Tag Archives: Mindfulness-Based Cognitive Therapy

Petaluma: Training in Mindfulness-Based Cognitive Therapy

text & photos by Dzung Vo
Windswept Trees. MBCT Training, Earthrise Retreat Center, Petaluma, California (2/18/13)
Gratitude
Hope
Connectedness

these three words
express my experience with
the Mindfulness-Based Cognitive Therapy (MBCT) Teacher Training
which is a very skillful application
of mindfulness for preventing relapse of chronic depression in adults

Sitting View. MBCT Training, Earthrise Retreat Center, Petaluma, California (2/17/13)

the five-day training was an interesting hybrid
of a meditation retreat
and professional training workshop
i was fascinated to watch my mind going back and forth
between “just being”
enjoying the breathtaking natural environment
walking, eating, and sitting mindfully
being fully in each breath
and “doing”
watching my analyzing, planning, comparing and judging mind at work

breathing in, i am aware of my thinking
breathing out, i smile …

View from Hill. MBCT Training, Earthrise Retreat Center, Petaluma, California (2/18/13)

how lucky i am
to be able to consider this experience
part of my “work”
more and more, as my work comes from the heart
the line between my profession and my bodhisattva path
begins to dissolve…

Deer Having Dinner. MBCT Training, Earthrise Retreat Center, Petaluma, California (2/18/13)
"May Peace Prevail on Earth." MBCT Training, Earthrise Retreat Center, Petaluma, California (2/21/13)

the faculty
(zindel segal, sarah bowen, and steve hickman)
brought tremendous warmth, gentleness
and clarity of vision
in teaching and embodying the training
the students brought a depth and diversity
of practice and experience
and a bright curiosity

it gives me great hope
to see these practices
skillfully adapted and offered to the world

it gives me great humility
to be a part of this growing “professional sangha”

MBCT Petaluma Class of 2013. Earthrise Retreat Center, Petaluma, California (2/22/13)
MBCT Teacher Training, Petaluma, Class of 2013

i bow deeply to all of you

Dzung Vo and Ken Ginsburg, Philadelphia, 11-21-11I have long had a dream to teach mindfulness practice to adolescents suffering from chronic illness and chronic stress. With my position at the British Columbia Children’s Hospital–and the luxury of having a more functional health care system with sufficient time to spend with my patients and explore issues deeply–I have finally had a chance to start making this a reality.

(see more photos on my flickr set)

Bridging the Hearts & Minds of Youth: February Conference on Mindfulness with Youth in San Diego

Mindfulness, as a powerful and important means of cultivating health, well-being and equanimity, is nowhere more important than in our work with the young people of our society. Alongside the explosive and transformative growth of mindfulness-based programs for adults, there is a particularly heartening and vibrant effort to bring mindfulness to youth of all ages, in a plethora of settings and formats designed to have a significant impact on the lives and futures of literally millions of young people around the world.

To support and grow this important movement, the UCSD Center for Mindfulness has teamed with Stressed Teens to organize and present a first of its kind conference on February 4 and 5, 2012 entitled Bridging the Hearts and Minds of Youth: Mindfulness in Clinical Practice, Education and Research . The intention of this conference is to bring together a number of key thought leaders in the field of mindfulness, both those engaged in bringing it to youth and those whose influence extends well beyond that one area, with the hope that the synergy created by such a gathering will provide further impetus to a growing and important field.

Keynote speakers, breakout sessions and half-day workshops will form the structure of this gathering, but the intention is to create an overall atmosphere of connection, collaboration, encouragement, support and innovation that will inspire attendees to continue or begin the work of teaching mindfulness to the young people with whom they work. A full description of the conference is available on the UCSD Center for Mindfulness Professional Training website, but a  few highlights include:

Rick Hanson, author of The Buddha’s Brain and Just One Thing: Developing a Buddha Brain One Simple Practice at a Time will be presenting a public talk on Friday evening, February 3 entitled “Taking in the Good: Helping Children Build Inner Strength and Happiness” and then will provide a keynote address on Saturday at the conference itself with the intriguing title “Managing the Caveman Brain in the 21st Century”.

