The 8-week MBCT programme Content and rationale. Major depression. European data 17% experience of depression 6.9% major depression WHO 2 nd major cause of disability. Relapsing condition. Keller et al followed 145 pts First episode 35% relapse in 2yr Second episode – 60%
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Major depression • European data • 17% experience of depression • 6.9% major depression • WHO • 2nd major cause of disability
Relapsing condition • Keller et al followed 145 pts • First episode 35% relapse in 2yr • Second episode – 60% • Third episode – 80 % • Fourth – 95%
Cognition , mood & relapse • Life event research (Robert Post ) • Teasdale Differential activation hypothesis
The ruminative mind • Relapse pathway • Problem solving becomes the problem • Metacognition – distance from thoughts
What is mindfulness? ‘Mindfulness is the awareness that emerges through paying attention in a particular way. . . . - on purpose - in the present moment non-judgementally”. To the unfolding of experience moment by moment’ Jon Kabat-Zinn 2003
Characteristics of Mindfulness-Based Programmes The central aim of mindfulness-based programmes is to systematically develop the skills of paying attention to: • internal experience (body sensation, thoughts, and mood) and • external experience (interactions with others, actions in the world) and • the interplay between these two.
Mindfulness-based approaches: aims To enable participants to step out of mental reactions that exacerbate difficulties and interfere with effective problem solving (changing mode of mind) To equip participants with ways of responding to stress, vulnerability to depression or other problems
The paradox… Participants are coming to the course to address their difficulties…. but the course invites them to let go of getting anywhere…….
Course structure: • An individual pre-course session. • Eight weekly sessions of 2 – 2.5 hours duration. • A day long guided and structured silent day of mindfulness practice.
Early sessions: concentrate mainly on learning to focus attention on specific aspects of experience such as the breath or body sensations(concentration practices) • Later sessions: participants learn to bring mindfulness to a broader range of internal and external experiences including thoughts and emotions, especially as they are experienced in the body(mindfulness practices)
We can be fully present with one thing at a time… BUT OUR AWARENESS CAN BE: • Narrow angle or • Wide angle
The 8-week MBCT programme Week 1 Automatic Pilot Week 2 Dealing with barriers Week 3 Mindfulness of breathing and the body in movement Week 4 Staying Present Week 5 Allowing-Letting Be Week 6 Thoughts are not facts The practice day Week 7 How can I best take care of myself? Week 8 Acceptance and change (using what has been learned to deal with future moods)
The raisin eating exercise We come to notice: • How much we are ‘not here’ for our experiences • How the experience feels different when we are ‘here’ • Experiencing the difference between mindful awareness and automatic pilot
Body Scan Meditation: the foundation to the programme Aims: • Direct experiential knowing • Deliberately engaging and disengaging attention • Relating skilfully to mind wandering • Allowing things to be as they are • Learning how the breath can act as a vehicle • Noticing and relating differently to mental states • Noticing, acknowledging and returning
Mindfulness of the body in movement…. • Yoga, Tai chi, Chi gong • Walking • Cycling • Swimming • Any activity we engage in But…deliberately setting time aside to practice bringing awareness to the experience
Sitting meditation Bringing awareness systematically to: • The breath • The body • Sounds • Thoughts • Emotions • ‘Choiceless awareness’
Mindfulness of thoughts and feelings • Learning to relate TO thoughts/feelings rather than FROM them • Relating to them much as we relate to sounds • Learning to see recurring patterns
Segal et al., 2002, p.168 An essential characteristic of this practice is that the aim is not really to prevent the mind wandering but to become more intimate with how one’s mind behaves
Regular practice • gives us more opportunities to notice when we have drifted away from awareness of the present moment • and gently and firmly bring our attention back to the moment
De-centreing skilfully relating to internal experience… • Leaning into difficulty • Standing back in order to move in close/in order not to get stuck • Witnessing our experience • Use of compassion
CBT – thoughts are a hypothesis to be tested MBCT – thoughts are mental events
Mindfulness class • Participatory – who’s the therapist • Paradox of expecting a lot from people • Lead from your own practice- only take people were you are prepared to go
Core skill taught in MBCT: To intentionally ‘shift mental gears’. RUMINATION: The pattern of mind which makes people vulnerable to depressive relapse
Being mode and • Doing mode
3 key differences between CBT and MBCT MBCT: • emphasises acceptance rather than change strategies • offers no training in changing the content of thinking, but rather emphasises seeing thoughts as thoughts rather than as reflections of reality (metacognitive awareness) • participants are taught to notice the effects of negative mind-states on the body, and to explore body sensations directly, rather than focusing on or suppressing the mind-state
Research project • Staff group • Adapt programme • evaluate