3 Mindfulness-Based Cognitive Therapy DAVID M. FRESCO, JESSICA J. FLYNN, DOUGLAS S. MENNIN, AND EMILY A. P. HAIGH
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ccording to the fourth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, American Psychiatric Association [APA], 2000), Major Depressive Disorder (MDD) is a mood disorder characterized by one or more major depressive episodes (i.e., at least two weeks of depressed mood or loss of interest or pleasure in nearly all activities), accompanied by at least four additional symptoms such as changes in sleep, appetite or weight, and psychomotor activity; decreased energy; feelings of worthlessness or guilt; difficulty thinking, concentrating, or making decisions; or recurrent thoughts of death or suicidal ideation, plans, or attempts. MDD represents an enormous mental health challenge, with lifetime prevalence estimated at 17% (Kessler, Bergland, & Demler, 2005). Similarly, individuals who suffer from one depressive episode will, on average, experience four major depressive episodes of 20 weeks’ duration over their lifetime. According to a recently released World Health Organization study of 245,000 in sixty nations, MDD is more damaging to everyday health than chronic diseases such as angina, arthritis, asthma, and diabetes (Moussavi et al., 2007). MDD is estimated to cause the fourth-greatest burden of ill health of all diseases worldwide and will move into second place by 2020 (Murray & Lopez, 1998). Despite successful medication and psychotherapies, fewer than half of patients achieve remission (Casacalenda, Perry, & Looper, 2002), and relapse is more likely in individuals who do not fully recover (Jarrett et al., 2001; Thase, Entsuah, & Rudolph, 2001). For these reasons, both basic and treatment research efforts are homing in on the identification of vulnerability factors associated with the onset and maintenance of depression as well mechanisms that promote risk of relapse. Meditation and other mental training exercises deriving from the 2,500-year Buddhist and Hindu traditions represent one potentially fruitful area of study that has the potential to expand contemporary models of depression as well as complement existing medication and psychotherapy treatments. The past 30 years have witnessed an increasing interest in meditation, yoga, and other mental training exercises that emanate from Hindu and Buddhist traditions. The use of these practices has dovetailed in recent years with the emergence of affective neuroscience, a subdiscipline within the fields 57
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