Mary experiences a whole avalanche of thoughts, feelings and sensations. It is not just the negative matter that caused her to be upset, however, nor is it just the way she found herself trying to deal with it. Instead, it’s as if a whole mode of mind – a complex configuration of moods, thoughts, images, impulses and body sensations – was very quickly wheeled into place in response to the situation. This mode of mind includes both the negative material and Mary’s tendency to deal with it by ruminating.
Like Mary, people who are vulnerable to depression can put much of their time and energy into ruminating about their experience – ‘Why do I feel the way I do?’ Thinking about their problems, their sense of personal inadequacy, they turn things over and over in their minds trying to think their way to solutions and to ways of reducing their distress. But, as Segal, Williams and Teasdale point out, the methods they use to achieve that aim are tragically counterproductive. In fact, when you’re low, repeatedly ruminating – thinking about apparently negative aspects of yourself or of problematic situations – actively perpetuates rather than resolves depression.
What seems to happen is that, at times of low mood, old habits of thinking switch in relatively automatically. That has two consequences: firstly, thinking now runs in well-worn grooves that don’t lead to a way out of depression; secondly, this way of thinking itself intensifies the depressed mood – and that leads to further rumination. In this way a series of self-perpetuating vicious cycles can cause mild and transient low mood to very quickly degenerate into severe, disabling depression.
As Segal, Williams and Teasdale saw it, the task of relapse prevention was therefore to find a way to help patients disengage from negative and self-perpetuating rumination when they felt sad or at other times of potential relapse.
While they were pursuing these questions, John Teasdale, who had long had a personal interest in meditation, was reminded of a Buddhist talk he had attended several years before where the speaker stressed that it is not your experience itself that makes you unhappy – it is your relationship to that experience. This is a central aspect of mindfulness meditation, in which you learn – among other things – to relate to your thoughts just as thoughts. In other words, you learn to see them just as mental events, rather than as ‘the truth’ or ‘me’.
John recognised that this way of ‘decentring’ from negative thoughts, of standing ever so slightly apart from them and witnessing them as an aspect of experience rather being completely immersed in them as the whole of experience, might be a key.
But how could you teach people to do that?
An American colleague, Marsha Linehan, who was visiting John Teasdale and Mark Williams at the Medical Research Council’s Applied Psychology Unit in Cambridge, provided a vital clue. Besides telling them of her own work in helping patients to decentre, she pointed them towards the work being undertaken at UMass by Jon Kabat-Zinn. Looking into his work, they came upon this piece from one of Jon’s books:
It is remarkable how liberating it feels to be able to see that your thoughts are just thoughts and that they are not ‘you’ or ‘reality’ . . . The simple act of recognising your thoughts as thoughts can free you from the distorted reality they often create and allow for more clearsightedness and a greater sense of manageability in your life.
Segal, Williams and Teasdale made contact with Kabat-Zinn and his Stress Reduction Clinic at the UMass Medical Center, began to engage in various ways with his programme and, based largely upon it, formulated their own eight-week Mindfulness-Based Cognitive Therapy (MBCT) programme. Although similar to Kabat-Zinn’s Mindfulness-Based Stress Reduction (MBSR) in many ways, MBCT contains elements of cognitive therapy and theory that address the specific vulnerabilities and exacerbating factors that make depression recurrent.
MBCT itself was originally specifically designed for those vulnerable to depression. Subsequently, variants of it have been developed to help with a wide range of issues: obsessive-compulsive disorder, disordered eating, addiction, traumatic brain injury, obesity and bipolar disorder among others.
When it comes to depression, the results of several large-scale randomised control trials suggest that, for people vulnerable to relapsing depression, a course of MBCT might more or less halve the rate of relapse and, if relapse does occur, those who have trained in MBCT appear to experience it less severely.
My Own History with Mindfulness
I come to this work from a Buddhist background. Born in South Africa and unable to reconcile myself to the apartheid regime, I left there at eighteen and settled in England. Driven to find a framework of values I could depend on and an understanding of how the world worked, I took up a degree in philosophy at the University of East Anglia in Norwich. But that didn’t really fulfil my need. In my final year, though, I had the good fortune to meet a committed practising Buddhist who had come to town to establish a Buddhist centre. He taught me to meditate and that changed everything. I committed to spending the rest of my life devoted to meditation, study, retreat and eventually to teaching others.
I lived sometimes in retreat centres, sometimes in city-based residential Buddhist communities, and gradually came to teach and to publish books on Buddhism (using my Buddhist name – Kulananda), and I thought that was how my life was going to go. For several years I took a kind of digression into the world of business. With a number of Buddhist friends I came to establish a ‘right livelihood’ fair-trade company that dealt in handicrafts from developing countries. The company came to be quite successful in time. At the peak of its success it employed around 200 people, had sales of around £10 million a year and gave its profits – often substantial sums – to various Buddhist charities each year. But running a business turned out not to be what I really wanted to do with myself and in 1988 I returned to a life based more in teaching, studying and meditating.
By 2002, however, more than 25 years after my first introduction to meditation, I began to feel the need to make another change and I looked about for a form of training that would build on my existing skills but which would allow me to earn a living in the world. I thought about training in psychotherapy. After all, I’d had many years doing informal pastoral counselling. Searching one day on the Internet, I came upon a master’s degree programme that was being run at Bangor University in Wales. The programme had originally been founded by Professor Mark Williams, one of the founders of MBCT, with the intention of training up a number of people who could begin to bring mindfulness into various clinical settings. That seemed like a marriage made in heaven to me. I joined the programme and graduated from it in 2006.
Reading Mindfulness-Based Cognitive Therapy for Depression – one of the set texts at Bangor – was a profound revelation for me. Here, for the first time, I saw the coming together of two great streams of tradition: Buddhist psychology, which implicitly informs much of what is found in that book, and Western psychology, founded in the tradition of scientific method, which explicitly informs it. Traditional Buddhist psychology, at its best, is founded on a detailed and scholarly investigation of the elements of experience revealed by a collective endeavour of deep introspection over more than 1,000 years. Plunging in meditation into the depths of their own minds, the founding scholars of Buddhist psychology provide us with profoundly valuable insights into the mechanisms of consciousness and the functioning of perception and experience. Western psychology at its best, on the other hand, brings a highly sophisticated scientific method and a well-developed scientific community to its investigations.
In Mindfulness-Based Cognitive Therapy for Depression I saw the first beginnings of what might be achieved as these two streams began to inform one another. I was deeply inspired by the way the authors illuminated some of the inner psychological processes at work in the client group they were concerned with. When we understand the processes that drive us and that make up our experience, we have a much greater chance of freeing ourselves from their unconscious grip. The intersection of mindfulness and Western science, I saw, opened up huge possibilities for human development