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For many years, scientists believed that only a physical or chemical intervention could change the function and structure of the brain’s neural connections. The idea was that even if therapy could help a person, it couldn’t alter networks in the brain. Over the past decade, however, our grasp of the plasticity of the brain has advanced. It is now widely accepted that changing our emotional and cognitive habits can also change our brain’s neural functions and structures. The right kind of therapy can also help change the brain.

Your reaction to fleeting sadness can predict depression

Zindel Segal, Distinguished Professor of Psychology in Mood Disorders at UTSC’s Department of Psychology, has been at the forefront of this change with his Mindfulness Based Cognitive Therapy (MBCT). Many patients who recover from depression relapse under difficult circumstances. Segal’s first breakthrough was to develop a method for predicting which patients are most likely to relapse into depression. Those who exhibit depressive thinking styles during a fleeting moment of sadness, Segal found, were far more likely to relapse into depression than those who did not.

Building on that discovery, Segal and his colleagues devised a way to help those inclined to relapse into depression. The aim is to stem relapse by changing the way patients respond to their habitual thoughts and emotions. To this end, MBCT incorporates mindfulness meditation into group cognitive therapy sessions to help patients reset their responses to life’s setbacks. In Canada and the US, the practice is growing in popularity. England’s National Health Service fully embraced the practice, incorporating it into their standard treatments for preventing relapse into depression.

Why mindfulness works to change our habitual response to emotions

As Segal explains, “one of the key skills we found to be helpful was teaching people to attend to their thoughts and emotions in a non-judgmental and curious manner. Doing so encourages an active approach and curiosity about negative experiences … and provides people with greater choice in what do next.” Rather than suppress or distract themselves from negative feelings, patients learn to explore them openly. Mindfulness turns out to be a key to avoiding depression.

Segal’s current research deploys clinical trials to further measure the effectiveness of MBCT as a way of preventing relapse into depression. He is also exploring how MBCT works, in part to establish criteria for when continuing MBCT is necessary to maintain its positive effects on the brain and when the practice may no longer be necessary.

Can online therapies make depression prevention accessible to everyone?

In addition, Segal is also researching innovative ways to deliver MBCT. While it is easy to deliver MBCT at a moderate cost in large cities, poorer patients and those living in more remote areas do not have access to it. To remove these financial and geographical barriers, the US National Institute of Health has granted Segal and his team $2 million US to study how MBCT could be delivered online. The central question for Segal is, “once we introduce this online therapy, can we further reduce people’s depressive symptoms?”

To deliver MBCT online, Segal will give the same tools to those accessing treatment online as patients receive in person. Accessing services through apps and websites, patients listen to recordings of guided mindfulness meditation, watch videos of in-person MBCT sessions, and can ask trained professionals for help online when they need it. Segal is currently evaluating the method with a clinical study of 460 patients.

Segal has already helped us understand the relationship between our cognitive habits and the structure of our brains and changed how we treat depression. Making his therapy affordable to anyone in the world could ultimately help millions of people leave depression behind forever.