Sunday, 3 May 2009

10 TIPS TO BE MORE MINDFUL IN YOUR DAILY LIFE

1. Begin the day with ten mindful breaths as you lie in bed.
The way you start the day has a big effective on how it goes so why not start well.

2. Change the order in which you get ready in the morning.
This can help you wake up to what's happening.

3. Do the body scan or sitting meditation daily.
This is an important way to boost your practice.

4. Practice mindful yoga or mindful walking.
If you find being physically still uncomfortable, this is just as helpful.

5. If driving, look forward to red lights.
Red lights are a lovely opportunity to rest on your breath or to look at a beautiful tree or flower.

6. Let the telephone ring a few more times.
This is a chance to just listen instead of jumping on the phone. It helps your mindful listening practice.

7. If on public transport, ground yourself.
Feel your feet on the ground, or the weight of your body on the seat for a few moments. What effect does it have?

8. You have two ears, one mouth. Try listening more.
In your next conversation, listen more and talk a little less. What did you learn?

9. Observe nature.
Enjoy what the earth has to offer.

10. Focus on what you achieved today. Come back to the breath.
At the end of the day, think of 5 things you are grateful for. Feel your breath as you gently drift into sleep.

Sunday, 15 March 2009

Who Says Stress Is Bad For You?

Here's a recent article from Newsweek on Stress...

Who Says Stress Is Bad For You?

It can be, but it can be good for you, too—a fact scientists tend to ignore and regular folks don't appreciate.

Mary Carmichael
NEWSWEEK
Published Feb 14, 2009 | Updated: 2:12  p.m. ET Feb 14, 2009
From the magazine issue dated Feb 23, 2009

If you aren't already paralyzed with stress from reading the financial news, here's a sure way to achieve that grim state: read a medical-journal article that examines what stress can do to your brain. Stress, you'll learn, is crippling your neurons so that, a few years or decades from now, Alzheimer's or Parkinson's disease will have an easy time destroying what's left. That's assuming you haven't already died by then of some other stress-related ailment such as heart disease. As we enter what is sure to be a long period of uncertainty—a gantlet of lost jobs, dwindling assets, home foreclosures and two continuing wars—the downside of stress is certainly worth exploring. But what about the upside? It's not something we hear much about.

In the past several years, a lot of us have convinced ourselves that stress is unequivocally negative for everyone, all the time. We've blamed stress for a wide variety of problems, from slight memory lapses to full-on dementia—and that's just in the brain. We've even come up with a derisive nickname for people who voluntarily plunge into stressful situations: they're "adrenaline junkies."

Sure, stress can be bad for you, especially if you react to it with anger or depression or by downing five glasses of Scotch. But what's often overlooked is a common-sense counterpoint: in some circumstances, it can be good for you, too. It's right there in basic-psychology textbooks. As Spencer Rathus puts it in "Psychology: Concepts and Connections," "some stress is healthy and necessary to keep us alert and occupied." Yet that's not the theme that's been coming out of science for the past few years. "The public has gotten such a uniform message that stress is always harmful," says Janet DiPietro, a developmental psychologist at Johns Hopkins University. "And that's too bad, because most people do their best under mild to moderate stress."

The stress response—the body's hormonal reaction to danger, uncertainty or change—evolved to help us survive, and if we learn how to keep it from overrunning our lives, it still can. In the short term, it can energize us, "revving up our systems to handle what we have to handle," says Judith Orloff, a psychiatrist at UCLA. In the long term, stress can motivate us to do better at jobs we care about. A little of it can prepare us for a lot later on, making us more resilient. Even when it's extreme, stress may have some positive effects—which is why, in addition to posttraumatic stress disorder, some psychologists are starting to define a phenomenon called posttraumatic growth. "There's really a biochemical and scientific bias that stress is bad, but anecdotally and clinically, it's quite evident that it can work for some people," says Orloff. "We need a new wave of research with a more balanced approach to how stress can serve us." Otherwise, we're all going to spend far more time than we should stressing ourselves out about the fact that we're stressed out.

