What is Mindfulness-based Cognitive Therapy?
Does it work?
How will Mindfulness practice help me?
What is depression?
Why do we remain vulnerable to depression?
How does mindfulness help reduce the downward mood spirals?
What is Mindfulness-Based Cognitive Therapy (MBCT)?
MBCT is based on the Mindfulness-based Stress Reduction (MBSR) eight week program, developed by Jon Kabat Zinn in 1979 at the University of Massachusetts Medical Center. Research shows that MBSR is enormously empowering for patients with chronic pain, hypertension, heart disease, cancer, and gastrointestinal disorders, as well as for psychological problems such as anxiety and panic.
Mindfulness-based Cognitive Therapy grew from this work. Zindel Segal, Mark Williams and John Teasdale adapted the MBSR program so it could be used especially for people who had suffered repeated bouts of depression in their lives.
Does it work?
The UK National Institute of Clinical Excellence (NICE) has endorsed MBCT as an effective treatment for prevention of relapse. Research has shown that people who have been clinically depressed 3 or more times (sometimes for twenty years or more) find that taking the program and learning these skills helps to reduce their chances that depression will return.
How will Mindfulness practice help me?
- It will help you understand what depression is.
- It will help you discover what makes you vulnerable to downward mood spirals, and why you get stuck at the bottom of the spiral
- It will help you see the connection between downward spirals, and:
- High standards that oppress us
- Feelings that we are simply “not good enough”
- Ways we put pressure on ourselves or make ourselves miserable with overwork
- Ways we lose touch with what makes life worth living.
What is depression?
Depression is a severe and prolonged state of mind and body in which normal sadness grows into a painful state of hopelessness, listlessness, lack of motivation, and fatigue. It can vary from mild to severe. When depression is mild, we find ourselves brooding on negative aspects of ourselves or others. We may feel resentful, irritable or angry much of the time, feeling sorry for ourselves, and feeling that we need reassurance from someone. We may suffer various physical complaints that do not seem to be caused by any physical illness.
However, as depression worsens, feelings of extreme sadness and hopelessness combine with low self-esteem, guilt, memory and concentration difficulties to bring about a severely painful state of mind. To make things worse, we may experience change in basic bodily functions. The usual daily rhythms seem to go ‘out of kilter’: we can’t sleep, or we sleep too much. We can’t eat, or eat too much. Others may notice that we are agitated or slowed down, and we find our energy for activities that we used to enjoy hit ‘rock bottom’. We may even feel that life it not worth living, and begin to get thoughts that we’d be better off dead.
The most commonly used treatment for major depression is antidepressant medication. It is relatively cheap, and easy for family practitioners (who treat the majority of depressed people) to use. However, once the episode has past, and we have stopped taking the antidepressants, depression tends to return, and at least 50% of those experiencing their first episode of depression find that depression comes back, despite appearing to have made a full recovery. After a second or third episode, the risk of recurrence rises to between 80 and 90%. Also, those who first became depressed before 20 years of age are particularly likely to suffer a higher risk of relapse and recurrence.
The main method for preventing this recurrence is the continuation of the medication, but many people do not want to stay on medication for indefinite periods, and when the medication stops, the risk of becoming depressed again returns. People are turning to new ways of helping them stay well after depression. To see what it is most helpful to do, we need to understand why it is that we may remain at high risk, even when we’ve recovered.
Why do we remain vulnerable to depression?
New research shows that during any episode of depression, negative mood occurs alongside negative thinking (such as ‘I am a failure’, ‘I am inadequate, ‘I am worthless’) and bodily sensations of sluggishness and fatigue. When the episode is past, and the mood has returned to normal, the negative thinking and fatigue tend to disappear as well. However, during the episode a connection has formed between the mood that was present at that time, and the negative thinking patterns.
This means that when negative mood happens again (for any reason) a relatively small amount of such mood can trigger or reactivate the old thinking pattern. Once again, people start to think they have failed, or are inadequate – even if it is not relevant to the current situation. People who believed they had recovered may find themselves feeling ‘back to square one’. They end up inside a loop of brooding and preoccupation that constantly asks ‘what has gone wrong?’, ‘why is this happening to me?’, ‘where will it all end?’ Such brooding (sometimes called “rumination”) feels as if it ought to help find an answer, but it only succeeds in prolonging and deepening the mood spiral. 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 people 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 such depression depends on learning how to keep mild states of depression from spiralling out of control.
How does mindfulness help reduce the downward mood spirals?
1. When we enter a phase in our lives when we are vulnerable to depression, we lose touch with what is going on around us. It is a sort of tunnel vision: we can only see part of the landscape. We do not notice the moment when a spiral of low mood is starting.
Mindfulness practice helps us to see more clearly these patterns of mind; and to learn how recognise when our mood is beginning to go down. This means we can ‘nip it in the bud’ much earlier than before.
2. The very ‘losing touch’ with things can put a barrier between ourselves and the small things in life that might have given us pleasure. This tendency can become extreme in clinical depression where it is known as ‘anhedonia’ (lack of pleasure from things we used to enjoy). But we all may know the feeling, especially when there is too much to do at work or home, or we are preoccupied on a project, when we don’t notice the small pleasures around us.
Mindfulness teaches us a way in which we can get back in touch with the experience of being alive – learning to savour again the simple pleasures that may have been available to us all along but which we took for granted.
3. Low mood can bring back memories and thoughts from the past, and make us worry about the future.
Mindfulness helps to halt the escalation of these negative thoughts and teaches us to focus on the present moment, rather than reliving the past or pre-living the future.
4. When we start to feel low, we tend to react as if our emotions were a problem to be solved: we start trying to use our critical thinking strategies. When these do not work, we re-double our efforts to use them. We end up over-thinking, brooding, ruminating, living in our heads.
Mindfulness helps us to enter an alternative mode of mind that includes thinking but is bigger than thinking. It teaches us to shift mental gears, from the mode of mind dominated by critical thinking (likely to provoke and accelerate downward mood spirals) to another mode of mind in which we experience the world directly, non-conceptually, and non-judgementally. Mindfulness allows us to feel more ‘space’ around our thoughts and feelings, that this negativity is not the final truth about ourselves.
5. When we have been depressed, we dread it coming back. At its first sign, we may try to suppress the symptoms, pretend they aren’t there, or push away any unwanted thoughts or memories. But such suppression often does not work, and the very things we tried to get rid of come back with renewed force.
Mindfulness takes a different approach. It helps develop our willingness to experience emotions, our capacity to be open to even painful emotions. It helps give us the courage to allow distressing mood, thoughts and sensations to come and go, without battling with them. We discover that difficult and unwanted thoughts and feelings can be held in awareness, and seen from an altogether different perspective – a perspective that brings with it a sense of compassion to the suffering we are experiencing.