CHAPTER 8
Kat was a twenty-year-old university student. Outwardly she had everything going for her but inwardly it was the opposite story. Although she didn’t let on to her friends, Kat was almost constantly critical of herself, going over the clumsy things she said, and what people thought about her, and whether she would ever get anywhere, and whether her boyfriend really did want to be with her. On and on and on ran this incessant and judgmental commentary on her life. Endlessly she would try to work herself out, beat herself up about past mistakes and plan so hard that she would be sure nothing would go wrong, but it always did.
Kat did get anxious about many things but it was more her mood that was the major concern for her. It had been low and getting lower for months. Her sleep was often disturbed but she had managed to continue to get to uni although she was not doing as well in her studies as her abilities would have allowed. Although Kat sometimes wished she wasn’t alive, she had never actually thought of taking her own life. Then it came to crunch time. Kat knew she wasn’t getting anywhere trying to work all this out for herself; in fact, she was making things worse. She needed to talk to someone and try to get some perspective on what was going on. Kat went to her GP, who said that he wasn’t an experienced counsellor but he could prescribe antidepressants, or he could suggest seeing a psychologist or psychiatrist. She wanted to learn to deal with it herself and thought perhaps there were some strategies she could learn, so she went to the university counselling service.
The counsellor was experienced in a range of approaches, including mindfulness. When the principles of mindfulness were explained to Kat it seemed to resonate with her, so they set out on a six-week program, at the end of which they would take their bearings. Kat learned a mindfulness meditation practice as a way of being more mindful in daily life and then explored a range of cognitive strategies based upon mindfulness. The counsellor said that for mindfulness to be effective it would take effort on Kat’s behalf, a commitment she was prepared to make.
Depression has been described as the common cold of psychopathology, but being common doesn’t make it natural or inevitable. So what really is depression and can it be successfully treated or even prevented? There are many different ideas about what depression is and isn’t, but most of them centre around the notion that if you’re depressed there’s something wrong with you, and you need to find somebody to fix you—fast. So what’s actually wrong with you if you have an unwelcome visitor such as the one that Winston Churchill called his ‘black dog’? Not as much as you might think there is. Depression didn’t stop Churchill from winning a world war, or stop Buzz Aldrin from landing on the moon, or stop JK Rowling from making a billion or two with Harry Potter, or stop Agatha Christie from writing a classic play called The Mousetrap that premiered in London’s West End in 1952 and is still running, or stop William James from being the great pioneer psychologist that he was, or stop Mozart from being Mozart, or even stop Mark Twain from being a great humorist and writer. Maybe one solution to depression is to stop trying to figure out what’s wrong with us, and to just experience more fully and mindfully what’s going on in our life and what’s right with us.
If you’re depressed, or if you’re close to somebody who is, or if you have some other deep personal connection with depression, you don’t need us to tell you what a huge and global problem depression is. It’s enough of a problem if it’s a problem for you. The point of throwing a few depression statistics at you, though, is to show you that nobody with depression is alone in their suffering, even if they think they are. Chances are high that just about every human being living on this planet today, especially in the more ‘developed’ bits of it, will personally experience at least a mild form of depression at some stage in their life, or know somebody who will. We’re all constantly moving along a scale of mood between really happy and really sad. Somewhere along that scale an arbitrary line is drawn and we say below that line a person is depressed, above it they’re not.
More than one in five people will have an episode that would be diagnosed as depression and almost one person in six will experience depressive symptoms intensely enough to require treatment at some stage in their life—one in five females, and one in eight males.[1] Depression accounts for approximately 75 per cent of psychiatric hospitalisations, and approximately 75 per cent of the inmates of nursing homes and psychiatric institutions are depressed.[2] There is evidence that long-term depression leads to dementia and to other serious consequences of people switching off their own mental life-support systems.
As previously mentioned, depression is overtaking heart disease as the developed world’s most destructive disease. It is predicted that by the year 2030, if trends over the past 60 years continue, depression will be way out in the lead.[3] This rise in depression isn’t just a matter of us being more aware of it—it’s a real rise. What’s going on? All this has been taking place in a time of unprecedented economic prosperity, technological advancement and the availability of antidepressant medications. If happiness were truly dependent on such things we should collectively be over the moon, as well as able to land on it. So what are some of the factors behind the rise of depression?
