Mindfulness of Mind
Dispassionately observing what goes on in our mind is one of Buddhism’s central practices. As Michael Stroud reports, the technique is being used to work with a variety of mental health problems, including depression.
Twenty-three years ago, during a weeklong Zen retreat in Taiwan, I entered a depression so profound I wondered if I would ever emerge. It took nine months of intensive psychotherapy to recover, and when I was done, I had left Taiwan, my fiancée, and my meditation practice.
In the decades since, I’ve benefited from new talk therapies and medicines designed to short-circuit depression. And to my surprise, I’ve also found that meditation—gingerly restarted after years of abandonment—has played an essential role in my mind’s healing.
I’m hardly alone in that discovery. A growing number of researchers and clinicians, many drawing from their own Buddhist practice, are exploring how meditation can be used to treat depression, anxiety, ADHD, drug and alcohol abuse, personality disorders, even sexual dysfunction.
Happily for people like me, one of the first fruits of that research is a depression therapy that combines mindfulness meditation with the leading therapy for depressed patients. Called Mindfulness Based Cognitive Therapy, or MBCT, the treatment leans heavily on Jon Kabat-Zinn’s groundbreaking work using mindfulness meditation to reduce stress and pain in patients.
Kabat-Zinn and the three researchers who co-developed MBCT—University of Toronto professor Zindel Segal, Oxford University professor Mark Williams, and retired U.K. Medical Research Council scientist John Teasdale—have recently published a book for the general public called The Mindfulness Way for Depression: Freeing Yourself from Chronic Unhappiness. It offers a new path to patients who have suffered repeated depressive episodes and have resigned themselves to illness, medication, and hopelessness.
“One of the messages of this book is that whatever arises in your life, no matter how awful, no matter how dark, is workable,” Kabat-Zinn said in an interview. “Everything is biology, but that doesn’t mean biology cannot influence itself. Other mind states can work to assuage what comes from high levels of mental conditioning.”
Depression, he concludes, “is not a life sentence.”
This flies in the face of medical orthodoxy, which holds that patients who have suffered three or more incidents of major depression should stay on a maintenance dose of medication for the rest of their lives.
But yesterday’s orthodoxy is melting in the face of new understandings about the brain’s plasticity. Once thought to begin dying at age five, the brain is now believed to change throughout life, actually altering its physical and chemical structures in response to experience. For the treatment of mental illness, the implications are huge: if “bad” habits like rumination and self-criticism can harm the mind, then “good” habits like meditation can heal it.
Studies of meditators have played an important role in this new vision of the brain, particularly the work of University of Wisconsin researcher Richard Davidson. His brain scans of Tibetan monks showed distinct changes in the hippocampus and frontal lobes when the monks entered meditative states. That raises a tantalizing question: if monks can change their brains using meditation, why can’t people struggling with mental illness be taught to do it,too?
They can, asserts Jeffrey Schwartz, a UCLA psychiatry professor who has successfully used mindfulness meditation to treat obsessive compulsive disorder.
“Before this work on self-directed neuro-plasticity, it was assumed that if you had a genetically inherited tendency to develop mental illness, the only thing that could be done about it was to treat the brain itself, usually with drugs, psychosurgery, or putting electrodes in the brain,” says Schwartz, author of the book Mind Lock. “That is not a scientifically justified statement anymore. Now we know that the mind can change the brain. We can use the power of directed attention to change brain function both in conjunction with appropriate medication or, if you're fortunate enough, in place of medication.”
Overwhelmingly, recent research on meditation and mental illness has focused on mindfulness meditation, also known as vipassana meditation. To make it palatable to non-Buddhists in the West, researchers and clinicians have stripped away vipassana’s South Asian cultural and ritual baggage and presented it as a simple way to walk through mental and emotional turmoil—much, perhaps, as the Buddha himself did 2,500 years ago.
Here’s a sampling of some of the recent research examining the effectiveness of mindfulness and other forms of meditation in treating psychological problems:
* Stanford University psychologist Philippe Goldin and colleagues are exploring the impact of mindfulness meditation on social anxiety.
* At UCLA, Drs. Lidia Zylowska and Susan Smalley are developing a meditation-based treatment for children and adults with ADHD.
* University of Washington psychologist Marsha Linehan has incorporated elements of mindfulness meditation and Zen into dialectical behavior therapy, designed originally to treat Borderline Personality Disorder, but also applied successfully to a wide range of other disorders such as suicidal depression.