Psychologist and well-known mindfulness researcher Amishi Jha will be offering her insights in another keynote address, entitled “From Dazed and Distracted to Attentive and Calm: What the Neuroscience of Mindfulness Reveals”. Dr. Jha will be joining the other keynote presenters, Susan Kaiser Greenland, Pamela Siegle and Chip Wood on a discussion panel on Saturday as well.

Three post-conference half-day workshops will be offered on Sunday, February 5, allowing attendees to deepen their understanding and training in working with mindfulness and youth. Workshops include one by conference co-organizer Gina Biegel, developer of the Mindfulness-Based Stress Reduction for Teens (MBSR-T); another by Randy Semple, who has adapted Mindfulness-Based Cognitive Therapy (MBCT) for children, and a wonderful session on “Nurturing Your Self in Your Work With Youth” offered by mindfulness teacher and holistic physician, Amy Saltzman.

These are just a few of the highlights of this inaugural conference that promises to be literally packed with interesting and engaging speakers, presentations and experiences. Co-organizers Steven Hickman, Director of the UCSD Center for Mindfulness and Gina Biegel, founder of Stressed Teens, hope that this will become an annual event that makes a significant contribution to the field of mindfulness with youth. If you are an educator, therapist, physician, or just a concerned and engaged parent looking to explore how you might integrate mindfulness in your work with youth, you may want to consider joining this impressive lineup of presenters in San Diego at the Catamaran Resort Hotel on February 4 and 5, 2012. Space is limited, register early and receive a $50 Early Bird Discount.

Mindfulness Based Cognitive Therapy 10 Years and Onwards: A Personal Reflection by Zindel Segal

Zindel Segal, Ph.D.

Zindel Segal, Ph.D.

Zindel 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 Retreat Training in MBCT on February 19-24, 2012 at the EarthRise Retreat Center in Petaluma, California. Registration is now open for this experiential training event.

With the 10-year anniversary of the publication of Mindfulness Based Cognitive Therapy for Depression nearly upon us, it is a good time to perhaps stop and reflect on where the field stands at this juncture.

Mindfulness-Based Cognitive Therapy for DepressionFor the past decade John, Mark and I have been largely concerned with reaching the first milestone of treatment development – reliable evidence for MBCT’s effectiveness.   Data from 6 Randomized Controlled Trials and 2 meta-analyses (Hoffman, 2010; Piet & Hoogard, 2011) now indicate that Mindfulness Based Cognitive Therapy is associated with a 50% reduction in depressive relapse risk as well producing symptom relief in  anxiety disorders for both adults (Kim et al., 2010) and children (Semple & Lee, 2011).

Having addressed the efficacy question, we are still left to ponder how exactly this multi-modal treatment achieves its benefits.  For example, what is the relative contribution of cognitive therapy principles versus mindfulness practice to outcome?  What about the role of kindness and compassion, both of which are implicit in the program and, as Willem Kuyken’s work suggests, may be one of the consistent gains reported by participants?

Clarifying mechanisms of action is of more than just academic interest, as it will likely inform the approach taken to training the next generation of MBCT practitioners.  The fact that these are questions being asked shows how far we have come from the early days when MBCT was described as a form of attentional control training.

It is always hard to predict what the next 10 years will bring, but my bet is that efforts to disseminate MBCT via online technologies will start to have an impact.  Online approaches may be a response to the fact that there are still far too few MBCT instructors and too many patients seeking care.  The challenge for online MBCT will be to adapt to an internet friendly format, while holding onto the practice dimension, which however you slice it, always comes down to being a personal, non-electronically mediated experience.  It should all make for a very interesting ride.

