Book Review

When Anti-Depressants Aren’t Enough:
Harnessing The Power of Mindfulness to Alleviate Depression

Reviewed by Sue Cristol, LMFT

As mental health professionals, we are all too familiar with the rising rates of depression and the damage it causes to individuals, families and our society at large. We also understand its sometimes catastrophic consequences. That is why it is so important that we continue to be open-minded to learning and understanding new ways of addressing such a fundamental mental health issue. For some of us, mindfulness-based cognitive therapy (MBCT) may not be new. However, there may be many of us who are attached to our usual “go-to” theoretical orientation that there may not be the curiosity to check out something else. I am of the belief that would be a mistake.

It has been established that Cognitive-Based Therapy (CBT) and use of antidepressant medication can be fairly effective in combatting the negative impacts of depression and anxiety in some clients. However, competing research indicates that anti-depressant medication produces nothing more than a placebo effect for a time whereupon the dose needs to be upped due to lack of effectiveness. We know that CBT’s research-based strategies and interventions are utilized successfully by many of us with and without the use of medication.

Mindfulness-based cognitive therapy (MBCT) turns CBT on its head. The operating theory here is that in the case of chronic, persistent episodes of depression, it is nearly impossible for patients to change the pervasive negative thinking. The author reviews many of the ways that depression causes distorted thinking patterns. Focusing on past mistakes and failures, rumination, having unrealistic expectations and jumping to conclusions based on false evidence contribute to the negative thinking and feelings that are the hallmark of a depressive episode.

With MBCT, the goal is not to remove our negative thoughts and replace them with positive ones, but rather, to develop an acceptance of the negative thinking patterns by becoming familiar with them and becoming an “objective observer.” In other words, the focus is on changing our relationship to the negative thoughts rather than the thoughts themselves.

The author of When Anti-Depressants Aren’t Enough, Dr. Stuart Eisendrath, began his work in mindfulness-based cognitive therapy (MBCT) almost 20 years ago. That is when he launched the pilot program at the University of California San Francisco. Since that time, he has assisted many patients in managing their symptoms of depression using MBCT.

This workbook created for the general public is easy to follow and understand. It is organized into four parts and is meant to be followed from beginning to end. However, one could open to a specific chapter (there are twelve of those) and benefit from what it covers. Dr. Eisendrath uses repetition and many patient stories to illustrate the principles of his theory. As we therapists know, once the client’s maladaptive patterns are identified, we utilize repetition and give examples when addressing those patterns of behavior. This helps to reinforce the message. Also, there are many mindfulness meditations interspersed throughout the workbook that are an integral part of successfully working the program. There are also some great poems included that are quire thought-provoking. The last chapter is a great conclusion to the workbook, reviewing key points, strategies and interventions. The last mindfulness meditation that’s included in this chapter is entitled, Three Minute Breathing Space. Here is a synopsis of that meditation:

First minute: Notice and focus on physical sensations without judgement

Second minute: Narrow the focus to the breathing

Third minute: Expand awareness to the entire body being a part of that breathing.

I enjoyed and appreciated this workbook very much. I learned about MBCT and am looking forward to utilizing its principles with clients. I would also recommend it for clients who are seriously considering reinforcement outside of the therapy hour. It could also be useful for individuals who are unable to come to therapy and are motivated to follow the program on their own.

Susan Cristol, LMFT, is a licensed marriage and family therapist. She works with children, adolescents, couples or adults. Susan stays current on research in the field of special education, as well as research and the many writings in the areas of psychology, sociology and marriage and family therapy. Her specialized training includes (but not limited to) cognitive behavioral therapy, trauma and abuse, domestic violence and play therapy. She may be reached 818.426.5546 or at https://susancristol.com/contact.