Tag Archives: Depression

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.

 

 

MBCT Ushers in the Next Era with Second Edition and Two Innovative Training Opportunities

Mindfulness-Based Cognitive Therapy for DepressionFew psychological interventions have engendered so much promise and delivered on that promise with such impressive clinical outcomes and research findings as Mindfulness-Based Cognitive Therapy (MBCT). The skillful “marriage” of cognitive behavioral therapy and mindfulness practice, MBCT has emerged as an effective treatment to prevent relapse in depression and is yielding good initial results in other settings and with other populations as well. With the imminent publication of the Second Edition of Mindfulness-Based Cognitive Therapy  (Guilford Publications), MBCT has entered it’s next generation, incorporating the ongoing work of co-founders Zindel Segal, Mark Williams and John Teasdale, with the input and efforts of numerous clinicians and researchers worldwide.

Zindel Segal, Ph.D.

Zindel Segal, Ph.D.

“Ten years have passed since the publication of Mindfulness Based Cognitive Therapy,” noted Zindel Segal recently, “and in that time there has been a productive engagement and interchange with clinicians and researchers who have offered and studied the program with their own patients.  Mark, John and I have been fortunate to be involved in some of these discussions and have learned from many ‘early adopters’ as well as from the increasing volume of empirical work that has evaluated and stretched MBCT to novel populations.  The second edition of MBCT gives us an opportunity to embed this ‘crowd sourced’ wisdom and feedback into an updated and expanded version of the book that offers a few refinements to the 8-week program and grapples, more generally, with the question of how the delivery of mindfulness based interventions can be optimized.”

“Kindness and compassion are the ground from which we practice, the ground from which we teach, and the ground that participants may then use in cultivating their own practice.”                 (From the Second Edition)

Perhaps most notable in the new edition is a chapter solely dedicated to the topic of compassion in MBCT. Segal reports that “an oft-repeated question I hear is ‘what is the role of compassion training in MBCT?’  This reflects perhaps the pervasive interest in bringing compassion to patients who are suffering, as well as an enthusiasm for newer protocols that feature compassion training as a central intervention.  The answer with respect to MBCT is not as straightforward as checking whether formal compassion or loving kindness is or is not taught within the 8 weeks.  It revolves around the deeper question of what exactly compassion means in a clinical context and how it can help address the vulnerability or illness perpetuating factors that keep people locked into symptoms and distress.”

FREE CHAPTER PREVIEW!
In advance of the release of the Second Edition of MBCT, Chapter 8, entitled “Pausing for Reflection: Kindness and Self-Compassion in MBCT” is available for free by emailing the UC San Diego Center for Mindfulness at mindfulness@ucsd.edu and requesting a copy.

Book purchasers get access to a companion Web page featuring downloadable audio recordings of the guided mindfulness practices (meditations and mindful movement), plus all of the reproducibles, ready to download and print in a convenient 8 1/2″ x 11″ size. A separate web page for use by clients features the audio recordings only.

As innovative as the MBCT program itself, the 5-day MBCT teacher training offered through the UC San Diego Center for Mindfulness is a “wonderful opportunity to experience the intricate interweaving of mindfulness practice and cognitive therapy skills in the delivery of the 8 week program,” said Segal. “Our days are long and incorporate elements of personal practice and clinical training all held within a retreat framework that clarifies intention, observation and self-compassion in the learning process.  If you are interested in learning the MBCT program ‘from the inside’ this is the best vehicle for doing so.”

For those who already have experience teaching MBCT or Mindfulness-Based Stress Reduction (MBSR) UCSD is now offering an Advanced Training for MBCT and MBSR Teachers taught by experienced teachers and trainers Susan Woods and Char Wilkins. Intended to focus upon universal principles for teaching mindfulness-based interventions. As such, the focus for this training is less about teaching to the structure of MBCT and/or MBSR and more about intentionally embodying mindful presence and strengthening the facilitation of mindful inquiry.

What Are Your Thoughts? We would love to hear your thoughts on the approach of explicitly teaching compassion and lovingkindness practice within mindfulness-based interventions like MBCT, versus the more implicit approach described by Segal et al in the new 2nd edition of the MBCT book (free pdf copy of the chapter available upon request at  mindfulness@ucsd.edu ). Please share your thoughts and opinions below.

