All over the world, research has shown that Mindfulness-Based Cognitive Therapy (MBCT) can halve the risk of future clinical depression in people who have already been depressed several times. Its effects seem comparable to antidepressant medications. But how?
In 2007, renowned psychologists John Teasdale, Mark Williams, and Zindel Segan penned the bestseller The Mindful Way Through Depression to explain how bringing awareness to all your activities can battle the blues.
Now the authors have followed that up with a workbook, The Mindful Way Workbook, that includes targeted exercise, self-assessments, and guided meditations. I have the privilege of conducting an interview here with coauthor John Teasdale, Ph.D. about how mindfulness can reduce depression.
1. How does being aware of what you’re doing while you’re doing it help with depression?
There are a number of ways in which being mindfully aware of what you’re doing while you’re doing it can help with depression.
Depression is often kept going, from one moment to the next, by streams of negative thoughts going through the mind (such as “My life is a mess,” “What’s wrong with me?” “I don’t think I can go on”). Redirecting attention away from these ruminative thought streams by becoming really aware of what we’re doing while we’re doing it can “starve” the thought streams of the attention they need to keep going. That way, we “pull the plug” on what is keeping us depressed, and our mood can begin to improve.
Being mindful of what we’re doing can be a powerful way to weaken the grip of these thought streams, particularly if we bring awareness to the sensations and feelings in our bodies. By doing this over and over again, we end up living more in the actuality of the present moment and less “in our heads,” going over and over things that happened in the past, or worrying about the future.
Being aware of what we’re doing while we’re doing it offers us a way to “shift mental gears.” Our minds can work in a number of different modes, or “mental gears.” We often operate as if we were on automatic pilot. In this mode, it’s very easy to slide unawares into the ruminative negative thinking that can transform a passing sadness into a deeper depression. When we’re deliberately mindfully aware of what we’re doing, it’s as if we shift mental gears into a different mode of mind. In this mode, we are less likely to get stuck in ruminative thinking – and life is richer and more rewarding.
In mindfulness, we pay attention to our experience rather than being lost in it. This means that over time we develop a different relationship to difficult experiences. In particular, we can see negative depressive thoughts for what they really are – just patterns in the mind, arising and passing away, rather than “the truth” about what kind of person I am, or how the future will be. In that way, we weaken the power of these thoughts to drag our mood down further and keep us trapped in depression.
And, of course, getting into the habit of knowing what we’re doing as we’re doing it allows us to know more clearly what we are thinking and feeling in any moment. In that way, we put ourselves in a better position to deal promptly and effectively with any depression that may arise. If we’ve been depressed in the past, we can, understandably, be reluctant to acknowledge or even be aware of the warning signs of another low mood coming on. That way, we may put off doing anything about it until we are already quite depressed, when it may be difficult to do things to improve the situation.
On the other hand, if we can be more tuned in to our experience from one moment to the next, we are in much better shape to know when our mood is beginning to slip. We can then take early action to nip the downward spiral “in the bud” at a time when simple actions may be very effective in halting the downward slide.
2. What is the biggest obstacle for people with depression to practice mindfulness?
Practicing mindfulness is not, in itself, difficult – we can be mindful in any moment by deliberately changing the way we pay attention, there and then. The difficult piece for all of us, including people with depression, is remembering to be mindful – our minds can become so absorbed in their usual ways of working that we totally forget the possibility of being more mindful. And, even if we remember, the mode of mind in which we usually operate can resist the shift to a different mode, asserting the priority of its own concerns over those of the mindful mode.
If we are depressed, even though our mode of mind is creating suffering, the “magnetic pull” of the thoughts and feelings keeping us stuck in that mode can be very strong, making it more difficult to remember to be mindful or to make the shift when we do remember.
That’s why giving time to practicing mindfulness is so important. By getting into the habit of being more mindful of all our experience, not just the thoughts and feelings that lead to depression, over and over and over again, we develop our skills of remembering to be mindful and of releasing ourselves from the mental gears in which we can get stuck.
3. Is there a practice (breath, body scan, eating) that is more helpful to people with depression?
People vary quite a bit, one from another, in the mindfulness practice they find most helpful. And, within the same person, the practice that is most helpful may vary from one time to another, depending on the current state of mind at the time.
That’s why, in mindfulness-based cognitive therapy (MBCT), participants learn a range of different practices. That way, they can discover what practices work best for them, and how to vary the practices they use depending on their mood.
As a general rule, when we are more depressed, it tends to be easier to focus attention on strong sensations in the body, rather than on more subtle thoughts and feelings in the mind. And if those sensations can be relatively neutral, then they are less likely to provide material for the negative storylines that are such a characteristic feature of the mind at those times.
So, although for many folk mindfulness of the breath is the most commonly used practice, they often find that as they get more depressed the most helpful practice is some form of mindful movement, yoga, or mindful walking. The actual physical movements and stretches involved in these practices provide “loud” signals for the attention to focus on, as well as offering the possibility of energizing the body.
Throughout the MBCT program, we stress the importance of practicing with a spirit of kindness toward the self, to the extent that we can. This becomes even more important as depression deepens and the tendencies to self-criticism, self-judgment, and treating oneself harshly get stronger. Again, practicing bringing kindness to the practice at all times makes it easier to incorporate kindness as you get more depressed.
And, finally, it’s important to stress that the single most important practice in the whole MBCT program is what we’ve called the three-minute breathing space. This is a brief mini-meditation we developed specifically for MBCT that, practiced over and over again, pulls together everything else that is learned in the program. We see it as always the first step to take to shift mental gears when lost in mindlessness, or in difficult or painful states of mind. This practice is particularly important in depression where the fact that it is so brief and well-practiced increases the chance of using it even if you are feeling pessimistic or unmotivated. It can then become a vital stepping stone to any one of a number of further effective practices.
4. Can you practice mindfulness when you are severely depressed?
This is what we say in “The Mindful Way Workbook“:
What If You Are Very Depressed Right Now?
MBCT was originally designed to help people who had previously suffered serious depressions. It was offered to them at a time when they were relatively well, as a way to learn skills to prevent depression from coming back. There is overwhelming evidence that the program is effective in doing that.
There is also growing evidence that MBCT can help people while they are in the midst of a depression.
But if things are really bad right now, and your depression makes it just too difficult to concentrate on some of the practices, then it can be disheartening to struggle with new learning. It might be most skillful to allow yourself to wait a while if you can, or, if you do start, to be very gentle with yourself—remembering that the difficulties you experience are a direct effect of depression and will, sooner or later, ease.
Originally posted on Sanity Break at Everyday Health.