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Overcoming Depression Using a Mind-Body Approach

Zindel Segal Explains His Mindfulness-Based Cognitive Therapy

Zindel Segal

Mindfulness isn't a skill that comes naturally. If you want to anchor your attention to what's happening in the present moment, you must actively engage your mind's natural tendency to fly all over the place. At the heart of mindfulness lies, not a desire to suppress this inner restlessness, but a nonjudgmental curiosity about it, and a willingness to simply observe it as it happens. Making friends with our attention---not beating it (and ourselves) up when it drifts from its intended focus---helps teach us how to deal with other deviations from perfection in ourselves and others.

This perspective is definitely at odds with traditional therapeutic ideas about insight and change. The prevailing clinical understanding of meditation's effectiveness emphasizes that it teaches patients how to relax and lowers their chronic physiological hyperarousal. But the point of mindfulness training is to help people sustain an alert, flexible, and focused attention, rather than to relax, though relaxation occurs as a secondary consequence.

Mindfulness, Cognitive Therapy, and Mood Disorders

More than 20 years ago, Jon Kabat-Zinn and his colleagues at the University of Massachusetts Medical Center faithfully adapted the teaching of mindfulness meditation for use in modern medical settings, and created something of a revolution along the way. Called Mindfulness-Based Stress Reduction (MBSR), their program of meditation training---taught without a particular religious or philosophical belief as a basic awareness technique that anyone could use---has helped many thousands of people with chronic medical problems find peace, calm, and joy, even while suffering from pain, inflammatory bowel disease, asthma, and heart disease---all of which occur episodically, waxing and waning like depression.

The program for depression my colleagues Mark Williams and John Teasdale and I developed, Mindfulness-Based Cognitive Therapy (MBCT), integrates the eight-week group approach of MBSR with basic principles of cognitive therapy. Participants in MBCT, like those in the MBSR program, meet together to practice various forms of mindfulness meditation---the body scan, mindful stretching and walking, and alternating the focus of attention by shifting between mindfulness of the breath, the body, ambient sounds, and thoughts. Group members learn informal practices that encourage close attention to the ordinary rote experiences of daily life as a hedge against depression---eating a meal mindfully, monitoring the physical sensations while brushing teeth, noticing how tightly one grips the wheel of the car while driving.

How does focusing on everyday physical actions help participants take a wholly different approach to the endless cycles of mental strategizing that often drive depression's return? When people get lost in thoughts or try to jettison their feelings, they typically pay very little attention to the physical sensations from their bodies. Yet, those sensations provide immediate feedback about what's going on at an emotional and mental level. The act of observing our bodies is good training for when we feel bad---anxious or depressed---because it gives us a kind of emotional detachment, which acts as a stable emotional platform, preventing us from being overwhelmed by our feelings.

Of course, it can be difficult to be mindful at just the times when mindfulness would be most helpful. When we're faced with a crisis, or when we're emotionally crashing, and there's no time to gather our thoughts, mindfulness can seem like a hopeless luxury, impossible to achieve. So, we created a tool specifically designed to bring mindfulness into everyday life at exactly those moments when someone's mood seemed to be heading south in a hurry. This emergency tool is a mini-meditation called the three-minute breathing space, in which the entire teaching of the MBCT program is concentrated in three brief steps: 1) Opening to experience as it is, 2) Gathering attention to a focus on the breath, 3) Becoming aware of the sense of the body as a whole.

The cognitive therapy aspects of MBCT include psychoeducation about depressive symptoms and the dark thinking styles that often accompany them. We teach participants to look at their negative thoughts as creations of their minds and not facts---not real reflections of themselves, but part of a larger package of depression. If, for example, they can regard a thought like, "I really am a loser!" simply as an artifact of their own minds, and say to themselves, "Oh there's another one of my put-downs of myself," they can rob it of its power to sink them in a tide of self-loathing. If certain thoughts or beliefs still have a strong pull on awareness, participants practice questioning them with an attitude of investigation, curiosity, and kindness.

What's Your Practice?

This question to a therapist who teaches mindfulness may be either challenging or merely curious. But the answer you give has enormous bearing on how effective you'll be with your patients. Participants in our program must ultimately learn about mindfulness through their own practice, of course. But it's critical for people already distressed and feeling overwhelmed to have an instructor who can embody these practices in his or her own interactions with them. Unlike manual-based therapies, which don't require the clinician to have undergone the procedures, mindfulness training requires instructors to participate alongside the patient, not just give instructions.

If we can approach this practice in the same spirit that we ask of our patients and trainees, we'll find our own way---as they must---to a place of true beginning. From there, the rest takes care of itself.

This blog is excerpted from “Finding Daylight." Read the full article here. >>

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Topic: Anxiety/Depression | Mindfulness

Tags: cognitive therapy | depression | ED | emotion | mbct | mbsr | meditation | meditation training | mindful | mindfulness meditation | mood disorder | mood disorders | practices | SPECT | stress reduction | TED | therapist | therapy | stress | anxious | University of Massachusetts

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