by Pat Vroom, PhD
Packet Online, April 2008
Judging from the number of articles in the popular press and the funding of new research, an increasingly high value is being put on psychotherapy that incorporates mindfulness. Mindfulness is short for mindfulness meditation, which focuses on self-empowerment through increasing awareness of being in the present moment. Since Jon Kabat-Zinn, PhD first introduced us to the benefits of Mindfulness-Based Stress Reduction, we have seen an expansion of mindfulness-based programs to include anxiety, depression, addiction, eating, behavior, pain, high blood pressure, etc. One of the newest and most heavily researched of these programs is Mindfulness-Based Cognitive Therapy (MBCT) for Depression.
Cognitive Behavioral Therapy (CBT) is the gold standard for short term, experience-based therapy. For treating depression-prone patients, CBT relies on identifying and disputing what are called “irrational thoughts”, such as “I will always be a failure,” “I do everything wrong,” “Everyone is against me.” This is sometimes called cognitive restructuring and it is a way to change long-standing thinking patterns and negative mood spirals. Adding mindfulness to the tools of cognitive therapy provides us with a powerful ally to learn to observe our thoughts.
Our MBCT Program is an innovative 8-week experiential and didactic course that uses small group learning experiences, meditation, and yoga as resources to prevent relapses of depression. It is not a treatment for active depression. It is based on the research of Drs. Zindel Segal, John Teasdale, Mark Williams, and Jon Kabat-Zinn and documented in their book The Mindful Way Through Depression (2007). MBCT will be offered for the first time in this area beginning in May 2008 by Pat Vroom, PhD (609.818.1226) at the Princeton Center for Yoga & Health in Skillman.
What Is Depression?
According to Segal et al. depression is a state of mind in which normal sadness grows out of proportion into a painful state of hopelessness, listlessness, and fatigue. When depression is mild, we find ourselves brooding, resentful, irritable or angry, and feeling sorry for ourselves. We may even feel physical symptoms, which cannot be diagnosed as any illness.
As depression worsens, feelings of extreme sadness and hopelessness combine with low self-esteem, memory and concentration difficulties to bring about a severely painful state of mind. The involvement of a physician is crucial for treatment. Sleep, eating, energy, interests may all go out of kilter.
An effective treatment for major depression is antidepressant medication. However, according to a 2006 study led by Dr. Zindel Segal at the Center for Addiction and Mental Health in Toronto, once we stop taking the medication, depression tends to return, and at least 50% of those experiencing their first episode of depression find that depression comes back. After a second or third episode, the risk of recurrence rises to between 80 and 90%.
Preventing this recurrence may mean 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. MBCT is the result of an effort to find new ways to lower the risk of recurrence.
Why Am I At Higher Risk For Repeated Depression Once I Have Had A First Episode?
During episodes of depression, negative thinking increases significantly and becomes tightly linked with negative mood. When episodes pass (usually through some form of medical treatment), mood returns to normal and physical symptoms tend to disappear. In the absence of depression, there is no difference between the thinking patterns of someone that is vulnerable to depression and one who is not.
This vulnerability surfaces with the appearance of even a small negative mood swing. Thoughts of I am a failure, I am inadequate, I am worthless again irrationally reappear. People who believed they had recovered find themselves feeling back to square one. This engenders further fears and often self-imposed isolation. They end up inside a rumination loop that constantly asks what has gone wrong?, why is this happening to me?, where will it all end? Part of the problem is that such rumination feels as if it ought to help, but it only succeeds in prolonging and deepening the mood spiral.
MBCT Model of Relapse Prevention: Mindfulness
The discovery of the reactivation of the link between negative mood and negative thought in high-risk people, is of enormous importance. It means that sustaining recovery from depression depends upon noticing this link early in its appearance and on having good tools and resources to keep mild states of depression from spiraling out of control.
MBCT provides these tools and the understanding to use them.
When sadness or low mood hits, we may unknowingly isolate ourselves, and thus eliminate sources of pleasure that could help stop the downward trend.
Mindfulness can act as an early warning system by keeping us in touch with ourselves and what is going on around us. It allows us to identify low mood and take immediate action to reverse it and reconnect with life.
A low mood may trigger anxiety and fear of return of depression ñ we start living in the future with “what if” statements filling our head.
Mindfulness brings us back to the present, where our mood is more manageable.
Anxiety and fear lead to over-thinking, brooding, living “in our head” in an attempt to suppress or “fix” our negative feelings and thoughts ñ this strategy never works.
Mindfulness shifts our mental gears into a non-judgmental mode of “being” rather than “doing” or “thinking.” Mindfulness teaches us to approach difficult feelings with acceptance and openness where we can trust in our strengths.
Pat Vroom, PhD is a licensed psychologist and Director of Integral Medicine at Capital Health System. Dr. Vroom collaborates with Deborah Metzger, MSW at the Princeton Center for Yoga & Health for MBCT, MBSR, and maintains a private practice for individual therapy at PCYH. She recently came to Princeton from Memorial Sloan-Kettering Cancer Center in NYC, where she established the Mind-Body Therapy Program. Her psychotherapy practice focuses on mindfulness and hypnosis in the management of stress, anxiety, and pain and coping with illness. For information call 609-818-1226.
For more information about upcoming Mindfulness Based Stress Reduction programs at the Princeton Center for Yoga & Health, call 609-924-7294.