Mindfulness Meditation and Cognitive Therapy for Depression

There is a method that pairs the meditative traditions of the East with the cognitive therapy that grew up in the West, and it goes by the name MBCT, short for mindfulness-based cognitive therapy. Mark Williams, Ph.D., and Danny Penman, Ph.D. lay out the case for it in their book Mindfulness in a Frantic World. The approach is taught across eight sessions. After that, patients keep it going on their own, roughly 30 minutes a day at home. The claim the authors make is a direct one: for managing the symptoms of depression, MBCT performs at least as well as antidepressants, and in some cases better.

The work behind it dates to the 1990s, when psychologists at Oxford, Cambridge, and Toronto set out to find a way to keep patients' moods steady both while they were taking antidepressants and after they stopped. What they noticed was striking. Something close to half of patients slipped back into depression once ordinary sadness hardened into repetitive, obsessive thinking.

Williams, who is professor of clinical psychology at Oxford and led the team that built MBCT, puts brooding at the center of the problem. In people who are mentally well, he explains, a sad thought tends to move through and leave. For someone who is depressed, it lingers. MBCT goes after that lingering directly, and part of what it teaches is a gentler, more forgiving attitude toward oneself and toward other people.

He describes another mechanism too, one he calls a hijacking of attention. Whatever mood you are in, your mind tends to surface the thoughts and memories that match it. So when you feel low or anxious, the bad memories come easily and the good ones stay out of reach, and that pull drags you from plain sadness down into something heavier. The therapy is meant to interrupt the slide before it finishes.

The authors point to research out of the University of Exeter as further backing. A study there compared MBCT against medication and against counseling, and found the mindfulness approach came out ahead for depression. Four months in, three quarters of the patients said they felt steady enough to come off their antidepressants.

Professor Willem Kuyken, who ran that research at Exeter's Mood Disorders Centre, is careful about what the finding means. Antidepressants are common precisely because they tend to help, he says, and they do a good job of easing symptoms. The trouble comes at the point people stop taking them, when the risk of relapse spikes. For a lot of people MBCT appears to hold that relapse off, which raises the possibility of using it in place of staying on medication for years.

The technique the book describes is plain enough to try. Sit upright in a chair with a straight back, keeping your spine about an inch away from the chair back and your feet resting flat on the floor. Shut your eyes and let your attention follow the breath moving in and out, noticing the sensations as they are without any effort to judge or change them. Your mind will drift off before long; when it does, guide it back to the breath. That moment of catching the wandering and returning is the whole point. Over time the mind quiets. Twenty to thirty minutes a day is the recommendation.

As cases of depression and anxiety climb, having options beyond a single track matters. Mindfulness can run alongside medication or stand in for it, and plenty of people already on medication might manage their symptoms better by adding it. There are also people who are frightened of medication and so go untreated entirely, and for them a practice like this could make a real difference. One open question I would like to see answered is whether a particular number of training sessions produces a meaningfully better result than fewer. If clinicians, psychiatrists, and family doctors were trained in these techniques, they would have something concrete to hand their patients. The catch is that both sides need training. Patients have to learn how to use mindfulness, and practitioners have to learn how to teach it, which is not something most university programs currently cover. Trained practitioners could offer more to the people they serve, and I would like this to become one more tool available to anyone working with depression and anxiety. - Kim B.

Insightful Comments. In the times I have sat with people as a counselor, a lot of them arrived carrying their own diagnosis. Most of us do that with whatever ails us, physical or mental or emotional, and often the self-diagnosis is right. The gap is knowing how to treat it. Take my own sinus infections. After dozens of them, maybe hundreds, I can call the illness correctly most of the time. But I am not a physician, over-the-counter remedies do not always do the job, and so I end up at the doctor's office anyway, which I resent a little, since I walk in, say what is wrong, and pay for the privilege of having done the diagnosing myself. The people I counseled were usually right that something was off, and often right about what it was, even without the clinical vocabulary. What they lacked was the treatment. Methods like CBT and mindfulness do not have to compete; they can genuinely strengthen each other, which is why I am glad to see newer approaches explored for depression, self-diagnosed or not. It may even turn out that a person can bring mindfulness and cognitive therapy into daily life without a doctor involved at all. Whether this stays inside the medical system or becomes something ordinary people simply practice on their own, like an over-the-counter habit, remains to be seen. - Bergen

References: Mark Williams, Ph.D., and Danny Penman, Ph.D., Mindfulness in a Frantic World. Walton, Alice (October 14, 2011). Retrieved from psychologytoday.com.