References
Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. J Consult Clin Psychol. 2010 Apr;78(2):169-83.
Piet J, Hougaard E. The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: a systematic review and meta-analysis. Clin Psychol Rev. 2011 Aug;31(6):1032-40.
Geschwind N, Peeters F, Drukker M, van Os J, Wichers M. Mindfulness training increases momentary positive emotions and reward experience in adults vulnerable to depression: A randomized controlled trial. J Consult Clin Psychol. 2011 Jul 18. [Epub ahead of print] 
Kim B, Lee SH, Kim YW, Choi TK, Yook K, Suh SY, Cho SJ, Yook KH Effectiveness of a mindfulness-based cognitive therapy program as an adjunct to pharmacotherapy in patients with panic disorder. J Anxiety Disord. 2010 Aug;24(6):590-5. Epub 2010 Apr 3.
Semple R & Lee, J (2011).  Mindfulness Based Cognitive Therapy for Anxious Children.  New Harbinger:  Oakland.

Cheers! Here’s to Wonderful Old Wine in Amazing New Mindfulness-Based Bottles

By Steven Hickman, Psy.D.
Director, UCSD Center for Mindfulness

A colleague of mine emailed me yesterday to ask my advice. She had submitted a paper for publication in a respected scientific journal that looked at one particular aspect of Mindfulness-Based Stress Reduction (MBSR). One of the reviewers, apparently intending it as a significant criticism, asked if MBSR wasn’t just “old wine in new bottles”, noting that Carl Rogers and Gestalt therapists had been bringing mindfulness into psychotherapy years before anyone had heard of MBSR. She wanted to know how to respond to this rather stern criticism of her very thoughtful and innovative work.

I told her that she should agree with the reviewer.

Mindfulness is indeed, VERY old wine. Relatively speaking, MBSR and all the rest of the mindfulness-based interventions being devised and deployed in clinical practice these days are indeed quite new “bottles.” But nobody has suggested otherwise! From the beginning, Jon Kabat-Zinn (MBSR) , Marsha Linehan (Dialectical Behavior Therapy – DBT), Zindel Segal, Mark Williams and John Teasdale (Mindfulness-Based Cognitive Therapy – MBCT) and other treatment developers have openly and reverently acknowledged the very deep and ancient roots of mindfulness, mindfulness practice and the wisdom of drawing on these roots for the relief of suffering.

In his book Full Catastrophe Living, Jon Kabat-Zinn writes:

Although at this time mindfulness meditation is most commonly taught and practiced within the context of Buddhism, its essence is universal. Mindfulness is basically just a particular way of paying attention. It is a way of looking deeply into oneself in the spirit of self-inquiry and self-understanding. For this reason it can be learned and practiced, as we do in the stress clinic, without appealing to Oriental culture or Buddhist authority to enrich it or authenticate it. Mindfulness stands on its own as a powerful vehicle for self-understanding and healing. In fact, one of its major strengths is that it is not dependent on any belief system or ideology, so that its benefits are therefore accessible for anyone to test for himself or herself. Yet it is no accident that mindfulness comes out of Buddhism, which has as its overriding concerns the relief of suffering and the dispelling of illusions. (p. 12-13)

But where the analogy of old wine in new bottles falls apart, is that the “bottles” or the interventions themselves are an integral part of what makes these new programs effective and powerful. These are not meditation classes or silent retreats at remote monasteries, but fully thought out, carefully devised and thoroughly researched psychological interventions that honor the roots of their “wine” and skillfully bring it to suffering individuals in very systematic, deliberate and empirically-supported ways.

A plethora of studies have established MBSR as an effective intervention for addressing the suffering associated with chronic pain, cancer, sleep disturbance, anxiety, and ADHD, just to name a few (Grossman, 2004)(Hofmann, 2010). The 8-week program has been shown to not only reduce a variety of physical and psychological symptoms, but more recently has been shown to bring about structural, measurable changes in the brain itself. Constructed thoughtfully, MBSR has a relatively standardized protocol and logical progression that has consistently (for over 30 years) guided skeptical novices (facing the full spectrum of illness and symptoms, both medical and psychological) through a series of specific exercises and homework practices to a place of ease and equanimity that motivates them to want to continue various forms of mindfulness and meditation practice for years to come.

