Sharp Brains: Brain Fitness and Cognitive Health News

Neuroplasticity, Brain Fitness and Cognitive Health News


Time to adopt Mindfulness-Based Cognitive Therapy (MBCT) as a public health intervention to ease depression?


As near­ly 10,000 fresh­men and trans­fers arrived on cam­pus at the Uni­ver­si­ty of Cal­i­for­nia, Los Ange­les, last fall, they were invit­ed to try some­thing nev­er before offered dur­ing stu­dent ori­en­ta­tion: depres­sion screen­ing.

The hope, admin­is­tra­tors explained, is that by iden­ti­fy­ing their risk for depres­sion, stu­dents can get the sup­port they need before they face the rig­ors of acad­e­mia and the dis­ori­ent­ing expe­ri­ence of liv­ing away at col­lege. There’s rea­son for the con­cern. In 2016, a record high of almost 12 per­cent of UCLA fresh­man report­ed “fre­quent­ly” feel­ing depressed in the past year. And a report from Penn State, draw­ing data from 139 uni­ver­si­ty and col­lege men­tal health ser­vices, found that in the 2015–2016 year, use of these ser­vices increased by 30 per­cent, although enroll­ment grew by just 5 per­cent. This includ­ed “a per­sis­tent increase in ‘threat-to-self’ char­ac­ter­is­tics such as non­sui­ci­dal self-injury and sui­ci­dal ideation.”

The screen­ing initiative—which will be extend­ed to the entire stu­dent body eventually—is part of the UCLA Depres­sion Grand Chal­lenge, a land­mark effort to under­stand one of the most per­va­sive and debil­i­tat­ing health con­di­tions in the world, one that affects an esti­mat­ed 350 mil­lion peo­ple and con­tributes to the sui­cides of 800,000 peo­ple, includ­ing 40,000 Amer­i­cans, every year.

The uni­ver­si­ty launched the chal­lenge in 2015 as a mul­ti­year, inter­dis­ci­pli­nary study to devel­op bet­ter meth­ods of under­stand­ing the genet­ic and envi­ron­men­tal caus­es of depres­sion and to improve detec­tion, eval­u­a­tion, and treat­ment. The goal is ambi­tious: to cut the glob­al depres­sion rate in half by 2030.

This comes at a time when pub­lic health offi­cials around the world strug­gle to get their hands around what is con­sid­ered the lead­ing cause of dis­abil­i­ty among adults, cost­ing some $210 bil­lion in med­ical and long-term care and lost pro­duc­tiv­i­ty hours each year.

That depres­sion has not been iden­ti­fied as our num­ber-one health issue astounds me,” UCLA chan­cel­lor Gene Block said in announc­ing the cam­pus screen­ing pro­gram in Sep­tem­ber 2017.

Unpacking the blues

While men­tal health experts are cau­tious about call­ing depres­sion an “epidemic”—citing bet­ter screen­ing and greater under­stand­ing and accep­tance of the con­di­tion as pos­si­ble rea­sons for increased diagnosis—the num­bers are still star­tling: 350 mil­lion suf­fer­ers world­wide. Accord­ing to UCLA, if you haven’t expe­ri­enced depres­sion your­self, you know some­one who has.

It is also now rec­og­nized as being at the core of numer­ous men­tal health con­di­tions, from bipo­lar dis­or­der (pow­er­ful swings between high and low mood) to post­par­tum depres­sion, just to name a few.

Many of the symp­toms of depres­sion are famil­iar: per­sis­tent low mood, exhaus­tion, loss of appetite and sex dri­ve, an inabil­i­ty to enjoy life or cope with every­day activities—like social­iz­ing or even get­ting out of bed. But some may not be as obvi­ous, such as dis­or­dered and dis­tort­ed think­ing, agi­ta­tion, phys­i­cal aches and pains, and insom­nia.

