Mindfulness-Based Cognitive Therapy a Primer

1. Mindfulness-Based Cognitive Therapya Primer Dr. Kerri McGuire Women’s Health Issues April 26, 2007

2. Outline • The Territory of Depression • Why does depression recur? • Mindfulness-Based Cognitive Therapy (MBCT) • Future Directions

3. The Territory of Depression • WHO predicts that by 2010 depression will rank second to cardiovascular disease in economic and personal costs. • Chronic illness, typically with several recurrences

4. Rates of Depressive Relapse Over 15 Years

5. Risk Factors For Depressive Relapse • Number of Past Episodes of Depression • Family History of Depression • Significant Losses/Stressors • Cognitive Reactivity to Sad Moods

6. Qualities of Relapse-Related States of Mind Automatic -Little intentional control of attention - Avoidant or suppressive Ruminative and Centered on Self -Strong identification with thoughts and feelings -Strongly correlated with the past # of depressions -Gender differences in rumination correlate with gender distribution in depression

7. Rumination Can Be Seen To Be Emotional Wisdom P<.002; Watkins & Moulds (2005) P<.02; J Pers & Soc Psych (2000)

8. Qualities of Relapse-Related States of Mind Content - “In order to be happy, I must be……” - “Admitting to your mistakes is a sign of weakness” - “If others look to me for guidance, it would make me feel important” Process - What does feeling this way say about me? - Why is this (sadness) happening to me? - How can I change this (sadness)?

9. Mindfulness-Based Cognitive Therapy An Integration of MBSR and Cognitive Therapy A Blend of Acceptance and Change models Customized for Depression

10. Mindfulness-Based Stress ReductionMBSR • University of Massachusetts Medical Center, Stress Reduction Clinic,1979 • Jon Kabat-Zinn, Ph.D., founder • 8 Week Program • Participants with a wide range of medical problems, including chronic pain, anxiety disorders, depression, hypertension, heart disease and cancer. • Program outlined in the book “Full Catastrophe Living, Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness”

11. A Definition of Mindfulness Mindfulness means paying attention, in a particular way, on purpose, in the present moment, and non-judgmentally Jon Kabat-Zinn

12. How Does Cognitive Therapy Prevent Depressive Relapse? Teaches Patients in Depressed Mood to: -Switch out of a habitual cognitive mode of mind -Decenter - thoughts are not necessarily me and not necessarily true -Turn towards the Difficult -Change Degree of Belief

13. How Does MBCT Prevent Depressive Relapse? Teaches Recovered Depressed Patients Regardless of Mood: -Automatic to Intentional Mode -Avoidance to Curiosity & Acceptance -‘Thinking About’ to ‘Directly Experiencing’ -Judging & Fixing to Non-Doing & Being

14. The Nature of the Work in MBCT • Systematic Training to Become More Aware • Moment to Moment • Bodily Sensations • Pleasant & Unpleasant Events • Thoughts & Feelings as Mental Events • Formal Practice • Body Scan • Mindful Stretching/Yoga • Mindfulness of Breath/Body/Sounds & Thoughts

15. The Nature of the Work in MBCT • Opportunity to Be Mindful Using Activities • Investigating Pleasure & Mastery • Taking Skillful Action – Preparing for Relapse • Inquiry/Discussion of Symptoms & Experiences of Depression • Informal Practice • 3 Minute Breathing Space • Mindfulness of Everyday Activities

16. 3 Minute Breathing SpaceProvides a way to step out of automatic pilot mode and reconnect with the present moment • AWARENESS • Acknowledge & register your experience, even if it is unwanted • GATHERING • Bring full attention to the breath, as an anchor to awareness & stillness • EXPANDING • Awareness of the body as a whole, your posture and facial expression

17. Rates of Depressive Relapse for Patients with 3 or More Past Episodes MBCT 66% TAU 34% P<.005; J Consult Clin Psych (2000)

18. Single Site Replication1 Year Follow Up TAU 22% MBCT 64% P<.05; J Consult Clin Psych (2004)

19. Meditation and the Brain • Frontal - Limbic pathways • Numerous studies ongoing • Meditators versus non-meditators

20. PET Scans and Meditation Dorsal Lateral Prefrontal Cortex Left associated with feelings of happiness & well-being and approach behaviours Right associated with feelings of distress and avoidance behaviours Meditation Increased left sided anterior activation compared to controls Over 8 weeks participants began to shift in the same direction as Buddhist monks

21. Future Directions and Research • Pilot Studies: • Anxiety disorders including panic disorder without agoraphobia • Actively depressed • Co-occurring addictive and mood disorders • Binge eating disorder • Immune response to Influenza vaccine

22. Summary • MBCT was designed to reduce relapse by helping patients disengage from ruminative thinking triggered by sad moods. • MBCT helps patients shift their relationship to thoughts/ sensations/feelings without trying to change belief in thought content. • It is ideal for patients in recovery because depression need not be present for them to practice • Shown to reduce relapse rate by 50% in patients with recurrent depression.

23. Resources • Books: • Full Catastrophe Living, by Jon Kabat-Zinn • Heal Thyself; Mindfulness in Medicine, by Saki Santorelli • Mindfulness-Based Cognitive Therapy for Depression, by Z.Segal, J. Williams & J. Teasdale • Wherever You Go There You Are, by Jon Kabat-Zinn Web Sites: www.ottawamindfulnessclinic.com www.umassmed.edu Dr. Kerri McGuire: mcgkerri@gmail.com