Review - Mindfulness-Based Cognitive Therapy for Depression
by Zindel Segal, Mark Williams and John Teasdale
Guilford Press, 2001
Review by Peter B. Raabe Ph.D.
May 9th 2002 (Volume 6, Issue 19)

This is an easy to read book written in ordinary English. While it contains references to research in clinical psychology and several graphs, the authors have been careful to speak in a conversational tone which prevents the book from becoming just another dry academic tome.

The book is meant to be used as a guide by psychotherapists and counselors in learning how to carry out a new sort of practice. The first five chapters explain what the authors mean by "mindfulness-based cognitive therapy," the next eight chapters are step-by-step instructions for a series of eight group counseling sessions, and the final two chapters and the epilogue summarize what the authors have tried to accomplish with this volume. It also contains work sheets for "patients," information hand-outs, homework assignment summary pages, and carefully detailed instructions to counselors and therapists in how to use each of these in their practices.

Unfortunately, this book is what I would consider a "light" book. By this I mean that the theoretical foundation on which this new method is based is very insubstantial, there are more pages than is necessary to say what was said, there are many repetitive passages, and there is nothing new in the material to stimulate the reader's thinking or imagination. The so-called new method the authors are promoting is simply a reworking of what some might call a New Age type of awareness, very similar to practices within Taoism, Buddhism, and yoga. The practice of "mindfulness" seems to be a combination of group meditation, phenomenology, breathing exercises, and an intentional focus on awareness. The authors explain that their approach involves a type of meditation which helps the patient be able to "recognize difficult situations early and deal with them skillfully" by "replacing the old mode of fixing and repairing problems with a new mode of allowing things to just be as they are" (95). The patient learns how to achieve an "acceptance of what is" (93) and how to "simply be with difficult and uncomfortable emotions" (italics in the original) (78). The book is filled with various attempts to explain the vague "accepting," "allowing" and "being with," but, of course, the authors never quite succeed in defining these terms adequately. They ultimately resort to telling their readers "you've got to try it to understand what we mean," which puts them in the paradoxical position of having tried to explain in this book that which they themselves admit can't be explained.

The authors cite some "scientific" research they have conducted to substantiate their claim that their method is effective in helping previously depressed individuals avoid relapsing into depression, but they leave me unconvinced that this is indeed something new or more effective than other methods. In fact, the authors are very careful not to claim too much for their method, stating that it is not meant to help people overcome severe depression, that it is not helpful in preventing depression in those who have only had one or two experiences of depression in the past, and that it will only help a portion of those individuals who have experienced multiple depressive episodes in the past to avoid future recurrences. This leaves them with a very soft claim regarding the efficacy of their method.

Not only is this a "light weight" book, it also contains a number of technical problems as well. For example, the authors show a lack of understanding of the neurological function of anti-depressant drugs, and they seem to be unaware of the many serious problems inherent in clinical drug trials involving placebos. They also reveal an ambiguity in their reasoning concerning what they believe to be the reasons for, or the causes of, depression, recovery, and relapse in that they accept environmental influences as the initial cause of depression, but then ignore this same cause in their discussion of later relapse into depression. Instead they claim that relapse depression results from the brain simply getting stuck in some sort of "downward spiral" of thinking. These are very surprising weaknesses in a book written by professionals whose long list of impressive academic and research positions are cited on the back flap for all to see.

There is no doubt that this so-called mindfulness-based cognitive group therapy will help some individuals. But the description of the method devised by these authors will seem very familiar to anyone with even the slightest interest in group meditational practices, and hardly warrants heralding the arrival of a "new" therapy (the sub title of this book is "A New Approach to Preventing Relapse"). Despite the book's weaknesses, I congratulate the authors on their honesty in offering their readers an interesting insight into their own trials and errors in the research they conducted in the development of their method. If nothing else, the authors offer their readers a fascinating insight into the failure of their initial research hypothesis and how they then reoriented their project so that there would be no interruption in their research funding.

© 2002 Peter B. Raabe