Depression

Caring for Caregivers

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“If you want others to be happy, practice compassion. If you want to be happy, practice compassion.” – Dalai Lama

 

There is a tremendous demand for caregiving in the US. It is estimated that over 65 million (29% of the adult population) provides care to someone who is ill, disabled or aged, averaging 20 hours per week spent caring for their loved ones. In addition, caregiver demand is increasing due to the increase in our older adult population. But, this caregiving comes at a cost to the caregiver. It exacts an economic toll in lost work hours, income, and even the opportunity to take a promotion or relocate for a better position. But, more significantly, it exacts a tremendous toll on caregivers’ health and well-being. Caregiving has been associated with increased levels of depression and anxiety as well as higher use of psychoactive medications, poorer self-reported physical health, compromised immune function, and increased mortality.

 

Palliative care of a dying loved one is particularly difficult as the emotional toll supplements the time and energy demands of the caregiving. The adverse effects of providing the care increase over the course of the disease, particularly as death approaches and tend to continue with bereavement. Hence there is a need to care for the caregivers. They are providing much needed care and support for the terminally ill family member, but need care and support themselves. This care for the caregiver is often totally lacking.

 

Mindfulness practice has been shown promise in improving the health and well-being of caregivers (see links at the bottom). Is it also effective for individuals providing end-of-life care? In today’s Research News article “Evaluating the effects of mindfulness-based interventions for informal palliative caregivers: A systematic literature review”

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Jaffray and colleagues review the literature exploring this question. They report that the published literature shows that mindfulness practice reduces depression and caregiver burden and increases quality of life in informal caregivers of palliative care.

 

The effect sizes for the reported improvements were moderate. This suggests that mindfulness practice is helpful but is not a miracle treatment for this difficult situation. This indicates that there is need for further study to try to identify what sorts of practices are most effective to improve the effectiveness of mindfulness techniques.

 

Some studies obtained interviews with the caregivers who reported that the practice increased acceptance of the care recipient’s illness, as well as of the self and family, increased a sense of presence, increased the sense of peace and reduced stress, and decreased the reactivity response to difficult care recipient behavior. These reports are interesting and suggest that the mindfulness practice may be having its effects by improving non-judgmental awareness of the present moment. This is exactly what mindfulness practices are aimed at developing. These reports also suggest that improved emotion regulation may also be responsible for the improvements, allowing the caregiver to be more in touch with their emotions and improving their ability to respond appropriately to the emotions.

 

So, caregivers should practice mindfulness to care for themselves.

 

CMCS – Center for Mindfulness and Contemplative Studies

 

 

LINKS

Mindfulness practice improves the stress levels experienced by caregiver for autistic children (see http://contemplative-studies.org/wp/index.php/2015/07/17/mindfulness-and-caregiving/) and in caregiving for spouses with chronic pain (see http://contemplative-studies.org/wp/index.php/2015/08/18/have-a-healthy-relationship-with-mindfulness/).

Keep up Yoga Practice for Anxiety and Depression!

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“The medical literature tells us that the most effective ways to reduce the risk of heart disease, cancer, stroke, diabetes, Alzheimer’s, and many more problems are through healthy diet and exercise. Our bodies have evolved to move, yet we now use the energy in oil instead of muscles to do our work.” – David Suzuki

Chronic diseases such as heart disease and diabetes are not only physically difficult but also very frequently associated with emotional challenges, being frequently accompanied by anxiety and depression. The presence of a chronic disease makes it three times more likely to have a major depression. About 15% of patients with diabetes are depressed while about 20% of patients with coronary heart disease evidence depression.

The comorbidity appears to be bidirectional. The presence of depression nearly doubled the likelihood that diabetes would occur and there is a 50% greater likelihood that a depressed individual will have a heart attack than matched individuals without depression. So, chronic disease tends to predict anxiety and depression and these psychological disorders tend to predict chronic disease.

Dealing with mental health issues with a background of chronic illness presents a complex picture for treatment. One option is yoga practice. It is known to have both physical and mental health benefits, so it would seem to be well suited to dealing with the combination of the two. In fact yoga has been found to reduce the symptoms of anxiety and stress http://contemplative-studies.org/wp/index.php/2015/07/29/get-your-calm-on/ and improve distress tolerance http://contemplative-studies.org/wp/index.php/2015/07/30/stop-emotional-eating-with-yoga/ as well as improving the immune response to combat disease http://contemplative-studies.org/wp/index.php/2015/07/17/healthy-balance-through-yoga/. It can even help protect the brain from aging degeneration http://contemplative-studies.org/wp/index.php/2015/07/17/age-healthily-protect-the-brain-with-yoga/.

