Mindfulness Based Cognitive Therapy (MBCT)
One of the greatest challenges facing those who have experienced depression or chronic anxiety is the question of how to stop it recurring. Ironically, the success of modern depression treatments has actually increased this problem. The most common treatment for depression is anti-depressant drugs, which are very effective and have helped thousands of people free themselves from the grip of depression. The problem is, drug treatment doesn’t address the problem of relapse. Once people stop taking the medication, the chances of depression returning are very high. Relapse rate estimations range from 50% to as much as 90% for those who have experienced three major depressive episodes.
In response to this challenge, a group of researchers have developed an eight-week workshop called Mindfulness-Based Cognitive Therapy, or MBCT. Remarkably, this short-term program is proving to be one of the most effective treatments currently available to address depression relapse. We have been presenting the MBCT workshop for the past few years and have seen exceptional results for our clients. The MBCT course empowers clients to understand and accept themselves and their minds, better and faster. People who have taken the course have said they find it helped them immensely, calling MBCT “extraordinary” and “extremely important.” And the effects are lasting. Last week, we ran into one client who took the very first course we offered, several years ago. After all this time, she still says, “It changed my life.”
MBCT was developed by Drs. Zindel Segal, Mark Williams and John Teasdale, and is based on Jon Kabat-Zinn’s Mindfulness-Based Stress Reduction program, which has helped thousands of people deal with chronic illness and pain. How does it work? Well, it starts with the premise that all of us are going to experience feelings of being down from time to time, but for those who have experienced major depression, these relatively minor episodes of low mood, sadness, or anxiety can trigger a spiral into depression.
The MBCT website (www.MBCT.com) explains: “During any episode of depression, negative mood occurs alongside negative thinking (such as ‘I am a failure’, ‘I am inadequate’, ‘I am worthless’ … During the episode, a connection has formed between the moods that were present at that time and the negative thinking patterns. This means that when negative mood happens again (for any reason), a relatively small amount of such mood can trigger or reactivate the old thinking pattern … When this happens, the old habits of negative thinking will start up again, getting into the same rut, and a full-blown episode of depression may be the result…. [Preventing relapse] depends on learning how to keep mild states of depression from spiraling out of control.”
This last sentence is very important and is the key to the success of MBCT. Learning how to deal with difficult periods without triggering major depression is the essential skill that the MBCT course teaches, and the most important ingredient in developing this skill is mindfulness.
Mindfulness is the capacity to hold the present moment — our perceptions, thoughts and feelings — in conscious awareness. Jon Kabat-Zinn offers this definition:
“Mindfulness means paying attention in a particular way:
in the present moment,
This is a very useful definition, because it is so clear and specific. We can ask ourselves questions like: “Am I paying attention to this moment?” “Am I doing it on purpose? That is, am I choosing what to pay attention to?” “Am I being judgemental of these feelings?”
These questions can help us learn how to be mindful. And developing the skill of mindfulness allows us to identify the presence of moods and thought patterns that can lead to depression and to use skillful means to redirect our path.
Mindfulness is very simple and easy to do – for a moment! To try it out you can use an exploration Eckhart Tolle suggests in his book The Power of Now. Just take a breath and think “I wonder what I’m going to think next,” and then wait and see what happens. Try it now, and see what you notice.
You might notice that for a moment you were aware of a silence and then the beginning of thoughts in your mind, but chances are that pretty soon the thoughts just took over, and you kind of zoned out or got caught up in them. It is challenging to develop the capacity to remain mindful for more than a few seconds. It’s just as hard to remember your intention to be mindful over the course of a day, and hardest of all to be mindful of very painful states of mind.
When we are feeling truly rotten, perhaps fearful, full of dread, full of self-hate, the last thing we want to do is be present with those feelings. In fact we have been taught not to. Most of our training teaches us not to give into the feelings, to go on in spite of them, to push them away. Feelings hold vital information for us, but in a moment of intense and overwhelming feeling our instinct and training lead us to check out, to distract ourselves, to look for a quick fix (food, pot, TV, even music or exercise). Or alternately we descend into a spinning spiral of thought that centers on our hopelessness. Either of these puts us at risk for moving toward depression. If we are going to be able to intervene in this automatic process, we need an effective tool and we need to develop some skill in using it.
MBCT teaches us to use mindfulness to stand in close proximity to our painful thoughts and feelings. This takes courage, and let’s be real – standing close to our pain is painful. But, as the great meditation teacher Pema Chodrom writes, “When you find yourself caught in extreme discomfort or negativity, the negativity itself is not the problem. If you can have a direct experience of that pain, it will be a great teacher for you. “ As we stand and experience our painful thoughts and feelings, staying connected to our breath and our bodies, an amazing thing happens. They lose some of their power. It’s like you’re standing in a wild ocean, feeling panicky as the waves break over your chest, almost knocking you over. You stagger and catch your balance, and realize that “Yes, this is powerful and almost overwhelming, and no, it doesn’t appear to be going away, but… Wow! I can handle it.“ This vivid moment of awareness can be the turning point between a bad day spiraling into depression or not. It can even be an invigorating discovery when you realize that, against all odds, you are able to be present to your powerful, painful feelings, and hard as it is, they are tolerable.
MBCT also teaches us to notice our patterns of mind. Through careful progressive exercises, we develop an understanding of the linkage between mood, thoughts and imagination. When something happens to lower our mood, subsequent events are colored by it. Because we are feeling low, we are much more likely to think negative thoughts and form self-defeating opinions. We tend to just believe these thoughts, and it doesn’t often occur to us to question them. But when we see how our thoughts are affected by our mood, we discover that there is an imaginary element to them. We are making a lot of it up! As we learn to observe more carefully we are able to see how our mind is tricking us into believing something that isn’t true. We slowly learn to challenge the reality of the kinds of thoughts that lead to depression. One of our favorite bumper stickers says, “Don’t believe everything you think.”
Through mindfulness, through practice, through compassion, through gentle guidance and self-acceptance, we learn, step by step, how to free ourselves from the tangle of negative thoughts, feelings and perceptions. We can take a conscious breath and move just one tiny inch outside of the morass of dark thoughts and say to ourselves, “Wow. I am in the midst of some very painful thoughts.” In that moment, instead of the thoughts having us, we are having them. This sliver of a gap between us and our thoughts can make all the difference.