When I started asking researchers about "good stress," many of them said it essentially didn't exist. "We never tell people stress is good for them," one said. Another allowed that it might be, but only in small ways, in the short term, in rats. What about people who thrive on stress, I asked—people who become policemen or ER docs or air-traffic controllers because they like seeking out chaos and putting things back in order? Aren't they using stress to their advantage? No, the researchers said, those people are unhealthy. "This business of people saying they 'thrive on stress'? It's nuts," Bruce Rabin, a distinguished psychoneuroimmunologist, pathologist and psychiatrist at the University of Pittsburgh School of Medicine, told me. Some adults who seek out stress and believe they flourish under it may have been abused as children or permanently affected in the womb after exposure to high levels of adrenaline and cortisol, he said. Even if they weren't, he added, they're "trying to satisfy" some psychological need. Was he calling this a pathological state, I asked—saying that people who feel they perform best under pressure actually have a disease? He thought for a minute, and then: "You can absolutely say that. Yes, you can say that."

This kind of statement might well have the father of stress research lying awake worried in his grave. Hans Selye, who laid the foundations of stress science in the 1930s, believed so strongly in good stress that he coined a word, "eustress," for it. He saw stress as "the salt of life." Change was inevitable, and worrying about it was the flip side of thinking creatively and carefully about it, something that only a brain with a lot of prefrontal cortex can do well. Stress, then, was what made us human—a conclusion that Selye managed to reach by examining rats.

Selye had virtually no lab technique, and, as it turned out, that was fortunate. As a young researcher, he set out to study what happened when he injected rats with endocrine extracts. He was a klutz, dropping his animals and chasing them around the lab with a broom. Almost all his rats—even the ones he shot up with presumably harmless saline—developed ulcers, overgrown adrenal glands and immune dysfunction. To his credit, Selye didn't regard this finding as evidence he had failed.Instead, he decided he was onto something.

Selye's rats weren't responding to the chemicals he was injecting. They were responding to his clumsiness with the needle. They didn't like being dropped and poked and bothered. He was stressing them out. Selye called the rats' condition "general adaptation syndrome," a telling term that reflected the reason the stress response had evolved in the first place: in life-or-death situations, it was helpful.

For a rat, there's no bigger stressor than an encounter with a lean and hungry cat. As soon as the rat's brain registers danger, it pumps itself up on hormones—first adrenaline, then cortisol. The surge helps mobilize energy to the muscles, and it also primes several parts of the brain, temporarily improving some types of memory and fine-tuning the senses. Thus armed, the rat makes its escape—assuming the cat, whose brain has also been flooded with stress hormones by the sight of a long-awaited potential meal, doesn't outrun or outwit it.

This cascade of chemicals is what we refer to as "stress." For rats, the triggers are largely limited to physical threats from the likes of cats and scientists. But in humans, almost anything can start the stress response. Battling traffic, planning a party, losing a job, even gaining a job—all may get the stress hormones flowing as freely as being attacked by a predator does. Even the prospect of future change can set off our alarms. We think, therefore we worry.

Herein lies a problem. A lot of us tend to flip the stress-hormone switch to "on" and leave it there. At some point, the neurons get tired of being primed, and positive effects become negative ones. The result is the same decline in health that Selye's rats suffered. Neurons shrivel and stop communicating with each other, and brain tissue shrinks in the hippocampus and prefrontal cortex, which play roles in learning, memory and rational thought. "Acutely, stress helps us remember some things better," says neuroendocrinologist Bruce McEwen of Rockefeller University. "Chronically, it makes us worse at remembering other things, and it impairs our mental flexibility."

These chronic effects may disappear when the stressor does. In medical students studying for exams, the medial prefrontal cortex shrinks during cram sessions but grows back after a month off. The bad news is that after a stressful event, we don't always get a month off. Even when we do, we may spend it worrying ("Sure, the test is over, but how did I do?"), and that's just as biochemically bad as the original stressor. This is why stress is linked to depression and Alzheimer's; neurons weakened by years of exposure to stress hormones are more susceptible to killers. It also suggests that those of us with constant stress in our lives should be reduced to depressed, forgetful wrecks. But most of us aren't. Why?

Step away from the lab, and you'll find the beginnings of an answer. In the 1970s and '80s, Salvatore Maddi, a psychologist at the University of California, Irvine, followed 430 employees at Illinois Bell during a companywide crisis. While most of the workers suffered as their company fell apart—performing poorly on the job, getting divorced and developing high rates of heart attacks, obesity and strokes— a third of them fared well. They stayed healthy, kept their jobs or found others quickly. It would be easy to assume these were the workers who'd grown up in peaceful, privileged circumstances. It would also be wrong. Many of those who did best as adults had had fairly tough childhoods. They had suffered no abuse or trauma but "maybe had fathers in the military and moved around a lot, or had parents who were alcoholics," says Maddi. "There was a lot of stress in their early lives, but their parents had convinced them that they were the hope of the family—that they would make everyone proud of them—and they had accepted that role. That led to their being very hardy people." Childhood stress, then, had been good for them—it had given them something to transcend.

