Mindfulness-Based Cognitive Therapya Primer

Dr. Kerri McGuire

Women’s Health Issues

April 26, 2007

Outline

• The Territory of Depression

• Why does depression recur?

• Mindfulness-Based Cognitive Therapy (MBCT)

• Future Directions

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

Rates of Depressive Relapse Over 15 Years

Risk Factors For Depressive Relapse

• Number of Past Episodes of Depression

• Family History of Depression

• Significant Losses/Stressors

• Cognitive Reactivity to Sad Moods

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

Rumination Can Be Seen To Be Emotional Wisdom

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Posi

tive

Belie

fs A

bout

Rum

inat

ion

Formerly Depressed Never Depressed0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

Prob

lem-S

olving

Ef

fectiv

enes

s

Ruminating in SadMood

Ruminating in NormalMood

P<.002; Watkins & Moulds (2005)P<.02; J Pers & Soc Psych (2000)

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)?

Mindfulness-Based Cognitive Therapy

An Integration of MBSR and Cognitive Therapy

A Blend of Acceptance and Change models

Customized for Depression

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”

Mindfulness means paying attention,

in a particular way,

on purpose,

in the present moment,

and non-judgmentally

Jon Kabat-Zinn

A Definition of Mindfulness

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

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

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

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

3 Minute Breathing Space

Provides 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

Rates of Depressive Relapse for Patients with 3 or More Past Episodes

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10

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% R

elap

se F

ree

10w

eeks

20w

eeks

30w

eeks

40w

eeks

50w

eeks

60w

eeks

1 Year Follow Up

TAU

MBCT

P<.005; J Consult Clin Psych (2000)

MBCT 66% TAU 34%

Single Site Replication1 Year Follow Up

0102030405060708090

100

% R

ela

ps

e F

ree

TAU MBCT

3+Previous MDD

TAU 22%

MBCT 64%

P<.05; J Consult Clin Psych (2004)

Meditation and the Brain

• Frontal - Limbic pathways

• Numerous studies ongoing

• Meditators versus non-meditators

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

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

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.

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.comwww.umassmed.edu

Dr. Kerri McGuire: mcgkerri@gmail.com