Tag Archives: Depression Research and Treatment

Learning to Teach MBCT Practices Via the Web: Technology Supporting Teacher Development

By Zindel Segal, PhD and Sona Dimidjian, PhD

Online Training for Teaching Mindfulness In Your Clinical Practice

Z MindfulNoggin_email_adIt was February in 2010, Sona and I were at the end of the fourth day of teaching together a five-day intensive training in MBCT. We were sitting in the lodge of the meditation retreat center in Joshua Tree, California enjoying the beauty, silence, and spaciousness of our surroundings and beginning to engage a question raised by participants in that workshop, like many before them and many to come: how do I carry all that I have learned back into my daily life and work setting? It is a common reaction among participants who have taken MBCT clinical workshops. It usually surfaces towards the end of the training and is expressed in questions such as ‘what comes next?’ or ‘how can I support my learning?’. As we reflected on these questions, we realized that some of the searching arose from the very natural apprehension about returning to solo practice after days of instructed group learning and returning to the hustle and bustle of daily life after engaging deeply the practices of MBCT in a retreat setting. At the same time, however, we also heard in these questions a desire for more support, guidance and community in their intention to integrate the skills and practices they had learned over the week. We began to wonder about ways in which we could support such intentions, building on what we could provide during in person workshops. How could we best support practitioners as they worked to strengthen the experiential and content learning that comes with personal practice and clinical implementation?

mmb-enroll-imgThe issue resurfaced in an interesting way, during our collaboration to develop an online version of Mindfulness Based Cognitive Therapy. We evaluated this digital version of MBCT – called Mindful Mood Balance – in a quasi-experimental open trial with 100 recovered depressed patients at Kaiser-Permanente Colorado and got promising results, Sona Dimidjian, S. Beck, A. Felder, J. Boggs, J. Gallop, R. & Segal. Z. (in press). Web-based Mindfulness-Based Cognitive Therapy for reducing residual depressive symptoms: An open trial and quasi-experimental comparison to propensity score matched controls. Behaviour Research and Therapy. We are continuing this work on extending MBCT for patients with a recently funded, larger definitive, randomized trial that we will conduct with recovered depressed patients reporting residual depressive symptoms (R01 – MH102229). As we developed Mindful Mood Balance, we began to realize that it was one way we might respond to the questions that were raised at the Joshua Tree retreat center in 2010. Mindful Mood Balance was built to teach patients explicitly some of the core skills of MBCT, but it also might be a valuable resource for clinicians who want to get the “feel” of the MBCT curriculum as it unfolds over time and who might benefit from the structure of an 8-week program in supporting their own practice of the core elements of MBCT. With this knowledge in mind, we also began to imagine other ways in which we could offer training to clinicians on some of the more subtle and challenging aspects of delivering MBCT. We built a program that taught therapists the detailed use of one of the core MBCT skills, the three minute breathing space, which they could use with their clients. We didn’t see either of these offerings as a replacement for in person training, but as another option in the array of treatment/ training resources, with distinct advantages of being able to learn from one’s home on one’s own schedule. .

The Three Minute Breathing Space Course, for example, teaches therapists how to deliver this practice, how to perform inquiry, how to make one’s own recordings and how to integrate the practice into daily life.

Therapists can also participate in a community of learners who are taking the course at the same time. Provided there is interest and benefit, our vision would be to build more contexts for learning responsive to what clinicians find challenging in delivering MBCT.

We have partnered with eLearning experts Brian and Traci Knudson in order to integrate clinical science and leading e-Learning technology, in courseware for health care professionals who want to enhance and enrich their clinical practice through delivering compassionate and effective mindfulness-based interventions. While it is still early days, we are curious to find out whether such modern / technological means can help support others in their use of these ancient / simple practices.

zindel_segal_120x1561Zindel Segal is one of the co-founders and developers (along with John Teasdale and Mark William) of Mindfulness-Based Cognitive Therapy (MBCT). Dr. Segal, along with Sarah Bowen and Steven Hickman, will be leading a 5-Day Professional Training Retreat in MBCT on February 15-20, 2015 at the EarthRise Retreat Center in Petaluma, California. Registration is now open for this experiential training event.