More recently, Robert Sapolsky of Stanford University has studied a similar phenomenon in alpha males. He's seen plenty of "totally insane son of a bitch" types who respond to stress by lashing out, but he's also interested in another type that gets less press: the nice guy who finishes first. These alphas don't often get into fights; when they do, they pick battles they know they can win. They're just as dominant as their angry counterparts, and they're subject to the same stressors—power struggles, unsuccessful sexual overtures, the occasional need to slap down a subordinate—but their hormone levels never get out of whack for long, and they probably don't suffer much stress-induced brain dysfunction.Sapolsky likes to joke that they've all been relaxing in hot tubs in Big Sur, transforming themselves into "minimalist Zen masters." This is a joke because they've clearly come by their attitudes unconsciously: Sapolsky studies wild baboons.

Sapolsky's and Maddi's work points to a flaw with much of the neurobiological research: so far, it has done a poor job of accounting for differences in how individuals process stress. Researchers haven't identified the point at which the effects of stress tip over from positive to negative, and they know little about why that point differs from person to person. (This is why they don't like to tell people that a little stress can be good, says Rabin—because "we don't know how to judge for each individual what a 'little' stress is.") The research thus tends to paint stress as a universal phenomenon, even though we all experience it differently. "If there are rats or mice or cultured neurons in a dish that seem superresilient to stress, far too many lab scientists view this as a pain in the ass, something that just throws off patterns," says Sapolsky. "It's only people who are tuned into animal behavior or humans and the real world who are interested in how amazing the outliers are." Explaining these outliers' healthy attitudes, says Sapolsky, is now "the field's biggest challenge."

As Maddi's work makes clear, a lot of the explanation stems from early experiences. This may be true of Sapolsky's baboons as well. Sapolsky suspects that part of what makes an animal a dominant Zen master instead of an angry alpha lies in what sort of childhood he had. If an adult baboon picks up on conflict around him but keeps his cool, "quelling the anxiety and exercising impulse control," that may be behavior his mom modeled for him years earlier. The key? Factors such as how many steps the baby baboon could take away from his mother before she pulled him back—i.e., how much she allowed him to learn for himself, even if that meant a few bumps and bruises along the way. "I think the males who had mothers who were less anxious, who allowed them to be more exploratory in the absence of agitated maternal worry, are more likely to be the Zen ones who are calm enough to resist provocation," he says. A little properly handled stress, then, may be necessary to turn children into well-adjusted adults.

Part of the explanation will also be found in genes. Scientists have already identified one that helps control how the brain processes serotonin; some variants seem to protect people from depression, depending on whether they've suffered through previous traumas. This gene may not mediate everyday stress, but others are bound to be fingered eventually, and "once people have found scores of genes," says Sapolsky, "I'm willing to bet the farm that that's going to begin to explain who gets depressed after disastrous unrequited love and who just feels lousy for two weeks."

The X and Y chromosomes also play a role in how people respond to stress, though how much of one isn't clear. Men and women both experience stress as a rise in adrenaline and cortisol. What differs is their reaction. Women "are more likely to turn to their social networks, and that prompts the release of oxytocin, which mutes the stress systems," says Shelley Taylor, a psychologist at UCLA. If they're surrounded by loved ones when a stressor arises, she says, "there's some evidence they don't even show as much of the initial hormonal response." Without that response, there's less risk of long-term harm to the brain. It's a critical concept—yet it wasn't on stress physiologists' radar until the mid-'90s, when Taylor pointed out that most stress research in animals and humans had been conducted overwhelmingly on males.

