Introduction
Cognitive Biases and Depression
Depression is one of the most common mental illnesses and is associated with significant impairment. Only about 60% of patients with depression respond to pharmacological or psychological treatment—and relapse rates are high.
In people with depression, information processing is impaired in that they tend to focus their attention on negative events and store them preferentially, but also in that it negatively alters the processing of positive events. These cognitive distortions can also occur during remission and are associated with a higher risk of relapse.
Mindfulness as a therapeutic approach to depression
Mindfulness involves paying attention to the present moment (thoughts, feelings, bodily sensations, awareness, and the environment) in a non-judgmental way.
In the scientific literature, the antidepressant efficacy of MBI (mindfulness-based interventions) has been demonstrated primarily in the context of MBSR (mindfulness-based stress reduction) and MBCT (mindfulness-based cognitive therapy).
In addition, mindfulness-based approaches are being integrated into various other clinical approaches, such as ACT (Acceptance and Commitment Therapy), which lead to an improvement in depressive symptoms or a reduction in the risk of relapse into depressive episodes.
Cognitive Bias Modification (CBM) for Depression
Cognitive biases are treated using computer-based programs—known as cognitive bias modification (CBM) programs. These programs train individuals to focus their attention on positive stimuli and aim to improve their processing of these stimuli (positivity training).
Efficacy and Research Evidence
MBI and Depression
Achtsamkeitsbasierte Stressreduktion (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 with 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 conditions.
The most comprehensive review to date examined the findings of 209 studies on mindfulness-based interventions involving 12,145 patients with a wide range of disorders, including depression. The results show superiority over waiting lists, psychoeducation, supportive psychotherapy, relaxation exercises, and imagery and suppression techniques. The effect size was greatest for psychological parameters related to anxiety, followed by depression.
Achtsamkeitsbasierte kognitive Therapie (MBCT)
MBCT is modeled after MBSR in terms of structure and duration. It combines elements of mindfulness training and cognitive therapy to prevent relapses of depression. Fluctuations in mood are first observed without judgment and then linked to new ways of thinking.
Several randomized controlled trials have demonstrated a reduction in the recurrence rate, particularly among patients at high risk of relapse (Cohen’s h = 0.88)
CBM and Depression
Attention training for positive stimuli
CBM focuses on attention to positive stimuli and the interpretation of experiences. In a 4-week study involving adult patients, Beevers et al. (2015) demonstrated that training to direct attention toward positive stimuli led to a significant reduction in negative attentional bias, which in turn was associated with a significant reduction in depressive symptoms.
Similar results were found in patients with remitted depression as well as in adolescents.
Cristea and colleagues conclude that CBM, as a form of attention and interpretation training, demonstrates therapeutic benefits. CBM may therefore be of therapeutic benefit in cases of mild to moderate depression, in relapse prevention, and as a supplement to other treatments for severe depression.
VR therapy for depression based on MBI and CBM
The scientific evidence, based on several independent randomized controlled trials, supports the use of mindfulness and attention training in the treatment of depression—including severe cases—as a complement to other approaches such as psychotropic medications and behavioral therapy. These interventions are expected to provide greater symptom relief and higher remission rates, as well as to improve relapse prevention in depression.
Apps using MBI and computer-based CBM are already in use—the use of VR with a correspondingly high level of immersion is both innovative and promising in this context.
Neurobiological Foundations
Mindfulness and the Default Mode Network
Mindfulness improves attention regulation, emotional regulation, and self-awareness. All three of these areas promote self-management, for example, in dealing with negative feelings and moods.
However, one possible fundamental effect of mindfulness and conscious attention could also lie in its role as a counterbalance to the brain’s default mode network (DMN). This state is reached when we are literally doing nothing and is characterized by mind wandering or daydreaming.
However, when we mind-wander, memories and fantasies become strongly associated with negative feelings, boredom, loneliness, and our self-image. Seli and colleagues show that episodes of mind-wandering correlate with depression, as well as anxiety and stress.
Mindfulness, or conscious attention in general, acts as a counterbalance to the resting-state network and may thus help alleviate or prevent depression by reducing mind wandering.
Learn more about using the VR Smart System to manage depression:
More Infos
Mindfulness and Cognitive Bias Modification for Depression