 

 

Mindfulness Interventions for Bipolar Depression

Dr. Marchand is an investigator at the George E. Wahlen Veterans Administration Medical Center in Salt Lake City, Utah and Assistant Professor of Psychiatry at the University of Utah.

Bipolar disorder is a severe psychiatric illness characterized by episodes of depression as well as periods of elevated mood, known as mania. This condition, previously known as manic-depressive illness, causes considerable suffering and disability. Furthermore, bipolar depression is often difficult to treat and associated with anxiety symptoms and an increased risk of suicide. Thus, additional treatment approaches are needed. Interventions that target anxiety and suicide risk, in addition to depression, could be particularly useful.

Mindfulness-based interventions have demonstrated effectiveness for symptoms of unipolar depression (major depression not associated with manic episodes) and anxiety. There is also evidence accumulating that these approaches may help reduce suicide risk. Therefore, I recently reviewed the literature to determine whether clinical trials of mindfulness-based approaches for bipolar depression are warranted. The results of that review were recently published in Depression Research and Treatment.

Several lines of evidence support studies of mindful-based interventions for bipolar depression. From a psychological perspective, bipolar depression appears to be associated with abnormal self-referential thinking, as has been established for unipolar illness. Further, ruminative analytical thinking about the self may contribute to symptom expression in both disorders. Thus, the practice of mindfulness would be expected to be beneficial for bipolar depression as a result of decreasing maladaptive self-focused thinking patterns. Similar mechanisms might also contribute to decreased suicide risk among those suffering from this condition.

Brain imaging studies also support clinical trials of mindfulness-based interventions for bipolar depression. Evidence links the function of the cortical midline structures with both emotional dysregulation and self-referential thinking in unipolar illness. Therefore, this brain region may mediate the relationship between aberrant self-referential thinking and negative emotion in major depression. Some evidence suggests that similar mechanisms may play a role in bipolar depression. Thus, while unipolar and bipolar depression are different psychiatric disorders, similar psychological and neurobiological mechanisms may underlie symptom expression in both conditions. This suggests that the response to mindfulness-based interventions may be similar across the disorders and provides a theoretical basis for the study of these approaches for bipolar depression.

A few studies (see references) have provided early evidence that mindfulness-based treatments may be useful for bipolar disorder. Moreover, diverse lines of investigation provide a conceptual background supporting continued clinical trials of mindfulness-based approaches for bipolar depression.

Please see Mindfulness Interventions for Bipolar Depression by William R. Marchand, MD for a free download of the complete review.

References:

P. Chadwick, H. Kaur, M. Swelam, S. Ross, and L. Ellett, “Experience of mindfulness in people with bipolar disorder: a qualitative study,” Psychotherapy Research, vol. 21, no. 3, pp. 277–285, 2011.

W. R. Marchand, J. N. Lee, C. Garn et al., “Aberrant emotional processing in posterior cortical midline structures in bipolar II depression,” Progress in Neuro-Psychopharmacology and Biological Psychiatry, vol. 35, no. 7, pp. 1729–1737, 1729.

W.R. Marchand, “Self-Referential Thinking, Suicide, and Function of the Cortical Midline Structures and Striatum in Mood Disorders: Possible Implications for Treatment Studies of Mindfulness-Based Interventions for Bipolar Depression,” Depression Research and Treatment, doi: 10.1155/2012/246725

B. Weber, F. Jermann, M. Gex-Fabry, A. Nallet, G. Bondolfi, and J. M. Aubry, “Mindfulness-based cognitive therapy for bipolar disorder: a feasibility trial,” European Psychiatry, vol. 25, no. 6, pp. 334–337, 2010.

J. M. G. Williams, Y. Alatiq, C. Crane et al., “Mindfulness- based cognitive therapy (MBCT) in bipolar disorder: preliminary evaluation of immediate effects on between-episode functioning,” Journal of Affective Disorders, vol. 107, no. 1–3, pp. 275–279, 2008.