CBC News Segment on Mindfulness and Mental Illness Features MBCT and Zindel Segal

Looking for a nice introduction to how and why mindfulness might be helpful in regard to depression and anxiety? This segment from CBC’s The Journal program does a great job of noting how mindfulness has become a standard approach to dealing with mood disorders and features one of the developers of Mindfulness-Based Cognitive Therapy (MBCT), Zindel Segal talking about how it all works.

Lead Author Zindel Segal Comments on Study Comparing MBCT to Antidepressants

Zindel Segal, Ph.D.

Zindel Segal of the University of Toronto, lead author of a recent study published in the Archives of General Psychiatry that found no difference between antidepressant medication and Mindfulness-Based Cognitive Therapy (MBCT) in preventing relapse in depression, spoke with us recently and offered this commentary on the implications of his study.

“With the growing recognition that major depression is a recurrent disorder, patients need treatment options for preventing depression from returning to their lives. Data from the community suggest that many depressed patients discontinue antidepressant medication far too soon, either because of side effect burden, or are unwilling to take medicine for years.  All depressed patients in our study were first treated with an antidepressant until their symptoms remitted.  They were then randomly assigned to come off their medication and receive MBCT; come off their medication and receive a placebo; or stay on their medication. The novelty here lies in comparing the effectiveness of sequencing pharmacological and psychological treatments versus maintaining the same treatment – antidepressants – over time

“Mindfulness-based cognitive therapy teaches skills in emotion regulation so that patients can monitor possible relapse triggers as well as adopt lifestyle changes conducive to sustaining mood balance.  Clinical assessments were conducted at regular intervals, and over an 18 month period, relapse rates for patients in the MBCT group did not differ from patients receiving antidepressants, with both in the 30% range.

“The real world implications of these findings bear directly on the front line treatment of depression.  For that sizeable group of patients who are unwilling or unable to tolerate maintenance antidepressant treatment, MBCT offers equal protection from relapse.  An additional benefite is that this strategy of sequential intervention– offering pharmacological and psychological interventions– may keep more patients in treatment and thereby reduce the high risk of recurrence that is characteristic of this disorder.”

Dr. Segal will be co-leading a 5-day professional training in MBCT through the UCSD Center for Mindfulness in Northern California in February 2011. For more details, see the Professional Training website.

 

 

New Study Highlights the Relationship Between Rumination and Mindfulness

A study just published in the Springer journal Mindfulness by Raes and Williams, explores the relationship between rumination and mindfulness. From the abstract: “when controlling for current depressive symptoms and prior history of depression, mindfulness was significantly negatively correlated with rumination, but it was only associated with the extent to which rumination was experienced as uncontrollable, not with global levels of rumination. Furthermore, mindfulness moderated the relationship between global levels of rumination and uncontrollability of rumination, consistent with the suggestion that high dispositional mindfulness reduces the extent to which ruminative reactions tend to escalate into self-perpetuating and uncontrollable ruminative cycles.”

The authors note that “The specific hypothesis we examined was based on MBCT’s underlying rationale; that rumination occurs to some extent as a common human experience, but becomes particularly dysfunctional when it is excessive and uncontrollable. The idea is that greater skill in mindful awareness, either naturally occurring or cultivated in meditation practices, does not mean that people do not ruminate, but that they are better at noticing it when it occurs, so that they subsequently can disengage from it.”

These findings highlight that it’s not the presence of rumination itself that is the primary issue, but instead it is the person’s relationship with the ruminative thoughts (i.e. seeing them as uncontrollable) that is key. Therefore, one would assume that through formally and systematically cultivating mindfulness (through MBCT or other mindfulness-based interventions), one can cultivate a different (more harmonious and accepting) relationship with rumination and, ultimately, reduce suffering.

New Study Shows MBCT as Good as Antidepressants for Preventing Depressive Relapse

Great new study that shows Mindfulness-Based Cognitive Therapy (MBCT) can be as effective as antidepressant medication for preventing relapse in depression. Dr. Zindel Segal, lead author of the study and co-developer of MBCT describes mindfulness training as: “It’s kind of like going like going to the gym and working a muscle, except in this case you’re not working a muscle in your body, you’re working the muscles in your brain that help you understand and control your emotions.”

Springer Publishes New Journal: Mindfulness

Springer's new journalHow nice to see a major publishing firm come out with a scientific journal dedicated solely to the study of mindfulness. The first volume contains several interesting and intriguing articles.

Mindfulness, Volume 1, 2010

Which article gets your interest? We would love to know . . .

Mindfulness in the popular press

More good press for mindfulness, this time from cnn.com.