Focused on helping people alter their relationship with the experiences of their lives (whether those experiences are physical symptoms like pain, or mental phenomena like critical thoughts), mindfulness practice exposes options and flexibility that many never realized they had. One patient of mine with chronic neck and back pain (and significant depression as well) said it best when he noted, “I’ve been a tough guy all my life. I learned to play hurt in sports, to claw my way to the top of my field, and even to fight every day with this horrendous pain. What mindfulness allowed me to do was to see that I could dance with my pain.”

A recent randomized clinical trial reported in the Archives of General Psychiatry by Zindel Segal and his colleagues has established MBCT as an equally effective treatment to antidepressant medication in preventing relapse in previously depressed patients (Segal et al. 2010). Based upon the twin foundations of cognitive behavioral therapy and mindfulness, MBCT is being implemented with a wider and wider variety of diagnostic populations with repeated (if still somewhat preliminary) success. The heart of MBCT is encouraging the patient to simply notice the activity and patterns of the mind, adopting a “decentered” stance toward thinking in which thoughts are experienced as arising phenomena in awareness and not fact or imperative. The patient begins to become aware of the constructions of the mind, the “stories” if you will, that the mind constructs around the actuality of experience. The unreturned wave of a friend soon balloons into yet another indication that one is not worthy of friendship. The flutter of a heartbeat in a stressful situation soon billows into the anxious mushroom cloud of the specter of a heart attack.  And the patient learns to adopt an abiding presence that notices these processes and recognizes the option to not become entangled in them in the way in which they have in the past.

In his 1923 encyclopedia article “Psycho-Analysis,” Freud noted that “the attitude which the analytic physician could most advantageously adopt was . . . a state of evenly suspended attention, to avoid so far as possible reflection and the construction of conscious expectations.”

“Construction of conscious expectations” indeed! And with some perspective and “evenly suspended attention” one can encounter the frightful booming Wizard of Oz and also notice the presence of the pathetic little man behind the curtain. Thoughts are not facts. “Don’t believe everything you think,” says the bumper sticker.

It is my observation that mindfulness, at its essence, is not a treatment in and of itself. It is a very important component of all good treatment, whether explicitly named or not. It is the attitude that we embody when we work with clients and patients, the space we create with them in the therapy room, and healing force that works in them when they encounter what they have often encountered and respond in a healthy way rather than react in a habitual way. And it can also be utilized in a very specific, explicit and replicable way to address a variety of psychological disorders.

I happily and gratefully acknowledge the roots of the old wine in its “new bottles.” And raise my glass to toast those who have applied their considerable wisdom, experience and intelligence to finding ways to relieve suffering in thousands, if not millions of our fellow human beings.

Cheers!

NOTE: This article will be appearing in the upcoming edition of the newsletter of the California Psychological Association.
REFERENCES:
Kabat-Zinn, J. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. New York: Delta. 1990

Grossman, Niemann, Schmidt and Walach Mindfulness-based stress reduction and health benefits: A meta-analysis Journal of Psychosomatic Research/Vol 57 (No. 1), July 2004

Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. J Consult Clin Psychol./Vol 78 (No. 2), Apr 2010

Segal, Bieling, Young, MacQueen, Cooke, Martin, Bloch and Levitan Antidepressant Monotherapy vs Sequential Pharmacotherapy and Mindfulness-Based Cognitive Therapy, or Placebo, for Relapse Prophylaxis in Recurrent Depression Arch Gen Psychiatry/Vol 67 (No. 12), Dec 2010

Humble in the Presence of Learning and Growing: The Experience of Leading a Professional Training

Steve HickmanBy Steven Hickman
For the eighth time in the past five years, I have had the profound honor and deep joy to participate as a teacher in a 5-Day Professional Training Retreat in Mindfulness-Based Cognitive Therapy (MBCT). The training took place at beautiful EarthRise Retreat Center in Petaluma, California and I had the privilege of teaching alongside my friends and esteemed colleagues, Dr. Zindel Segal and Dr. Sarah Bowen.

