mindfulness based cognitive therapy

The 12 session Mindfulness Based Cognitive Therapy (MBCT) was developed by Zindel Segal, Mark Williams and John Teasdale, to help people who suffer multiple episodes of depression and chronic unhappiness. It combines ideas from cognitive therapy with meditative practices and attitudes cultivated through mindfulness. The central focus of this work is becoming familiar with the mental states that often characterize mood disorders, at the same time as you learn to relate differently to them. The UK National Institute of Clinical Excellence (NICE) endorses MBCT as an effective treatment for relapse prevention in depression.

This program has also been adapted to help people struggling with anxiety and/or binge eating disorder (BED), as well as for people facing a cancer diagnosis or recovery process. 

If you are suffering from chronic pain and/or illness, facing a diagnosis or recovery process from cancer, or physical manifestations of stress and wish to benefit from the MBSR (Mindfulness Based Stress Reduction) or MBCT program, or from flexible mindfulness and compassion instruction sessions, please contact me

 

Here's a talk by Zindel Segal, with whom I trained in MBCT through UCSD's Center for Mindfulness. Below you can read more about depression and the 12 week MBCT program. 

 

why do we remain vulnerable to depression once we've had an episode?

During any episode of depression, a negative mood state occurs in association with negative thoughts (such as 'I am a failure', 'I am inadequate', 'I am unworthy') and physical sensations of heaviness and fatigue. Once the episode has passed and your mood goes back to normal, negative thinking and fatigue tend to fade as well. However, during the episode a link has been established between certain mood states and negative thought patterns.

Additionally, for many people depression appears as a consequence of traumatic experiences, which affect emotional regulation pathways and activate guilt and shame reactions when facing stressful events or distressing emotions. 

This means that whenever negative mood states happen again (for whatever reason), a relatively minor state of distress can trigger the old thinking pattern. Once more, you begin thinking you have failed, or you are inadequate or unworthy - even if this is not relevant to the current situation. Even if you believed you had recovered you may find yourself feeling that you're 'back to square one'. You end up in a rumination circuit, constantly asking 'What went wrong?', 'Why does this always happen to me?', 'When will this end?' This rumination may seem to be an attempt to find an answer, but it lengthens and deepens the descending mood spiral. When this happens, the negative thought patterns begin all over again, and may result in another (worsening) episode of depression.

The discovery that the link between negative mood states and negative thoughts is there, ready to be activated, even when you feel well, is of great importance. It means that avoiding amplification of mild states of depression can help to sustain recovery and prevent relapse. 

 

how can mindfulness help?

  1. It will help you understand what depression is and how it manifests in your lived experience. 
  2. It will help you discover what makes you vulnerable to the descending spiral of negative mood states, and why you get stuck at the lowest end of the spiral. 
  3. It will help you see the connection between these descending spirals and 
    • Perfectionistic and oppressive standards that make us feel 'not good enough'
    • Ways in which we push ourselves or make ourselves unhappy with excessive demands*
    • Ways in which we lose touch with what makes life worth living
    • The voice of the inner critic

* Please know that I am well aware that many of these things are not a matter of individual attitude or choices, but of oppressive societal and cultural structures and discourses, and of (historical) trauma. My practice is rooted in intersectional feminism and a systems perspective, so I don't align with the view that our suffering stems solely from the ways in which we interpret the world and respond to experience. There are unjust and traumatic situations to which the only wise response of our body-mind is depression. And I can support you with this. 

When you enter a phase during which you are vulnerable to depression, you lose touch with which is happening around you. It is a sort of tunnel vision: you can only see part of the landscape. You cannot notice the moment in which a low mood spiral is beginning. 

The practice of mindfulness helps you see mental patterns more clearly and learn how to recognize when your mood is starting to change. This means you can implement self-care strategies sooner. 

'Losing touch' with things can introduce a barrier between you and the things in life that give you pleasure. This tendency can become extreme in clinical depression, in which it is known as 'anhedonia' (lack of pleasure in the things we used to enjoy). But we all know this feeling, especially when there is so much to do at home or at work, or we are worried with unfinished business, when we don't notice the sources of joy around us. 

The practice of mindfulness shows you a path to awaken again to the experience of being alive and be present to what is here for you right now. 

Low mood can bring back memories and thoughts from your past, and make you worry about the future, trapping you in rumination cycles.

The practice of mindfulness helps you stop the escalation of negative thoughts and teaches you how to focus your attention on the present moment, instead of reliving the past or anticipating the future. 

When you begin to feel bad, you tend to react as though your emotions were a problem to be fixed: you begin trying to use your critical thinking strategies. When they don't work, you redouble your efforts to use them. You end up over-analyzing, ruminating, going over the same thing over and over again, and living in your head. 

