Henry has been feeling down for days, and is afraid that he may be sliding into another severe depression. His last bout, his third, was paralyzing and debilitating, and cost him his boyfriend. He’s fighting his mood by alternately trying to suppress it and struggling to think his way out of it, mostly through rumination and self-blame. Suppression doesn’t work: he inevitably returns to himself and becomes aware, with increasing alarm, of how badly he’s feeling. And when he tries to think his way out of it, he dredges up past pain and worries about the future, which just digs him deeper into the hole. In his imagination, he tries out solution after solution, and feels more and more like a failure because none of his thoughts pull him out of the gathering darkness. Moreover, the more he tries to figure out what’s wrong and fix it, the more obsessed he becomes with what’s happening in his mind; which sets up a vicious circle of increasing withdrawal and self-preoccupation.
While Henry’s internal flailing is dragging him deeper into the quicksand of depression, his fears of relapse are unfortunately not unfounded. Depression is an illness characterized by a tendency to relapse: each episode increases the likelihood of another episode by 16%.
In 2007, a team of researchers went public with a new treatment for depression which appears to reduce relapses significantly. According to their theory of the causes of relapse, Henry is making the common mistake of trying to ward off depression by using what they call the “doing mode.” The doing mode is triggered whenever the mind sees that things are not the way it wants them to be. Whenever that happens, negative feelings are triggered, and the mind tries to find ways out of the pain by reducing the gap between the current and the desired state. This problem-solving mode works very well for things like figuring out how to drive across town, but is counterproductive when applied to internal states. When the doing mode is used on even mild unhappiness by people who have previously suffered depression, it actually seems to set in motion a cascade of increasing unhappiness. This is an important finding, because it’s common to believe that practical, problem solving attitudes which are effective for dealing with problems in the external world also ought to work for managing our internal lives as well. But this assumption appears to be incorrect.
What seems to help prevent a temporary blue mood from spiraling into a black hole of depression is what the researchers call “being mode,” which is characterized by attention to the present rather than the future. In being mode, the focus is on accepting and allowing internal states to be as they are instead of trying to change them. The idea is that when we get out of the way and stop fighting with our moods, they ebb and flow on their own, and are less likely to congeal into deep depression.
There is a well-researched stress-reduction technique which facilitates the transition from doing to being mode fairly easily. In the 1970’s Jon Kabat-Zinn, at the University of Massachusetts Medical Center, showed that mindfulness practice, a traditional Buddhist meditation technique, has measurable benefits in the treatment of heart disease, chronic pain, stress-related gastrointestinal problems, headaches, high blood pressure, sleep problems, and anxiety disorders. He defined mindfulness as “the awareness that emerges through paying attention on purpose, in the present moment, and non-judgmentally to things as they are.” He developed an eight-week program for teaching this form of meditation to patients. Today this program is taught in medical centers all over the country (including Stanford and Kaiser) as Mindfulness Based Stress Reduction (MBSR).
When the researchers used a modified version of MBSR with patients recovering from depression, they discovered that mindfulness can also be a powerful prophylactic against depressive relapse. They found that, in patients with three or more previous episodes of depression, their program, which they call Mindfulness Based Cognitive Therapy (MBCT), almost halved the relapse rate compared to those who received standard treatment alone.
One of the benefits of MBCT is that the practices can be taught in a class format, making it a highly cost-effective form of treatment. Some self-motivated patients can even master the practices completely on their own. The entire eight-week program is available in a book and accompanying CD, called The Mindful Way through Depression (Williams, Teasdale, Segal, and Kabat-Zinn, 2007). A word of caution: it isn’t advisable to do this program while in the depths of a severe depression: its usefulness is in preventing relapse in those who have emerged from an episode of depression. But for those concerned with preventing relapse, this course in mind training may be an important addition to their self-care. In the past four years, I’ve used it with many patients who have dealt with multiple episodes of depression. All of my patients who’ve practiced it have experienced positive results, including Henry, the man I described above, who appears to be nipping a potentially serious relapse in the bud. I highly recommend this program.