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Information-processing theory of depressive relapse

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Individuals who have experienced major depressive episodes are vulnerable to recurrences whenever mild dysphoric states are encountered, because these states may reactivate the depressive thinking patterns present during the previous episode --> new episode

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MBCT

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- 8 week program based on MBSR - incorporates elements of cognitive therapy

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Decentralization

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A way of observing thoughts and emotions without getting absorbed by it. - "Thoughts are not facts" - "I am not my thoughts"

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Goal of MBCT

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- teaching formerly depressed individuals to observe their thoughts and feelings nonjudgmentally, and to view them simply as mental events that come and go -prevent the escalation of negative thoughts into ruminative patterns

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Clinical depression

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ersistent depressed mood or loss of interest occurs with other reliable physical and mental signs (eg. Difficulty sleeping, poor appetite, impaired concentration, feelings of hopelessness & worthlessness, lack of energy, preoccupation with negative themes or ideas)

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Depression diagnosis

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number of symptoms is present for at least 2 weeks and are shown to interfere with person's ability to perform his or her day-to-day activities

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Four psychological approaches to depression

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- Behavioral therapy - Cognitive therapy - Interpersonal therapies - Cognitive and Interpersonal therapies

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Relapse

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worsening of a previous controlled episode that had not yet run its course

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Different stages of depression

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acute, continuation and maintenance

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Acute treatment

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prescribing antidepressant medication with the aim of relieving current symptoms during an episode

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Continuation treatment

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prescribing antidepressants for 6 months beyond the period of recovery from the episode of depression

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Maintenance treatment

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extending antidepressants for as long as 3 to 5 years following recovery

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Cognitive therapy

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a type of psychotherapy in which negative patterns of thought about the self and the world are challenged in order to alter unwanted behavior patterns or treat mood disorders such as depression. (Aaron T. Beck in the 1960s and 1970s)

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Cognitive therapy techniques

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activity scheduling, rating mastery and pleasure, thought monitoring and challenging, cognitive rehearsal, generating alternative options, and noticing and dealing with dysfunctional attitudes

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Vulnerability

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risk of becoming depressed again once the person has recovered from an episode

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Dysfunctional Attitude Scale

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describes attitudes or assumptions that reflect, as it were, a personal contract for maintaining self-worth → if conditions of the contract are met, the person is fine (not the cause of relapse)

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differential activation hypothesis (teasdale)

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sad moods were likely to reactivate thinking styles associated with previous sad moods - important factors determining whether one's initial depression becomes more severe or persistent are the degree of activation, and content, of negative thinking patterns that become accessible in the depressed state.

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Cognitive reactivity

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tendency to react to small changes in mood with large changes in negative thinking

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Ruminative response style

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some ppl respond to low mood by acting in ways that focus attention on themselves

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Decentering

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decentering means seeing thoughts in a sufficiently wider perspective, to be able to see them as simply "thoughts" rather than reflecting reality

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CT and buddhism

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1) Unhappiness --> Relationship/interpretation to experiences 2) Decentralization of thoughts

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Mindfulness (Kabat-Zinn)

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Mindfulness means paying attention in a particular way: on purpose, in the present moment and nonjudgmentally

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Mindfulness helps in 2 ways

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- Paying attention, individuals take space from their information processing channels -Learn to recognize depression signs early (body, feelingsm & thoughts)

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Attentional control Training (pre MBCT)

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-still very strong CT component (change ppls thougths and beliefs) -Need to solve attitude

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CT AND DECENTERING

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- only focus on the importance of the change in relationship to thoughts (too specific approach) not specific enough: very broad term; it can be done in many different ways, and with different attitudes; decentering = stepping away from (ignoring problem or hoping it will go away; or trying to dissociate from thoughts or feelings to suppress, repress or avoid)

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MBSR AND DECENTERING

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-teaching people to explore how they might have a different relationship not only to thoughts, but also feelings, body sensations, and impulses to act → whole mind-body state : encourages "opening" to the difficult and attitude of gentleness to all experience → welcoming and allowing It also extends to feelings, impulses and body sensations

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aim of MBCT program

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help individuals make a radical shift in their relationship to the thoughts, feelings and body sensations that contribute to depressive relapse

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Discrepancy monitor

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process that continually monitors and evaluates the self and the current situation against a model or standard - an idea of what is desired, required, expected or feared. Once this monitor is switched on, it will find mismatches between how things are and how we think they should be;

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modes of mind

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limited number of core brain activity patterns that seem to crop up as recurring features in a wide variety of different mental activities

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Doing mode

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get things done strategy: discrepancy monitor valuate feelings as "good things" to hang on to or "bad things" to get rid off work out likely future consequences, anticipate what might happen if we reach goal, or look back at memories of times when we have dealt with similar situations to get ideas on how to proceed; mind travels forward to future or back to the past

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Being mode

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not devoted to achieving particular goals mind has "nothing to do, nowhere to go" and can focus fully on moment-by-moment experience, allowing us to be fully present and aware of whatever is here, right now; characterized by direct, immediate experience of the present "decentered perspective"

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Aim of early sessions MBCT

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teach participants to recognize driven-doing mode in its many manifestations and to begin the cultivation of being-mode by intensive, formal mindfulness practice

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Later sessions of MBCT

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training focuses more on recognizing when, in everyday life, negative emotions and reactions trigger driven-doing, and on learning how to disengage from that mode, enter being mode, and how, if necessary, to "turn toward" and explore difficult and uncomfortable emotions.