Finally, there's that murky territory where genes and environment interact, with lifelong effects: the womb. It's not hard to find studies suggesting that maternal stress harms later child development. But what the evidence means, no one knows. "Project Ice Storm," a survey of nearly 150 expectant mothers who toughed out a 1998 squall in Quebec—some without power for up to 40 days—is one of the scariest studies. Late last year researchers reported that the women's children had lower-than-average IQs and language skills at age 5; they say the storm and its stress on the mothers had "significant effects [on the children] … in every area of development that we have examined." The study surveys many children in great detail, but it doesn't mean all pregnant women should panic about their stress levels (or panic about the fact that they've just panicked). An ice storm isn't the same kind of stressor that people encounter in everyday life, and the women in the ice-storm study don't necessarily represent all women. Those who were stuck in Quebec during the storm were likely some of the ones with the fewest resources. Their children may have been prone to low scores as 5-year-olds simply because they were poor.

A lot of the research on stress and infant development can be picked apart this way, says DiPietro, of Johns Hopkins. Also, she notes, "nobody ever got funded by saying stress doesn't harm babies." DiPietro herself is a rare exception. Two years ago, she showed that women under moderate stress in mid-to-late pregnancy wound up with toddlers who were developmentally advanced, scoring highly on language and cognitive tests. In an upcoming paper, she confirms the trend: 2-week-old babies whose mothers were under moderate stress show evidence of faster nerve transmission—and possibly more mature brain development—than those whose moms had stress-free pregnancies. It's hard to know what to make of the findings, but DiPietro has an intriguing theory. A stressed-out mother's "internal environment"—her heartbeat, blood pressure and other signals the fetus can perceive—is constantly in flux. Her restlessness may stimulate the fetus's brain, giving it something to think about. In this light, DiPietro thinks, the kind of mild to moderate stress that is pervasive in many women's hectic lives may be beneficial, perhaps even "essential," for fetal development. The idea is controversial—but if it's correct, it certainly complicates the theory that stress can permanently damage a child in utero.

When Stanford's Sapolsky gives lectures on stress, he cites the "depressing" research on failing neurons, some of which he has conducted. But his talks end optimistically, thanks to his observations in the wild. "If some baboons just happen to be good at seeing water holes as half full instead of half empty … we should be able to as well," he once told an audience. Even if we're not born well equipped to deal with stress, he said, "we can change," because as humans, we ought to be "wise enough to keep this stuff in perspective."

So how do we do that? One place to start is with the human equivalent of Zen baboons: Buddhist monks. Their mental stability and calmness isn't mystical; it's biological. The brain can grow new cells and reshape itself, and meditation appears to encourage this process. Monks who have trained for years in meditation have greater brain activity in regions linked to learning and happiness. "The mind is far more malleable than we previously assumed," says Saki Santorelli, executive director of the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School. Studies at the center have shown that meditation can help people cope with stress. It may repair or compensate for damage already done to the brain.

Not all of us want to or can become monks; not all of us can spare even eight weeks for a course at the Center for Mindfulness. But there are quicker ways to learn to harness and handle stress. For this article, I tried one: the Williams LifeSkills program, a cognitive mini-makeover based on the research of Duke University psychiatrist Redford Williams. LifeSkills teaches adherents to approach life like a Zen baboon, picking the right battles—and it can be completed in a day and a half. "You won't achieve enlightenment, but it will help you," Williams told me before I embarked on the course, which gave me a formula for assessing conflicts (How important is this to me? Should I be mad? Can I do something about the problem? Would that be worth the trouble?). He was right. I did feel a bit calmer afterward. But then, I had willed myself to. I liked Williams; I was hoping his program would work.

This is the problem with all stress-management tactics: you have to want them to succeed and be willing to throw yourself into them, or they'll fail. If you force yourself to do them, you'll just stress yourself out more. This is why exercise relieves stress for some people and makes others miserable. It's also why Sapolsky says he's "totally frazzled" but doesn't bother with meditation: "If I had to do that for 30 minutes a day," he says, "I'm pretty sure I'd have a stroke."

For all of the science's shortfalls, there's animal research that suggests why something that should lower stress can actually cause stress if it's done in the wrong spirit. In a classic study, scientists put two rats in a cage, each of them locked in a running wheel. The first rat could exercise whenever he liked. The second was yoked to the first, forced to run when his counterpart did. Exercise, like meditation, usually tamps down stress and encourages neuron growth, and indeed, the first rat's brain bloomed with new cells. The second rat, however, lost brain cells. He was doing something that should have been good for his brain, but he lacked one crucial factor: control. He could not determine his own "workout" schedule, so he didn't perceive it as exercise. Instead, he experienced it as a literal rat race.