31 professionals came from as far away as Hong Kong to learn about MBCT andMBCT Professional Training how it is taught, learning “from the inside out” in this amazing retreat format. Early morning movement and meditation practice and periods of silence (including several silent meals) punctuated our five days together in a way that allowed participants to ground their learning in the refuge of mindfulness. They began as students and ended as teachers, in that they first were participants in an actual MBCT group (reacting and responding to the various practices and exercises that are part of MBCT) and by the end of the training they were leading each other through sitting meditations, body scans and more.

Each time that I get to do this I experience something different, and this time what I took away was captured in the comments and questions people offered late in the week. Early in the week I was struck by the virtual collision between the typical ways in which therapists encounter patients and how an MBCT teacher meets those same individuals. Wanting to teach, fix, shift and “improve” is embedded in our training as therapists, but what we are doing here is so different. Gently guiding people to their own discoveries or awarenesses and to trust their direct moment-to-moment experience above all else feels awkward and insubstantial at first.

But oh, those shifts that took place during the week! It was as if the largely internal process of attending non-judgmentally to all that arises and staying rooted in the fullness of the moment, began to blossom and flourish outwardly in the space between teacher and student, therapist and client. What a great honor and privilege it is to be a part of that process, in some small way, and to be reminded of the power and potential of mindfulness practice. To prevent relapse in depression, to facilitate effective psychotherapy, to bring depth and richness to life itself. There are moments when it all becomes more than words can fully express.

A deep and reverent bow to my colleagues, my students, my new friends. Thank you for the honor of your presence and your hard work.

Mindfulness-Based Stress Reduction (MBSR) & Meditation Studies Show Brain-Changing Results

Are you more aware of the “here and now?” Do you feel your developing enhanced learning skills, and your memory is improving?

If so perhaps you have participated in one of our MBSR Programs. Recent studies of MBSR participants are showing these benefits along with an increased ability to regulate emotions.

In the article from the Toronto-based The Globe and Mail, “Meditation alters your grey matter, studies show,” Adrianna Barton reports on these finding, and more.

This article includes insights from Dr. Zindel Segal, professor of psychiatry at the University of Toronto, who developed Mindfulness-Based Cognitive Therapy (MBCT) to treat depression, along with resources for MBSR programs in cities across Canada.

Find information relevant to our own upcoming MBSR classes, special events, upcoming all-day sessions, and other things of interest to people practicing, or inquiring about mindfulness at UCSD Center for Mindfulness.

Article in LA Times today highlights mindfulness-based therapies, especially MBCT

An article by Chris Woolston in today’s LA Times entitled “Mindfulness therapy is no fad, experts say” features an impressive array of researchers, as well as personal accounts of patients, highlighting the power of mindfulness-based therapies. Among those featured in this article is Dr. Zindel Segal of the University of Toronto, one of the founders of Mindfulness-Based Cognitive Therapy (MBCT) and the lead teacher for the UCSD Center for Mindfulness’ upcoming 5-Day Professional Training in MBCT.

An excerpt from the article:

“Mindfulness has become a buzzword, especially with younger therapists,” said Stefan Hofmann, a professor of psychology at Boston University’s Center for Anxiety and Related Disorders.

Mindfulness therapy encourages patients to focus on their breathing and their body, to notice but not judge their thoughts and to generally live in the moment. It may sound a bit squishy and New Agey to some, but Hofmann and other experts say mindfulness has something that discredited theories of the past never had: solid evidence that it can help.

“I was skeptical at first.” Hofmann said. “I wondered, ‘Why on Earth should this work?’ But it seems to work quite well.”

Hofmann and colleagues burnished the scientific credentials of mindfulness therapy with a review article in the April issue of the Journal of Consulting and Clinical Psychology. After combining results of 39 previous studies involving 1,140 patients, the researchers concluded that mindfulness therapy was effective for relieving anxiety and improving mood.

The treatment seemed to help ease the mental stress of people recovering from cancer and other serious illnesses, but it had the strongest benefits for people diagnosed with mood disorders, including generalized anxiety disorder and recurring depression.

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.”