Yet despite how much we now know about what depres­sion is, we still don’t real­ly know what caus­es it. What we do know is that a vari­ety of wide-rang­ing fac­tors seem to influ­ence a person’s risk of devel­op­ing depres­sion, includ­ing child­hood adver­si­ty; genet­ic make­up; chem­i­cal changes in the brain and body; cer­tain unhelp­ful styles of think­ing and relat­ing; and social, eco­nom­ic, and cul­tur­al depri­va­tion.

The truth is, there are like­ly myr­i­ad inter­re­lat­ing caus­es involved in each case. “We’re all vul­ner­a­ble in a sense because we all have fac­tors that con­tribute to that vul­ner­a­bil­i­ty,” says Zin­del Segal, a pro­fes­sor of psy­chol­o­gy at the Uni­ver­si­ty of Toron­to who spe­cial­izes in depres­sion.

Fur­ther com­pli­cat­ing mat­ters, depres­sion doesn’t always act the same way from indi­vid­ual to indi­vid­ual, or from episode to episode, which can range from mild to severe. An episode can last from a few days to weeks, months, or even years.

All of these fac­tors make treat­ment dif­fi­cult, because each suf­fer­er will need some­thing dif­fer­ent. Indeed, treat­ment for depres­sion is a bit of a guess­ing game, with only a 50 per­cent suc­cess rate with the first inter­ven­tion tried. Anti­de­pres­sants work some­times, but not always. Talk ther­a­pies help some peo­ple, but not oth­ers. Some­one may feel bet­ter with increased social con­tact, a change in rela­tion­ships, or a new job. For oth­ers, becom­ing less busy or start­ing an exer­cise regime is what makes the dif­fer­ence. Some­times the pas­sage of time is what helps. Unfor­tu­nate­ly, because depres­sion plays hav­oc with the capac­i­ty to see things accu­rate­ly, it’s hard for a depressed per­son to know what they need.

And while most peo­ple recov­er from a depres­sive episode, it’s a chron­ic, relaps­ing con­di­tion, with recur­rence ever more like­ly each time it strikes. It’s com­mon­ly accept­ed that if you expe­ri­ence even one depres­sive episode, you have a 50 per­cent greater chance of expe­ri­enc­ing anoth­er.

Dodging the wrecking ball

At this point you might be think­ing, “Now you’re going to tell me that this is where mind­ful­ness fits in.” After all, doesn’t the prac­tice of pay­ing atten­tion to the present moment enhance our abil­i­ty to see clear­ly, sta­bi­lize the mind, and be freed from unskill­ful pat­terns of think­ing and behav­ior? Doesn’t it have salu­tary effects on the mind, brain, and body?

Well, yes. But, also, no.

Psy­chol­o­gists wide­ly agree that mind­ful­ness has an impor­tant role to play in man­ag­ing the condition—as a self-care prac­tice, and by help­ing us to tune in to the nat­ur­al ebbs and flows of ener­gy and mood.

In fact, hav­ing a reg­u­lar mind­ful­ness prac­tice may help some­one who strug­gles with depres­sion to notice when they’re at risk, allow­ing them to take appro­pri­ate action, if not to avoid an episode, then to at least min­i­mize its impact.

I think some­body who has a mind­ful­ness prac­tice and a his­to­ry of depres­sion will know them­selves whether they need rest, or whether it would be bet­ter to walk the dog or go to work,” says Willem Kuyken, a pro­fes­sor of clin­i­cal psy­chol­o­gy at the Uni­ver­si­ty of Oxford, and direc­tor of the Oxford Mind­ful­ness Cen­tre, which has pio­neered mind­ful­ness-based treat­ments for depres­sion. “What’s so beau­ti­ful and trans­for­ma­tive about mind­ful­ness is that it places the wis­dom in the per­son and their own prac­tice. They have a sense of ‘what’s hap­pen­ing with my mind and body at the moment?’ and how to shift from auto­mat­ic pilot to more of an expe­ri­en­tial present-moment mode. From that place they can judge what feels skill­ful and dis­cern­ing.”

