Depression

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”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1068976086459650/?type=1&theater

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

psyjdc 2 Comments

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/

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1062542103769715/?type=1&theater

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

psyjdc 2 Comments

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”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1051111154912810/?type=1&theater

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”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1047670165256909/?type=1&theater

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.”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1046335465390379/?type=1&theater

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

Dealing With Major Depression when Drugs Fail

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Mindfulness training has been repeatedly demonstrated to be an effective treatment for depression. It is so effective that the in the UK it is considered the treatment of choice for depression. But Major Depression is another level entirely. Very few treatments other than drugs have been effective.

Major Depression appears to be the result of a change in the nervous system that can generally only be reached with drugs that alter the affected neurochemical systems. Once under control with drugs, other therapies are helpful in assisting the individual to adjust to the new normal and to remedy the sequellae of years of depression.

But what can be done when drugs do not work which happens quite frequently. It is suggested in today’s Research News article, “Mindfulness-based cognitive therapy vs. psycho-education for patients with major depression who did not achieve remission following antidepressant treatment”

http://www.sciencedirect.com.ezproxy.shsu.edu/science/article/pii/S0165178115000736#

that Mindfulness Based Cognitive Therapy (MBCT) may be a solution. Patients with Major Depression who have not responded to drugs did significantly improve with MBCT treatment and the improvement was superior to an active control group designed to simulate many of the conditions of MBCT.

This is remarkable. A mindfulness based treatment is effective on a major mental illness, which is principally a physiologically based disease, even when drugs fail. How is this possible that MBCT can be effective when other therapies and even drugs don’t help?

One possibility is the emphasis on the present moment in mindfulness. Depression is often rooted in the past and the individual ruminates about the misery of the past. By shifting focus to the present moment, mindfulness can move the individual from being preoccupied with a troubling past to being focused on a safe and secure present. Mindfulness also stresses non-judgmental awareness of the present. There is a decreased tendency to be constantly judging what is happening and instead just accept it as what is, which is a difficulty in depression.

Another possibility is mindfulness’ ability to increase emotion regulation. That is mindfulness assists the individual in recognizing emotions as they arise and not over respond to them. It doesn’t prevent emotions. It simply allows the individual to better deal with them when they do arise. So when depression occurs the individual can recognize it, accept it, and then let it go and not respond to it. This liberates the individual to find new ways of responding to the environment and other people.

Still another possibility is that mindfulness produces a heightening of acting with awareness. The individual then is more aware of what they’re doing. For the depressed individual this can help in the recognition of how he/she is acting in response to the depression. This allows them to reprogram their responses to be more appropriate to the circumstances of the present rather than responding to the depression itself.

Finally, it is known that drugs are effective for depression by altering the brain. It is also known that mindfulness training produces alterations of the nervous system. Perhaps, they act on the brain in similar ways, producing similar changes that help to relieve depression.

Regardless, if you’re depressed, try mindfulness.

CMCS