A new study from the University of Oxford finds that mindfulness-based cognitive therapy (MBCT) is just as effective as antidepressants for preventing a relapse of depression. In MBCT, a person learns to pay closer attention to the present moment and to let go of the negative thoughts and ruminations that can trigger depression. They also explore a greater awareness of their own body, identifying stress and signs of depression before a crisis hits.
The study is wonderful news because the relapse rate for major depression disorder is as high as 50 percent for persons who have experienced one episode and as high as 80 percent for people who have experienced two episodes of depression. As my psychiatrist said in our last session, it usually takes less medicine to keep someone well than to get someone well. So that means people can wean off antidepressants with a kind of security net under them, without the high risk of relapse.
However, I’m going to risk the backlash of readers and go against popular opinion when I say that I don’t think mindfulness is a cure-all for depression. It has gotten so much buzz lately that I fear that some severely depressed people out there may make the same mistake I did.
Last year this time, I was immersed in an eight-week intensive Mindfulness-Based Stress Reduction (MBSR) program at Anne Arundel Community Hospital. The course was approved by and modeled from Jon Kabat-Zinn’s incredibly successful program at the University of Massachusetts. I was familiar with Zinn’s writings and had read about the many miracles that mindfulness had brought to his patients, from helping with diabetes and arthritis to heart disease and chronic pain. People with insomnia were sleeping through the night, and diabetics were improving their blood sugar.
I salivated over his pages.
I wanted a miracle, too.
I had been unable to break free of chronic “death thoughts” (“I wish I were dead”) for over five years, and was growing disillusioned with traditional psychiatry, as I had tried countless medication combinations that didn’t seem to do much beyond gift me with lovely side effects, and had been in therapy off and on for 20 years. The only thing that did help was aerobic exercise, so I was swimming more than 300 laps some days to escape the thoughts.
There were three people in our small group of 15 that were clinically depressed at the time, or at least were willing to talk about it. During the sixth class, when the instructor was talking about how to let your thoughts be, I became a little agitated and raised my hand. “Are there ever times when your thought process is so distorted that mindfulness and meditation can’t help you?” I asked.
“You can always shift to another object of attention, like from your breath to sound,” she replied.
“No, I mean, like sometimes if you simply get too frustrated trying to meditate, isn’t it better to go watch a movie or do something that will distract you?” I was thinking of the introduction to The Mindful Way through Depression, when authors Kabat-Zinn, Mark Williams, John Teasdale, and Zindel Segal write:
“It may be wise to not undertake the entire program while in the midst of an episode of clinical depression. Current evidence suggests that it may be prudent to wait until you have gotten the necessary help in climbing out of the depths and are able to approach this new work of working with your thoughts and feelings, with your mind and spirit unburdened by the crushing weight of acute depression.”
I finally quoted Zinn, the Dalai Lama of the MBSR world, to get my point across, and then she agreed with him. But I was relieved when one of my other classmates who had experienced the same kind of debilitating depression I had whispered to me, “I don’t think she has ever been depressed like we have.”
He confirmed what I was thinking during that moment and what has been my experience: mindfulness is better at keeping a person from getting depressed than from pulling a person out of depression.
I say this because I gave the program everything I had. I meditated everyday for 45 minutes for more than eight weeks, read everything I was supposed to for the class, went to a weekly three-hour class, and participated in a retreat. But, upon graduating from the program, I drove home still fighting those damn death thoughts.
I felt like a complete mindfulness and MBSR failure.
What went wrong?
In hindsight, I wish there was more than one paragraph in Zinn’s book about when mindfulness isn’t the solution, about when it’s better to swim laps or ride your bike into town or call a friend you haven’t talked to in a while. I still would have taken the course — and I do feel like I benefited immensely from it — but I would have been more forgiving of myself that it didn’t “work” like everyone else’s magic.
Today I am more aware of my stress reactions and am proactive about reducing my stress before I start wilting. I can identify the thinking patterns that lead to depression, like the inner critic and jumping to the future. Especially beneficial is locating tension in a certain region of my body, and trying to relax it. All of this I learned from the class. And I still meditate — actually it has morphed into prayer, which is a more natural form of meditation for me, and more beneficial (for me).
Mindfulness and meditation may very well keep me from relapsing from depression, now that I am finally without the death thoughts.
I hope so anyway.
But I don’t attach to it the magical properties that I did before, and I think we need to be careful in our optimism.
There are many, many tools to help those of us who are at risk for depression relapse.
Mindfulness is one.