Mindfulness in Psychotherapy: Depression with Steve Shealy, PhD 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)   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 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 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 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 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 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 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 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 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 o Prevention of Relapse/Recurrence in Major Depression by Mindfulness-Based Cognitive Therapy. Teasdale, Williams, etal. JCCP, 2000, 68 (4), o o N = 145, y/o, comm. health care facilities o o hx of anti-depress meds (currently off meds) o o hx at least 2 episodes of Maj Dep, 1 or more w/n 24 mos o o last episode mo. o o TAU vs TAU + MBCT 8-week program o o 1-yr follow up

MBCT: Research Findings Prevention of Relapse/Recurrence in Major Depression by Mindfulness-Based Cognitive Therapy. o o Results: o o 37% of MBCT pts relapse/recurrence (hx 3 or more episodes of Maj Dep, 77% of sample) o o 66% of TAU pts relapse/recurrence o o overall, MBCT resulted in a reduction of relapse/recurrence of nearly 1/2 o 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 o Why the non-sign results for hx < 3 episodes o o Age differences w/n sample (one explanation): o o at onset of MDD - younger o o at time of study - older o o these variables combined for a relationship of 5:1 o o More time cultivating dysphoria-linked thinking patterns)

Mindfulness Based Stress Reduction & Psychotherapy Steve Shealy, PhD