Mindfulness-Based Interventions to Depressive Symptomatology II: Mindfulness in Psychology and its Efficacy
by Stefanie Gobin, MPsy
This series was originally completed as a Major Research Project in partial fulfillment of Adler Graduate Professional School’s Master of Psychology degree.
Mindfulness-Based Approaches in Psychology
Psychologists and mental health professionals tend to center approaches in therapy around acquiring knowledge of events that have occurred in the client’s past or present and then finding resources to help the person cope more with his or her situation (Segal et al., 2013). Hence, the goal of therapy traditionally is to assess and remove problems in the individual in order to create more effective coping strategies with life (Segal et al., 2013). However, mindfulness-based approaches advocate that this form of therapeutic relief would offer only a temporary solution to the overall problem as people must find a way to enhance their well-being and learn to take care of themselves (Segal et al., 2013). Segal et al. (2013) asserted that depressed individuals must learn to employ a different stance in relation to their thoughts and feelings for improvement. Mindfulness offers a different approach to therapy in that the focal point of this practice is to provide a clearer vantage point to the problem (Segal et al., 2013). Specifically, the mindfulness approach predicts that if the situation is no longer obscured, then a different response will be able to be used as opposed to merely focusing on fixing problems as they continue to resurface (Segal et al., 2013).
Within the context of psychotherapy, the melodrama that most significantly affects individuals is that pertaining to ego-oriented content (Deatherage, 1975). Hence, one can postulate that a central goal of mindfulness-based approaches in therapy would therefore be to assist individuals in changing the relationship that they have to thoughts of an ego-oriented nature.
In relation to treatment of depression as a psychopathology, two mindfulness-based paradigms are predominantly cited in the literature, which are MBSR and MBCT. Fennell (2004) noted that clinical depression tends to be sustained by the negative biases that one holds towards oneself. Fennell advocated that regardless of the etiology of the depressive mood, whether it be from mood state or negative thinking patterns, metacognitive awareness honed by the patient is crucial for the betterment of the patient. Metacognitive awareness entails accepting the notion that thoughts, beliefs, or assumptions are merely processes and mental events as opposed to being reflective of an objective truth (Fennell, 2004).
Mindfulness-Based Cognitive Therapy
The third wave of cognitive behavioral therapy (CBT) has entailed mindfulness, acceptance, and psychotherapy with a basis in compassion (Germer, 2013). Mindfulness-based approaches to psychopathology share the belief with CBT that holding a variety of distorted core beliefs leads to suffering (Fulton & Siegel, 2013). However, Buddhist teachings extend beyond merely possessing the belief that the etiology of suffering is from holding a dysfunctional belief (Fulton & Siegel, 2013). Namely, Buddhist teachings further advocate that adhering to any and all beliefs that are fixed in nature creates distress in an individual regardless of how positive a given belief is (Fulton & Siegel, 2013).
MBCT was developed by Zindel Segal, Mark Williams and John Teasdale (Kabat-Zinn, 2013). MBCT follows the 8-week format that is utilized within MBSR programs, mentioned later in this review, except that it has been designed for individuals who have suffered from multiple depressive episodes of a clinical nature, also referred to as major depressive disorder (Kabat-Zinn, 2013; Segal et al., 2013). Overall, MBCT is described as an 8-week course that is utilized in treating individuals who have a proclivity towards relapse in depression through teaching a program that combines practices of mindfulness meditation and cognitive theory (Finucane & Mercer, 2006). The individuals within the program are not currently depressed as they have received treatment from antidepressants or cognitive therapy (Kabat-Zinn, 2013). Statistics show that individuals who have experienced three or more episodes of depression have a 90 % likelihood of experience of a relapse in relation to depressive mood (Kabat-Zinn, 2013). Hence, this pervasiveness of depression is why these theorists thought that it would be ideal to determine a treatment methodology to specifically address individuals experiencing depressive relapse in individuals who have experienced multiple bouts (Kabat-Zinn, 2013). Hence, overall MBCT differs from MBSR techniques in that more of a focus is placed on components of cognitive therapy that address factors that make one have a proclivity to depression (Segal et al., 2013).
Segal et al. (2013) overall observed in their MBCT program that patients have a tendency to deal with unwanted, intense emotions of depression before they have the appropriate coping tools of decentering in order to cope with these emotions. Segal et al. maintained it would not be pragmatic to implement standard cognitive therapy, involving identifying negative thoughts affiliated with emotion and assessing evidence for and against these thoughts in a group context. MBCT as a modality was formulated to model Saki Santorelli’s approach to working with individuals with painful emotions (Segal et al., 2013). Namely, in Santorelli’s model individuals were permitted to allow intense emotions such as sadness to occur without having to engage in judgment of them such as feeling hopeless (Segal et al., 2013). Santorelli specifically allowed the individuals he worked with to allow thoughts to be and to welcome them as opposed to adopting a compulsion to fix them (Segal et al., 2013).