In today’s Research News article “Influence of Intensity and Duration of Yoga on Anxiety and Depression Scores Associated with Chronic Illness”

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4512118/

Telles and colleagues test not only the effectiveness of yoga practice for anxiety and depression in chronically ill patients but also investigated the amounts of practice that are effective. They found that the more months that yoga has been practiced the lower the levels of both anxiety and depression. In addition, the amount of daily practice in minutes was also associated with lower levels of anxiety associated with chronic illness.

There are a number of effects of yoga practice that may underlie its ability to relieve anxiety and depression in chronically ill patients. Yoga practice has been shown to decrease the physical and psychological responses to stress. The stress related to chronic illness can magnify both the symptoms of the illness and also the psychological impact of the illness. By relieving this stress yoga practice can affect both the physical and psychological symptoms of the illness.

Yoga practice is also known to improve mood which could directly affect the levels of anxiety and depression. It may also do so by altering brain chemistry which is known to be associated with depression and anxiety. In addition, the fact that yoga is frequently practiced in a group can provide social support and stimulation that can assist with mental health.

Regardless of the mechanism it appears clear that the more you practice yoga, the better you begin to feel psychologically and physically. So, keep up your yoga practice for physical and emotional health.

“Even if you have a terminal disease, you don’t have to sit down and mope. Enjoy life and challenge the illness that you have.” – Nelson Mandela

CMCS – Center for Mindfulness and Contemplative Studies

Alter Your Thinking with Meditation for Mental Health

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Meditation has been shown to have significant promise as a treatment for a variety of mental illnesses, including depression (see http://contemplative-studies.org/wp/index.php/2015/07/17/dealing-with-major-depression-when-drugs-fail/), obsessive compulsive disorder (see http://contemplative-studies.org/wp/index.php/2015/07/17/mindfully-improve-psychological-wellbeing/), and worrying (see http://contemplative-studies.org/wp/index.php/2015/07/17/stop-worrying/). It is known that one mechanism by which meditation works is by improving emotion regulation, making the individual better able to control and deal with emotions. Meditation also produces cognitive (thought) changes that appear to assist in improving mental challenges.

In today’s Research News article “Common Factors of Meditation, Focusing, and Cognitive Behavioral Therapy: Longitudinal Relation of Self-Report Measures to Worry, Depressive, and Obsessive-Compulsive Symptoms Among Nonclinical Students.”

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4432024/

Sugiura and colleagues investigate how these cognitive effects of meditation might work to improve the symptoms of worry, depression, and obsessive-compulsive disorder. They studied five psychological states affected by meditation, refraining from catastrophic thinking, logical objectivity, self-observation, acceptance, and detached coping.

They found that detached coping was associated with a decrease in both depressive and obsessive compulsive symptoms. Detached coping is a cognitive skill involving detachment and distancing from external events. This is cultivated by meditation in developing non-judgmental awareness of what is transpiring in the present moment. This allows the individual to simply observe what is happening around them without becoming identified with the events, which then are taken much less personally and thereby have a much smaller impact on depression and obsessions and compulsions.

Sugiura and colleagues also found that refraining from catastrophic thinking was associated with a decrease in worrying. Refraining from catastrophic thinking involves cognitive skills to analyze and reinterpret negative thoughts. This effect was meditated by negative beliefs about worrying, where refraining from catastrophic thinking is associated with fewer and less intense negative beliefs about worrying which in turn was associated with reduced worrying. Worrying about worrying is a problem in that it tends to intensify worrying. By reducing the negative beliefs about worrying meditation interrupts this process disabling the worrying about worrying. In this way meditation helps reduce worrying.

These findings indicate that, of the cognitive (thought) processes that are affected by meditation detached coping and refraining from catastrophic thinking are particularly important for relief of symptoms of troubling mental conditions. Both of these cognitive processes involve distancing the individual from the events and thoughts about the events that occur. This suggests that distancing attitudes are useful for long-term reduction of various psychological symptoms. It further emphasizes the importance of the non-judgmental observing that is cultivated by meditation.

So, meditate, improve non-judgmental observing, and improve mental health.