Having an unhappy or traumatic upbringing can predispose us to depression, as can a family history of the illness. Unsupportive relationships, marital break-up and a poor work environment can also predispose us to depression. Special risk factors include physical conditions such as thyroid problems, brain injuries including stroke, heart disease and chronic pain; and also personality characteristics such as shyness, unassertiveness, low self-esteem, perfectionism, social anxiety and sensitivity to criticism; and environmental characteristics such as isolation and being in a threatening environment. Lifestyle issues can also be major contributors. Alcohol, smoking and other drug abuse are all risk factors. Insomnia is a major risk factor. A lack of sunlight is an issue, particularly in winter months. Physical inactivity, particularly a lack of aerobic exercise, and a poor-quality diet are risk factors. And, importantly, unmindfulness or inattention leaves us vulnerable to depression.
The positive side of the coin is that with all these things that we know contribute to depression it gives us a whole lot of things we can do to prevent or manage it. The main prevention, and possibly the most important—which we are exploring in this book—is mindfulness.
Depression isn’t just ordinary misery; it’s something even more serious. The Diagnostic and Statistical Manual of Mental Disorders, regularly published by the American Psychiatric Association since 1952, has been seen as a scientific bible for the diagnosis of mental conditions including depression, and is broadly accepted as being accurate and clinically useful. The current version emphasises the great diversity of depressive symptoms, which can mainly manifest as agitation and irritability in some people, and as sleeping or eating too much or too little in others, or as feeling guilty and worthless in yet others. The bottom line of the depression experience, though, is, according to the Manual at least, a general loss of interest and pleasure in life and its activities.
Table 1 summarises the major types of depression described by The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.[4]
• Major depressive disorder—a depressed mood that lasts for at least two weeks. This may also be referred to as clinical depression or unipolar depression, which means there are no symptoms of bipolar disorder.
• Major depressive disorder with psychotic features—a depressed mood that includes symptoms of psychosis. Psychosis involves seeing or hearing things that are not there (hallucinations), feeling everyone is against you (paranoia) and having delusions (beliefs that are not true but are still believed even in the face of evidence to the contrary).
• Major depressive disorder with melancholic features—a depressed mood that is characterised by a loss of pleasure in activities (anhedonia).
• Bipolar disorder (once known as manic-depressive illness)—this involves periods of feeling low (depressed) and high (manic).
There are many scientific theories of depression, which tend to all arise from particular scientific evidence and be associated with particular treatments. There may be so many of these theories that it can be difficult to see that they actually aren’t as different as they seem, and may just be emphasising different facets of the same complaint. This is often the case when there are so many brands on offer that you don’t know what to buy or believe in. There’s a story about an elephant and some blindfolded men that might help illustrate that sometimes our problems and disputes come from us only seeing a part of the whole truth.
A group of blind men were invited to feel an elephant and based on what they experienced to come up with a theory of what an elephant is. One blind man felt its tail and came up with: ‘An elephant is like a brush!’ One blind man felt its trunk and came up with: ‘An elephant is like a hose!’ One blind man felt one of the elephant’s legs and came up with: ‘An elephant is like a tree!’ When they were asked to share their views each argued vehemently that they were each right and the others were wrong.
Well, they were all right, but if they took their limited experience as the whole truth then they were all wrong. Depression is an elephant the totality of which is difficult to see, and the underlying truth of which is impossible to understand, unless we uncover our eyes.
Aaron Beck and others developed an important theory of depression in the 1960s and 1970s that is known as cognitive theory.[5] They also developed an associated therapy known as cognitive therapy.[6] According to these practical theorists, depression isn’t caused by negative life events, even though the people who suffer from it often think that it is. Although life events can trigger depressive episodes, depression is actually caused by distorted thinking processes. As the ancient Greek philosopher Epictetus said, ‘Man is not disturbed by events, but by the view he takes of them.’
