Mindfulness And
Cognitive Bias Modification
In Depression
Introduction
Depression is one of the most common mental illnesses that is associated with severe impairment. Only around 60% of depressed patients respond to pharmacological or psychological treatment – with a high relapse rate.1
In people with depression, information processing is disturbed in that they preferentially focus attention on negative events and preferentially store them, but also in that it negatively alters the processing of positive events. These cognitive distortions can also occur in remission and are associated with a higher risk of relapse.2
Mindfulness involves paying attention to the present moment (thoughts, feelings, body sensations, awareness and environment) in a non-judgmental sense.3
The antidepressant effectiveness of MBI (mindfulness-based interventions) has been shown in the scientific literature, especially in the context of MBSR (mindfulness-based stress reduction) and MBCT (mindfulness-based cognitive therapy).3
In addition, mindfulness aspects are integrated into various other clinical approaches such as ACT (Acceptance and Commitment Therapy), which lead to an improvement in depressive symptoms or the risk of relapse of depressive episodes.3
Cognitive biases are treated with computer-based programs – cognitive bias modification (CBM) programs. These train attention to positive stimuli and aim to better process them (positivity training).2
MBI And Depression
Mindfulness-based Stress Reduction (MBSR)
MBSR is an 8-week program based on regular meditation and mindfulness exercises, as well as yoga, breathing exercises and group discussions. Randomized controlled trials comparing MBSR to active control conditions suggest that MBSR is moderately to highly effective in reducing the severity of anxiety and depression symptoms in individuals with a wide range of medical and psychiatric illnesses.4
The most comprehensive review to date examined the effects of 209 studies of mindfulness-based interventions on 12,145 patients with a variety of disorders, including depression. The results show superiority to waiting list, psychoeducation, supportive psychotherapy, relaxation exercises and imagination and suppression techniques. The effect size for psychological parameters was largest for anxiety followed by depression.4
Mindfulness-based Cognitive Therapy (MBCT)
MBCT is structurally and permanently based on MBSR. It combines elements of mindfulness training and cognitive therapy to prevent depressive relapses. Deviations in mood are initially observed without judgment and then linked to new ways of thinking.5
Several controlled, randomized studies demonstrate a reduction in the relapse rate, especially in patients with a high risk of relapse (Cohen’s h = 0.88).5
CBM And Depression
CBM targets attention to positive stimuli and interpretation of experiences. Beevers et al. (2015) were able to show in a 4-week study with adult patients that attention control training towards positive stimuli led to a significant reduction in negative attention bias, which in turn was accompanied by a significant reduction in depressive symptoms.2,6 Comparable results were found in remitted depressive patients and in adolescents.2
Cristea and colleagues conclude that CBM shows improvement as attention and interpretation training.7 CBM can therefore be of therapeutic benefit for mild to moderate episodes, in relapse prevention and in addition to other methods for severe depression.
Virtual reality (VR) against depression based on MBI and CBM
The scientific data based on several independent randomized and controlled studies support the use of mindfulness and attention training in the treatment of severe depression in addition to other procedures such as psychotropic drugs and behavioral therapy. Both a greater relief of symptoms and an increase in the remission rate as well as an improvement in the prevention of recurrence of depression can be expected.
Apps with MBI and computer-supported CBM are already in use – the use of VR with a correspondingly high level of immersiveness is both innovative and promising in this context.
Neurobiological explanations
Mindfulness improves attention regulation, emotion regulation and self-awareness. All three domains promote self-management, for example in dealing with negative feelings and moods.
A possible, fundamental effect of mindfulness and conscious attention could also lie in its role as a counterpart to the DMN (default mode network) or resting network of the brain. This state is reached when we literally do nothing and is characterized by mind wandering or daydreaming.
During mind wandering, memories and fantasies are strongly linked to negative evaluations, boredom, loneliness and our self-image. Seli and colleagues show that episodes of mind wandering correlate with depression, but also anxiety and stress.8
Mindfulness or conscious attention in general represents a counterpart to the calm network and could thus alleviate or prevent depression by reducing mind wandering.
- DeRubeis RJ, Hollon SD, Amsterdam JD et al (2005) Cognitive therapy vs medications in the treatment of moderate to severe depression. Arch Gen Psychiatry 62(4):409.
- Tendolkar, I., Vrijsen, J.N. & Becker, E.S.(2019) „Cognitive bias modification“ als mögliche Add-on-Therapie bei Depression. Psychotherapeut 64, 180–185.
- Hofmann SG, Gómez AF. Mindfulness-Based Interventions for Anxiety and Depression. Psychiatr Clin North Am. 2017 Dec;40(4):739-749.
- Khoury B, Lecomte T, Fortin G, et al. Mindfulness-based therapy: A comprehensive meta-analysis. Clin Psychol Rev. 2013;33(6):763–771.
- Creswell JD. Mindfulness Interventions. Annu Rev Psychol. 2017;68:491–516.
- Beevers CG, Clasen PC, Enock PM et al (2015) Attention bias modification for major depressive disorder: effects on attention bias, resting state connectivity, and symptom change. J Abnorm Psychol 124(3):463.
- Cristea IA, Kok RN, Cuijpers P (2015) Efficacy of cognitive bias modification interventions in anxiety and depression: meta-analysis. Br J Psychiatry 206(1):7–16.
- Seli, P., Beaty, R. E., Marty-Dugas, J., & Smilek, D. (2019). Depression, anxiety, and stress and the distinction between intentional and unintentional mind wandering. Psychology of Consciousness: Theory, Research, and Practice, 6(2), 163–170. https://doi.org/10.1037/cns0000182