CMCS – Center for Mindfulness and Contemplative Studies

 

 

Prayer helps Cancer Patients

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“Prayer is not asking. It is a longing of the soul. It is daily admission of one’s weakness. It is better in prayer to have a heart without words than words without a heart.” – Mahatma Gandhi

Depression affects approximately 15% to 25% of cancer patients. This is not surprising as a diagnosis of cancer can cause a number of patients to become depressed. The problem is, though, that depression can affect the course of the disease, with mortality rates 25% to 39% higher in cancer patients who are also depressed. So it would appear that the two are linked such that cancer diagnosis can induce depression and depression can reduce the prognosis for recovery.

Many cancer patients pray to help cope with the disease, but it is not known if prayer is in any way affective in helping the patients with either depression or with dealing with cancer and its treatment. In today’s Research News article “Types of prayer and depressive symptoms among cancer patients: the mediating role of rumination and social support”

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4183194/

John Perez and colleagues investigated the relationship between different kinds of prayer and depression in cancer patients and find that certain types of prayer are associated with lower depression in these patients.

They investigated eight different types of prayer—adoration, confession, reception, supplication, thanksgiving, prayer for one’s physical health, prayer for emotional strength, and prayer for others’ well-being. They found that more adoration prayer, reception prayer, thanksgiving prayer, and prayer for the well-being of others the lower the level of depression.

In looking deeper at the pattern of results they determined that prayers of thanksgiving acted by decreasing ruminative self-focused attention which in turn reduced depression. It would make sense that prayer that helped focus the patient on what they are thankful for in life would result in an increase in positive emotions and a decrease in the time spent ruminating about the cancer, leading to lower depression.

They also found that that prayer for the well-being of others was directly associated with lower depression and indirectly by being positively related to social support which is in turn associated with reduced depression. Praying for others directs attention away from the patient toward the problems of others. This can help provide a perspective on their problems with cancer and thereby reduce the depression. People who are thinking of the well-being of others tend to be better cared about and liked by others. The increase in the social support for them may follow. If someone cares about others, others care about them.

Reception and adoration prayer are both forms of contemplative prayer which is a form of meditation. Mindfulness meditation has been shown to improve the negative psychological issues that can go along with a cancer diagnosis http://contemplative-studies.org/wp/index.php/2015/07/17/tackle-cancer-with-mindfulness/. So engaging in these forms of prayer may work through the same mechanism as meditation in improving the mood of cancer patients.

Hence it appears that the common response of cancer patients to pray is more than just an expression of religious faith. It has a positive impact on the patient’s psychological well-being which is known to improve the prognosis for recovery.

So, pray when cancer is diagnosed, reduce depression, and increase survival chances.

CMCS

 

This is the Brain on Meditation – Major Depressive Disorder

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Major Depressive Disorder (MDD) is a severe mood disorder that includes mood dysregulation and cognitive impairment. It is estimated that 16 million adults in the U.S. (6.9% of the population suffered from major depression in the past year and affects females (8.4%) to a great extent than males (5.2%). It is second-leading cause of disability in the world following heart disease.

The usual treatment of choice for MDD is drug treatment. In fact, it is estimated that 10% of the U.S. population is taking some form of antidepressant medication. But a substantial proportion of patients (~40%) do not respond to drug treatment. In addition the drugs can have nasty side effects. So, there is need to explore other treatment options. Mindfulness meditation is a safe alternative that has been shown to be effective for major depressive disorder even in individuals who do not respond to drug treatment. (see http://contemplative-studies.org/wp/index.php/2015/07/17/dealing-with-major-depression-when-drugs-fail/ ).

In today’s Research News article “The effect of body-mind relaxation meditation induction on major depressive disorder: A resting-state fMRI study”

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Chen and colleagues explore potential brain mechanisms for meditation effects on depression. They observed neural activity in patients with MDD before and after a mindfulness meditation exercise. They observed decreased activity in the frontal pole and increased connectivity between the right side dorsal medial prefrontal cortex (r-dmPFC) and both the left side dorsal lateral prefrontal cortex (l-dlPFC) and the left side orbitofrontal cortex (l-OFC).

The frontal pole area of the brain has been shown to be heavily involved in evaluation, monitoring, or manipulation of internally generated information, basically thinking without an external referent. One of the characterizing features of depression is rumination, which is a repetitive thought pattern involving worry about past troublesome events. Hence rumination comprises negative internal thoughts without external referents. This has the effect of amplifying the depression as worry about depression produces more depression which produces worry about the depression, etc. So, decreased activity of the frontal pole would signal that after meditation there is a reduced tendency for rumination. This suggests that meditation may in part reduce depressive symptoms by reducing frontal pole meditated rumination.

