Meditation in psychology & medicine.

Mindfulness based cognitive therapy & stress reduction.

(This article was published in Dutch in the “ Psyche” magazine, dec. 2003.      Download )

MBSR is an 8 week program for people with chronic disease or stress from daily life challenges. Stress reduction, medical symptom reduction and emotional reactivity management. The patterns of conditioned habits are worked upon through the use of mindfulness exercises.
Focus is on self regulation. In the US, over 200 programmes are running. The University of Massachusetts Medical School (U.S.A.) has 20 years of experience. 14 000 patiënts took part in the program. In the Harvard “Mind/Body Medicine programmes” mindfulness is an important part MBCT has recently been developed for the prevention of depression.
It embraces key elements from both cognitive therapy as well as the mindfulness tradition. This provides an unique approach for depresssion.
The results reported seem very promising for various patient populations. In UZ Gent, the MBCT-programmes are thoroughly researched scientifically.

MINDFULNESS
Mindfulness focuses on increasing present moment awareness, the here and now-experience. The purpose is to recognize and accept reality as is, without bias from emotional reactions or mental distortions and without reacting to automatic behavioural patterns.
Our untrained attention is continually focussed on getting more of what is experienced as pleasant (attachment) and on avoiding what is experienced as unpleasant (aversion).
A certain standard which can never be achieved is aimed for. This creates a persistent unhappiness about how things are. Happiness is sought for outside oneself and in the future. Attention travels restless from past to future and gets stuck in worries, feelings of guilt, fear,...

Mindfulness means connecting to the here and now experience with acceptance. In the first place, concentration, stability of attention is trained. In a first phase, breath is used as a focus. Interfering thoughts and sensations which ask for attention are released in a kind but firm manner and focus is brought back to breathing. In this way, participants are trained to return their attention to the present moment.
Secondly, one learns to observe (primary process) in meditation without immediate interpretation or reaction (secondary process). One speaks of “bare attention”. This enables one to live in the here and now experience instead of losing oneself in fantasies, worries, anticipations, … A typical exercise for this is to hear a sound as a sound and dropping the mentally constructed concept e.g. car.
Thirdly, one learns to observe things without being attached to a specific point of view or result. Openness and acceptance are central. This creates inner stability and peace. Saying ‘yes’ to reality as it is, is conditional to seeing the full perspective and responding to it adequately.

COGNITIVE THERAPY AND MORE
Mindfulness is a proven remedy against the downward spiral caused by automatic negative thoughts.

1. One learns to see thoughts as ideas (and not as truth).
2. One awakes from the automatic pilot (conditioned patterns) and learns to step out of it.
3. Labelling (depressing) thoughts competes with their contents (by filling the cognitive space) which brakes the downward spiral
4. Recognizing negative thoughts early allows to follow a different track. Instead of walking the path of confusion and reactivity, there is a possibility of insight and focussed action.
5. Next to thoughts, one also works with the breath, the body, sounds and emotions. One works directly with the emotion and is completely present for the change of mood and its physical manifestation. This has a direct effect on preventing or limiting cognitive reactivity. These are the depressing thought programs that patients, who recovered from a depression, carry with them and which reactivate during minor mood swings. It are programmes which more or less everyone carries along.

MECHANISM
In the meditative attention exercises one learns to handle these thought programs. One learns to recognize and patterns of thoughts, emotions and impulses which come to the surface, and let them pass by. One observes which process is present and allows it to be there. Observing and labelling the process that presents itself, has a direct affect on the cognitive space, the limited capacity of conscious information processing. This competes with processes that do something with the contents and therefore with the rumination condition. The rumination condition appears to be important as a predictor for relapse of depression. The rumination condition means that one ponders continuously about things and tries to understand the why. While these people have the impression that they understand themselves better, there seems to be a lessening of the capability to solve problems and the negative mood persists. The “why”-question distracts us from direct experience of reality and adds to the rumination condition. This condition is counter-productive. Mindfulness only wants to give kind attention to what happens here and now, without analysing. This means direct experiencing, without asking why, why, …?

MINDFULNESS: HERE AND NOW

Mindfulness means that you step out of your life story and step into life itself, here and now. Concrete exercises help you to do that.
In case of a depression, for instance, this is very important. In the mind, the same things are continuously repeated, a rumination of what was, a closed circuit without giving entry to new, real experiences, without entry to the richness of life itself that is present here and now.
Mindfulness teaches how to give attention to what is positive and beautiful in life, despite of stress situations in which we often find ourselves. It is about seeing the same things with different eyes. It is an attitude that leads to appreciation of the simple and small things of life. As a famous mindfulness teacher said: “Also look at the flowers on the grave of the friend that you are burying.

THE MBCT PROGRAM

During 8 weeks, participants come together, 2,5 hours every week. Different skills are taught, like breath focus, insight meditation (working with physical sensations, sounds, emotions and thoughts), bodyscan, yoga, physical awareness, cognitive and solution-oriented techniques, biofeedback, communication and a health care program. Currently, UZ Ghent offers 8 programs a year. At least 7 mindfulness practice and meditation days are organised on top of that, in which you can also take part after the 8-week program.

NEURO-ANATOMIC FINDINGS

Experimental research has proven increased activity in the prefrontal left lobe of the brain after 2 months of exercise. This region of the brain inhibits tubulent emotional flows from the amygdola, which creates a strong neurological brake on agonizing emotions. This circuit seems also stronger in the period between meditations.
Boudhist psychology talks in this context about cognitive obscurations: overactive amygdala influence the neocortex in the analysis of its observation, its interpretations of what was seen or heard and in thinking. Twisted interpretations and emotional thoughts thus prevail and, as it were, bewitche us. By giving strong, continuous attention to surfacing emotions, we are less subject to them.

SCIENTIFIC RESEARCH

Scientific research shows a reduction from 66% to 33 to 37% of relapse of depression over 60 weeks, for people who have a history of 3 or more depressed periods. Besides a recent confirmation of the results of MBCT for depression, another controlled study of mindfulness interventions for cancer patients show a reduction of 65% for general mood swings and a reduction of 35% of stress symptoms. The amount of time taken to meditate, corresponded to the lessening in mood swings. MBCT seems to hold promise to especially the psychosocial functioning within the stress and mood swings caused by cancer.
A non controlled, yet interesting study with chronic pain patients with a long medical history, with little to no improvement of their pain or emotional behaviour, showed an important reduction in functional disability, psychiatric symptoms and emotional distress until 4 ears after treatment. Also for fibromyalgia a significant reduction (39%) was seen in the seriousness of psychiatric symptoms. For “binge eating” too promising results were reported.

MORE INFORMATION: Dr. David Dewulf, dd@mindbody.be