Maladaptive thoughts can lead to depressive feelings because, in scientific language, they introduce a B factor to the initial or A factor, the A being the environmental event—such as losing our job, or spouse, or even a football match. Next is the C factor, which is our emotional reaction to losing our job or spouse or the football match. This might be anger, depression, sadness, or even joy, depending on our perceived value of our job or spouse or which football team we support. The important point here is that most of us think that the environmental event (loss of job, spouse or even a football match) caused our emotional reaction. It actually didn’t. If it did, we would have no choice of response to adversity and we would be the human equivalent of laboratory-conditioned rats. It’s the B factor—our interpretation of events—that causes our emotional state. In slightly less scientific terms, the rollercoaster of our up and down mental and emotional states isn’t driven by what happens to us; it’s driven by the spin that our mind puts on what’s happened to us.
According to cognitive therapists such as Beck there is a particular way of thinking that is very likely to make us depressed, and this is what they call global, negative and personal thinking. Let’s say that our environmental event is getting a flat tyre on the way to an exam in a faraway place. Let’s say that we habitually think in a way that’s global, negative and personal. We might come up with a response to this actually neutral environmental event along the lines of, ‘Bad things are always happening to me! I’m an idiot! I won’t get to the exam in time now and what would be the point even if I did—I would fail! My life is as good as washed up.’ A specific, positive and impersonal response might be: ‘This road is particularly hard on tyres, so it’s not surprising that I got a flat. It won’t take me long to change the tyre, so there’s every chance I can still get to the exam—for which I’m well prepared—on time. If, however, I don’t make it on time I will need to explain the situation to my examiners and find an alternate exam arrangement.’
Another important theory of depression is the learning-based theory developed by Martin Seligman and colleagues in the 1970s and 1980s.[7] Martin Seligman is, incidentally, even more famous now for helping to found the positive psychology movement. He has written very popular and helpful books about this such as Learned Optimism (the opposite of learned helplessness).[8] The basic theory here is that we can get depressed when we feel overwhelmed by life; out of control; out of our depth; helpless. Seligman’s experiments showed scientifically what we already know unofficially: if you keep giving any life form more than it can deal with it’s likely to give up, eventually, and get depressed.
One of the authors once performed a computer-simulation version of the learned-helplessness experiment that Seligman and his colleagues performed on animals and on (simulated) people. Even in the early 1980s ethics committees often successfully protected the general public from psychologists and psychology students and their sometimes inappropriately grand designs, so a computer simulation was a good way to learn something useful without damaging anyone more vulnerable than a computer. A highly challenging virtual simulated environment was created where participants’ actions had no bearing on their outcomes, which led to a very strong simulated tendency to develop simulated depression.[9]
From a purely biomedical point of view, there is also the low-neurotransmitter-level theory that could be described as the medical model of depression. This sees depression as caused by low levels of neurotransmitter substances in the brain such as serotonin, epinephrine, norepinephrine, tryptamine and dopamine. A number of the inflammatory chemicals mentioned in other chapters regarding the high allostatic load are associated with depression, and can activate what is called the sickness response when they act on the brain. The symptoms of the sickness response include lack of energy, motivation and appetite—which is fine when we have the flu, but not so good when we are chronically ruminating about past events. To say, however, that low-neurotransmitter high-inflammatory substances cause depression is a little superficial and possibly ill-informed. Knowing that neurotransmitter substances are associated with depression doesn’t tell us that they cause depression. It might well be the case that they are both caused by something else, like the way we think, live and relate to each other, and that low neurotransmitter substances are a result, rather than a cause of depression.
If the real cause of depression was just low neurotransmitter levels (for example, serotonin) then the real treatment for depression would be giving an antidepressant drug to increase neurotransmitter levels. The evidence shows, however, that the benefit of antidepressants for mild to moderate depression is a placebo effect—like taking a sugar pill you believe will improve your mood and so it does.[10] It’s only in severe depression that there’s some effect that can be attributed to the chemical action of the drug.