The increased connectivity between the r-dmPFC and both the l-dlPFC and the (l-OFC is significant as these areas have been implicated in cognitive reappraisal, a strategy to regulate emotions by reinterpreting their meaning from a negative interpretation to a more positive one. For example rather than the feeling surrounding an emotion signaling that the individual is upset and unhappy, it is reinterpreted to mean that the individual is sensitive and empathetic toward other people. So, meditation by improving communications between these areas helps the individual to better and more positively interpret the feeling that they’re experiencing, moving them away from thoughts about depression toward thoughts about more uplifting characteristics.

Hence it appears that even a brief meditation practice can alter the activity of the brain in such a way as to relieve depression.

So, meditate and induce your brain to relieve depression.

CMCS

Spiraling Up with Mindfulness!

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Mindfulness Based Cognitive Therapy (MBCT) was designed to treat depression. It has been so effective that the British Medical Service considers it a treatment of choice for depression. In a prior post http://contemplative-studies.org/wp/index.php/2015/07/17/dealing-with-major-depression-when-drugs-fail/ the effectiveness of MBCT for depression was discussed. The relief of depression was evident even with depressed individuals who did not respond to antidepressant drugs.

Depression is characterized by negative mood states. But, depression is also supported by thought processes which tend to emphasize the negative. In addition the depressed individual tends to particularly pay attention to negative stimuli. They even contribute to their negativity by interpreting ambiguous situations as negative and even tend to see their own thoughts in a negative light. This creates a negative downward spiral where a depressed mood is interpreted negatively, for instance as indicative of low self-worth, which increases the depression, where they pick out the negative to focus on from all that is available in daily life, increasing depression, where even neutral events are seen as negative, increasing depression. So, depression leads to more depression which leads to more depression etc., a negative spiral into the depths of depression.

MBCT combines cognitive therapy for depression, which aims to alter the thought processes that reinforce the depression, and mindful meditation practice, which enhances focus on the present moment. Since depression is often characterized by rumination which is repetitive thoughts about negative past or future events, mindfulness training by its emphasis on staying in the present moment tends to markedly reduce ruminative thinking. (http://contemplative-studies.org/wp/index.php/category/research-news/depression/ ). Hence, there are clear reasons for MBCT’s effectiveness as it combines two components, CBT and meditation, each of which individually are effective for relief of depression and prevention of relapse.

It is obvious that depression emphasizes the negative. In fact, depressed individuals are not only characterized by increased negativity they also have very little if any positive feelings or thoughts. One way that MBCT is thought to ameliorate depression is by increasing positive thoughts as well as decreasing negative thoughts. In today’s Research News article “Mindfulness training promotes upward spirals of positive affect and cognition: multilevel and autoregressive latent trajectory modeling analyses”

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4313604/

Garland and colleagues investigated how MBCT works on a day to day basis in improving positive mood and thoughts in depressed individuals in remission and find that it creates a positive upward spiral of thoughts and feelings, the exact opposite of untreated depression.

They found as others have that MBCT tended to increase positive thoughts and feelings. But, in looking day to day after the end of the active treatment phase they observed that each day the positive feelings tended to increase the positive thoughts and feelings on the next day which in turn increased the positive thoughts and feelings on the next day etc. leading to an upward spiral where positivity led to greater positivity which led to even greater positivity. Hence the combination of CBT with mindfulness training creates an emotionally driven upward spiral by stimulating positive thoughts and feelings among people with deficits in positive feelings.

Hence MBCT relieves the negative thoughts and feelings and in addition produces a cascade in the opposite direction of positive thoughts and feelings. No wonder it’s so effective.

So, practice mindfulness and spiral up!

CMCS

 

Get Out of the Dumps with Loving-Kindness Meditation

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Depression is epidemic. It’s been estimated to affect one in ten Americans at one point or another.  Eleven percent of adolescents in the United States experience a depressive episode before the age of 18. If that isn’t bad enough somewhere up to 15% of those who are clinically depressed die by suicide.

The most common treatment for depression is antidepressant drugs. But they are not always effective, can actually increase the risk of suicide, and often have troubling side effects. As a result there is an ongoing search for alternative treatments for depression.