This experiment brings up a troubling point about stress. Psychologists have known for years that one of the biggest factors in how we process stressful events is how much control we have over our lives. As a rule, if we feel we're in control, we cope. If we don't, we collapse. And no amount of meditation or reframing our thinking can change certain facts of our lives. With the market languishing and jobs hemorrhaging and the world going to hell, too many of us probably feel like that rat in the second wheel: it's hard to convince ourselves we're in control of anything.

But stress science even provides a little hope here, if we go back to Selye. He first published his ideas during the Great Depression—a time of stress if ever there was one, and a time in which survival demanded creativity. That Depression ended. Now we're entering what may be a new one, and we'll need more creative thinking to get out of it. We're going to have to figure out what parts of our future we can control, and we'll need to engage with them thoughtfully. Fortunately, we have the kind of brain that permits that. Sure, it will be stressful. Maybe that isn't a bad thing.

Friday, 13 March 2009

Mindfulness-Based Stress Reduction

Here's an extract from Health News:

In 1979, a young doctor by the name of Jon Kabat-Zinn proposed a new alternative program at the University of Massachusetts Medical School. Kabat-Zinn called it the Stress Reduction Clinic in opposition to using the word “meditation” for fear of not being taken seriously enough. The program gained popularity and soon expanded, ending up being called The Center for Mindfulness in Medicine, Healthcare and Society. 

By fusing mindfulness, meditation, a mixture of martial arts and yoga, MBSR teaches you to work through your own demons such as stress, pain, illness, or emotional challenges that can plague your life, MBSR uses spirituality to create awareness. Patients going through the program are able to take hold of their own life using affirmations to ensure a positive outlook. With tens of thousands of patients having graduated from the MBSR program, there are now hundreds of hospitals across the United States that have enacted similar programs. 

MBSR has been used to treat minor pains and chronic illnesses and new research is being done all the time. One study in particular set to end this year is sponsored by the National Center for Complementary and Alternative Medicine (NCCAM) and is being conducted at the Osher Center for Integrative Medicine at the University of California San Francisco.  Professor and co-director Susan Folkman and her team are conducting a threefold rigorous study in order to show the effects of MBSR in patients with HIV diagnosed in an early stage. Hoping to slow the progression of HIV when patients need to start the antiretroviral treatment (ART)—the process of helping to stop or slow the disease—by using MBSR to decrease T-cells is their first goal. Secondly, the team of scientists will use MBSR to combat stress and biological stress arousal that could be affecting the immune functions. The third project is to test the immunity pathways and functions which are affected by MBSR and stress against HIV cell replication.

It seems that Dr. Kabat-Zinn was onto something in the 1970s when he came up with the idea for Mindful Based Stress Reduction and the trend has stuck. More than just meditation and yoga, MBSR has been shown to help many patients struggling to cope with outside forces because he or she is not at peace with what is inside. Who knows, the foundations of MBSR and the act of taking a look inside of you may just be the answer to hundreds of dollars worth of therapy sessions, acupuncture treatments, or the overused rubber stress ball. 

See www.LearnMindfulness.co.uk for distance learning courses, or courses in London, UK

Sunday, 8 March 2009

Mindfulness for depression grows in popularity

This morning I am preparing to give a talk in Central London on Mindfulness Based Cognitive Therapy for depression. Mindfulness continues to grow in popularity, particularly since the NHS recommend it for people suffering from repeated relapse into depression.

But how does it work? Good question! The theory is that the body and mind make a connection between how one is feeling (depressed) and how the body feels (tired, aching etc). This connection leads to a spiralling low mood when they are linked up. You feel a little sad, the body aches, you get worried you may get depressed again, and this makes the body even more sluggish. These two keep bouncing back into each other until you are back into a relapse of depression. Mindfulness helps to gently untie this connection. It shows through experience that it is possible to feel negative mood without allowing the thoughts to go out of control.

Mindfulness practice helps you to see more clearly the patterns of the mind, and to learn how to recognise when your mood is beginning to go down. This means you can 'nip it in the bud' much earlier than before.

Tuesday, 23 December 2008

Mindfulness and Stress Reduction

I'm a teacher at a local school in south west London and am fortunate enough to be on holiday at the moment. I've been spending some of my time preparing for a talk I plan to give at an occupational health company. They're not sure what mindfulness is, but are interested in stress reduction and want me and another colleague to present to them. I have read a bit on stress recently and would like to share what I have learnt. Hope that's ok!