A recent large statistical meta-analysis incorporated the results of many individual scientific studies of the benefits or otherwise of antidepressants.[11][12] Unlike most studies published in this area, this one actually invited science’s poor relatives—the results of unpublished research—in from the statistical cold. This analysis showed that for mild and moderate depressions, antidepressants don’t give people a clinically meaningful advantage over placebos. This result demonstrates some interesting medical and human principles. Firstly, if placebos can improve people’s health, then the human mind must have an enormous capacity to heal the human body and mind that probably hasn’t yet been fully explored. Secondly, the results of this study and others suggest that antidepressants tend to offer an initial reprieve from depression, until the people taking them revert back to their previous state unless they have learned to do something different. Thirdly, this study suggests that antidepressants are probably not the ultimate answer to healing depression. The mental health system invests too much energy and resources in these drugs to fully respond to the results of such non-supportive studies, often at the expense of other more beneficial therapies that address the deeper causes of depression.
There are also the theories of depression that we won’t go into here but have been re-badged from ‘psychoanalytic’ to ‘psychodynamic’. These basically see depression as being caused by repression and associated guilt.
According to various philosophical and spiritual traditions, a common form of depression could be seen as arising from mental, physical or spiritual exhaustion. We try to find fulfilment in pleasure and various superficial and material pursuits rather than in a deeper understanding of ourselves. Ultimately this depression is caused by anxiety—by the idea that I am separate and therefore I have to go all out to find or escape something out there to compensate. This is depression that comes from too much activity, or rather from too much mindless activity, aimed at getting and acquiring. According to these traditions depression can also come from mental, physical or spiritual lassitude—a deep jadedness that comes from seeing life as unfulfilling and uninteresting. The deep cause of this form of depression is also a feeling of disconnectedness from ourselves and the universe around us. Also associated with these traditions is the notion of natural laws and the importance of living a moderate, carefully paced and balanced life, rather than a life of haste and excess.
Another model of depression that may offer a broad insight is the idea of a pain body described by Eckhart Tolle in his popular philosophical/spiritual/healing book The Power of Now.[13] Tolle based this idea on his reading of works from various wisdom traditions and possibly also from modern psychology, and came up with an idea that perhaps links them. The ‘pain body’ is a monstrous sense of self as something deeply vulnerable, over-sensitive and keen to be upset by circumstances. The basic idea of this construct is that it’s a mind-child creation of the individual sense of self—the ego—that wants nothing more than to create and protect a false identity of ‘who I think I am’ and will defend this idea even if it’s to the death. Central to the idea of the pain body is an important characteristic of the person who identifies with being in pain or with being a victim. For some ambivalent, self-sabotaging reason we don’t really want to be free of our pain bodies, maybe for the same reason that sometimes at least we don’t really want to free of a destructive relationship or job. There’s something comfortable and complacent about being what we usually are, even if it’s painful.
The idea of the pain body is consistent with the observations of psychotherapists from a range of traditions who say that people who present to them with conditions such as depression usually tell them that they want to change and get better and be happier, but when it comes to actually challenging the ideas and behaviours that keep them miserable, they usually just let them go and grow. We all know what it’s like to think one thing and yet do another—and then justify it. This idea is also consistent with learning theory: we usually don’t keep repeating any behaviour unless we get rewarded for it in some way. This explains seemingly strange phenomena such as why the unruly behaviour of children in classrooms persists in spite of their being yelled at or otherwise ‘punished’ by their frazzled teachers. Being punished can be seen by at least some children as a form of attention, and can actually be a reinforcement rather than a punishment. In the case of depression we can get reinforced for being depressed if the reinforcer is a sense of identity, no matter how flawed—‘a poor thing but mine own’, from Shakespeare’s As You Like it.
Mindfulness-based approaches put an entirely new perspective on depression, emphasising that depression can be caused by inattention, attachment and not being present. Rumination about ideas of self, past and future, is the main cognitive style in depression. The more we identify ourselves with these depressive thoughts and elaborate on them the more we get bogged in this mental quicksand. Depression is associated with anhedonia (lack of pleasure) and poor functioning—both related to a lack of focus or engagement with what life is presenting, right here, right now.
Each of the theories of depression mentioned above has spawned associated therapies, which we will briefly talk about below and then we will explore the answers that mindfulness provides for depression.
