The Mindful Way Through Depression
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Maybe if he mentally ran through his schedule for the day ... that always got him moving, started the ball rolling. But not today. Every appointment, every meeting, each phone call he had to return made him swallow what felt like an iron ball, and, with each swallow, his mind wandered away from the day's agenda to the nagging question that seemed to be with him every morning:
As visions of being unemployed swirl through Alice's head, a deep fear of being unable to do what she needs to do for herself and her kids lurks around the edges of her mind. Not again, she thinks with a sigh. She remembers well what happened when she found out that Burt had been cheating on her and she kicked him out of the house. Naturally, Alice had felt sad and angry, but also humiliated by the way he had treated her. He had been unfaithful. She had wound up feeling that she had \"lost\" her battle to save the relationship. Then she felt trapped by her circumstances as a single mother. At first she had put up a good front for the sake of the children. Everyone was supportive, but there came a point when she thought that she should be over it by now. She couldn't continue to ask for help from family and friends. Four months later, she found herself feeling more and more tearful and depressed, losing interest in the children's choir she directed, unable to concentrate at work, and feeling guilty about what a \"bad mother\" she was. She couldn't sleep, she was eating \"constantly,\" and eventually she went to her family physician, who diagnosed depression.
Alice has recurrent major depressive disorder. Jim may suffer from dysthymia, a sort of low-grade depression that is more a chronic state than an acute condition. The diagnosis doesn't matter that much. The problem for Alice and Jim and many of the rest of us is that we want desperately to be happy but have no idea how to get there. Why do some of us end up feeling so low over and over Why do some of us feel as if we're never really happy but just dragging ourselves through life, chronically down and discontented, tired and listless, with little interest in the things that used to give us pleasure and make life worthwhile
For most of us, depression starts as a reaction to a tragedy or reversal in life. The events that are particularly likely to produce depression are losses, humiliations, and defeats that leave us feeling trapped by our circumstances. Alice became depressed following the loss of her long-term relationship with Burt. At first she was fueled by righteous indignation and tackled single-parenthood with a vengeance. But it was all she could do to take care of things on the home front when she returned from work at night, so she gave up post-work get-togethers with friends, dinner with her mother, and even phone calls to her sister in a nearby state. Soon she felt weighed down by loneliness, crushed by a constant sense of abandonment.
Loss is an unavoidable part of the human condition. Most of us find life an enormous struggle after the sort of crisis that Alice went through, and many of us feel diminished by disappointments in ourselves or others, as Jim did. But embedded in Alice's and Jim's stories are clues to why only some of us suffer lasting effects from such difficult experiences.
Depression is a huge burden affecting millions today and becoming more common in Western countries, as well as in developing countries that are \"Westernizing\" their economies. Forty years ago depression struck people first, on average, in their 40s and 50s; today it's their mid-20s. Other statistics in the box on page 16 show the scope of the problem today, but none may be more alarming than the data showing that depression tends to return. At least fifty percent of those experiencing depression find that it comes back, despite the fact that they appeared to have made a full recovery. After a second or third episode, the risk of recurrence rises to between eighty and ninety percent. People who first became depressed before they were twenty years of age are at particularly high risk for becoming depressed again. What's going on here As psychologists who had been involved in treating and researching depression for many years, three of us (Mark Williams, Zindel Segal, and John Teasdale) wanted to find out. The rest of this chapter, plus Chapter 2, explains what science has learned about the nature of depression and unhappiness and how that knowledge, once we banded together with our fourth author (Jon Kabat-Zinn), ultimately produced the treatment on which this book is based.
Unfortunately, our valiant efforts to figure out how we got where we are turn out to be part of a complicated mechanism by which we get dragged down even farther. The way in which our efforts to understand ourselves can lead to additional problems instead of solutions is a complex story. It starts with a fundamental knowledge of the anatomy of depression and of its four key dimensions: feelings, thoughts, body sensations, and behaviors, through which we respond to the events of life. Key to this understanding is how these different dimensions interact.