If I say the word stress, what does it mean to you? It has become such a common word to throw around, it has almost lost its scientific label. "I'm stressed!", "don't stress me out!", "He looks stressed at the moment - BIG TIME", are comments we hear quite often.

Stress, and what it means to us, actually comes from an engineering term. When a piece of metal is stressed, it's got a force on it. When I feel stressed, I suppose I do have a force on me - deadlines, the internet suddenly decides to shut down or at the moment, the flu, act like a force. Damn flu!

So what? Well, I'm telling a little story about stress and how it was discovered. It all started with a guy called Hans Selye. He started researching stress in 1936, after experimenting on rats. He noticed that the rats kept having the same physiological reactions, no matter what he injected them with. He discovered that they all had a specific response to being 'stressed'. He thought stress was so important that he then went all over the world to tell people from England to Germany to use the word 'stress'. It's the same word used in most countries. Amazing.

So, what is the stress response and why do you need to know about all this anyway? If you know what it is, and what happens to your body in a stress response, you know what's going on. You can then go on to choose coping strategies that would be helpful like mindfulness (finally I got my favourite word in) as apposed to caffeine or cocaine something inbetween.

The stress response is also called the 'fight or flight' response. When someone annoys you, or something for that matter, we feel stressed. Now you know why you feel like shooting your computer or strangling your boss - it's the fight or flight response. Your body produces hormones that make you want to either lash out, or run, run, run. Unfortunately, if you're sitting in an office cubicle, or sitting in traffic, running is not really an option - unless you're quitting your job, or aren't keen on that old banger after all.

What's happening inside to make us want to do this? It all starts at the hypothalamus. This is a small part at the base of the brain. Through the use of nerves and hormones, it releases amongst other things, adrenaline and cortisol into the bloodstream, from the adrenal glands which are at the top of the kidneys.

- Adrenaline increases your heart rate, elevates your blood pressure and boosts energy supplies.
- Cortisol helps to release sugar into the bloodstream, so that the major muscles in the arms and legs are ready for action. It also releases substances to allow tissue to be repaired quickly if it is damaged. Non-essential processes for a dangerous situation, like immune system, reproductive system, digestive system and growth processes are all reduced though the use of cortisol.

OK, so where's the problem with all this? We get stressed, but we get over it, right? Well, yes and no. The body naturally regulates itself after a stressful situation, but if the stress is sustained, long term, day after day, it takes its toll. The intense response is only designed for short periods of time and not continuous. This leads to health problems such as:
- Heart disease
- Obesity
- Sleep problems
- Digestive problems
- Depression
- Memory impairment
- Skin problems such as eczema

That's why it's important to cut down on your stress! Just chill out is easier said than done. That's where mindfulness and the mindfulness based stress reduction (MBSR) program comes in. Eight weeks of hard work on your part, to result in possibly a life time of lower stress and greater well-being. And you don't have to just believe me - go to google, type in MBSR research and look at what the scientists have found out. About 90% of participants in the program continue some sort of meditative practice 3 years later.

Sunday, 21 December 2008

BBC Report on Mindfulness for Depression

Here is the latest report from the BBC on the benefits of mindfulness based cognitive therapy for reducing the relapse of depression.


Group therapy 'beats depression'