One mod­el in par­tic­u­lar, Mind­ful­ness-Based Cog­ni­tive Ther­a­py (MBCT), which offers mind­ful­ness train­ing in con­junc­tion with cog­ni­tive-behav­ioral ther­a­py, appears to be par­tic­u­lar­ly effec­tive. “We’ve got 10 ran­dom­ized con­trolled tri­als sug­gest­ing that for peo­ple with a long his­to­ry of depres­sion, MBCT does much bet­ter than usu­al care,” Kuyken says.

He explains that depres­sion makes some­one more like­ly to react to life’s set­backs with neg­a­tive, judg­men­tal think­ing, which can low­er their mood and trig­ger a new episode. Mind­ful­ness helps cre­ate men­tal space around these thoughts, enabling peo­ple at risk to observe, with kind­ness, the pat­terns of the mind that might oth­er­wise drag them down.

He shared the exam­ple of a for­mer client. “She was a young moth­er who was push­ing her tod­dler son on a swing. It was a hap­py moment, but then a thought popped into her head: ‘I don’t deserve to be hap­py, and this hap­pi­ness won’t last.’ We all have thoughts like this, but for some­one who’s vul­ner­a­ble to depres­sion, those shards of neg­a­tive think­ing can quick­ly spi­ral into a whole bunch of oth­er neg­a­tive thoughts, asso­ci­at­ed emo­tions, and behav­iors.”

For this woman, he says, the thoughts came in the form of “I’m a rub­bish moth­er” and the inter­nal thrash­ing that typ­i­cal­ly fol­lowed. Pri­or to MBCT, he says, going down that path “might have led her to do a ‘duvet dive’ and hide away from the world,” result­ing in more rumi­na­tion and fur­ther­ing the down­ward spi­ral. Instead, she was able to rec­og­nize the destruc­tive pat­tern forming—what she called “wreck­ing-ball thoughts”—and take a side­ways step, allow­ing the thought to pass through her mind with­out being knocked over by it.

Zin­del Segal, one of the cre­ators of MBCT, agrees. “Qual­i­ta­tive analy­ses show the core take­away from MBCT is I am not my depres­sion. That the self is big­ger than that.”

That’s a source of lib­er­a­tion, because they can choose how they want to act, rather than run­ning to the first solu­tions that the mind offers, which can often be reac­tive,” he adds. “Their symp­toms may not reduce to zero, but their well-being and resilience increas­es as they devel­op a dif­fer­ent rela­tion­ship to them.”

There’s a time and place for mindfulness

For the great suc­cess mind­ful­ness, and MBCT in par­tic­u­lar, has shown for help­ing peo­ple with a his­to­ry of depres­sion to avoid or lessen the impact of those depres­sive dips, there are equal­ly strong caveats against using the prac­tice when you’re in the throes of an episode.

It’s very hard to sit and do for­mal med­i­ta­tion prac­tices when you’re depressed,” Segal says. “The exec­u­tive con­trol net­works of the brain are often com­pro­mised when you’re in an episode of depres­sion, and it’s dif­fi­cult to engage.” In oth­er words, when the world goes dim and life feels bleak, your brain might not have the band­width to be a kind, non­judg­men­tal observ­er to its own thoughts, or to grasp the big­ger pic­ture.

Susan Woods, a psy­chother­a­pist and mind­ful­ness teacher in Ver­mont, goes fur­ther: “If some­body is in a major depres­sion episode, mind­ful­ness is use­less. There’s just no ener­gy there, no abil­i­ty to con­cen­trate for any length of time.”

Even if a per­son with depres­sion is able to engage with med­i­ta­tion, there is a risk that height­ened expo­sure to the unpleas­ant symp­toms of their ill­ness, expe­ri­enced while pay­ing mind­ful atten­tion, could actu­al­ly increase their fear and aver­sion, trig­ger­ing a reac­tive spi­ral of deep­en­ing low mood. “There is some evi­dence that vul­ner­a­ble peo­ple exposed to mind­ful­ness can have quite unset­tling expe­ri­ences,” says Kuyken. “That makes com­plete sense,” he says, because when peo­ple are depressed, the mind “can be quite dark and scary.”

