Mindfulness and depression

When depression is recurrent： Mindfulness-based Cognitive Therapy (MBCT)

Depression can be recurrent (happening repeatedly). Each episode of depression increases a person’s chances of another episode by about 15%. Therefore, the more episodes of depression you have, the more likely you’ll get another relapse.

Mental health professionals are working hard to find ways to deal with recurrent depression. One of the promising ways is through Mindfulness based Cognitive Therapy (MBCT), which was developed by Professor Dr. Mark Williams and his team at the Oxford University.

MBCT is based on ancient wisdom of mindfulness (originated from contemplative traditions especially Buddhism) and state of the art research in cognitive behavior therapy (CBT). MBCT has been shown to reduce the risk of relapse by half in those who have had 3 or more episodes of depression. This is an outline of some principles and exercises used in MBCT.

1. Paying attention to the here-and-now:

It means trying to give full attention to whatever we’re doing. This is important as when the mind isn’t anchored in the present-moment experience, it tends automatically to ruminate about the past (guilt content) or future (worrying content) which is vulnerable to depression relapse. Strategies to cultivate here-and-now awareness include:

a) Labeling – mentally naming and giving full attention to our activities, e.g. ‘typing,’ ‘eating,’ ‘walking,’ ‘thinking,’ ‘talking,’ ‘sweeping,’ ‘checking e-mails.’

b) Sensing - giving full attention to our sensory experience, e.g. seeing, hearing, smelling, tasting, touching.

c) Beginner’s mind – experiencing life with an attitude of a beginner, as if seeing things through fresh lenses and thinking of it as once in a-lifetime experience, e.g. eating chocolate slowly, with full attention and as though tasting it for the first time.

2. Mindful walking:

It involves paying full attention to the process of walking: 1. Labeling the movements of the legs, “Left…right…left…right,’ and 2. Noting the sensations around the feet and other parts of the body (e.g. wind brushing against the skin). Besides benefiting physical fitness, this is very helpful for overcoming bodily restlessness and slowly calming the mind.

3. Breath as an emotional anchor:

Mindfulness of breathing involves repeatedly bringing gentle awareness to our breathing, “Breathing in, I’m aware that I’m breathing in. Breathing out, I’m aware that I’m breathing out.” This trains the mind to be less scattered and more present or calm, which is very useful during emotional storms. Breathing is a useful mindfulness ‘tool’ as it’s with us wherever we go (we can’t go anywhere without it).

4. Body scan and awareness:

It involves repeatedly bringing gentle awareness to the physical sensations (e.g. heat, tightness, tiredness, pain) in different parts of the body (e.g. chest, neck, head, hands, legs, stomach, back), and noting them with kindness, acceptance, and a sense of curiosity (beginner’s mind). This is useful in several ways: 1. It helps to disentangle ourselves from our thoughts; we won’t be so easily sucked into the drama of negative thoughts. 2. It breaks the conditioned link between body sensations and thinking (e.g. feeling physically tired, which triggers negative memories). 3. It helps us to be more aware of our ‘thinking-feeling’ as body sensations are the mirror to our thoughts and emotions, sort of a natural bio-feedback device.

5. Mindful awareness of thoughts:

In recurrent depression, the problem is usually not so much of the sadness, which is brief and ‘normal’ (part and parcel of life). It’s more of how our mind reacts to the sadness with aversion, “Oh my God, It’s back again!” “What’s wrong with me?!” “Why can’t I just get over this?!” “Come on, move on lah!” “I shouldn’t be like this!” “Shit, I should have tried harder!”

Such kind of self critical thoughts can easily suck us back into the depression ‘black hole.’ Mindfulness of thoughts involve mentally stepping back and looking at the thoughts from a distance with kindness – like watching birds and clouds passing through the sky.

This is the Chinese character for ‘Mindfulness （念）,’ with sub characters of ‘now （今）,’ and ‘heart/compassion （心）’ - all representing important values for healing of depression.

In Malaysia, similar mindfulness-based therapy is available at Sunway Medical Centre http://sunwaymedical.com/doctor/dr-phang-cheng-kar/

FREE online MINDFULGym course by Dr. Phang Cheng Kar for stress reduction, good health, and healing https://youtube.com/playlist?list=PLNc2P7HrfkuUjLUTpqMMya6TAuSZUq6e7

For further information on MBCT, you may refer to the book, “The Mindful Way through Depression: Freeing Yourself From Chronic Unhappiness,” by Mark Williams, John Teasdale, Zindel