Negative thinking leads to depression and vice versa, which increases risk of recurrent and chronic depression. Growing evidence suggests the brain forms biochemical “scars” so that even normal events and emotions disproportionately trigger negative thoughts.
On their own, thoughts come and go from moment to moment. They are transient mental events. People who experience chronic or recurring depression are more likely to hang on to negative thoughts, however; habitually but unconsciously choosing to ruminate and obsess about them. Researchers propose that this rumination and obsessing results in brain scars. In common parlance, what fires together wires together.
Mindfulness-Based Cognitive Therapy (MBCT) teaches people to notice, accept and be curious about negative thoughts, recognizing that they are just thoughts, that our thoughts do not define us. These skills — noticing, accepting, being curious and letting go — help us let go of the negative thoughts before we start ruminating and obsessing.
The average person has some 70,000 thoughts a day, according to the Laboratory of Neuro-Imaging at the University of Southern California. That’s roughly 50 thoughts a minute.
As I type this sentence, I’m aware of the microwave beeping that my water is hot. I will finish writing this paragraph first. My partner is washing dishes and I have a pang of guilt. Tonight it’s my turn to do the dishes so it’s OK. There’s a train whistle in the distance and my feet are cold. The furnace just turned on. I wonder if I should get up and check the thermostat. All this is going on as I try to write a succinct paragraph to make the point there’s a lot more going on in our minds than the willful act of thinking.
I’ve been working on noticing and letting go of negative rumination for the last 10 or so years. In years gone by, I likely would have been thinking a lot more as I was writing. My almost automatic thoughts might have gone something like this.
I don’t want to get up. I’m lazy. I don’t even like tea. I’m not helping my partner wash dishes. I’m worthless. My feet are freezing. I don’t care enough to even turn up the thermostat. What’s the point anyway?
These automatic negative thoughts attached to normal events and emotions lead to recurrent depression that seemingly comes out of nowhere and chronic depression that never seems to go away.
An Evidence-Based Approach
Major depression will affect approximately one in five people in their lifetimes. At least 50% of those who recover from a first episode will have one or more additional episodes across their lifetime. Some 80% who have had two episodes will have another recurrence.
An evidence-based adaptation of Mindfulness-Based Stress Reduction (MBSR), MBCT combines mindfulness and elements of Cognitive Behavioral Therapy (CBT) to reduce the risk of recurrent depression, decrease symptoms of chronic depression and increase self-compassion.
What To Expect In A Session
Mindfulness is paying attention in a particular way: on purpose, in the present moment, non-judgmentally to things as they are, according to Jon Kabat-Zinn. The mindful way reminds us that we can’t change our negative thinking if we don’t notice it and we can’t notice it if we aren’t paying attention consciously in the present moment.
We teach mindfulness in an 8-week class using guided meditation. While the class assumes participants have little or no experience with meditation, people with a regular meditation practice will benefit from the addition of elements of CBT to their practice.
Each session starts with a guided mindfulness meditation, which change each week as follows.
- Mindfulness of eating
- Mindfulness of body sensations
- Mindfulness of movement
- Mindfulness of breathing
- Mindfulness of sound
- Mindfulness of emotions via listening to body sensations
- Mindfulness of thoughts via visualizing a difficult situation
- Awareness without an object
Following the mindfulness meditation, we discuss what participants experienced and how it relates to everyday life, especially managing depression. The discussion resembles a therapy group. Each week participants are asked to keep thought records between sessions aimed at identifying automatic thoughts just beneath the surface and what triggers them. In the discussion, we explore patterns, identify lessons learned and determine how mindfulness can help relate to them differently.
What is Mindfulness?
Mindfulness is a way of being with your internal self as well as your external world. Mindfulness does not come naturally but requires practice, much the same as learning martial arts or a musical instrument. Even the masters have to practice regularly.
We learn to be mindful using meditation. Just the word strikes fear in many. The reality is, however, that everyone’s minds wander. Nearly everyone has fallen asleep a time or two. Frustration happens. And most of us have wanted to quit at times. It’s all okay.
Part of the fear comes from the misconception that mindfulness meditation requires clearing the mind. In reality, mindfulness meditation is the practice of bringing the mind back to the present moment on purpose without judgment. We call it a practice because the only thing that matters is that you do it on a regular basis, preferably daily.
If your conscious mind wanders 10 times a minute and you bring your mind back to the present moment without judging yourself half of the time, you are amazing! If you panic when you close your eyes, keep your eyes open. If you sit in a chair or cross-legged on the floor or lying down, it makes no difference. There is no “right way” to meditate. The only thing that matters is that you practice noticing when your mind wanders or your emotions intrude and you bring your attention back to the present moment on purpose without judgment.
The practice is not clearing your mind or focusing or concentrating. The practice is bringing your attention back to the present moment on purpose without judging yourself or the circumstances that distracted you, accepting it is what it is and you are as you are.
Between Session Practice
Daily practice is expected. Without daily practice, participants don’t achieve the expected results — decreased risk of recurrent depression, reduced symptoms of depression and increased self-compassion. Participants plan for 30-60 minutes of homework six days a week, including a guided meditation, thought records and reading The Mindful Way Through Depression: Freeing Yourself From Chronic Unhappiness. A CD of guided meditations comes with the book.
Structure of the MBCT Group
In our program, two therapists work with 6-10 participants in an 8-week group. Each session runs for two hours from 6 pm to 8 pm on Wednesday nights. We will offer our MBCT group three times in 2017, starting in February, June and September. Registrations are accepted on an ongoing basis. To enroll, email firstname.lastname@example.org.
Some Related References
Burcusa, S. L., & Iacono, W. G. (2007). Risk for Recurrence in Depression. Clinical Psychology Review, 27(8), 959–985. http://doi.org/10.1016/j.cpr.2007.02.005
Kuyken W et al. Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): A randomised controlled trial. Lancet 2015 Apr 20
Kuyken, W., Watkins, E., Holden, E., White, K., Taylor, R.S., Byford, S., Evans, A., Radford, S., Teasdale, J.D., & Dalgleish, T. (2010). How does mindfulness-based cognitive therapy work? Behaviour Research and Therapy, 48(11), 1105-1112.
Segal, Z. V., J. M. G. Williams and J. D. Teasdale (2013). Mindfulness-based cognitive therapy for depression. New York, Guilford Press.
Teasdale, J.D., Moore, R.G., Hayhurst, H., Pope, M., Williams, S. & Segal, Z.V. (2002). Metacognitive awareness and prevention of relapse in depression: Empirical evidence. Journal of Consulting and Clinical Psychology, 70, 278-287.
Teasdale, J.D., Segal, Z.V., Williams, J.M.G., Ridgeway, V., Soulsby, J., & Lau, M. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 68, 615-623.
Williams, J. M. G., Teasdale, J.D., Segal, Z.V.& Kabat-Zinn, J. (2007). The mindful way through depression: Freeing yourself from chronic unhappiness. New York: Guilford Press
Williams, M., Kuyken, W (2012) Mindfulness-Based Cognitive Therapy: A Promising New Approach to Preventing Depressive Relapse, The British Journal of Psychiatry
Sandra Miller, MSW, LCSW and sometimes blogger, sees clients at St. Louis DBT four days a week. She is currently taking individuals and couples as clients.