You might have noticed that there isn’t really an impenetrable divide between each of the main scientific theories of depression, and that perhaps they are really just different descriptions of the same elephant. A psychopathology, by any other name, would be just as unpleasant to its experiencer—with apologies to Shakespeare. It’s perfectly possible to believe in Seligman’s depression theory without having to completely renounce Beck’s, and to believe in Beck’s theory without having to renounce Seligman’s, and to believe in both and also to believe that repression and guilt can contribute towards depression, and at the same time to acknowledge that there are chemical changes in the brain associated with depression. There is a common element or elephant emerging here.
To believe that you are helpless or guilty is to have a negative belief. Learning and cognitive theories of depression are actually compatible and easy to combine to generate treatments that link behaviour and thought modification. This is the principle behind the most common psychotherapy used to treat depression—Cognitive Behavioural Therapy (CBT), which we will meet again soon. The mindful approach to treating and also preventing depression relates to all of the depression theories that we have described, and to their associated therapies. This might be a ‘new’ or ‘deeper’ or more ‘all-embracing’ approach to depression that combines other theories and yet transcends them. Mindfulness-based therapies also see thoughts and behaviour as being closely related and involve guiding people to a place above and beyond their addiction to thoughts—good or bad—rather than instructing them in how to improve their thoughts and behaviours. CBT, for example, focuses largely on examining the content of thoughts, whereas mindfulness examines our essential relationship to thoughts; that is, no particular relationship. No matter what the theory or treatment is that recognises it, the universal bottom line here is that thinking can cause vast human problems, including depression. An unquestioned belief that more thinking will eventually get us out of our mire may be the very thing that is driving us out of the thinking frying pan and into the thinking fire.
It may be that mindfulness is the missing link between all of the above theories of depression. This is a clinical and life behavioural remedy and prevention that all depression treatment roads may ultimately be leading to, no matter how rocky they may be.
According to the official position of noted Harvard mindfulness researcher Ellen Langer, the opposite of mindfulness—mindlessness—causes most of the world’s problems, including depression. According to the unofficial position of Ellen Langer, mindlessness causes all of the world’s problems! This is actually what earlier great psychologists also said, such as Gautama the Buddha, or Plato about 2400 years ago—if somebody does something that you blindly react to, then the pain gets multiplied and eventually the whole world is in trouble. This process causes arguments, psychosomatic conditions, wars and misery. If anybody anywhere responds to their situation mindfully, not mindlessly, then the whole infectious misery buck can stop with them, and the individual’s and the world’s troubles will instantly start decreasing.
Ellen Langer is a prominent psychologist who gives us a refreshingly short list of psychological states that we can be in: either mindful or mindless. This contrasts with the psychological states described by The Diagnostic and Statistical Manual of Mental Disorders, which are many in number but don’t include wellness. According to Ellen Langer most people, in most places, are mostly mindless. The good news is that we have considerable room for improvement.
Depression can be seen as an extreme form of mindlessness. What is the mind up to when we’re not paying attention? It tiptoes off and starts to worry and ruminate. What are we listening to when we’re not really listening to what is going on around us? An endless internal dialogue of self-criticism, self-doubt, negativity and all the rest. What are we trying to suck happiness from when we’re not connected to what’s happening in the present moment? We’re trying to derive happiness in the imagination about some other place or other time, which is like trying to suck water out of a mirage. What are we fleeing from or wrestling with when we’re not paying attention? All of the catastrophes our imagination can cook up.
Ellen Langer’s view of depression is that it can be seen as what happens when our experience of life has gone stale. A lack of novelty can result in a filter between us and our experience of the beauty and wonder of life in general and also of our own life. This is why we experience anhedonia or a lack of pleasure with depression. Mindfulness directly treats depression whether we see it as coming from too much anxiety or too much lassitude, because in both cases what’s gone wrong is our connection with what is, which is ever-changing, ever-novel. Taking a half-hour unmindful walk in the morning could be just another thing to fit into a packed and pressured day. If that walk is taken mindfully, however, it’s a feast for the senses—an opportunity to clear the mind and a chance to connect with who and what passes us by.
