The Effects of Mindfulness-Based Cognitive Therapy on Depressive Gait Patterns

Abstract According to embodiment theories, the experience of emotional states affects somatovisceral and motoric systems, whereas the experience of bodily states affects methods by which emotional information is processed. In the light of the embodiment framework, we proposed that formerly depressed individuals with a high risk of depressive relapse would display deviations in the way they walk, which might then play a role in the escalating process of depressive relapse. Moreover, we proposed that training in mindful body awareness during mindfulness-based cognitive therapy (MBCT) might have a normalizing effect on gait patterns. Gait patterns of 23 formerly depressed outpatients were compared to those of 29 never-depressed control participants. Also, gait patterns of formerly depressed patients were measured before and after MBCT to assess changes in patterns. A Fourier-based description of walking data served as the basis for the analysis of gait parameters. Before MBCT, gaits of formerly depressed patients were characterized by reduced walking speed and reduced vertical movements of the upper body. After MBCT, walking speed and lateral swaying movements of the upper body were normalized, and a trend towards normalization of vertical head movements was observed. It was concluded that MBCT has a normalizing effect on gait patterns, thus displaying not only cognitive, but also "embodied" effects. Keywords: embodiment, gait, major depression, mindfulness, relapse prevention . when the practitioner walks, he is aware, "I am walking. " When he is standing, he is aware, "I am standing. " When he is sitting, he is aware, "I am sitting. " When he is lying down, he is aware, "I am lying down. " In whatever position his body happens to be, he is aware of the position of his body. (Buddha, trans. 1974, Hanh) Introduction1 Mindfulness-based cognitive therapy (MBCT; Segal, Williams & Teasdale, 2002) was developed as an intervention for relapse prevention in depression, and its effectiveness has been demonstrated in three randomized controlled trials. Two of these trials (Teasdale, Segal, Williams, Ridgeway, Soulsby, & Lau, 2000; Ma & Teasdale, 2004) compared rates of relapse/recurrence in major depressive disorder (MDD) following treatment as usual (TAU) versus TAU plus MBCT. TAU consisted of help from family doctors or other sources normally contacted by patients when encountering symptomatic deterioration or other difficulties. In both studies, considerable reductions of rates of relapse/recurrence in MDD were reported for patients with three or more previous episodes of MDD (reduction of 44% and 54 % respectively). Moreover, a recent study (Kuyken et al., 2008) found MBCT to be at least as effective in reducing relapse/recurrence in MDD as maintenance pharmacological treatment with antidepressant medication, which forms the 'gold standard' of evidence-based relapse prevention in MDD (NICE, 2004). The group-based MBCT-program (Segal et al., 2002) consists of eight weekly sessions of approximately 2.5 hours in duration. MBCT combines intensive training in mindfulness with elements of cognitive behavioral therapy. Mindfulness is rooted in eastern meditation traditions and can be characterized as paying attention in a certain way: on purpose, in the present moment, and nonjudgmentally (Kabat-Zinn, 1990). Training in mindfulness is thought to enable patients to recognize and disengage from mind states characterized by selfperpetuating patterns of ruminative, negative thought, which might increase risk of relapse. By learning to recognize that thoughts and feelings are events in the mind as opposed to self-evident truths or aspects of the self, patients may be able to prevent the depressive thought-affect cycle from escalating (Teasdale, Moore, Hayhurst, Pope, Williams, & Segal, 2002). In addition to changing one's relationship to thoughts, another fundamental characteristic of MBCT (and other mindfulness-based approaches) is its focus on increasing awareness of information the body provides. …