MBCT emphasizes a core skill of stepping out of negative thought patterns that are routine for an individual (Segal et al., 2013). Individuals who are depressed often attempt to escape from or avoid unhappiness in relation to thought patterns, which in terms perpetuates negative thinking cycles (Segal et al., 2013). Hence, the overall goal of MBCT is for one to experience freedom from this process of thought aversion (Segal et al., 2013). Segal et al. (2013) delineated therefore that relaxation is not the end goal of MBCT. Segal, Williams and Teasdale (2002) described that MBCT specifically assists individuals in coping with major depressive disorder through interception of the downward spiral of ruminative processes that occur in depressive relapse as a result of self-destructive thought processes (as cited in Gause & Coholic, 2010). Hence, in MBCT participants are encouraged to assume a decentered position in relation to their negative thoughts affiliated with depression (Gause & Coholic, 2010). MBCT advocates that one afflicted with depression should shift from attempting to fix what one perceives as being wrong with oneself and instead engage in using awareness in relation to one’s thoughts (Kabat-Zinn, 2013).
As mentioned, when an individual takes MBCT classes, one is often in a state of mind that is relatively devoid of depression, and so the skills learned within the class are for use at preventing subsequent depressive relapses (Segal et al., 2013). Attitudes of kindness and compassion are central to MBCT classes (Segal et al., 2013). Awareness is emphasized in relation to thoughts by inviting a gentle curiosity to thoughts (Segal et al., 2013). Another central component to MBCT training is something termed “attentional control training” which entails combining mindfulness-based and cognitive-based approaches in order to enable the clients to heighten their awareness (Segal et al., 2013). MBCT advocates that awareness is central to one’s recovery in relation to depression in that it permits one to notice when one is on the cusp of a depressive relapse (Segal et al., 2013). Awareness also permits one to notice that one is utilizing processing resources that are supporting ruminative processes, which in turn reduces the strength of this occurrence (Segal et al., 2013). Furthermore, awareness is useful as it allows one to decenter from automatic, depression-based patterns of thought that the moods tended to bring to one’s mind (Segal et al., 2013). Then, cognitive therapy techniques can be utilized to permit patients to cope with negative thoughts that sad moods can reactivate (Segal et al., 2013). Thoughts are viewed as being mere passing phenomena that do not need to be acted upon (Segal et al., 2013).
Formal mindfulness practices are also a central focal point in MBCT (Segal et al., 2013). Individual homework meditations are assigned in the MBCT group based on evidentiary support from cognitive therapy that homework generates a more positive outcome in relation to treatment (Segal et al., 2013). Particularly, Segal et al. (2013) incorporated the 3-minute breathing space within MBCT to provide the group members with the same experience as in classes. The 3-minute breathing space permits individuals to condense the benefits of the longer practices into a shorter time frame (Segal et al., 2013). The 3-minute breathing space helps to take one away from automatic pilot that one may have been engaging in in relation to one’s thoughts (Segal et al., 2013). Namely, in the 3-minute breathing space, the patients are requested to place awareness on their current experience, place attention on breath and bodily sensations, and then are asked to expand awareness to the body in total while remaining focused on the breath sensations (Segal et al., 2013). Other practices that are utilized within the context of MBCT are the mindful eating of the raisin exercise and the body scan (Segal et al., 2013). The mindful eating of raisin the entails using curiosity in relation to sensory experience as one consumes and views a raisin (Segal et al., 2013). The body scan practice is a longer meditative practice, and this is also utilized in this program (Segal et al., 2013). The body scan practice allows for one to have nonjudgmental awareness of one’s body, which permits one to relate to it in a different way (Segal et al., 2013). The meditative practices that occur within the context of MBCT encourage individuals to hone metacognition in relation to the thoughts that they are experiencing (Segal et al., 2013). For instance, individuals are encouraged to identify that they are engaging in cognitive distortions of “all or nothing thinking” or “jumping to conclusions” and to acknowledge that these thoughts are present (Segal et al., 2013).
Within the context of MBCT, individuals are also encouraged to engage in mastery-based and pleasure-based activities (Segal et al., 2013). Mastery-based activities, such as engaging in household chores, permit individuals to feel that their actions have an influence on the world (Segal et al., 2013). Pleasure-based activities permit one to have a sense of enjoyment (Segal et al., 2013). These activities are encouraged in MBCT so that individuals can be taken out of the dismissive mental state that they are immersed in while in a state of depression (Segal et al., 2013). These activities also allow one to engage in self-care when presented with negative, habitual patterns of thinking during depressive relapse (Segal et al., 2013).
The overall goal in MBCT for depression is to assist individuals who have experienced depression in the past to prevent it from recurring by becoming more cognizant of bodily sensations and feelings (Segal et al., 2013). More particularly, a different relationship to the thoughts and feelings is encouraged through mindfully based acceptance (Segal et al., 2013). Hence, choosing a more skillful response to thoughts, feelings, or situations that are unpleasant is taught in MBCT (Segal et al., 2013). When mind wandering occurs during the process of mindfulness meditation in program, individuals are encouraged to bring their focus of attention back to the breath (Segal et al., 2013). When attention is diverted from focusing the body or the breath, it is compassionately encouraged that the attention be brought back to the breath (Segal et al., 2013). One is encouraged to accept thoughts as they occur and utilize kindness with them so as to have a new relational experience (Segal et al., 2013).