* Linehan’s colleague G. Alan Marlatt demonstrated reduction in alcoholism and drug abuse among prisoners in a study funded by the National Institutes of Health.
* An international team of researchers from the U.S., Italy, and New Zealand published an article in Behavior Modification on how “individuals with mental illness can control their aggressive behavior through mindfulness training.”
* Stephen Hayes of the University of Nevada has integrated Buddhist meditation into a new program called Acceptance and Commitment Therapy.
* Kristin Neff of the University of Texas in Austin is examining the use of “self-compassion” in building self-esteem and psychological health.
* University of British Columbia researcher Lori Brotto and Julia Heiman of the Kinsey Institute published a paper earlier this year discussing the use of mindfulness in the treatment of women with sexual problems.
One of the most promising uses of mindfulness meditation is in combination with cognitive therapy as a treatment for depression. Developed by Dr. Aaron Beck at the University of Pennsylvania in the 1950s, cognitive therapy asks patients to write down their self-condemning thoughts as they arise, label them (“magnification” or “all-or-nothing thinking” are two common labels), and then write out a rational thought to replace the dysfunctional one.
For example, “I’m a failure” is an example of all-or-nothing thinking and might be met by a reply of, “I’m good at some things and not so good at others, just like all human beings.” The therapist’s job is to teach patients the technique and then give them “homework assignments” designed to help them meet the challenges of everyday life.
This isn’t just good psychotherapy, it’s also good Buddhism. In a meeting last year with Beck at a cognitive therapy conference in Sweden, the Dalai Lama compared cognitive therapy to Buddhist analytical meditation used to combat “toxins” such as anger, envy, and cravings. Beck later wrote that he was struck by the importance in both systems of acceptance, compassion, knowledge, and understanding.
Zindel Segal was also struck by these similarities when he and colleagues John Teasdale and Mark Williams began studying how Kabat-Zinn’s hugely successful Mindfulness Based Stress Reduction courses at UMass Medical Center might prevent depressed patients from relapsing.
Through mindfulness meditation, Kabat-Zinn and his colleagues at the Center for Mindfulness in Medicine, Health Care, and Society were teaching patients with serious illnesses to neither ignore their pain nor compound it by struggling against it. This compassionate attention, Segal and his colleagues realized, might be the perfect medicine for patients who had suffered three or more bouts of serious depression. Studies have shown that more than 90 percent of these patients will have a relapse at some point in their lives.
In MBSR, patients learn a range of mindfulness practices, such as scanning their body sensations, following their breath, and watching their thoughts and feelings as passing events in the field of their awareness. By applying moment-to-moment, non-judgmental attention to their perceptions, body sensations, emotions, and thoughts, patients experience a new and more accepting way of being. Interestingly, although they are not trying to fix or change anything, things often do change—on their own and for the better.
“In cognitive therapy, relapse prevention is dealt with by getting patients to pull out their therapy materials if they notice that symptoms are beginning to reappear,” Segal says. “On the other hand, mindfulness is something that can be practiced anywhere.”
Subsequent studies have confirmed the usefulness of mindfulness for depressed patients. People who had suffered three or more depressions and who were taught the principles of mindfulness meditation experienced a 50 percent lower rate of remission. Segal is currently recruiting patients for an NIH-funded study to see whether patients who are weaned from medication are less likely to relapse if they practice MBCT.
There is a caveat. “MBCT works best when patients are no longer in the throes of a depression,” Segal says. “People who are very depressed find it very hard to sit.”
Curiously, MBCT had no effect on patients who had suffered only two major depressive episodes. The less-afflicted patients, Segal says, are less likely to faithfully continue doing MBCT after they’ve completed a course of instruction; more afflicted patients have what he calls the “gift of desperation”—the certainty that despair will return.
Cognitive therapy helped me survive the worst of a depression by using the antidote of “good thoughts” to offset the despair of “bad thoughts.” My best hope for not suffering another major depression lies in accepting my propensity for it—neither imagining I’m free of it nor dreading its arrival. In an absolute sense, depression and other manifestations of the suffering mind aren’t good or bad, desirable or undesirable, bearable or unbearable. They are simply ruts in the path that some of us take through life. We may trip and fall more than some people. But if we meditate, we’re more likely to keep our eyes on the road.
Michael Stroud is a freelance writer living in southern California. His articles have appeared in the New York Times, Los Angeles Times, Asian Wall Street Journal, and other publications.
Mindfulness of Mind, Michael Stroud, Shambhala Sun, March 2008.
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