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Sessions 1-4

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(1) Become aware of how little attention we give to daily life How quickly mind shifts from one topic to another (2) learn how to bring back mind that has wandered (bring it to single focus); first with reference to parts of the body and breathing (3) Become aware of how wandering mind can allow negative thoughts and feelings to escalate without them being aware that it is happening

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Sessions 5-8 (second phase)

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Whenever negative thought or feeling arises, allow it to simply be there, exploring it as it is, before taking steps to skillfully by using specific strategies How? → Become fully aware of thought or feeling → acknowledge it → move attention to breathing for 1 min or 2 → expand attention to body as whole (this is the breathing space): introduced first in session 3

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Breathing space

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essential first step in dealing with difficulties, after which they may choose how to respond THREE STEPS (1) acknowledge what is going on (2) gather themselves by going to the breath (3) expanding focus of attention to sense the wider perspective of the here and now

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Seven signs of driven doing mode

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(1) Living on "automatic pilot" (rather than with awareness and conscious choice) (2) Relating to experience through thought (rather than directly sensing) (3) Dwelling on and in the past and future (rather than being fully in the present moment) (4) Trying to avoid, escape or get rid of unpleasant experience (rather than approach it with interest) (5) Needing things to be different from how they are (rather than allowing them to be just as they already are) (6) Seeing thoughts as true and real (rather than as mental events that may or may not correspond to reality) (7) Treating oneself harshly and unkindly (rather than taking care of oneself with kindness and compassion)

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Experiential learning

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Required skills/knowledge can only be obtained through direct experience

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MBCT learning objectives

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-Concentration -Awareness/mindfulness of thoughts, emotions/feelings, impulses to act, body sensations -Being in the moment -Decentering -Acceptance/nonaversion, nonattachment, kindly awareness -Letting go (learned in body scan) -"Being" rather than "doing", non-goal attainment, no special state (of relaxation, happiness, peace, etc): -Bringing awareness to the manifestation of a problem in the body

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Session 1

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Awareness and Automatic Pilot (e.g. the raisin eating exercise) THEME: we're not aware of what's going on a lot of the time

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Raisin exercise: intentions

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awareness vs. automatic pilot paying attention in detail can reveal things we had not noticed or had forgotten paying attention in this way can transform the experience noticing mind wandering as normal

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Why use the body as first object of attention?

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- what happens in the body importantly affects what happens in the mind -Ppl who have been depressed very often try to think their way out of troubling feelings. An alternative is to bring awareness to manifestations of emotion as physical sensations or felt senses in the body. In time, this allows a shift of the center of gravity of attention away from "being in the head", toward an awareness of the body

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Session 2 & Theme

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Living in our Heads Theme of session 2: Mindfulness of the body provides opportunity to explore a new way of knowing directly, intuitively - "experientially" CT practice: Thoughts and Feelings task Aim: be more aware, more often

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Summary of Intentions for the Body Scan

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-Practice deliberately engaging and disengaging attention -Notice and relate differently to mental states and mind wandering: acknowledge and return to what you had intended to be focused on -Use breath as a "vehicle" to help direct and sustain attentional focus -Allow things to be as they are -Cultivate direct experiential knowledge

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ABC model of emotional distress

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we are in situation (A) and end up with feeling ( C); thought (B) is the link between A and C and often we are not aware of them

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Summary of intentions for the thoughts and feelings exercise

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It is not so much what happens, but what we make of it (meanings, interpretations) that determines our reactions This influences other systems (body state, behavior) Reactions may reflect old, familiar patterns There is no "right" interpretation - everyone has a different angle. Because of this variability, it is easier to see that thoughts are not facts And the same person may have different reactions at different times (e.g., good days vs bad days) Our interpretations of events, and our reactions in the next moment, are central to what keeps depression in place

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AWARENESS OF PLEASANT EXPERIENCES (session 2)

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asked to be aware of different pleasant experiences each day (preferably while it occurs); write down thoughts, feelings and body sensations that accompany the event AIM: to link awareness of the body to awareness of body's reactions and responses to everyday events

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Summary of Intentions for the Pleasant Experiences Calendar

