Biological Psychology 88 (2011) 243–252 Contents lists available at SciVerse ScienceDirect Biological Psychology journa l h o me page: www.elsevier.com/locate/biopsycho Mindfulness-based cognitive therapy (MBCT), cognitive style, and the temporal dynamics of frontal EEG alpha asymmetry in recurrently depressed patients Philipp M. Keune a,∗ , Vladimir Bostanov b , Martin Hautzinger a , Boris Kotchoubey b a Institute of Psychology, Department of Clinical and Developmental Psychology, Eberhard Karls University, Tübingen, Gartenstr. 29, 72074 Tübingen, Germany b Institute of Medical Psychology and Behavioral Neurobiology, Eberhard Karls University, Tübingen, Gartenstr. 29, 72074 Tübingen, Germany a r t i c l e i n f o Article history: Received 26 May 2011 Accepted 16 August 2011 Available online 30 August 2011 Keywords: Major depression Mindfulness-based cognitive therapy Rumination Mindfulness Alpha asymmetry Meditation a b s t r a c t Mindfulness-based cognitive therapy (MBCT), a meditation-based maintenance therapy, reduces the relapse risk in individuals suffering from major depressive disorder (MDD). However, only a few studies investigated the psychophysiological mechanisms underlying this protective effect. We examined effects of MBCT on trait rumination and mindfulness, as indicators of global cognitive style, as well as on resid- ual depressive symptoms in a group of recurrently depressed patients (n = 78) in remission. Additionally, alpha asymmetry in resting-state electroencephalogram (EEG) was assessed. Alpha asymmetry has been found to be predictive of affective style and a pattern indicative of stronger relative right-hemispheric anterior cortical activity may represent a trait marker for the vulnerability to develop MDD. In line with previous findings, residual depressive symptoms and trait rumination decreased, whereas trait mindfulness increased following MBCT, while no such changes took place in a wait-list control group. Mean values of alpha asymmetry, on the other hand, remained unaffected by training, and shifted systematically toward a pattern indicative of stronger relative right-hemispheric anterior cortical activity in the whole sample. These findings provide further support for the protective effect of MBCT. In the examined patients who were at an extremely high risk for relapse, however, this effect did not manifest itself on a neurophysiological level in terms of alpha asymmetry, where a shift, putatively indicative of increased vulnerability, was observed. © 2011 Elsevier B.V. All rights reserved. 1. Introduction One of the major challenges in the treatment of major depres- sive disorder (MDD) is the prevention of relapse after recovery from a major depressive episode (MDE; Keller, 2003; Kennedy et al., 2003). This is due to the fact that MDD is a dynamic disor- der, in which successive episodes become increasingly autonomous from external life stressors, and their probability progressively increases with every episode (Solomon et al., 2000). The risk for relapse is attributed to the fact that patients who have experienced MDE differ from never-depressed individuals in their cognitive vulnerability (Teasdale and Dent, 1987; Teasdale et al., 2002). In particular, the repeated co-occurrence of negative thought patterns and depressed mood during MDE seems to result in learning an association between the two (Segal and Ingram, 1994). In the sub- sequent remitted state, this association appears to enable relatively mild dysphoric mood to activate thought patterns characteristic of MDE (Segal et al., 1999). For individuals in remission, this learnt association can therefore be a major threat, since the triggering of ∗ Corresponding author. Tel.: +49 7171 29 78358; fax: +49 7171 29 5956. E-mail address: philipp.keune@uni-tuebingen.de (P.M. Keune). depressogenic thought patterns may yield relapse. In support of this assumption, it has been shown that cognitive reactivity, the tendency to react to sad mood provocations with increased dys- functional attitudes, predicts depressive relapse (Segal et al., 2006). An additional important factor of depressive vulnerability is rumi- nation, a method of coping with negative mood, which involves self-focused attention and repetitive, passive focusing on one’s neg- ative emotions (Nolen-Hoeksema et al., 2008). Mindfulness-based cognitive therapy (MBCT; Segal et al., 2002), a derivative of mindfulness-based stress reduction (MBSR; Kabat- Zinn, 1990) and classical cognitive behavior therapy (CBT; Beck, 1979), is a highly economic intervention designed to prevent depressive relapse. In several controlled studies, MBCT has been shown to reduce the relapse risk particularly in patients who have experienced three or more MDE (Godfrin and van Heeringen, 2010; Ma and Teasdale, 2004; Teasdale et al., 2000). In MBCT, patients practice various forms of mindfulness meditation in a group set- ting and learn to apply these techniques during daily life. Core elements of MBCT are refining attentional skills and cultivating mindfulness, i.e. the skill to attentively relate to the experience of the present moment purposefully and in a non-judgmental man- ner (Kabat-Zinn, 1990). In turn, patients become more aware of their physical sensations and feelings, and can identify potentially 0301-0511/$ – see front matter © 2011 Elsevier B.V. All rights reserved. doi:10.1016/j.biopsycho.2011.08.008