In Canada, up to 20 per cent of older adults experience symptoms of depression, and these rates increase to up to 40 per cent for those in hospitals and long-term care homes.
Depression and anxiety disproportionately affect older adults and are associated with adverse health outcomes, reduced quality of life, and increased healthcare costs. Traditional treatments such as one-on-one psychotherapy and medication use may often be inconvenient for older adults due to low accessibility and negative side effects. Therefore, alternative therapies that provide a non-pharmacological, safe, and more accessible option would be beneficial.
Mindfulness-based cognitive therapy (MBCT), a type of psychotherapy that combines elements of cognitive therapy and mindfulness, usually includes eight weekly two-hour sessions, typically delivered in a group format. It has become widely used and has shown to be effective in the treatment of depression and anxiety, particularly among older adults. However, studies regarding the psychological pathways through which MBCT improves psychological outcomes, including depression and anxiety, are scarce.
In a recent paper, Soham Rej, associate professor in McGill’s Department of Psychiatry and Principal Investigator at the Lady Davis Institute for Medical Research (LDI), and his team investigated whether MBCT influenced mindfulness and psychodynamic defense mechanisms.
“Defense mechanisms are ways that we cope with reality and the ways we react to difficulties in life,” Rej said in an interview with The Tribune.
Namely, these mechanisms are unconscious psychological responses that protect people from feelings of anxiety and threats to self-esteem. In addition, Rej’s team also looked for changes in depression and anxiety symptoms.
The three defensive categories, from the least to the most adaptive, are “immature,” “neurotic,” and “mature” defenses.
Immature mechanisms are counterproductive and can involve using projection or passive-aggressive behaviours, while the neurotic category includes the repression and detachment of emotions. These behaviours still aren’t ideal, but they are generally considered more adaptive than immature mechanisms. Rej underscored how immature and neurotic defenses can lead to psychological distress and worse health.
On the other hand, mature defenses are considered adaptive and involve using humour or rationalization to cope with challenging emotions or situations. According to Rej, mature defense mechanisms are usually more socially acceptable and help promote better mental health outcomes.
“We found that MBCT improved mature defenses and reduced neurotic and immature defense mechanisms,” Rej said. “In addition, MBCT improved mindfulness as self-reported by the patients, and this improvement was statistically significantly associated with improvements in anxiety.”
These findings emphasize the potential for short interventions, such as MBCT, to change defense mechanisms, suggesting that treating depression and anxiety can lead to healthier ways of coping.
“If somebody is depressed and has certain immature defense mechanisms, we shouldn’t have any prejudice against such people and should try to treat their depression,” Rej said.
Rej’s study is the first to evaluate the effects of MBCT on defense mechanisms and their relationship with depression and anxiety symptoms.
Although Rej’s team observed a trend of change toward increased mature defense mechanisms and decreased neurotic and immature defense styles, larger studies are necessary to confirm the role of MBCT in promoting psychodynamic defense mechanisms.
Moving forward, Rej would like to see future studies continue exploring different psychological and biological mechanisms underlying various types of psychotherapies. He also points to the need to increase access to psychotherapy.
“In Quebec, you can be waiting 12 months, or even longer, to get psychotherapy, so access needs to be improved. Ways to do that include giving consultations via Zoom and offering group therapies,” Rej said. “The future is about increasing access by scaling up access to these interventions using new technologies.”
Rej highlights the potential application of MBCT in preventing mental disorders before their onset.
“We need to have low-cost, highly scalable ways of preventing depression and anxiety through exercise, diet, and programs like MBCT targeted at people at risk of anxiety or depression,” Rej said.
