Mindfulness-Based Cognitive Therapy a Primer Dr. Kerri McGuire Women’s Health Issues April 26,...
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Transcript of Mindfulness-Based Cognitive Therapy a Primer Dr. Kerri McGuire Women’s Health Issues April 26,...
![Page 1: Mindfulness-Based Cognitive Therapy a Primer Dr. Kerri McGuire Women’s Health Issues April 26, 2007.](https://reader035.fdocuments.us/reader035/viewer/2022062517/56649e865503460f94b888ad/html5/thumbnails/1.jpg)
Mindfulness-Based Cognitive Therapya Primer
Dr. Kerri McGuire
Women’s Health Issues
April 26, 2007
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Outline
• The Territory of Depression
• Why does depression recur?
• Mindfulness-Based Cognitive Therapy (MBCT)
• Future Directions
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The Territory of Depression
• WHO predicts that by 2010 depression will rank second to cardiovascular disease in economic and personal costs.
• Chronic illness, typically with several recurrences
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Rates of Depressive Relapse Over 15 Years
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Risk Factors For Depressive Relapse
• Number of Past Episodes of Depression
• Family History of Depression
• Significant Losses/Stressors
• Cognitive Reactivity to Sad Moods
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Qualities of Relapse-Related States of Mind
Automatic - Little intentional control of attention
- Avoidant or suppressive
Ruminative and Centered on Self -Strong identification with thoughts and feelings
-Strongly correlated with the past # of depressions
-Gender differences in rumination correlate with gender distribution in depression
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Rumination Can Be Seen To Be Emotional Wisdom
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Posi
tive
Belie
fs A
bout
Rum
inat
ion
Formerly Depressed Never Depressed0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
Prob
lem-S
olving
Ef
fectiv
enes
s
Ruminating in SadMood
Ruminating in NormalMood
P<.002; Watkins & Moulds (2005)P<.02; J Pers & Soc Psych (2000)
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Qualities of Relapse-Related States of Mind
Content
- “In order to be happy, I must be……” - “Admitting to your mistakes is a sign of weakness” - “If others look to me for guidance, it would make me
feel important”
Process
- What does feeling this way say about me? - Why is this (sadness) happening to me? - How can I change this (sadness)?
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Mindfulness-Based Cognitive Therapy
An Integration of MBSR and Cognitive Therapy
A Blend of Acceptance and Change models
Customized for Depression
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Mindfulness-Based Stress ReductionMBSR
• University of Massachusetts Medical Center,
Stress Reduction Clinic,1979
– Jon Kabat-Zinn, Ph.D., founder– 8 Week Program– Participants with a wide range of medical problems, including
chronic pain, anxiety disorders, depression, hypertension, heart disease and cancer.
– Program outlined in the book “Full Catastrophe Living, Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness”
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Mindfulness means paying attention,
in a particular way,
on purpose,
in the present moment,
and non-judgmentally
Jon Kabat-Zinn
A Definition of Mindfulness
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How Does Cognitive Therapy Prevent Depressive Relapse?
Teaches Patients in Depressed Mood to:
-Switch out of a habitual cognitive mode of mind
-Decenter - thoughts are not necessarily me and not necessarily true
-Turn towards the Difficult
-Change Degree of Belief
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How Does MBCT Prevent Depressive Relapse?
Teaches Recovered Depressed Patients Regardless of Mood:
-Automatic to Intentional Mode
-Avoidance to Curiosity & Acceptance
-‘Thinking About’ to ‘Directly Experiencing’
-Judging & Fixing to Non-Doing & Being
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The Nature of the Work in MBCT
• Systematic Training to Become More Aware
– Moment to Moment– Bodily Sensations– Pleasant & Unpleasant Events– Thoughts & Feelings as Mental Events
• Formal Practice
– Body Scan– Mindful Stretching/Yoga– Mindfulness of Breath/Body/Sounds & Thoughts
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The Nature of the Work in MBCT
• Opportunity to Be Mindful Using Activities
– Investigating Pleasure & Mastery– Taking Skillful Action – Preparing for Relapse– Inquiry/Discussion of Symptoms & Experiences of Depression
• Informal Practice
– 3 Minute Breathing Space– Mindfulness of Everyday Activities
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3 Minute Breathing Space
Provides a way to step out of automatic pilot mode and reconnect with the present moment
• AWARENESS• Acknowledge & register your experience, even if it is
unwanted
• GATHERING• Bring full attention to the breath, as an anchor
to awareness & stillness
• EXPANDING• Awareness of the body as a whole, your posture
and facial expression
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Rates of Depressive Relapse for Patients with 3 or More Past Episodes
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100
% R
elap
se F
ree
10w
eeks
20w
eeks
30w
eeks
40w
eeks
50w
eeks
60w
eeks
1 Year Follow Up
TAU
MBCT
P<.005; J Consult Clin Psych (2000)
MBCT 66% TAU 34%
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Single Site Replication1 Year Follow Up
0102030405060708090
100
% R
ela
ps
e F
ree
TAU MBCT
3+Previous MDD
TAU 22%
MBCT 64%
P<.05; J Consult Clin Psych (2004)
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Meditation and the Brain
• Frontal - Limbic pathways
• Numerous studies ongoing
• Meditators versus non-meditators
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PET Scans and Meditation
Dorsal Lateral Prefrontal Cortex
Left associated with feelings of happiness & well-being and approach behaviours
Right associated with feelings of distress and avoidance behaviours
Meditation
Increased left sided anterior activation compared to controls
Over 8 weeks participants began to shift in the same direction as Buddhist monks
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Future Directions and Research
• Pilot Studies:
– Anxiety disorders including panic disorder without agoraphobia
– Actively depressed– Co-occurring addictive and mood
disorders– Binge eating disorder– Immune response to Influenza vaccine
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Summary
• MBCT was designed to reduce relapse by helping patients disengage from ruminative thinking triggered by sad moods.
• MBCT helps patients shift their relationship to thoughts/ sensations/feelings without trying to change belief in thought content.
• It is ideal for patients in recovery because depression need not be present for them to practice
• Shown to reduce relapse rate by 50% in patients with recurrent depression.
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Resources• Books:
– Full Catastrophe Living, by Jon Kabat-Zinn– Heal Thyself; Mindfulness in Medicine, by Saki Santorelli– Mindfulness-Based Cognitive Therapy for Depression, by Z.
Segal, J. Williams & J. Teasdale– Wherever You Go There You Are, by Jon Kabat-Zinn
Web Sites:www.ottawamindfulnessclinic.comwww.umassmed.edu
Dr. Kerri McGuire: [email protected]