There’s a simple test of mindfulness, according to Langer, that can also give us a very rapid idea of how mindfulness might start to improve or prevent depression. Simply look at your finger for a minute or so. Is your finger interesting and engaging and new? Or is it the same old finger that is possibly even more completely and utterly uninteresting than it usually is? Now look at your finger again—and really look at it. There it is, pulsating with life. Look at its shape, colour, form and movement. Is there maybe a line on it or even a wart that you hadn’t really noticed before? If you really look at or listen to or smell or taste or feel anything then you are being mindful, and it’s easy to accept whatever you’re experiencing, warts and all. Try doing the same with your life. Taste the foods you eat as if you have never tasted them before—because the truth is that you probably haven’t really tasted them. Look at your spouse or partner as if you haven’t really seen them before, as if for the first time.
According to Ellen Langer and other researchers who are interested in the potential of mindfulness to heal and prevent depression, the key to this approach is that mindfulness keeps us alive to the new. To avoid allowing life to get stale—just really attend to it. Mindfulness increases our natural ability to be creative, and can restore our natural creativity and also our natural humour. When we see the joke, when we see the solution, we are seeing something new, or something old in a new way; we are being mindful. Ellen Langer described a very simple experiment that shows the benefits of mindfulness for treating depression in people who haven’t developed it yet.[14] One group of jaded orchestra musicians was instructed to add some novelty to their performance by creating some distinctions from past performances. Another group was instructed to re-create a past performance—to play as they always did. The results were measured according to objective criteria such as ratings by expert musicians, as well as by satisfaction of the performers. According to all criteria, the musicians who were doing something new, creative and mindful did much better than the musicians who did the same old thing. These musicians also played better together as a group, making for a richer and more satisfying experience.
If we don’t have an understanding of what depression is then it is hard to address the cause of it. Depression stems from something that causes even more harm than depression does, and that’s human suffering itself, of which depression is perhaps the most obvious example. What most theories of depression hint at, without going so far as to offer a real understanding of, is that depression is a disconnection between the depressed person and their basic sense of being present in their life. Depression involves switching off, giving up, the development of hostility towards the individual self and others, a belief that what’s bad is more real than what’s good. All of this simply means that there’s a lack of belief in, a lack of participation in, a lack of connection to, life.
Mindfulness therapies and practices may well offer depressed and potentially depressed people (that is, all of us) all of the benefits that other theories and treatments do, such as improving our thinking processes and even our neurotransmitter levels, but they also offer a lot more. The real potential benefit of mindfulness as a treatment and prevention of depression is that it doesn’t directly aim at doing any of these things because it operates at a deeper level.
Depression is fundamentally an awareness problem that typically arises in response to an illusion of separation. This might have been caused by difficult life events, or by whatever other situation that’s resulted in non-acceptance and therefore non-awareness. The active ingredient of the mindful response to depression is to simultaneously restore acceptance and awareness, and this is done automatically when we are mindful. This isn’t accomplished by training us to think better thoughts, or even to change the contents of the thoughts, or by giving us drugs, but by guiding us in a natural process of regaining our lost life by simply encouraging us to connect non-judgmentally, vividly and completely with the unfolding of life as it takes place, moment by moment.
One common RSVP to the open invitation to be mindful is: ‘Why would I want to pay attention to the people and events around me if I don’t actually like them?’ That’s a fair question. Firstly, if the situation is a challenging one then it needs our attention if we are to have any chance of dealing with it. Secondly, if we look closely we may find that our attention may not be as engaged with the event as we think it is, and it is not so much the event itself but what we are thinking about it that makes it so onerous. For example, when we are with a person we may not like being with, we may not actually be listening to them but rather to our internal dialogue: ‘When is this going to be over? I can’t stand them...’ Or with a job: ‘This is so hard. I’ll never get through it. Why do I have to do it anyway...?’ Or when experiencing pain: ‘This is so bad. I can’t stand it. When is it going to be over...?’ Or stepping up to present in public: ‘Oh no. I’m going to stuff it up. What will everyone think about me...?’ We could go on but we hope you get the idea. Paying attention helps to circumvent these well-worn thought patterns.
This emphasis on the new as a treatment for depression and as a general revitalising mental, physical and spiritual tonic links modern approaches to mindfulness such as Ellen Langer’s with traditional approaches such as Vipassana meditation. The New York and Bodhgaya schools of applied mindfulness offer exactly the same antidote to depression, and also to less-clinical manifestations of being overwhelmed or jaded by life. Simply be aware of the ever-changing, ever-new quality of life—whether it’s manifesting right here and now in the sensations of our body or in the traffic whizzing past us—and eventually the whole world will be new again and we won’t be depressed. This is our natural state of wonder and beauty and we can all experience it when we are accepting and aware enough, when we are creative and free enough to realise that we are all playing essential parts of the orchestra of life.