When we become deeply unhappy or depressed, an avalanche of feelings, thoughts, physical sensations, and behaviors comes into play, as revealed in the checklist of the hallmark symptoms of major depression (see box, p. 19). The huge emotional upheaval that can come from experiencing loss, separation, rejection, or any reversal that brings a sense of humiliation or defeat is normal. Disturbing emotions are an important part of life. They signal to us and to others that we are severely distressed, that something untoward has happened in our lives. But sadness can give way to depression when the sadness turns into endemically harsh negative thoughts and feelings. This morass of negative thinking then generates tension, aches, pains, fatigue, and turmoil. These, in turn, feed more negative thinking; the depression gets worse and worse and, with it, the hurt. We only compound our feelings of depletion if we deal with them by giving up activities that normally nourish us, like getting together with friends and family who might be a real support for us. Our exhaustion is compounded if we deal with it by simply working harder.
It's not difficult to see how feelings, thoughts, physical sensations, and behaviors are all part of depression. Earlier in this chapter we described the aches that Alice felt after a night of berating herself, the \"iron ball\" that Jim felt like he had to keep swallowing when he thought about what his day held in store. As many of us are only too aware, being \"down\" can make it hard to do much of anything or to make choices that get us where we want to go. What's harder to see is how any one part of this anatomy can trigger the downward spiral and then how each component feeds into and reinforces the others. By this process the state of mind that keeps us unhappy or leaves us vulnerable to depression gets stronger and stronger. A closer look at the parts at this point may help us see the whole more clearly.
If you think back to the last time you began to feel unhappy and describe your feelings, many different words might come to mind: sad, blue, downhearted, miserable, despondent, low, feeling sorry for yourself. The strength of such feelings can vary; for example, we can feel anywhere from slightly sad to extremely sad. It's normal for emotions to come and go, but it is rare for such depressive feelings to occur by themselves. They often cluster with anxiety and fear, anger and irritability, hopelessness and despair. Irritability is a particularly common symptom of depression; when down, we may feel impatient, at the end of our rope with many of the people in our lives. We may be more prone than usual to angry outbursts. For some, especially young people, irritability is a more prominent experience than sadness in depression.
The feelings by which we generally define depression are usually thought of as an end point. We're depressed; we feel sad, low, blue, miserable, despondent, desperate. But they're also a starting point: research has shown that the more we've been depressed in the past, the more sad mood will also bring with it feelings of low self-esteem and self-blame. Not only do we feel sad, we may also feel like failures, useless, unlovable, losers. These feelings trigger powerful self-critical thoughts: we turn on ourselves, perhaps berating ourselves for the emotion we are experiencing: This is dumb, why can't I just get over this and move on And, of course, thinking this way just drags us down further.
\"The book is well written and easy to read....People who are prone to depression, dysthymia, or general unhappiness will find this a helpful new way to reframe their thinking about their issues, and practitioners may also find it a useful basis for counseling.\"
Reviewer: Christopher J Graver, PhD, ABPP-CN(Madigan Healthcare System)Description: Depression is a common psychological disease with many options for treatment, including psychotherapy and pharmacotherapy. Nevertheless, many patients never seek professional treatment. In the growing trend of bibliotherapy, this book provides a self-treatment resource for individuals who suffer from depression or dysthymia.Purpose: The primary aim of this book is provide a self-help resource for depression sufferers. It does so with an eye towards mindfulness-based cognitive behavioral therapy (CBT), combining traditional CBT concepts with mindfulness and meditation.Audience: Persons who have symptoms of depression, dysthymia, or a sense of an unfulfilled life and who are looking for a self-help avenue for treatment are the intended readers. There is no particular expertise or esoteric knowledge required to fully comprehend this book. The authors are outstanding researchers and pioneers in mindfulness-based treatment.Features: This book takes a narrative approach rather than a lecturing approach. The authors convey the sense of a conversation with the reader and impart an understanding of the difficulties faced in depression. The book progresses from an introduction to mindfulness through exercises designed to facilitate awareness of the therapeutic concepts. Vignettes help readers associate with the problems and techniques that are introduced. Small shaded boxes in the margins highlight important concepts and a CD included with the book provides guided meditations. While there are recognizable components of CBT in the book, much of it is focused on changing the readers' attitudes and ways of interpreting the world around them. It would have been nice to see more of the traditional CBT techniques to at least provide a foundation before leaping into mindfulness.Assessment: This is a helpful book for readers interested in mindfulness and meditation approaches to treating depression. The CBT underpinnings are well founded, but there are not a lot of concrete examples or step-by-step methods as in traditional CBT. For readers who prefer a more structured approach to treatment, Feeling Good: The New Mood Therapy , Burns (HarperCollins, 1999), may be easier to follow. Nevertheless, this can be a good resource for individuals wishing to embark on a self-therapy voyage. 59ce067264