How does cognitive therapy prevent depressive relapse and why should attentional control (mindfulness) training help?
Abstract
There is encouraging evidence that structured psychological treatments for depression, in particular cognitive therapy, can reduce subsequent relapse after the period of initial treatment has been completed. However, there is a continuing need for prophylactic psychological approaches that can be administered to recovered patients in euthymic mood. An information-processing analysis of depressive maintenance and relapse is used to define the requirements for effective prevention, and to propose mechanisms through which cognitive therapy achieves its prophylactic effects. This analysis suggests that similar effects can be achieved using techniques of stress-reduction based on the skills of attentional control taught in mindfulness meditation. An information-processing analysis is presented of mindfulness and mindlessness, and of their relevance to preventing depressive relapse. This analysis provides the basis for the development of Attentional Control Training, a new approach to preventing relapse that integrates features of cognitive therapy and mindfulness training and is applicable to recovered depressed patients.
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CBT is hypothesized to work by providing patients with repeated experiences of refocusing attention away from automatic negative schemas toward alternative views or ideas.
“CBT is hypothesized to work by providing patients with repeated experiences of refocusing attention away from automatic negative schemas toward alternative views or ideas”
From Mindfulness Training Alters Emotional Memory Recall Compared to Active Controls: Support for an Emotional Information Processing Model of Mindfulness (2012) · cites this paper as Teasdale et al., 1995
Mindfulness-based cognitive therapy's theoretical rationale posits that mindfulness decreases risk for depression by helping individuals view thoughts and feelings as impermanent mental events, disrupting the connection between dysphoric affect and ruminative depressogenic thought patterns.
“This finding is consistent with the theoretical rationale for mindfulness-based cognitive therapy, a mindfulness-based intervention, which posits that mindfulness decreases risk for depression because it assists individuals in viewing their thoughts and feelings as impermanent mental events.”
From Mechanisms of action in the inverse relationship between mindfulness and psychological distress (2008) · cites this paper as Teasdale et al., 1995
Mindfulness improves emotion regulation by helping one recognize that distressing thoughts are not always accurate representations of reality.
“Some treatment outcome researchers have suggested that mindfulness improves emotion regulation by helping one recognize that distressing thoughts are not always accurate representations of reality (Linehan, 1993;Teasdale, 1999;Teasdale, Segal, & Williams, 1995).”
From Mechanisms of action in the inverse relationship between mindfulness and psychological distress (2008) · cites this paper as Teasdale et al., 1995
Decentering actively protects against and promotes recovery from anxiety and depression symptoms.
“One possibility is that an ability to decenter actively protects individuals against, and promotes recovery from, anxiety and depression symptoms7,52–54.”
From Decentering as a core component in the psychological treatment and prevention of youth anxiety and depression: a narrative review and insight report (2021) · cites this paper as [53]
Higher levels of present moment awareness can reduce negative thinking, a characteristic of depression and anxiety.
“In this context, it has already been shown that higher levels of present moment awareness can reduce negative thinking, a characteristic of depression and anxiety (30).”
From Mindfulness as Predictor of Itch Catastrophizing in Patients With Atopic Dermatitis: Results of a Cross-Sectional Questionnaire Study (2021) · cites this paper as [30]
The interpretation that improvements in mood were due to regression to the mean or non-specific group effects is at odds with theoretical and empirical support for mindfulness training.
“This interpretation however is at odds with theoretical and empirical support for mindfulness training [2-4,11,18].”
Ruminative thinking often involves extended pondering over personal shortcomings and problematic situations and perpetuates rather than alleviates the depressed state.
“Ruminative thinking often involves extended pondering over personal shortcomings and problematic situations and perpetuates rather than alleviates the depressed state [11].”
MBCT was designed to target cognitive processes that render depressed individuals vulnerable to repeated relapse and recurrence, such as rumination and high cognitive reactivity to mood shifts.
“MBCT was designed to target the cognitive processes that render depressed individuals vulnerable to repeated relapse and recurrence, such as rumination and high cognitive reactivity to mood shifts (Teasdale, Segal, & Williams, 1995).”
From Mindfulness-based cognitive therapy for severe health anxiety (hypochondriasis): An interpretative phenomenological analysis of patients' experiences (2011) · cites this paper as Teasdale, Segal, & Williams, 1995
Mindfulness-based approaches have been shown to be effective in managing stress, anxiety, depression, and chronic pain.
“mindfulness-based approaches have been shown to be effective in managing conditions such as stress, anxiety, depression, and chronic pain.”
From Exploring patient experiences with a mindfulness course in a general practice setting: a qualitative study. (2025) · cites this paper as [23]
MBSR has demonstrated significant benefits in stress, anxiety, depression, and chronic pain and is recommended in several guidelines.
“the extensively researched MBSR program, has demonstrated significant benefits in these areas [16–23], and are recommended in several guidelines [22, 24, 25].”
From Exploring patient experiences with a mindfulness course in a general practice setting: a qualitative study. (2025) · cites this paper as [23]
Theoretical foundations suggest that mindfulness may help people develop a detached, de-centered relationship to thoughts and feelings, preventing escalation of thought patterns that can lead to relapse.
“Theoretical foundations for integration of mindfulness with traditional cognitive-behavioral relapse prevention (34) suggest that mindfulness may help develop a detached and de-centered relationship to thoughts and feelings, preventing escalation of thought patterns that may lead to relapse (35,36).”
From Mindfulness-Based Relapse Prevention for Substance Use Disorders: A Pilot Efficacy Trial (2009) · cites this paper as [36]
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- Authors
- Teasdale, J. D., Segal, Z., & Williams, J. M. G.
- Affiliations
- University of Toronto (CA)
- Bangor University (GB)
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 1995-01
- Volume
- 33
- Issue
- 1
- Pages
- 25-39
- ISSN
- 0005-7967 (ISSN-L)
- OpenAlex
- W1977027217
- Cited by
- 1,349
- References
- 26
- Citations by year
- 2026: 23 · 2025: 34 · 2024: 32 · 2023: 53 · 2022: 52 · 2021: 45 · 2020: 53 · 2019: 66 · 2018: 68 · 2017: 61 · 2016: 87 · 2015: 82 · 2014: 94 · 2013: 65 · 2012: 64
- FWCI
- 4.19
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behaviour Research and Therapy (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- cognitive therapy, depression relapse, relapse prevention, mindfulness meditation, attentional control, stress reduction, mindlessness
- MeSH terms
- Aftercare, Attention, Awareness, Depressive Disorder, Humans, Recurrence, Relaxation Therapy, Cognitive Behavioral Therapy
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