1. Managing Depression: Mindfulness Based Therapies John D. McKellar, PhD Clinical Psychologist Department of Veteran Affairs, Clinical Educator Stanford University

2. Depression Recap 1.We started by defining depressive episodes as periods of negative mood that last for at least two weeks (every day) and that include significant problems in everyday functioning 2.We identified numerous causes for depression both related to negative events and to other factors such as genetics/family and noted that medications and psychotherapies all appear to work about as well 3.We then identified two specific psychotherapies that can alleviate depression: cognitive-behavioral therapy that targets increasing pleasant activities and challenging negative thoughts and behavioral activation that targets only increasing pleasant activities 4.Last time we met we talked about antidepressant medications and how to judge their effectiveness by weighing benefit to mood versus side effects 5.Today finish this section by talking about mindfulness-based interventions.

3. What is Mindfulness? Focus is on finding ways to accept, tolerate, or understand current experiences rather than trying to change our experiences or our thoughts Mindfulness interventions all involve practice of some form of relaxation and/or meditation Most interventions in this area focus on how to “live in the moment” as contrasted to our (human) tendency to focus our thinking on re-living past events or anticipating future events One difference between Mindfulness and other simple relaxation techniques is that these exercises involve a conscious decision to tolerate negative emotions through “observing” one’s emotions and allowing them to rise, crest, and fall as a wave on the beach

4. Mindfulness-Based Treatments 1.Mindfulness-Based Cognitive Therapy (MBCT) for Depression 2.Acceptance and Commitment Therapy (ACT) for Depression

5. Mindfulness-Based Cognitive Therapy 1.This approach acknowledges the importance of negative thoughts as an on-going problem in repeated depressive episodes 1.Rather than challenging thoughts, however, MBCT teaches the individual how to separate himself or herself from negative thought patterns to prevent relapse of depression 1.The primary vehicle for separating oneself from negative thought patterns involves use of mindfulness techniques

6. MBCT Central Components 1.Developing awareness of how our thoughts and perceptions are set on autopilot and how these interpretations often determine how we end up feeling 2.Meditations practiced in MBCT help identify how much “chatter” that constantly occurs in our mind and then help us separate from the “chatter” and see life more clearly 3.On-going meditation practice reveals that the “chatter” of the mind tends to focus on past events (often negative in nature) or the prediction of future events (also often negative in nature) and ignores current experience 4.The best escape from the mind is to learn to focus greater and greater attention on the present moment (thoughts are not facts) 5.Prevention of depression involves greater and greater focus on current experience and less attention to the “chatter” of the mind

7. MBCT Techniques 1.Eating a raisin: Directs all sense to focus on examination of a raisin- sight, smell, touch, and taste. This is a contrast between mindful awareness and autopilot. 2.Body Scan: A guided (via leader or recorded guidance) meditation that focuses on scanning the body and discovering body sensations- a good technique for bringing one into the present moment. 3.Mindful Movement: A meditation in motion that involves focused attention on body movements and on breathe. A more complex method involves walking meditation. Also focuses attention on present experience. 4.Sitting Meditation: Focus on posture, breathing, body sensations, and bring to mind current difficulties. At this point negative emotions are allowed to flow without being overwhelmed or needing to suppress them.

8. Three Minute Breathing Space Exercise Experiential exercise

9. Acceptance and Commitment Therapy Accept Thoughts and Feelings: Accept and embrace thoughts and feelings, particularly unwanted ones, and end the struggle against them. Choose Directions: Decide to move forward with life and goals regardless of negative emotions. Take Action: Commit to a course that moves toward valued life goals.

10. The ACT Approach 1.Attempts to control depression/negative emotions/thoughts are part of the problem. 2.Acceptance presents a different path. 3.Practicing mindfulness techniques allows willingness to tolerate emotions, thoughts, and bodily experiences 4.Focusing too much on impact of depression has derailed engagement with life.

11. The Techniques of ACT 1.Mindfulness exercises very similar to MBCT 2.Clarify important areas of life (e.g., recreation, community, work, spirituality, parenting, etc.) 3.Moving forward towards values life areas in the context of depression

12. Mindfulness Resources 1.The Mindful Way through Depression- Mark Williams, John Teasdale, Zindel Segal, John Kabat-Zinn 2.The Mindfulness and Acceptance Workbook for Depression: Using Acceptance and Commitment Therapy to Move Through Depression and Create a Life Worth Living (by Patricia J. Robinson and Kirk D. StrosahlThe Mindfulness and Acceptance Workbook for Depression: Using Acceptance and Commitment Therapy to Move Through Depression and Create a Life Worth Living (by Patricia J. Robinson and Kirk D. Strosahl