The group therapy is based on some techniques found in Buddhism
Group-taught meditation is as effective as staying on drug treatments for stopping people slipping back into depression, say UK scientists.
Compared to one-to-one sessions, or medication, "mindfulness-based cognitive therapy" (MBCT) is cheaper for the NHS, they say.
The trial of 123 people found similar relapse rates in those having group therapy and those taking drugs.
The study was published in the Journal of Consulting and Clinical Psychology.
It's given me the ability to come up against something that would have previously thrown me, think it through, come up with a solution and then move on.
Di CowanPatient
Recent years have seen much more evidence that so-called "talking therapies" can be as effective as drugs in alleviating mild to moderate depression, and health secretary Alan Johnson recently announced millions in new funding for the treatments.
However, this is the first time, according to its authors, that a group therapy has been shown as an alternative to a prescription.
The study, funded by the Medical Research Council, found MBCT, developed in 2002 by a team of psychologists from Canada, Oxford, and Cambridge, was actually more effective than medication in improving patients' quality of life.
The sessions involve the teaching of meditation techniques based on some found in Buddhism.
The aim is to teach skills which help patients recognise and cope with their tendency towards depression.
GP alternative
Di Cowan, from East Devon, had suffered from depression since his late teens.
The 53-year-old said: "It's helped me immensely - it's given me the ability to come up against something that would have previously thrown me, think it through, come up with a solution and then move on.
"My view of the world has changed and I look at life in a new light."
One of those championing the technique is Professor Willem Kuyken, of the Mood Disorders Centre at the University of Exeter.
He said: "Our results suggest MBCT may be a viable alternative for some of the 3.5 million people in the UK known to be suffering from this debilitating condition.
"I think we have the basis for offering patients and GPs an alternative to long-term antidepressant medication."
Marjorie Wallace, the chief executive of mental health charity SANE, said the charity would be helping to fund future research into how "ancient meditative techniques" could work together with modern psychotherapy in people with long-term depression.
She said: "We are delighted that this study shows the potential of Mindfulness-Based Cognitive Therapy as an alternative for the treatment of severe and recurring depression.
"Just one in five depressed callers to our helpline report that they are receiving any kind of talking therapy, which is recommended as a first line of treatment."

The NHS responded to the above article with the following:

