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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

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
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
slide16
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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