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Mindfulness in Psychotherapy: Depression

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Mindfulness in Psychotherapy: Depression. with 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)

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  • 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

“A complex disorder with biological,

psychological, and social components”


“ 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…”


“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.

definitions of 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
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 depression1
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 depression2
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 depression3
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
MBCT: Weekly Themes
  • 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 themes1
MBCT: Weekly Themes
  • 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 themes2
MBCT: Weekly Themes
  • 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 themes3
MBCT: Weekly Themes
  • 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 themes4
MBCT: Weekly Themes
  • 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 themes5
MBCT: Weekly Themes
  • 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 themes6
MBCT: Weekly Themes
  • 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 themes7
MBCT: Weekly Themes
  • 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
MBCT: Research Findings
  • Prevention of Relapse/Recurrence in Major Depression by Mindfulness-Based Cognitive Therapy. Teasdale, Williams, etal. JCCP, 2000, 68 (4), 615-623.
    • N = 145, 18-65 y/o, comm. health care facilities
    • hx of anti-depress meds (currently off meds)
    • hx at least 2 episodes of Maj Dep, 1 or more w/n 24 mos
    • last episode 0 - 24 mo.
    • TAU vs TAU + MBCT 8-week program
    • 1-yr follow up
mbct research findings1
MBCT: Research Findings

Prevention of Relapse/Recurrence in Major Depression by Mindfulness-Based Cognitive Therapy.

  • Results:
    • 37% of MBCT pts relapse/recurrence (hx 3 or more episodes of Maj Dep, 77% of sample)
    • 66% of TAU pts relapse/recurrence
    • overall, MBCT resulted in a reduction of relapse/recurrence of nearly 1/2
    • No sign diff for subs w/hx 2 episodes
mbct research findings2
MBCT: Research Findings

Prevention of Relapse/Recurrence in Major Depression by Mindfulness-Based Cognitive Therapy.

  • Why the non-sign results for hx < 3 episodes
  • Age differences w/n sample (one explanation):
  • at onset of MDD - younger
  • at time of study - older
  • these variables combined for a relationship of 5:1
  • More time cultivating dysphoria-linked thinking patterns)
mindfulness based stress reduction psychotherapy

Mindfulness Based Stress Reduction& Psychotherapy

Steve Shealy, PhD