in Madison, Wisconsin, to meditate with EEG caps stuck on their already shaven heads. These were ‘Olympic-level athletes’ of meditation, with many years of intensive practice behind them. The results were astounding. The expert meditators exhibited patterns of brain activity never before measured by science. We’ll look in more detail at some of these findings in Week Three. They’re particularly interesting because from them scientists were encouraged to investigate what changes might show up in people who had no previous meditation experience and who took up an eight-week mindfulness training course. Here, they found (and research continues to find) highly significant changes in the patterns of brain activation – and even changes in the brain’s physical structure – that follow from just eight weeks of mindfulness training.
A significant event in the development of secular mindfulness training came about in 1992 when three distinguished cognitive psychologists – Zindel Segal, Mark Williams and John Teasdale – were asked by the director of a clinical psychology research network to develop a group-based therapy for the treatment of relapsing depression.
Significant depression is a highly disabling condition. Besides emotional pain and anguish, people who are depressed also experience levels of functional impairment comparable to those found in major medical illnesses – including cancer and coronary heart disease – and a World Health Organization projection suggests that of all diseases depression will impose the second-largest burden of ill health worldwide by the year 2020.
Roughly one in 10 of us in Europe and North America will experience serious depression at some point in our lives. In some parts of the population that is more like one in four. What is more, when people have had three or more serious episodes of depression there is something like a 67 per cent chance that their depression will relapse.
Back in 1992, the two treatments that seemed to be most effective in treating people with relapsing depression were one-to-one cognitive behaviour therapy (CBT) or maintenance doses of antidepressants. Both of these are relatively expensive. Not everyone is comfortable taking the drugs and they can have unwanted side effects. And not everyone can have one-to-one CBT – there is a limit to the availability of trained therapists. Coming up with an economically viable and effective group-based intervention therefore seemed urgent.
To understand the approach Segal, Williams and Teasdale took, and why they took it, it will be helpful to consider a scenario they outline in the first of their books – Mindfulness-Based Cognitive Therapy for Depression.
Mary has just come from work. She’s tired and she looks forward to spending her evening relaxing in front of the television. However, there’s a message on her answerphone. Her partner is going to be late getting back from work. She gets angry and feels disappointed and upset. Then she starts to recall other occasions that month when the same thing happened. She begins to imagine that her partner may be being unfaithful to her. She pushes that thought to one side but it comes back with even greater force when she imagines that she has heard some laughter in the background of his voicemail. Nausea comes up – and it doesn’t end there. Her mind rapidly starts to conjure up images of an unwanted future – solicitors, divorce courts, having to buy another home, living in poverty. She feels herself getting more and more upset as her anger begins to turn into depression. Her mind throws up images from the past when she was rejected and lonely. She ‘knows’ that all their mutual friends would abandon her for him. Tears flow as she is left wondering what to do. Sitting in her kitchen she asks herself ‘Why does this always happen to me?’ and she tries to work out why she always reacts this way.
Mary experiences a whole avalanche of thoughts, feelings and sensations. It is not just the negative matter that caused her to be upset, however, nor is it just the way she found herself trying to deal with it. Instead, it’s as if a whole mode of mind – a complex configuration of moods, thoughts, images, impulses and body sensations – was very quickly wheeled into place in response to the situation. This mode of mind includes both the negative material and Mary’s tendency to deal with it by ruminating.
Like Mary, people who are vulnerable to depression can put much of their time and energy into ruminating about their experience – ‘Why do I feel the way I do?’ Thinking about their problems, their sense of personal inadequacy, they turn things over and over in their minds trying to think their way to solutions and to ways of reducing their distress. But, as Segal, Williams and Teasdale point out, the methods they use to achieve that aim are tragically counterproductive. In fact, when you’re low, repeatedly ruminating – thinking about apparently negative aspects of yourself or of problematic situations – actively perpetuates rather than resolves depression.
What seems to happen is that, at times of low mood, old habits of thinking switch in relatively automatically. That has two consequences: firstly, thinking now runs in well-worn grooves that don’t lead to a way out of depression; secondly, this way of thinking itself intensifies the depressed mood – and that leads to further rumination. In this way a series of self-perpetuating vicious cycles can cause mild and transient low mood to very quickly degenerate into severe, disabling depression.
As Segal, Williams and Teasdale saw it, the task of relapse prevention was therefore to find a way to help patients disengage from negative and self-perpetuating rumination when they felt sad or at other times of potential relapse.
While they were pursuing these questions, John Teasdale, who had long had a personal interest in meditation, was reminded of a Buddhist talk he had attended several years before where the speaker stressed that it is not your experience itself that makes you unhappy – it is your relationship to that experience. This is a central aspect of mindfulness meditation, in which you learn – among other things – to relate to your thoughts just as thoughts. In other words, you learn to see them just as mental events, rather than as ‘the truth’ or ‘me’.
John recognised that this way of ‘decentring’ from negative thoughts, of standing ever so slightly apart from them and witnessing them as an aspect of experience rather being completely immersed in them as the whole of experience, might be a key.
But how could you teach people to do that?
An American colleague, Marsha Linehan, who was visiting John Teasdale and Mark Williams at the Medical Research Council’s Applied Psychology Unit in Cambridge, provided a vital clue. Besides telling them of her own work in helping patients to decentre, she pointed them towards the work being undertaken at UMass by Jon Kabat-Zinn. Looking into his work, they came upon this piece from one of Jon’s books:
It is remarkable how liberating it feels to be able to see that your thoughts are just thoughts and that they are not ‘you’ or ‘reality’ . . . The simple act of recognising your thoughts as thoughts can free you from the distorted reality they often create and allow for more clearsightedness and a greater sense of manageability in your life.
Segal, Williams and Teasdale made contact with Kabat-Zinn and his Stress Reduction Clinic at the UMass Medical Center, began to engage in various ways with his programme and, based largely upon it, formulated their own eight-week Mindfulness-Based Cognitive Therapy (MBCT) programme. Although similar to Kabat-Zinn’s Mindfulness-Based Stress Reduction (MBSR) in many ways, MBCT contains elements of cognitive therapy and theory that address the specific vulnerabilities and exacerbating factors that make depression recurrent.
MBCT itself was originally specifically designed for those vulnerable to depression. Subsequently, variants of it have been developed to help with a wide range of issues: obsessive-compulsive disorder, disordered eating, addiction, traumatic brain injury, obesity and bipolar disorder among others.
When it comes to depression, the results of several large-scale randomised control trials
