Transcript Mindfulness in Psychotherapy: Depression

Mindfulness in
Psychotherapy:
Depression
with
Steve Shealy, PhD
Depression
Feelings of overwhelming sadness or fear
 A decrease in the amount of interest or pleasure
 Changing appetite (weight gain or loss)
 Disturbed sleep patterns (too much, too little)
 Psychomotor agitation or retardation
 Fatigue, mental or physical loss of energy
 Feelings of guilt, helplessness, hopelessness
and/or anxiety
 Trouble concentrating or making decisions
 Recurrent thoughts of death and/or suicide

Depression
“A complex disorder with biological,
psychological, and social components”
Depression
“ Depression involves turning away from
experience to avoid emotional pain…
thereby depriving the depressed person of the life
that can only be experienced in the present
moment…”
Depression
“The opposite of depression is not happiness,
the opposite of depression is vitality.”
“The antidote to exhaustion isn’t rest. The
antidote to exhaustion is wholeheartedness.”
David Whyte, Clear Mind, Wild Heart.
What is Mindfulness?
Definitions of Mindfulness:
As Mindfulness relates to psychotherapy in the
treatment of depression, it may be best defined as…
“the practice of turning toward the experience at
hand with engaged equanimity, a non-judgmental
openness and trust in the ultimate workability of
all experience.”
“being present, available without turning away
from the pain that life at times presents.”
with Mindfulness…
“You become sensitive to the actual experience of
living, to how things actually feel. You do not sit
around developing sublime thoughts about
living. You live.” Bhante G.
Mindful Approaches to Depression
 Dialectical Behavior Therapy (DBT)
 helps clients accept emotions while changing their
emotional experience
 mindfulness helps reduce avoidance of negative
emotions through exposure
 used with BPD especially self-harming behaviors
 shown to be effective with older adult population of
non-BPD, depressed patients
Mindful Approaches to Depression
 Acceptance and Commitment Therapy (ACT)
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full acceptance of present experience
identifying life goals (Bliss)
mindfully letting go of obstacles to these goals
effectiveness seems related to the reduction of
believability (not frequency) of negative thoughts
Mindful Approaches to Depression
Mindfulness-Based Cognitive Therapy for Depression: a
New Approach for Preventing Relapse. Segal, Williams
& Teasdale (2002), Gilford Press, New York. (MBCT)
 Adaptation of Kabat-Zinn’s Mindfulness-Based Stress
Reduction Program (2 hrs not 2.5, no day-long)
 8-Week, structured program with CDs, homework and
handouts specific to depression, group
interaction/support
 Book is a Comprehensive Therapist’s Manual for
providing this form of treatment
Mindful Approaches to Depression
What does a client learn in a MBCT program?
 concentration
 awareness/mindfulness of thoughts, emotions/feelings.
bodily sensations
 being in the moment
 decentering
 acceptance/nonaversion, nonattachment
 letting go
 being rather than doing, non-goal attainment, no
special state to be achieved
 awareness of manifestation of the problem in the body
MBCT: Weekly Themes
o 1. Mindfulness starts when we recognize the
tendency to be on automatic pilot
and make a commitment to learning how best to
step out of auto-pilot to become aware of each
moment.
Practice in purposely moving attention around the
body shows both how simple and how difficult
this can be.
MBCT: Weekly Themes
o 2. Further focus on the body begins to show more
clearly the chatter of the mind
and how it tends to control our reactions to
everyday events.
MBCT: Weekly Themes
o 3. With greater awareness of how the mind can
often be busy and scattered,
learning to take awareness intentionally to the
breath
offers the possibility of being more focused and
gathered.
MBCT: Weekly Themes
o 4. The mind is most scattered when it tries to
cling to some things and avoid/escape other
things.
Mindfulness offers a way of staying present by
giving another place from which to view things:
to help take a wider perspective and relate
differently to experience.
MBCT: Weekly Themes
o 5. Relating differently involves bringing to
experience a sense of “allowing” it to be,
just as it is, without judging it or trying to make it
different.
Such an attitude of acceptance is a major part of
taking care of oneself and
seeing more clearly what, if anything, needs to
change.
MBCT: Weekly Themes
o 6. Negative moods, and the thoughts that
accompany them,
restrict our ability to relate differently to
experience.
It is liberating to realize that our thoughts are
merely thoughts,
even the ones that say they are not.
MBCT: Weekly Themes
o 7. There are some specific things that can be
done when depression threatens.
Taking a breathing space will come first,
and then deciding what action, if any, to take.
Each person has his of her own unique warning
signs of relapse,
but participants can help each other in making
plans for how best to respond to the signs.
MBCT: Weekly Themes
o 8. Maintaining a balance in life is helped by
regular mindfulness practice.
Good intentions can be strengthened by linking
such intentions
to a positive reason for taking care of oneself.
MBCT: Research Findings
o Prevention of Relapse/Recurrence in Major Depression
by Mindfulness-Based Cognitive Therapy. Teasdale,
Williams, etal. JCCP, 2000, 68 (4), 615-623.
o N = 145, 18-65 y/o, comm. health care
facilities
o hx of anti-depress meds (currently off meds)
o hx at least 2 episodes of Maj Dep, 1 or more
w/n 24 mos
o last episode 0 - 24 mo.
o TAU vs TAU + MBCT 8-week program
o 1-yr follow up
MBCT: Research Findings
Prevention of Relapse/Recurrence in Major Depression by
Mindfulness-Based Cognitive Therapy.
o Results:
o 37% of MBCT pts relapse/recurrence (hx 3
or more episodes of Maj Dep, 77% of
sample)
o 66% of TAU pts relapse/recurrence
o overall, MBCT resulted in a reduction of
relapse/recurrence of nearly 1/2
o No sign diff for subs w/hx 2 episodes
MBCT: Research Findings
Prevention of Relapse/Recurrence in Major Depression by
Mindfulness-Based Cognitive Therapy.
o Why the non-sign results for hx < 3 episodes
o Age differences w/n sample (one explanation):
o at onset of MDD - younger
o at time of study - older
o these variables combined for a relationship of
5:1
o More time cultivating dysphoria-linked
thinking patterns)
Mindfulness Based
Stress Reduction
&
Psychotherapy
Steve Shealy, PhD
www.BeMindful.org
813-980-2700