Also, if depres­sion seems more to do with a person’s life sit­u­a­tion, rather than their inner pat­terns of think­ing, feel­ing, and relat­ing, they may need assertive action more urgent­ly than med­i­ta­tion. “If some­one is in cir­cum­stances of tremen­dous adver­si­ty or abuse, they first need to get to a place that’s safe,” adds Segal. “If your house is on fire, you need to get out.”

A mindful exception

There are excep­tions to every rule, of course. I learned to med­i­tate toward the end of a two-and-a-half-year major depres­sive episode, and it was the key that released me from a prison of con­stant­ly fight­ing my inner demons, a pat­tern that kept them run­ning ram­pant.

How­ev­er, by the time I start­ed prac­tic­ing, I had already under­gone inten­sive psy­chother­a­py, begun to make much-need­ed lifestyle shifts, and under­stood some of the ingrained men­tal and behav­ioral habits that were main­tain­ing my low mood. Med­i­ta­tion was a vital piece of the puzzle—a prac­ti­cal skill that helped me dis­cov­er the art of let­ting go—but I also remem­ber how tough it was the first times I tried to sit and focus on my breath. It felt like I was going to explode from the inten­si­ty of the sen­sa­tions inside me. It took a lot of com­mit­ment, a lot of sup­port, and a lot of going gen­tly for the prac­tice to bear fruit. In the ear­li­er phas­es of my ill­ness, I doubt it would have helped so much.

A few small-scale stud­ies sug­gest MBCT can help peo­ple in the midst of an episode, but Segal notes the qual­i­ty of evi­dence is low, and Woods points to the fact that the cours­es in these tri­als were often led by very expe­ri­enced teach­ers, who were also spe­cial­ists in treat­ing depres­sion. Kuyken shares their con­cerns: “With vul­ner­a­ble clients, teach­ers need to be well-trained and very skilled in how they teach mind­ful­ness.”

Because it’s so dif­fi­cult for the depressed mind to dis­cern what it needs, the best first step to well­ness is pro­fes­sion­al sup­port. A com­pe­tent ther­a­pist can act as a guide to skill­ful action, help­ing you form a treat­ment plan. This, accord­ing to Woods, is like­ly to include anti­de­pres­sant med­ica­tion, slow­ly build­ing in self-care activ­i­ties that can help sta­bi­lize and ele­vate mood, and cog­ni­tive ther­a­py to help you under­stand and work with your indi­vid­ual trig­gers. There is mind­ful­ness here, but it comes from the ther­a­pist as a wise, com­pas­sion­ate friend—much need­ed when you can’t locate your own inner com­pass.

Once mood has sta­bi­lized, mind­ful­ness train­ing can be part of the plan. At this point, says Segal, a mind­ful­ness-trained ther­a­pist might rec­om­mend a mind­ful move­ment prac­tice. Woods sug­gests short sit­ting prac­tices, such as the three-minute breath­ing space, to be prac­ticed sev­er­al times a day and at the begin­ning of a ther­a­py ses­sion. After a few months of sta­bil­i­ty, it might be time to enroll in a group-train­ing pro­gram, such as MBCT.

Moving forward

So, when depres­sion is present, it prob­a­bly isn’t the time to engage in med­i­ta­tion. How­ev­er, there’s cau­tious opti­mism that when mind­ful­ness is devel­oped and prac­ticed while a per­son is feel­ing emo­tion­al­ly sta­ble, it may increase their abil­i­ty to nav­i­gate dif­fi­cult sit­u­a­tions or emo­tion­al upheavals in the future. In this sense, it may be a pow­er­ful buffer against the ups and downs inevitable in every life.

