DEPRESSION
January 5, 2009

Mindfulness Therapy

Mindfulness-based cognitive therapy can derail the negative thought patterns that lead to depression
Currently, antidepressant drugs are the most effective and widely-used therapy for depression. A recent study from the UK shows that mindfulness-based cognitive therapy (MBCT) may be more effective than antidepressants, or at minimum, an effective additional tool in preventing a relapse among long-term sufferers of depression.

Mindfulness-based cognitive therapy borrows from Buddhist meditation, asking people to observe their thoughts dispassionately...

When most people use the word depression, they're talking about a normal mood that contains elements of sadness and unhappiness. Clinical or major depression is much more overwhelming. To sufferers, it can feel like the strongest force in the entire world, with hopelessness dominating their outlook to the point where they may no longer be able to continue performing the functions of day-to-day living. And while it occurs episodically, those who have suffered through a depressive episode are likely to have a relapse at some point in their life.

A relapse can be triggered by most anything that negatively affects the mood. Picture a person who has been turned down for a job after an interview. He or she might begin to think, "Who would want to hire me? I'm such a loser." In those prone to depression, these feelings tend to spiral out of control and become the main focus of their life, making them feel low and inadequate and therefore unlikely to mount an energetic job search. So the thought patterns become a self-fulfilling prophecy.

MBCT attempts to teach people to recognize the signs of impending depression and nip them in the bud before they become a full-blown, overwhelming depressive incident. The patient has previously been down this road and it's like being caught in a feedback loop or a trip down a steep hill. The key is that this trip can be stopped.

How does MBCT do this? Mindfulness-based cognitive therapy borrows from Buddhist meditation, asking people to observe their thoughts dispassionately and to focus on the physical sensation of breathing. This enables them to regulate their feelings more effectively, rather than being carried away by negative thoughts and the feelings those thoughts give rise to.

Mindfulness teaches people to pay attention to thoughts. It can be thought of as the opposite of mindlessness. Rather than try to suppress these feelings (a natural reaction), it tries to teach acceptance. It teaches living in the present, not re-living the past or pre-living the future and most importantly, being less judgmental. It also emphasizes that even during depression, the small pleasures of life are still there; sufferers are just not paying attention to them.

Because depression is a feeling, and a strong one at that, it doesn't always yield to logic and reasoning. That's why meditation is an important part of MBCT. It helps lower stress, and the world always seems better when seen through a less stressful lens.

Coming back to the job that didn't happen, MBCT might point out that the client and not the interviewer is the one who has made the judgment of inadequacy; all the interviewer has done is decide that they are not the best person for the job. They could even have been judged second best out of 50 or 100. They're still the same person they were before taking the interview, no more or less adequate. And whatever they enjoyed in life before the interview is still there for them to enjoy.

Any treatment that helps break through the fog of depression is a useful one. And this small study indicates that MBCT can get through to more people than antidepressants alone can.

The trial involved 123 UK residents who had suffered repeat incidents of depression. Half continued their ongoing antidepressant therapy and half participated in an MBCT course and were given the option of coming off of antidepressants. The course was eight weeks long, taught to groups of eight to twelve patients by a single therapist. 15 months after the study's end, 47% of the participants who took the MBCT course had experienced a relapse, compared to 60% of the group who did not take the course.

The results of the study appear in the December 1, 2008 issue of the Journal of Consulting and Clinical Psychology.
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