Meditation and depression

MBCT involves group sessions
“Buddhist meditation techniques can be just as effective at combating depression as medication,” the Daily Mail reported. It said a study has found that “mindfulness-based cognitive therapy (MBCT)” helps people to focus on the present rather than looking to past or future events. The newspaper continued that 15 months after an eight-week trial in people with long-term depression, 47% of those who had the therapy relapsed compared to 60% of those taking antidepressants.
This well-designed trial has been oversimplified by the news reports. The trial did not compare MBCT alone with antidepressants alone, but examined how relapse rates compared between combined MBCT and antidepressants and simply continuing with antidepressants. Therefore, MBCT cannot be said to be “as effective as medication”. It did, however, significantly reduce the amount of time the participants spent on antidepressants with the same relapse rates.
How comparable Buddhist meditation is to MBCT is also questionable, as the therapy involves a schedule of group education by a trained therapist, of which meditation is only a part.Where did the story come from?
This research was carried out by Willem Kuyken and colleagues from the University of Exeter, the Peninsula Medical School, Kings College London, and Devon Primary Care Trust. The work was funded by the UK Medical Research Council. The study was published in the peer-reviewed, Journal of Consulting and Clinical Psychology.What kind of scientific study was this?
In this randomised controlled trial, the researchers compared the effectiveness of cognitive therapy and ‘maintenance antidepressant’ medication with maintenance antidepressants alone for preventing relapse in people with recurrent depression. Maintenance antidepressants, means the continued use of antidepressants by people who have recovered following treatment for an episode of depression, but the drug is continued at a lower dose with the aim of preventing recurrence.
The therapy that the researchers were interested in was Mindfulness Based Cognitive Therapy (MBCT). It consists of classes involving group-based education in skills for easing distress and preventing the recurrence of depression. It aims to make people more aware of the thoughts and feelings that are counterproductive and contribute to depression and self-criticism. In this study, sessions included mindfulness practises (including yoga and meditation), teaching and discussion, weekly homework and a review of the participants’ experiences.
The researchers recruited 123 people over 18 years of age with recurrent depression who had been diagnosed using recognised criteria. All the participants had a history of at least three previous episodes of depression. They had received MBCT treatment for the previous six months and were now in either full or partial remission and taking antidepressant medication. The researchers excluded those with other psychiatric disorders or substance abuse.
The participants were randomly allocated to either continue on antidepressants alone or have an additional eight-week MBCT course. The course was made up of eight, once weekly two-hour sessions, and four follow-up sessions the next year.
The MBCT included support in decreasing or discontinuing antidepressants. This subject was initially raised with participants during weeks four to five of the regime. Participants were asked to consider decreasing or discontinuing their medication as soon as they and their physician deemed appropriate following MBCT and within six months of the course ending. An ‘adequate dose’ of MBCT was considered to be participation in four of the eight sessions. Medication adherence was monitored by the participants’ self-report at each three-month follow-up and scored on an adherence scale.
The participants were followed up at three-monthly intervals for 15 months. The main outcome that was examined was the relapse or recurrence of depression. Secondary outcomes including cost effectiveness and quality of life measures were also examined, but are not discussed here.What were the results of the study?
Of the 123 participants, 85% completed the study, with exclusions/drop-outs balanced between the two treatment groups. There was generally good adherence to study protocol. The average number of days that antidepressants were taken was significantly shorter in the MBCT group (266 days) compared to those taking antidepressants alone (411 days). At the end of six months, 75% of the MBCT group had stopped taking antidepressants.
There was a general trend towards reduction in the risk of relapse/recurrence among those treated with MBCT and antidepressants compared to antidepressants alone. Over the total 15-month follow-up, 47% of the MBCT patients relapsed compared to 60% of those on antidepressants alone; however, this difference was not statistically significant.What interpretations did the researchers draw from these results?
The authors conclude that in people with recurrent depression, MBCT in addition to antidepressants produces comparable outcomes to antidepressants alone in terms of relapse and recurrence rates, and therefore significantly reduces antidepressant use.
What does the NHS Knowledge Service make of this study?This was a well-designed randomised controlled trial. It demonstrated that MBCT with antidepressants produces comparable outcomes to antidepressants alone in terms of relapse and recurrence rates. MBCT also has significant benefit in terms of helping to reduce antidepressant use.
However, this trial has been over simplified by the news report:
This study was in a very select group of people. All had recurrent episodes of depression, for which they had recently received antidepressant treatment, and were currently receiving lower dose antidepressants. The results cannot therefore be generalised to people with depression who do not fulfil these specific criteria.
Although there was a trend towards reduced relapse and recurrence rates with MBCT, this difference was not statistically significant when compared to taking antidepressants alone.
The news incorrectly refers to the treatment as meditation. Although meditation was involved, this was only a part of the sessions, which involved a complex schedule of group education by a trained clinical psychologist or occupational therapist. This cannot be considered comparable to unsupervised meditation alone at home.
As the researchers state, it is likely the participants had a greater adherence to their medication compared to what would be found in general practise due to the measures that the researchers took to enhance adherence.
The trial could not be blinded and so the participants knew the nature of the trial when they chose to take part. This could have led to some people with an interest in psychological interventions to take part and therefore introduce some possible bias in the results (i.e. believing that MBCT was helping them).
This is the first trial to investigate what is a relatively new therapy (MBCT) and compare it to another active treatment (antidepressant medication). It should be noted, however, that the study only examined whether combined MBCT and antidepressants had a different outcome to taking antidepressants alone. It did not make a direct comparison between MBCT and antidepressants and so it cannot be concluded that one is more effective than the other. Further research into MBCT is required for a clearer picture.
Sir Muir Gray adds...Good study and worth trying. Combine it with an extra 3,000 steps a day as walking is also effective for depression.
Links to the headlines
Meditation 'as effective as medication' in treating depression. Daily Mail, December 01 2008
Group therapy 'beats depression'. BBC News, December 01 2008
Links to the science
Kuyken W, Taylor RS, Barrett B, et al. Mindfulness based cognitive therapy to prevent relapse in recurrent depression. Journal of Consulting and Clinical Psychology 2008
Further readingThere are several reviews in the Cochrane Library that deal with treatments (including psychological) for depression, including the examples below. None specifically considers MBCT.
Lane DA, Chong AY, Lip GYH. Psychological interventions for depression in heart failure. Cochrane Database Syst Rev 2005, Issue 1
Dennis CL, Ross LE, Grigoriadis S. Psychosocial and psychological interventions for treating antenatal depression. Cochrane Database Syst Rev 2007, Issue 3
Jorm AF, Morgan AJ, Hetrick SE. Relaxation for depression. Cochrane Database Syst Rev 2008, Issue 4
Analysis by
Edited by NHS Choices

Saturday, 25 October 2008

Mindfulness Based Cognitive Therapy

Mindfulness based cognitive therapy or MBCT blends two approaches - Cognitive Behavioural Therapy (CBT) and Mindfulness.

In MBCT, the emphasis is on becoming aware of thought processes and their impact in a non-judgemental way. Traditional Cognitive Behavioural Therapy focuses on changing unhelpful thoughts to more helpful, positive ones.

MBCT is based on the eight week Mindfulness Based Stress Reduction (MBSR) Program developed by Jon Kabat-Zinn at the UMASS Medical Centre in Massachusetts. Research has shown that MBSR is very helpful for people with chronic pain, hypertension, cancer, heart disease and digestive disorders, as well as anxiety, panic and stress.