By show­ing peo­ple sad movie clips dur­ing an fMRI scan, Segal and his col­leagues in Toron­to found that mind­ful­ness prac­ti­tion­ers’ brains showed more acti­va­tion in sen­so­ry pro­cess­ing regions, such as the insu­la and somatosen­so­ry cor­tex, but less acti­va­tion in mid­line pre­frontal struc­tures, which are asso­ci­at­ed with the men­tal rumi­na­tion that is often prob­lem­at­ic for peo­ple with depres­sion. This indi­cates that while mind­ful­ness-trained peo­ple feel their emo­tions intense­ly, they are less like­ly to think that sad­ness is a prob­lem to fix, a cog­ni­tive stance that can lead to depres­sion. Also, a key ele­ment of mind­ful­ness may be a shift to enhanced sen­so­ry expe­ri­ence and a cor­re­spond­ing decrease in “liv­ing in your head.”

Evi­dence also shows that prac­tic­ing mind­ful­ness can start an upward spi­ral of mood and behav­ior, enabling peo­ple to become more ful­ly inte­grat­ed in their lives, and bring­ing with it a greater sense of free­dom and flour­ish­ing. “In the longer term, sus­tained prac­tice is a pro­found gen­er­a­tor of com­pas­sion and con­nec­tiv­i­ty,” explains Segal, “and that starts to change how peo­ple inter­act with one anoth­er. It’s at a much broad­er scale than peo­ple just look­ing to deal with their mind dis­or­der, although that is an impor­tant start­ing point.”

This poten­tial for wider social impact hasn’t escaped the notice of politi­cians: A 2015 report by the Unit­ed Kingdom’s Mind­ful­ness All-Par­ty Par­lia­men­tary Group rec­om­mend­ed that MBCT be made more avail­able in the country’s Nation­al Health Ser­vice, and a glob­al group of policymakers—including U.S. Con­gress­man Tim Ryan—has formed to explore the pos­si­bil­i­ties fur­ther. Mean­while, the Oxford Mind­ful­ness Cen­tre has begun a sev­en-year pro­gram of research into teach­ing mind­ful­ness in schools to see if it can help stu­dents’ resilience as they enter the teenage years, a com­mon age for the first appear­ance of men­tal health prob­lems. “Can we take 11 to 14 year olds,” asks Kuyken, who’s lead­ing the project, “and teach them the skills to pre­vent depres­sion from ever occur­ring?”

Pre­vent­ing depres­sion among those at risk is where more mind­ful­ness train­ing could be, as Segal says, “a pub­lic health win.”

It would have a huge impact on the health land­scape, because peo­ple wouldn’t be com­ing back into treat­ment, and they’d be more effec­tive in par­ent­ing, as part­ners, and at work,” he explains. “They could enroll in all sorts of activ­i­ties that would have much-need­ed effects in areas of well­ness aside from men­tal health.”

Based at UC-Berke­ley, Greater Good high­lights ground break­ing sci­en­tif­ic research into the roots of com­pas­sion and altru­ism. Ed Hal­li­well is a mind­ful­ness teacher and writer, based in Sus­sex and Lon­don, UK. He is author of Into The Heart of Mind­ful­nessHow To Live Well By Pay­ing Atten­tionco-authored The Mind­ful Man­i­festo and teach­es cours­es and retreats to pub­lic groups, in orga­ni­za­tions and to indi­vid­u­als, face-to-face and online via Skype. He is also an advi­sor to The Mind­ful­ness Ini­tia­tive, which is sup­port­ing the Mind­ful­ness All-Par­ty Par­lia­men­tary Group to devel­op mind­ful­ness-based poli­cies for the UK. This arti­cle was orig­i­nal­ly pub­lished on Mind­ful, includ­ing first steps to take when feel­ing the blues.

Related reading:

Leave a Reply...

Loading Facebook Comments ...

Leave a Reply

Categories: Cognitive Neuroscience, Education & Lifelong Learning, Health & Wellness

Tags: , , , , , , ,

About SharpBrains

As seen in The New York Times, The Wall Street Journal, BBC News, CNN, Reuters,  SharpBrains is an independent market research firm tracking how brain science can improve our health and our lives.

Search in our archives

Follow us and Engage via…

RSS Feed

Watch All Recordings Now (40+ Speakers, 12+ Hours)