There is a wealth of scientific evidence that demonstrates that mindfulness-based treatments are very effective in improving people’s depression levels. A great advantage of these treatments is that they offer these improvements in a wellness-based, life-improving context, and they don’t cause negative side-effects or stigma.
Scientific studies have shown that mindfulness-based therapies compare well with Cognitive Behavioral Therapy (CBT) and are just as effective for less-serious forms of depression, unlike CBT, which isn’t.[15] Recent studies have even shown that mindfulness can be an effective treatment for depression when given over the phone or via the internet.[16]
Jon Kabat-Zinn, along with a team of psychologists who took his work with Mindfulness-Based Stress Reduction (MBSR) and developed Mindfulness-Based Cognitive Therapy (MBCT) described much of this research in their book The Mindful Way Through Depression.[17] It has been found to more than halve the risk of recurrence of depression even for those who have had many episodes in the past.
In Chapter 3 we discussed the main elements of mindfulness in more detail, but here are a few key points. MBCT uses mindfulness meditation as its cornerstone, with up to 40 minutes’ practice daily. This can be supplemented with some mindful yoga. We then use this as a platform to be more present in daily life, to engage more fully with events as they unfold, without getting ahead of ourselves with anxious anticipation and bias or behind ourselves with reliving the past and rumination. If our mind goes back into the past again, we just gently escort it back to the present moment using our senses.
Acceptance is a crucial element of mindfulness whether it’s called MBSR, MBCT or anything else. We cannot stop depressive thoughts or feelings from ever arising nor need we. Our experience will have taught us that the harder we try not to have the thoughts and feelings we hate having, the more we focus on and amplify them. Try a simple exercise that can show us how useful it is to try to control your mind. Sit comfortably for a minute and don’t think about pelicans. What you can do is accept your thoughts about pelicans or anything else as they arise, but change your relationship to them by learning that you can observe them not as facts but as just another passing momentary event. Psychologists like to call this meta-cognition. We can give attention to a thought if it’s interesting enough or not give it attention, if we so choose. It helps to learn to be matter-of-fact about this process rather than judgmental about it. The less we engage with depressive thought patterns, the less disturbance they cause as they come and go. We think they have a hold on us, but it’s the other way around. We have a hold on them and may not have realised that we won’t let them go. We take them so personally because we latch on to them and have never learned to stand back from them with a little more objectivity. It gets easier, but it takes time and patience as we learn how to do this.
Kat made good progress with the counsellor. She made the effort to apply the mindfulness practices and reported her breakthroughs, challenges and insights each week so that she could learn from her experience. The most important insight she had, when the penny dropped after a few weeks, was that she had previously assumed she needed to work out her thinking, but she realised that most of what went through her mind was irrelevant or unhelpful. It suddenly occurred to her that she could stand back from her thoughts and watch them like a curious bystander. She said, ‘I thought because I had a thought I had to think it. Now I realise I don’t. That’s the most liberating thing of all.’
Not so helpful
• Label what we’re experiencing as either good or bad.
• Unquestionably believe in our diagnoses and prognoses. (We would be better off unquestionably believing in pixies!)
Helpful
• Practise being present and not living in a past that has already gone or a future that may never come.
• Do something new today or do something old in a different way, or even do something old in the same way but really attend to it.
• Enliven stale ideas by consciously examining them.
• Give more attention to life—the bits labelled as good and the bits labelled as bad. None of it stays the same, so we needn’t cling nor resist but go with the flow of events as they unfold.
• See the funny side of something—of anything! The main difference between a sit-com and a drama is the perspective we take to the unfolding events. Stand back and look at how we are, and how others are. If we can see the joke—a new way of looking at something—we’re being mindful.
• Notice newness—be more and more aware of the subtle changes constantly taking place in our mind and body and life.
• Allow ourselves to unconditionally enjoy life.