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Brings mindful awareness to the earlies reaction to moment-by-moment experience as pleasant or unpleasant or neutral - a pivotal point in triggering rumination or avoidance Helps ppl notice what positive things may be occurring in their daily lives Allows ppl to become more aware of thoughts, feelings, and body sensations that accompany pleasant experiences Helps ppl to tune into the "felt" dimension of experience is a nonthreatning way Helps ppl to deconstruct fleeting or powerful experiences into constituent elements, such as thoughts, feelings and body sensations

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Sitting meditation

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awareness of breathing as the primary object of attention (single focus) Paying attention to a single focus, the breath, is the next step in training participants to recognize old mental habits as they arise

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Session 3

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GATHERING THE SCATTERED MIND -seeing and hearing meditation -sitting meditation

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Discrepancy-based processing

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Current situation (A) is compared with the desired state (B), and the various possibilities of getting from A to B are considered

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Theme session 3

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Theme session 3: mind is often scattered and lost in thought because it is working away in the background to complete unfinished tasks and strive for future goals; we need to find a way to intentionally come back to here and now

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seeing and hearing meditation

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let go of categories they normally use to make sense of what they are looking/seeing; do not see things but rather patterns of color, shapes and movement

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Sitting meditation

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Breath: (1) takes place in the present; (2) it is always here, always available for focus; (3) by intentionally bringing awareness to the breath, we take up space in the same limited capacity channel that has been filled with ruminative thought → temporary substitute/distraction; (4) attention to breath is opposite of goal orientation → emotional lives: attention to the simple can be more effective than analysis of the comples Aim of sitting meditation: not to prevent mind wandering but to become more intimate with its patterns

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Central intention to first half of program

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train the skill of deliberate focus of attention

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3 minute breathing space

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Three basic steps to exercise: (1) get out of automatic pilot to ask "where am I?", "whats going on?" → recognize and acknowledge experience of the present moment (2) bring attention to breath (3) expand attention to include sense of breath and the body as a whole

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Mindful movement

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build on the foundation of the body scan in learning how we can bring awareness to and "inhabit" body experience/sensation see old habitual patterns of the mind - especially those that emphasize striving work with physical boundaries and intensity, and learn to accept our limits learn new ways of taking care of ourselves

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Unpleasant experiences calendar

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Notice thoughts, feelings and body sensations associated with unpleasantness "What is the weather pattern in body and mind when unpleasantness occurs, and what reactions to this weather do I notice?"

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Session 4

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Recognizing aversion recognize aversion, "stay present" in the face of tendency to chase after the pleasant and avoid the unpleasant

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Theme session 4

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The skill of "coming back" needs to be complemented by seeing more clearly what takes us away into doing, ruminations, mind wandering and worry; experiential investigation of "aversion", mind's habitual reaction to unpleasant feelings and sensations, driven by the need not to have these experiences, which is at the root of emotional suffering; mindfulness helps with taking a wider perspective and relate differently to experience

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Choiceless awareness

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letting go of any particular intentional focus of attention, and instead letting the field of awareness be open to whatever arises in the mind, body and the world around them

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Automatic Thoughts Questionnaire:

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variety of negative statements: participants are asked to reflect on each item

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Kolb's model of adult learning - the "learning cycle"

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1. Experience 2. Reflection 3. Context 4. Invitation

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Instructor Qualities and Attitudes that facilitate Inquiry

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Not knowing - you don't have all the answers Curiosity Kindness and hospitality Embodying the practice Not fixing - solutions are not required Opening the space of dialogue Asking permission Letting go - working with no fixed agenda Asking open-ended questions Humility Avoiding attachment to insight - ask "how" and "what" instead of "why" Flexibility and letting go

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Session 5

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Allowing/Letting Be AIM: Cultivating a different relationship to experience Allowing things to be as they already are.

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Session 5 theme

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relating differently to unpleasant feelings and sensations - allowing things to be as they already are

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Session 6

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Thoughts are not Facts AIM: Why are thoughts so adhesive? Thoughts are best seen as events in the mind.

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(Between session 6 and 7) - A day of Mindful Practice

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Includes all types of meditation: -Sitting meditation (breath, body, sounds, thoughts, and choiceless awareness) -MIndful stretching -Body scan -Informal meditation -Mindful walk -Mountain meditation -Extended breathing space

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Session 7

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"How can I best take care of myself?" -develop relapse prevention plan

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Session 7 Theme

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Using skillful action to take care of ourselves in the face of lowering mood -The exhaustion funnel

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Session 8

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Maintaining and extending new learning

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Session 8 theme

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Planning for a new way of living

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Possible aCtions to be taken after 3 min breathing space

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1. responsive breathing space whenever unpleasant feelings arise (after session 4) 2. responsive breathing space whenever unpleasant feelings are notices, adding a sense of opening to the difficult through the body (after session 5) 3. responsive breathing space as first step before taking a wider view of thoughts (after session 6) 4.esponsive breathing space as first step before taking mindful action whenever unpleasant feelings or thoughts are noticed (after session 7)

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