Researcher at a glance
- Affiliation: Department of Psychiatry, University of Toronto; Centre for Addiction and Mental Health, Toronto
- Orientation: Cognitive vulnerability to depressive relapse; the differential-activation / cognitive-reactivity account; mindfulness-based cognitive therapy (MBCT) as relapse prophylaxis
Key contributions
- Co-developer of Mindfulness-Based Cognitive Therapy (MBCT) with J. Mark G. Williams and John D. Teasdale — an 8-week group programme adapting MBSR to prevent depressive relapse by training decentering from ruminative thought.
- Operationalized cognitive reactivity to sad mood provocation as a prospective predictor of relapse (Segal et al. 2006, Arch Gen Psychiatry), giving the differential-activation hypothesis a measurable clinical form.
- Ran the relapse-prophylaxis trial (Segal et al. 2010, Arch Gen Psychiatry) comparing antidepressant maintenance, MBCT, and placebo, from which the remitted patients in Farb et al. (2011) were recruited.
- Senior author on Farb et al. (2010), showing MBSR alters the neural expression of sadness — trained participants keep the interoceptive insula online under a dysphoric challenge where controls deactivate it, and insula recruitment tracks lower depression.
- Senior author on Farb et al. (2011), locating the neural signature of relapse-predicting cognitive reactivity.
- Senior author on the RCT sequel Farb et al. (2022), which scanned remitted patients before and after MBCT or Well-Being CT and found no mechanistic difference between the therapies — reduced prefrontal cognitive reactivity is a trans-therapeutic prophylactic marker, consistent with the null process dissociation in his own trial (Segal et al. 2019).
- Co-author on Wu et al. (2026), the same trial scanned during self-referential processing: behavioural negative self-referential bias predicted concurrent symptoms and lower decentering but not relapse, while somatosensory markers dominated the relapse-predictive model — extending his cognitive-reactivity/decentering account toward embodied self-experience.
Key papers
- Farb et al. (2010) — Farb, Anderson, Mayberg, Bean, McKeon & Segal (2010), Emotion 10(1):25-33.
- Farb et al. (2011) — Farb, Anderson, Bloch & Segal (2011), Biological Psychiatry.
- Farb et al. (2022) — Farb, Desormeau, Anderson & Segal (2022), NeuroImage: Clinical 34:102969.
- Wu et al. (2026) — Wu, Livingston, Segal & Farb (2026), NeuroImage: Clinical 51:104025.
- Segal, Z. V., Kennedy, S., Gemar, M., Hood, K., Pedersen, R., Buis, T. (2006). Cognitive reactivity to sad mood provocation and the prediction of depressive relapse. Arch Gen Psychiatry 63:750-755.
- Segal, Z. V., Bieling, P., Young, T., et al. (2010). Antidepressant monotherapy vs sequential pharmacotherapy and MBCT, or placebo, for relapse prophylaxis in recurrent depression. Arch Gen Psychiatry 67:1256-1264.
- Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. Mindfulness-Based Cognitive Therapy for Depression (Guilford).
Connections
- Debates: contemplative training increase objective interoceptive accuracy?, Is more interoceptive awareness better?
- Related researchers: Norman A. S. Farb
Clinical psychologist and co-developer of Mindfulness-Based Cognitive Therapy (MBCT), and Farb’s senior collaborator on the wiki’s first Farb empirical paper. Segal enters the wiki as the theorist of why a recovered depressive relapses — and the person who turned that theory into both a prediction and a treatment.
The theory: cognitive reactivity / differential activation
Segal’s central claim (developed from Teasdale’s differential-activation hypothesis) is that vulnerability to depressive relapse lives not in a person’s baseline mood but in what mild dysphoria reactivates. In the recovered-but-vulnerable patient, a small dip in mood re-opens a whole pattern of negative, ruminative, self-referential thinking — the pattern present during the original episode — and it is this reactivated processing, not the dip itself, that drives the slide back into depression. See Cognitive reactivity (to mood).
Segal et al. (2006) made this measurable: sad-mood provocation in remitted patients, and the degree of reactivated dysfunctional attitude predicted relapse up to 18 months later. Farb et al. (2011) is the neuroimaging sequel — the same paradigm (sad film provocation, 18-month follow-up) locating the reactivity in self-referential cortex, and finding that felt sadness itself does not predict relapse while its mode of cortical processing does.
The treatment: MBCT and decentering
MBCT adapts Kabat-Zinn’s MBSR specifically for relapse prevention. Its proposed active ingredient is Decentering — learning to see thoughts and feelings as passing mental events rather than as truths or cues to elaborate — which is precisely the disengagement from self-referential rumination that Farb et al. find protective. Farb et al. (2010) gives the mechanism a neural form one step upstream of relapse: MBSR (the training MBCT is built on) reduces exactly the midline self-referential and left-language elaboration of a sad film that decentering is meant to disengage, while keeping the interoceptive insula online. MBCT is the clinical bridge from this wiki’s contemplative-interoception material (contemplative interoceptive training for well-being, body-focused contemplative training) to the depression-relapse literature: the mindfulness the wiki treats mostly as a wellbeing intervention was, in Segal’s hands, first a prophylactic against a specific, measurable neural vulnerability.
A caution his own later work supplies: in Farb et al. (2022), MBCT and Well-Being CT produced identical neural prophylaxis (reduced left-DLPFC reactivity) and identical relapse rates. Whatever is doing the protective work, it is not unique to mindful decentering — the same effect appears in a well-being reappraisal therapy that does not train body awareness at all. See Two-factor model of relapse vulnerability.
Why he belongs in an interoception wiki
Obliquely, but load-bearingly. Segal is the clinical anchor of the sensory-vs-elaborative distinction the wiki’s interoception theory rests on: his cognitive-reactivity paradigm is where Farb first showed (in 2011) that elaborative self-referential reactivity is pathogenic and sensory reactivity protective — the finding Farb then generalized from exteroceptive vision to interoception. MBCT is also the intervention most often named on this wiki’s applied pages (Interoceptive training in clinical practice, Is more interoceptive awareness better?) as the body-awareness treatment for depression, and Segal is its source.