The practice of mindfulness helps you to enter into an alternative mind state that includes thought but is more expansive than thought. It teaches you how to make the transition from a mental state dominated by critical thinking (which tends to provoke and accelerate the descending mood spirals) to a mental state in which you experience the world in a more direct way, which is non-conceptual and with cultivation of equanimity. 

When you've been depressed, of course it is terrifying to go back to this state. At the first hint you may try to suppress the symptoms, pretend they aren't there, or fight against any unwanted thought, emotion or memory. But this suppression often doesn't work, and the things you've tried to get rid of come back with increased strength. 

The practice of mindfulness adopts a different approach. It helps you develop your willingness to experience emotions, your ability to open up to painful feelings and make space for discomfort. It helps you develop the courage and presence to allow unpleasant sensations, thoughts and feelings to come and go, without fighting against them. Through mindfulness, you find that difficult and unwanted thoughts and emotions can be held in awareness and seen from a different perspective - one that brings a sense of warmth and compassion with the suffering you are already experiencing. 

 

what is compassion and how can it help? 

To have compassion for someone you first need to notice they're suffering. Then, to feel moved by that suffering in a way your heart responds to their pain. When this happens, you feel warmth and the wish to help so that the person can stop suffering. Having compassion also means that you offer understanding and kindness when someone fails or makes a mistake, instead of judging them harshly. Finally, when you feel compassion for someone (instead of pity), it means you are aware that suffering, failure and imperfection are part of our shared human experience.

Having compassion for yourself is really no different from having it for others. Compassion involves responding in the same supportive and understanding and kind way to yourself as you would to a good friend when you are having a difficult time, when you fail or when you notice something you don't like about yourself.

Instead of ignoring your pain, you tell yourself 'This is really hard. How can I take care of myself and comfort myself in this moment?' Instead of judging or criticizing yourself harshly for your faults or shortcomings, compassion means you are kind and understanding. You may try to change in ways that allow you to be happier and healthier, but you do so because you accept yourself and care about yourself, not because you feel unworthy or ashamed of who you are. Perhaps the most important thing about having compassion for yourself is that you honor your humanity. Things will not always be the way you'd like them to be. You will face frustration and loss, you will make mistakes, you will find that you have shortcomings. That is the human condition, a reality shared by all people. The more you can open your heart to this reality instead of constantly fighting against it, the more you will be able to have compassion for yourself and for your fellow humans.

As well as mindfulness, compassion is something we practice and cultivate. Through the practice of compassion you can learn:

  • How to stop being so hard on yourself;
  • How to counter the inner critic's voice and hold your suffering with kindness;
  • How to manage difficult emotions with more ease;
  • How to encourage yourself with inspiration instead of judgment;
  • How to transform challenging relationships.

The practice of compassion increases life satisfaction and wellbeing, and is linked with less depression, anxiety and stress and better interpersonal relationships. Unlike what many people could think, a compassionate attitude with ourselves allows us greater adherence to health related behaviors (so it's not about slackening or 'indulging') and greater success in achieving meaningful goals. 

 

is the practice of mindfulness and compassion useful even if you haven't been depressed? 

Of course. You can benefit from the practice of mindfulness and compassion whether you have a specific problem or not. We all have moments in our lives in which we experience difficulty, stress, loss and struggle; and for some of us this is our daily experience.

Developing a greater awareness can allow you to see how the mind gets trapped by its own craving and aversion patterns, of pursuing or rejecting as an attempt to increase happiness, but creating suffering in the process.

The practice of mindfulness and compassion can help you see more clearly how you can approach your experience moment by moment skillfully, with an open heart, rejoicing in pleasant things that often go unnoticed or unappreciated, and facing obstacles and challenges - both real and imaginary - more effectively.

 

can i practice without following the program? 

The MBCT program has been developed to follow a structure that involves a weekly live session, so that you have the benefit of discussing with your instructor (and the group, if you are participating in a group program) how your practice is going and what challenges and obstacles you've found yourself facing. It is the combination of these live sessions and home practice that has been proven to prevent relapse prevention in depression so effectively.

If you are currently not depressed, and for whatever reason you wish to begin the practice independently to prevent future relapses and find more happiness, you can use the books The Mindful Way Through Depression: Freeing Yourself from Chronic UnhappinessThe Mindful Way Workbook: An 8-Week Program to Free Yourself from Depression and Emotional Distress, and Uncovering Happiness: Overcoming Depression with Mindfulness and Self-Compassion

If you are interested in the practice of compassion, you will find books, guided practices and additional resources in the websites of Kristin Neff and Chris Germer, co-creators of the Mindful Self-Compassion (MSC) program.

If you are suffering from chronic pain and/or illness, facing a diagnosis or recovery process from cancer, or physical manifestations of stress and wish to benefit from the MBSR or MBCT program, or from flexible mindfulness and compassion instruction sessions, please contact me

 

 

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