Background: People who have had an episode of depression are at an increased risk for future episodes of depression. The amount of triggering required for each ensuing occurrence of depression becomes less each time depression returns. Researchers Zindel Segal (Toronto), Mark Williams (Wales) and John Teasdale (Cambridge) have been investigating how meditation may help people maintain their mental health after recovery from a depressive episode.
Why does depression return?: If you have been depressed, and then recovered, you may have noticed that a relatively small amount of negative mood, such as disappointment or sadness, can trigger a large amount of negative thinking (e.g., 'I am weak,' 'I am a failure,' 'I am worthless'). These negative thoughts often occur together with bodily sensations of fatigue and weakness or unexplained aches and pain. Both the negative thoughts and fatigue often seem out of proportion to the situation. If you thought you had recovered from depression, you may start thinking you are 'back to square one.' You may find yourself ruminating: 'what has gone wrong'?, 'why is this happening to me again'?, 'when will this end'?. All this rumination feels as though it ought to yield a logical answer, yet it only succeeds in prolonging and deepening the negative mood.
So why does this happen? During an episode of depression, negative mood occurs alongside negative thinking and bodily sensations of sluggishness and fatigue. When the episode has passed, and the mood has returned to normal, the negative thinking and body sensations may disappear as well. However, they have not really gone. During the episode, the mind has learned to associate the various symptoms. This means that when negative mood happens again, whatever the reason, it will likely trigger all the other symptoms. When this happens, the old habits of negative thinking will start up again, negative thinking gets into the same rut, and a full-blown episode of depression may be the result.
The discovery that even when you feel well, the link between negative moods and negative thoughts remains ready to be re-activated is of enormous importance. It means that sustaining recovery from depression depends on learning how to keep mild states of depression from spiraling out of control.
Mindfulness Based Cognitive Therapy (MBCT): MBCT is based on Jon Kabat-Zinn?s Mindfulness Based Stress Reduction program at the University of Massachusetts Medical Center. This approach includes simple breathing meditations and yoga stretches to help you become more aware of the present moment, including getting in touch with moment-to-moment changes in the mind and the body. MBCT is ideally presented in an eight-week class (less like a therapy group, more like a class). By listening to tapes (or CDs) at home during the week, participants learn the practice of mindfulness meditation. MBCT also includes basic education about depression, including several exercises from cognitive therapy, which teach you how to recognize the connection between your thoughts and feelings. Also, participants in MBCT learn how best to take care of themselves when depression starts to feel overwhelming.
Mindfulness Based Cognitive Therapy differs a bit from mindfulness meditation as it is usually taught at retreat centers. MBCT includes structured exercises that integrate mindfulness practice into a psychological model of depression (cognitive therapy) and depressive relapse. This approach helps you see more clearly the patterns of your mind and teaches you to recognize when your mood is beginning to go down. Through mindfulness meditation you develop the capacity to allow distressing mood, thoughts and sensations to come and go, without having to try to battle them. This helps you break the link between negative mood and the negative thinking that it would normally have triggered.
A useful metaphor is that of a waterfall of negative thoughts, feelings and sensations. Through MBCT you can learn how to stand behind the waterfall rather than getting washed over the falls and into the drowning pool below. You may still catch the 'spray' of your negative thoughts, feelings and sensations, but it need not pull you down into a full-blown depressive episode. By staying in touch with the present moment, without ruminating about the past or worrying about the future, you can mindfully disengage from distressing mood and negative thoughts.
Can MBCT help me? If you answer 'yes' to any of these questions, you may benefit from MBCT.
Have you suffered from 3 or more episodes of depression in the past? If 'YES', have you recovered enough to consider taking steps to prevent future episodes?
Do you find that, when you become sad or angry, you tend to ruminate about things?
Does your thinking rapidly become negative in response to small downward shifts in your moods?
When your mood goes down, do you find yourself thinking about why you always react this way?
When your mood goes down, do you find yourself thinking about how it will all end?
When your mood goes down, do you find yourself trying to analyze everything?
The mindfulness approach is meant to enhance, not to compete with, whatever type of treatment you may be receiving for depression, whether antidepressants or psychotherapy. The aim is to reduce the risk of relapse by developing a practice of self-care, which you will continue to use in those periods when you are feeling well, and beyond.
Effectiveness of MBCT: Research in the use of MBCT and prevention of relapse is encouraging. In the original trial, which included 145 participants in three different treatment centers, MBCT substantially reduced the risk of relapse in participants who had three or more previous episodes of depression (from 66 percent to 37 percent). Participants reported being able to develop a different ('decentered') relationship to their experience, so that their depression-inducing thoughts could be viewed from a wider perspective as they were occurring. (For a report of this research trial see: Teasdale, J.D., et al., 2000 'Reducing risk of recurrence of major depression using Mindfulness-based Cognitive Therapy.' Journal of Consulting and Clinical Psychology, 68, 615-23.
To learn more about the use of the mindfulness approach for those who remain vulnerable to depression, the approach is described in the book by Zindel Segal, Mark Williams, and John Teasdale (Segal, Z.V., Williams, J.M.G., & Teasdale, J.D. (2002) Mindfulness-based Cognitive Therapy for Depression: a new approach to preventing relapse. Guilford Publications, New York.)
Further Reading and Resources: Jon Kabat-Zinn's own book, Full Catastrophe Living (1990; New York: Delacorte) describes the University of Massachusetts Mindfulness-Based Stress Reduction program in a very engaging way. It is an excellent introduction to clinical applications of mindfulness training (e.g., chronic pain, anxiety, and stress-related physical illness) and is essential reading for anyone wishing to explore this approach further. This book is an important resource that is used in the MBCT program.
Jon Kabat-Zinn has also written, Wherever You Go, There You Are: Mindfulness Mediation in Everyday Life. (1994; New York: Hyperion). This is a book that conveys the spirit of bringing mindfulness to everyday experience, together with suggestions for practice.
The material that is actually used in the MBCT program can be found from the website http://www.mindfulnesscds.com. The CDs (or tapes) come in three series, all recorded by Jon Kabat-Zinn. Series One consists of two 45 minute CDs (tapes)--(also used in the University of Massachusetts Mindfulness-based Stress Reduction program) that narrate a guided body scan, a guided meditation on the breath, body, sounds, thoughts and awareness, together with two different sessions of guided mindful Hatha Yoga.
Series Two consists of CDs (tapes) with shorter guided meditations (from 10 to 30 minutes long), including a CD (tape) of silence with bells. The guided meditations on Series Three are between 20 and 30 minutes long and include more instruction about how to meditate as well as some more advanced meditations.
Where I can I find MBCT? Dr. Victoria Peters has been using an 8-session program with individuals for the past year with good results. There is the possibility that she will offer a MBCT group (class) in the future.
If you are interested in MBCT, please call Dr. Peters at 225-9098.
