Dear Anonymous

Thank you for your comment.

Yes, you are correct that concreteness has some overlaps with aspects of mindful awareness (especially in Step 1) and problem solving (especially in Step 3). It also has an element that helps people to put events into perspective and reduces overgeneralization, which is a common cognitive bias in depression.

There are some theoretical and practical convergence with aspects of mindfulness: both emphasize the importance of paying attention to specific present moment experience, and of shifting away from conceptual, evaluative, analytical thinking. There are also differences - the concrete approach is a more direct exercise, whereas mindfulness tends to emerge more indirectly from meditative practice. In turn, mindfulness often includes other elements as well as focusing on concrete experience, including practice at shifting attention, distancing from thoughts by seeing them as mental events, and self-compassion.

You are also correct to recognize that it is sometimes difficult for people to stay away from becoming too abstract and it is easy for even a question like "How did this come about?" to become an analytical "Why?" question. This is why in the concreteness training exercises we emphasize focusing on the actual sequence and chain of events, behaviors and circumstances that lead to an outcome - we want people to focus on the mechanics of events rather than their meaning. This, of course, also has parallels with functional analysis and situational analysis found in behavioral treatments for depression as well as in dialectial behavior therapy.

This goes to show that even the simplest treatment intervention often has multiple things going on - and that even novel approaches include elements of existing approaches.

One of the reasons for the focus on concreteness is that it emerged from our scientific research into shifting rumination so that it had a good theoretical and sound basic science evidence base. Another reason was that I am interested in trying to understand what the core elements in therapy might be - by parsing out fractional elements of treatments, we have a better chance of determining which components are most active and have the biggest effect, whether in general, or for particular individuals.

Your question of how "concreteness training" compares with positive thinking or exercising or meditating on gratitude is thus a very pertinent one - it is critically important that as a field we try and work out the relative impact of each possible intervention, and indeed who benefits most from each approach.

I agree that a combination approach is more likely to work for a given individual. It may well be that certain combinations of treatment elements interact to produce more powerful therapy. This is one of the drivers behind the IMPROVE-1 study I describe in a subsequent blog - we want to look at the individual effects of a range of different treatment approaches (including increasing activity, challenging thoughts, concreteness, compassion, relaxation) for depression, as well as whether certain combinations seem to have added benefit. And within these studies we will also look at whether individual differences help to predict which combinations works best for whom.