Mindfulness based cognitive therapy a primer
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Mindfulness-Based Cognitive Therapy a Primer. Dr. Kerri McGuire Women’s Health Issues April 26, 2007. Outline. The Territory of Depression Why does depression recur? Mindfulness-Based Cognitive Therapy (MBCT) Future Directions. The Territory of Depression.

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Mindfulness-Based Cognitive Therapy a Primer

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Mindfulness based cognitive therapy a primer

Mindfulness-Based Cognitive Therapya Primer

Dr. Kerri McGuire

Women’s Health Issues

April 26, 2007


Outline

Outline

  • The Territory of Depression

  • Why does depression recur?

  • Mindfulness-Based Cognitive Therapy (MBCT)

  • Future Directions


The territory of depression

The Territory of Depression

  • WHO predicts that by 2010 depression will rank second to cardiovascular disease in economic and personal costs.

  • Chronic illness, typically with several recurrences


Rates of depressive relapse over 15 years

Rates of Depressive Relapse Over 15 Years


Risk factors for depressive relapse

Risk Factors For Depressive Relapse

  • Number of Past Episodes of Depression

  • Family History of Depression

  • Significant Losses/Stressors

  • Cognitive Reactivity to Sad Moods


Qualities of relapse related states of mind

Qualities of Relapse-Related States of Mind

Automatic

-Little intentional control of attention

- Avoidant or suppressive

Ruminative and Centered on Self

-Strong identification with thoughts and feelings

-Strongly correlated with the past # of depressions

-Gender differences in rumination correlate with gender distribution in depression


Rumination can be seen to be emotional wisdom

Rumination Can Be Seen To Be Emotional Wisdom

P<.002; Watkins & Moulds (2005)

P<.02; J Pers & Soc Psych (2000)


Qualities of relapse related states of mind1

Qualities of Relapse-Related States of Mind

Content

- “In order to be happy, I must be……”

- “Admitting to your mistakes is a sign of weakness”

- “If others look to me for guidance, it would make me feel important”

Process

- What does feeling this way say about me?

- Why is this (sadness) happening to me?

- How can I change this (sadness)?


Mindfulness based cognitive therapy

Mindfulness-Based Cognitive Therapy

An Integration of MBSR and Cognitive Therapy

A Blend of Acceptance and Change models

Customized for Depression


Mindfulness based stress reduction mbsr

Mindfulness-Based Stress ReductionMBSR

  • University of Massachusetts Medical Center,

    Stress Reduction Clinic,1979

    • Jon Kabat-Zinn, Ph.D., founder

    • 8 Week Program

    • Participants with a wide range of medical problems, including chronic pain, anxiety disorders, depression, hypertension, heart disease and cancer.

    • Program outlined in the book “Full Catastrophe Living, Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness”


A definition of mindfulness

A Definition of Mindfulness

Mindfulness means paying attention,

in a particular way,

on purpose,

in the present moment,

and non-judgmentally

Jon Kabat-Zinn


How does cognitive therapy prevent depressive relapse

How Does Cognitive Therapy Prevent Depressive Relapse?

Teaches Patients in Depressed Mood to:

-Switch out of a habitual cognitive mode of mind

-Decenter - thoughts are not necessarily me and not necessarily true

-Turn towards the Difficult

-Change Degree of Belief


How does mbct prevent depressive relapse

How Does MBCT Prevent Depressive Relapse?

Teaches Recovered Depressed Patients Regardless of Mood:

-Automatic to Intentional Mode

-Avoidance to Curiosity & Acceptance

-‘Thinking About’ to ‘Directly Experiencing’

-Judging & Fixing to Non-Doing & Being


The nature of the work in mbct

The Nature of the Work in MBCT

  • Systematic Training to Become More Aware

    • Moment to Moment

    • Bodily Sensations

    • Pleasant & Unpleasant Events

    • Thoughts & Feelings as Mental Events

  • Formal Practice

    • Body Scan

    • Mindful Stretching/Yoga

    • Mindfulness of Breath/Body/Sounds & Thoughts


The nature of the work in mbct1

The Nature of the Work in MBCT

  • Opportunity to Be Mindful Using Activities

    • Investigating Pleasure & Mastery

    • Taking Skillful Action – Preparing for Relapse

    • Inquiry/Discussion of Symptoms & Experiences of Depression

  • Informal Practice

    • 3 Minute Breathing Space

    • Mindfulness of Everyday Activities


Mindfulness based cognitive therapy a primer

3 Minute Breathing SpaceProvides a way to step out of automatic pilot mode and reconnect with the present moment

  • AWARENESS

    • Acknowledge & register your experience, even if it is unwanted

  • GATHERING

    • Bring full attention to the breath, as an anchor

      to awareness & stillness

  • EXPANDING

    • Awareness of the body as a whole, your posture

      and facial expression


  • Rates of depressive relapse for patients with 3 or more past episodes

    Rates of Depressive Relapse for Patients with 3 or More Past Episodes

    MBCT 66%

    TAU 34%

    P<.005; J Consult Clin Psych (2000)


    Single site replication 1 year follow up

    Single Site Replication1 Year Follow Up

    TAU 22%

    MBCT 64%

    P<.05; J Consult Clin Psych (2004)


    Meditation and the brain

    Meditation and the Brain

    • Frontal - Limbic pathways

    • Numerous studies ongoing

    • Meditators versus non-meditators


    Pet scans and meditation

    PET Scans and Meditation

    Dorsal Lateral Prefrontal Cortex

    Left associated with feelings of happiness & well-being and approach behaviours

    Right associated with feelings of distress and avoidance behaviours

    Meditation

    Increased left sided anterior activation compared to controls

    Over 8 weeks participants began to shift in the same direction as Buddhist monks


    Future directions and research

    Future Directions and Research

    • Pilot Studies:

      • Anxiety disorders including panic disorder without agoraphobia

      • Actively depressed

      • Co-occurring addictive and mood disorders

      • Binge eating disorder

      • Immune response to Influenza vaccine


    Summary

    Summary

    • MBCT was designed to reduce relapse by helping patients disengage from ruminative thinking triggered by sad moods.

    • MBCT helps patients shift their relationship to thoughts/ sensations/feelings without trying to change belief in thought content.

    • It is ideal for patients in recovery because depression need not be present for them to practice

    • Shown to reduce relapse rate by 50% in patients with recurrent depression.


    Resources

    Resources

    • Books:

      • Full Catastrophe Living, by Jon Kabat-Zinn

      • Heal Thyself; Mindfulness in Medicine, by Saki Santorelli

      • Mindfulness-Based Cognitive Therapy for Depression, by Z.Segal, J. Williams & J. Teasdale

      • Wherever You Go There You Are, by Jon Kabat-Zinn

        Web Sites:

        www.ottawamindfulnessclinic.com

        www.umassmed.edu

        Dr. Kerri McGuire: [email protected]


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