Mindfulness-Based Cognitive Therapya Primer

Dr. Kerri McGuireWomen’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

Bel

iefs

Abo

ut R

umin

atio

n

Formerly Depressed Never Depressed0

0.51

1.52

2.53

3.54

4.5

Prob

lem-S

olving

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fectiven

ess

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

0102030405060708090

100

% R

elap

se F

ree

10w

eeks

20w

eeks

30w

eeks

40w

eeks

50w

eeks

60w

eeks

1 Year Follow Up

TAUMBCT

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

MBCT 66% TAU 34%

Single Site Replication1 Year Follow Up

0102030405060708090

100

% R

elap

se F

ree

TAU MBCT3+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 controlsOver 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