Recently, meditation, particularly in the form of Mindfulness Based Cognitive Therapy (MBCT) has emerged as a viable alternative treatment. There is also interest in another form of meditation, Loving-Kindness Meditation (LKM). In depression, the individual is usually very unhappy with themselves and their lives regardless of the actual conditions. LKM has been shown to help the individual show compassion and understanding toward themselves and others. It has also been shown to improve mood. Hence, LKM would appear to be well suited as a treatment for depression.

In addition, we recently posted a discussion of some research that LKM improves social interactions. https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1043328429024416/?type=1&theater

In depression, the individual frequently withdraws from social contact. This removes from the individual compassionate social contact that is actually essential for healing. So, LKM, again appears on the surface to have potential for the treatment of depression.

In today’s Research News article “Loving-Kindness Meditation to Target Affect in Mood Disorders: A Proof-of-Concept Study”

http://www.hindawi.com/journals/ecam/2015/269126/

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Hofmann and colleagues pilot the use of LKM for the treatment of depression and found very promising results. They found large, clinically significant effects of LKM in reducing both self-reported and clinician-reported depression. In addition LKM reduced negative emotions and increased positive emotions, increased emotion regulation, and markedly decreased the rumination that is so characteristic of depression.

These pilot results are exciting. They certainly stand as strong justification for a controlled trial being conducted in the future. LKM by having the individual wish themselves and others well repeatedly appears to improve self-compassion and compassion for others. It is impossible to have true compassion for oneself and at the same time not like oneself. This would seem to be a wonderful antidote for the issues present in depression.

So, practice Loving-Kindness Meditation and get out of the dumps.

CMCS – Center for Mindfulness and Contemplative Studies

Spirituality Improves End of Life

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Death in inevitable, but that does not mean that it has to be awful. We don’t know how or when we will die, but we will die. It could be sudden or gradual or prolonged. We don’t know which it will be. But, regardless, how we approach it makes a huge difference.

Suzuki Roshi at the end of his life was in excruciating pain from cancer yet he told everyone around him “Don’t worry, It’s just Buddha suffering”. He passed with a smile on his face. Augustus Montague Toplady, the preacher author of the hymn “Rock of Ages” dying from tuberculosis said “”Oh, what delights! Who can fathom the joy of the third heaven? The sky is clear, there is no cloud; come Lord Jesus, come quickly!” These stories exemplify how our religiousness and spirituality can influence the quality of our passing.

In today’s Research News article “Religion, Senescence, and Mental Health: The End of Life Is Not the End of Hope”

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4357420/

Van Ness & Larson showed that individuals with high levels of religiousness/spirituality had significantly higher levels of well-being and were less likely to be depressed or suicidal at the end of life.

Americans 65+ portray themselves as more religious than do their younger counterparts. Hence it would appear that people understand that religiousness/spirituality can help in confronting end of life. But, how exactly does religiousness/spirituality help when dealing with eminent death?

Religiousness/spirituality can function by providing hope that helps the individual overcome increasing disease, disability, and emotional difficulties. Indeed, it has been shown that people high in religiousness/spirituality are significantly lower in hopelessness. This hope may take the form of belief in a life after death, reincarnation, or rebirth. Such a hope may be interpretable as a symbol of personal integrity that survives the indignities of illness, disability, and dissolution. This can be a great comfort to the dying person improving well-being and decreasing depression.

Religiousness/spirituality in older individuals is associated with a higher sense of well-being. This in turn can help the individual cope with the afflictions and challenges they face as death approaches. It can also help to bring families and communities to the dying process. It is often these connections that are the most important to the dying.

When approaching death, religiousness/spirituality can provide the structure to grapple with the basic questions of existence. Without it the person may experience spiritual distress. “When our bodies are under assault from disease or illness and our minds are reeling from the threat of disability or death, our spirit is there to hold it all together.” (Rev. Dr. Walter J. Smith).

So, practice religiousness/spirituality to be better prepared for death.

CMCS

Stop worrying

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“If a problem is fixable, if a situation is such that you can do something about it, then there is no need to worry. If it’s not fixable, then there is no help in worrying. There is no benefit in worrying whatsoever.” ― Dalai Lama XIV

Humans worry a lot. It is built into our DNA. Being concerned about what might happen in the future from an evolutionary perspective is a very good thing. It can help us anticipate or prevent problems from happening. It can help us avoid harmful occurrences. Worry about what another driver in front of us might do is useful in preventing accidents. So, worrying can help us survive.

