analyzing Your Moods, Symptoms, and Events with Excel At Life's Mood Log

Why You Get Anxious When You Don't Want To

Why People Feel Grief at the Loss of an Abusive Spouse or Parent

“Are You Depressed?”: Understanding Diagnosis and Treatment

15 Coping Statements for Panic and Anxiety

Beyond Tolerating Emotions: Becoming Comfortable with Discomfort

Emotion Training: What is it and How Does it Work?

How You Can Be More Resistant to Workplace Bullying

Are You Passive Aggressive and Want to Change?

When Your Loved One Refuses Help

Newest Audios

Building Blocks Emotion Training

Hot Springs Relaxation

5 Methods to Managing Anger

Panic Assistance While Driving

Autogenic Relaxation Training

Rainbow Sandbox Mindfulness

Mindfulness Training