Written by four luminaries of the mindfulness movement in psychotherapy and counselling, The Mindful Way through Depression is a self-help book in the best sense of the term, and you don’t need to suffer from depression to find it useful.
The Mindful Way Through Depression: Freeing Yourself From Chronic Unhappiness
By Mark Williams, John Teasdale, Zindel Segal, and Jon Kabat-Zinn, 2007. ISBN 9781593851286. Guilford Press. 273 pages.
Mindfulness, the “awareness that emerges through paying attention on purpose, in the present moment, and non-judgementally to things as they are” (p.47), has entered the therapy scene quite forcefully over the past few years — thoroughly divorced from its religious context as a part of contemplative spiritual practices, notably Buddhism, and usually partnered with Cognitive Behavioural Therapy. CBT has long noted that a large proportion of human suffering, and certainly the maintenance of it, is not caused by our actual feelings or thoughts but by our thoughts about them, and the mindfulness element takes this insight one step further. Acceptance and Commitment Therapy and Dialectical Behavioural Therapy, with its central concept of Radical Acceptance, are all parts of the stream.
Mindfulness, in the specific form of MBCT, Mindfulness Based Cognitive Therapy, has been the subject of some exciting research — for example the much cited study from the University of Massachusetts in which a group of participants in an eight week MBCT programme, who suffered from recurring bouts of clinical depression, showed half the relapse rate of the control group. (Teasdale, et al. 2000)
Written by four luminaries of the mindfulness movement in psychotherapy and counselling, The Mindful Way through Depression presents that very eight week programme in detail, making information about the process and methods available to all, rather than leaving them as part of the secret knowledge of the therapist. I find this a refreshingly generous and practical approach.
The book is ordered into sections entitled Mind, Body and Emotion (“Once […] harsh and negative views of ourselves are activated […] they also have profound effects on our body — and then the body […] has profound effects on the mind and emotions”, p. 24); Moment By Moment, Transforming Unhappiness, (“Reconnecting with our feelings — those we like, those we don’t like, and those we don’t know we have”, p. 117); and Reclaiming Your Life. It ends with a useful notes section, including further reading and web resources. A CD, over an hour long, of the same seven guided meditations explained in the book is narrated by Jon Kabat-Zinn and completes the package.
These meditations start with the “body scan”, a relaxation and awareness technique which lands us firmly in our bodies (counterbalancing very well the tendencies of depression, and also of cognitive therapy, to work primarily with the ‘head’). They move on to “mindful standing yoga”, and then to “mindfulness of the breath”, and “mindfulness of the breath and body”, before we come to “mindfulness of sounds and thoughts”. The final technique is a mini-lifesaver called “the breathing space”, which gives instructions for coming back to our own awareness and sense of ourselves in difficult situations, when we start to “lose it” under stress.
The whole idea is that we can always “come back to our senses”, as it were, enter the “being” rather than “doing” mode, “sidestep the cascade of mental events that draws us down into depression” (p. 47) and not be overwhelmed by the panic taking over our bodies. Part of this idea is that the peace, stability, ability to feel really alive in the moment, aware of what we are thinking and feeling and of what we want, all the things that are the most dramatically lost to someone in depression, but that we all maybe would like more of — all these things do not have to be visualised, cultivated or relentlessly “worked on”; and they cannot be bought, sold or learnt; they are already inside us. Our intention to change ourselves, rid ourselves of depression and take ourselves in hand, are examples of the “doing mode” which “focuses on the gap between our ideas of where we are now and our ideas of where we want to be” (p. 64) and thereby creates more conflict as it strives, struggles, evaluates and judges everything in terms of the narrow goal chosen, in terms of successes and, more usually, failures. What we need is already there, and all we need to do is develop a compassionate relationship to it, and a lighter touch — our thoughts are just thoughts, our feelings are just feelings. They may be intense, they may be useful, they may be true. But there is no need to take them all so seriously and get all tangled up in judgements about them and attempts to make them stay, or make them go away, or just make them other than what they are.
The Mindful Way through Depression is a great exposition of what mindfulness is and what it means for human beings, with their seemingly innate tendencies to create stress for themselves. It has a clear, calming tone, plenty of quotes from “real people” who have tackled the exercises themselves, and tell their stories. It is not aimed at therapists or theorists, and although the first chapter is a useful introduction to the phenomenon of depression and does a great job of showing what it feels like on the inside, it does not address itself narrowly to sufferers of depression. It divorces mindfulness from its overtly spiritual aspects, and its connection with Buddhism and other contemplative religious practices, so its appeal is broad and inclusive. It also divorces mindfulness from therapy. What is proposed is a set of techniques used or an attitude taken by the individual (I would argue that the former seamlessly flows into the latter), which is not dependent on a relationship with another, as therapy is. The heart of this kind of healing practice is a state of mind/heart/consciousness and not a dialogue; it is something which, while it might benefit from the supportive atmosphere of a group, in essence must be done alone.
The idea is deceptively simple — what we feel, think and perceive is already here. If we can allow it to be as it is, we will remove at a stroke a large swathe of our mental and physical tension, and be able to use all of our resources to choose how to act in the situation we are in, however difficult it may be. It is not the case that we create all our suffering ourselves and can therefore banish it with a few exercises, but it is the case that the extra layer of suffering we can create by adamantly refusing to accept our actual experience is dispensable.
I find the book particularly good on the depressive habit of rumination, the endless circling of thoughts, mainly concerned about interpretations of past events and worries about the future, and how mindful awareness cuts it off at the root. I also enjoyed its insistence that mindful awareness and acceptance of what is does not mean a rudderless existence, but rather freedom from the entrenched habits of mind which usually “run us” and the ability to make real choices, here and now, with all information we need available to us.
I am of course not coming to this from a neutral perspective. I am a therapist, and although I do not practice MBCT I have found that the insights of mindfulness — that being with and accepting ourselves as we are tends to dissolve mental distress — work in my own practice time and time again. In fact the insights have emerged by themselves from the experience of therapy rather than my signing up to the theory and then applying it. People tend to come to these conclusions themselves, when given half a chance.
In my opinion, this is a self-help book in the best sense of the term, and you don’t need to suffer from depression to find it useful.
Teasdale, J.D.; Z.V. Segal; J.M.G. Williams; V. Ridegway; J. Soulsby; M. Lau. (2000) Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Clinical and Consulting Psychology 68:615-23.
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