Worry involves cognitive processes (thoughts) that help us to project into the future and anticipate potentially harmful events. But, worry itself can become a problem. Worrying is an unpleasant state. It can produce fear and anxiety. It produces unpleasant feelings. So, we can even worry about the bad internal feelings that worrying produces and end up worrying about worrying. It can become a vicious cycle and can make us miserable. “Worry never robs tomorrow of its sorrow, it only saps today of its joy” (Leo Buscaglia).

Worry can be useful but if we worry about every possible negative outcome or event it becomes rumination and produces more trouble than it prevents. As Mark Twain quipped “I am an old man and have known a great many troubles, but most of them have never happened.” So, we need to use worry in constructive ways while not letting it get out of hand and wreak havoc with our emotions.

Contemplative practices have been shown to decrease worry and rumination. The mindfulness training appears to be an antidote to being overly worried. In today’s Research News article “Dissociation between the cognitive and interoceptive components of mindfulness in the treatment of chronic worry”

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Delgado-Pastor and colleagues demonstrated that mindfulness training reduces worry, depression, and anxiety in overly worried female students. They took it, however, one step further and found that a mindfulness practice that involved particularly paying attention to the internal feelings associated with worry was more effective in reducing worry than a practice focused on the thoughts surrounding worry. In other words, it appeared that focusing on feeling rather than thoughts was the best strategy for dealing with excessive worry but both strategies were helpful.

What does mindfulness do to help regulate worry? For one thing it helps us focus on the present and experience it in preference for the past or the future. Since worry involves concerns about future occurrences to some extent based upon past experiences, the more one can focus on the present the less opportunity there is for worries to arise. Mindfulness training also involves learning to view events non-judgmentally. It trains the individual to accept the worry, experience it, and then move on. This reduces the impact of the worry and prevents the development of worrying about worrying.

Particularly by learning to mindfully pay attention to the feelings arising with worry the individual can learn to experience the unpleasant feelings associated with the anxiety produced with non-judgmental awareness. This undercuts the power of the worries. Learning to mindfully pay attention to the thought process involved in worry, the individual can learn to rationally evaluate the thoughts and sort out which anticipated future events are likely and should be avoided and which are too unlikely to be concerned about, eliminating many worries altogether.

So, be mindful, follow the Dalai Lama’s advice and stop worrying.

CMCS

Does spirituality account for mindfulness’ anti-depressive effects.

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Mindfulness training has physical, psychological, emotional, and spiritual components. Mindfulness-Based Stress Reduction (MBSR) is even more complex as it contains yoga and body scan in addition to meditation. Because of the complexity and the variety of effects of these practices it is difficult to know which components are effective in promoting well-being and which are not.

In today’s Research News article “Decreased Symptoms of Depression After Mindfulness-Based Stress Reduction: Potential Moderating Effects of Religiosity, Spirituality, Trait Mindfulness, Sex, and Age.”

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It is well established that MBSR is quite effective in treating and preventing depression. But it is not clear who benefits the most and what characteristics of the individual might be related to MBSR effectiveness. Greeson and colleagues investigate this question, particularly whether spirituality and religiosity or other demographic characteristics might be important for MBSR effects on depression. They demonstrate that MBSR acts independent of these other characteristics; it works regardless of level of spirituality or religiousness.

These results should not be surprising as chronic depression, as opposed to reactive depression, appears to be primarily physiologically based. It appears to be a problem with neurotransmitter balance in the central nervous system and is highly related to genetic inheritance. So, it is not surprising that behavioral and psychological characteristics such as  spirituality and religiousness would not be associated with effective treatment.

MBSR, like all contemplative practices, has marked physiological effects. It is known to change the nervous system, increasing the size of some areas, decreasing others, and altering connectivity. It also changes hormonal balances and activity in the peripheral nervous system producing greater calm and lower arousal. It is likely that these physiological effects of MBSR are responsible for its effectiveness in treating depression.

This is not to discount the importance of spirituality and religiousness. They can be very helpful with a number of conditions. Had Greeson and colleagues investigated MBSR effects on more experientially based psychological problems, such as eating disorders or panic disorder, they might have seen a large impact of spirituality and religiousness.

It is clear though that depression can be treated effectively with Mindfulness-Based Stress Reduction.

CMCS