Themes and sub-themes.

Depression is a common and growing mental health problem, with around 5% of the world’s population experiencing an episode of depression during their lifetime. Relapse rates are high, with around half experiencing more than one depressive episode and a further 10–20% experiencing a chronic and persistent depression. Mindfulness has been incorporated into treatments for depression and several studies have explored the impact of mindfulness training on depressive symptomatology and recurrence. However, to date no studies have looked at the changing relationship between mindfulness and depression in those naïve to mindfulness training. 20 participants with moderate-to-severe persistent depression were interviewed to explore their experience of mindfulness in the context of low mood. Thematic analysis captured six themes highlighting changes in mindfulness relating to the onset of depression. Themes included: behavioural withdrawal; perceptual detachment from one’s experience; intentional reduction in awareness; increased self-criticism; mind racing; impaired cognitive performance. Thematic analysis suggested that mindfulness reduces in the context of moderate-to-severe persistent depression. This appears to occur indirectly as the consequence of depression-related processes, e.g., rumination and experiential avoidance, but also arises as a deliberately instigated self-protective strategy. However, findings seemed to indicate that reduced mindfulness maintains and intensifies depressive experience. Despite growing evidence of the value of mindfulness approaches for those with more chronic and severe depression, study findings suggest that introducing mindfulness to this population may be particularly challenging due to the intensity of symptomatology potentially obstructing access to a mindful perspective. Findings bear important implications for the treatment of depression and can inform future intervention development and delivery.

抑郁症是一种常见且发病率持续攀升的心理健康问题，全球约5%的人口在一生中曾经历过抑郁发作。该病复发率居高不下，约半数患者会出现多次抑郁发作，另有10%~20%的患者会发展为慢性持续性抑郁症。正念（Mindfulness）已被纳入抑郁症的临床治疗体系，多项研究探讨了正念训练对抑郁症状及疾病复发的影响。然而迄今为止，尚无研究针对未接触过正念训练的人群，探讨其正念水平与抑郁症之间的动态关联变化。本研究对20名中度至重度持续性抑郁症患者开展访谈，以探究他们在情绪低落状态下的正念体验。通过主题分析共提炼出六大核心主题，阐明了伴随抑郁发作出现的正念水平变化：行为退缩、对自身体验的感知解离、主动降低觉知水平、自我批评加重、思维奔逸以及认知功能受损。分析结果显示，在中度至重度持续性抑郁症患者群体中，正念水平会出现显著下降。这种下降似乎间接源于抑郁相关的心理过程，例如反刍思维与经验回避，同时也可能是患者主动采取的自我保护策略所导致的结果。但研究结果同时表明，正念水平的降低会进一步维持并加重抑郁体验。尽管已有越来越多的证据表明正念疗法对慢性重度抑郁症患者具有临床价值，但本研究结果显示，向该人群引入正念疗法可能面临特殊挑战：患者症状的严重程度可能会阻碍其获取正念视角，进而影响干预效果。本研究结果对抑郁症的临床治疗具有重要启示，可为未来抑郁干预方案的开发与落地实施提供参考依据。