Mindfulness of Mind
by Michael Stroud
Shambhala Sun, March 2008
The Dalai Lama advocates a Buddhist approach to a variety of mental
health problems, including depression. MICHAEL STROUD reports on the
growing evidence of meditation's helpfulness.
TWENTY THREE YEARS AGO, during a weeklong Zen retreat in Taiwan, I
entered a depression so profound I wondered if I would ever emerge. It
took nine months of intensive psychotherapy to recover, and when I was
done, I had left Taiwan, my fiancée, and my meditation practice.
In the decades since, I've benefited from new talk therapies and
medicines designed to shortcircuit depression. And to my surprise,
I've also found that meditation gingerly restarted after years of
abandonment has played an essential role in my mind's healing.
I'm hardly alone in that discovery. A growing number of researchers
and clinicians, many drawing from their own Buddhist practice, are
exploring how meditation can be used to treat depression, anxiety,
ADHD, drug and alcohol abuse, personality disorders, even sexual
dysfunction.
Happily for people like me, one of the first fruits of that research
is a depression therapy that combines mindfulness meditation with the
leading therapy for depressed patients. Called Mindfulness Based
Cognitive Therapy, or MBCT, the treatment leans heavily on Jon Kabat-
Zinn's groundbreaking work using mindfulness meditation to reduce
stress and pain in patients.
Kabat-Zinn and the three researchers who codeveloped MBCT: University
of Toronto professor Zindel Segal, Oxford University professor Mark
Williams, and retired U.K. Medical Research Council scientist John
Teasdale have recently published a book for the general public called
The Mindfulness Way for Depression: Freeing Yourself from Chronic
Unhappiness. It offers a new path to patients who have suffered
repeated depressive episodes and have resigned themselves to illness,
medication, and hopelessness.
"One of the messages of this book is that whatever arises in your
life, no matter how awful, no matter how dark, is workable' Kabat-Zinn
said in an interview. "Everything is biology, but that doesn't mean
biology cannot influence itself. Other mind states can work to assuage
what comes from high levels of mental conditioning."
Depression, he concludes, "is not a life sentence."
This flies in the face of medical orthodoxy, which holds that patients
who have suffered three or more incidents of major depression should
stay on a maintenance dose of medication for the rest of their lives.
But yesterday's orthodoxy is melting in the face of new understandings
about the brain's plasticity. Once thought to begin dying at age five,
the brain is now believed to change throughout life, actually altering
its physical and chemical structures in response to experience. For
the treatment of mental illness, the implications are huge: if "bad"
habits like rumination and self-criticism can harm the mind, then
"good" habits like meditation can heal it.
Studies of meditators have played an important role in this new vision
of the brain, particularly the work of University of Wisconsin
researcher Richard Davidson. His brain scans of Tibetan monks showed
distinct changes in the hippocampus and frontal lobes when the monks
entered meditative states. That raises a tantalizing question: if
monks can change their brains using meditation, why can't people
struggling with mental illness be taught to do it, too?
They can, asserts Jeffrey Schwartz, a UCLA psychiatry professor who
has successfully used mindfulness meditation to treat obsessive
compulsive disorder.
"Before this work on self-directed neuroplasticity, it was assumed
that if you had a genetically inherited tendency to develop mental
illness, the only thing that could be done about it was to treat the
brain itself, usually with drugs, psychosurgery, or putting electrodes
in the brain" says Schwartz, author of the book Mind Lock. "That is
not a scientifically justified statement anymore. Now we know that the
mind can change the brain. We can use the power of directed attention
to change brain function both in conjunction with appropriate
medication or, if you're fortunate enough, in place of medication."
Overwhelmingly, recent research on meditation and mental illness has
focused on mindfulness meditation, also known as vipassana meditation.
To make it palatable to non-Buddhists in the West, researchers and
clinicians have stripped away vipassana's South Asian cultural and
ritual baggage and presented it as a simple way to walk through mental
and emotional turmoil--much, perhaps, as the Buddha himself did 2,500
years ago.
Here's a sampling of some of the recent research examining the
effectiveness of mindfulness and other forms of meditation in treating
psychological problems:
• Stanford University psychologist Philippe Goldin and colleagues are
exploring the impact of mindfulness meditation on social anxiety.
• At UCLA, Drs. Lidia Zylowska and Susan Smalley are developing a
meditation-based treatment for children and adults with ADHD.
• University of Washington psychologist Marsha Linehan has
incorporated elements of mindfulness meditation and Zen into
dialectical behavior therapy, designed originally to treat Borderline
Personality Disorder, but also applied successfully to a wide range of
other disorders such as suicidal depression.
• Linehan's colleague G. Alan Marlatt demonstrated reduction in
alcoholism and drug abuse among prisoners in a study funded by the
National Institutes of Health.
• An international team of researchers from the U.S., Italy, and New
Zealand published an article in Behavior Modification on how
"individuals with mental illness can control their aggressive behavior
through mindfulness training."
• Stephen Hayes of the University of Nevada has integrated Buddhist
meditation into a new program called Acceptance and Commitment Therapy.
• Kristin Neff of the University of Texas in Austin is examining the
use of "self-compassion" in building self-esteem and psychological
health.
• University of British Columbia researcher Lori Brotto and Julia
Heiman of the Kinsey Institute published a paper earlier this year
discussing the use of mindfulness in the treatment of women with
sexual problems.
One of the most promising uses of mindfulness meditation is in
combination with cognitive therapy as a treatment for depression.
Developed by Dr. Aaron Beck at the University of Pennsylvania in the
1950s, cognitive therapy asks patients to write down their self-
condemning thoughts as they arise, label them ("magnification" or "all-
or-nothing thinking" are two common labels), and then write out a
rational thought to replace the dysfunctional one.
For example, "I'm a failure" is an example of all-or-nothing thinking
and might be met by a reply of, "I'm good at some things and not so
good at others, just like all human beings." The therapist's job is to
teach patients the technique and then give them "homework assignments"
designed to help them meet the challenges of everyday life.
This isn't just good psychotherapy, it's also good Buddhism. In a
meeting last year with Beck at a cognitive therapy conference in
Sweden, the Dalai Lama compared cognitive therapy to Buddhist
analytical meditation used to combat "toxins" such as anger, envy, and
cravings. Beck later wrote that he was struck by the importance in
both systems of acceptance, compassion, knowledge, and understanding.
Zindel Segal was also struck by these similarities when he and
colleagues John Teasdale and Mark Williams began studying how Kabat-
Zinn's hugely successful Mindfulness Based Stress Reduction courses at
UMass Medical Center might prevent depressed patients from relapsing.
Through mindfulness meditation, Kabat-Zinn and his colleagues at the
Center for Mindfulness in Medicine, Health Care, and Society were
teaching patients with serious illnesses to neither ignore their pain
nor compound it by struggling against it. This compassionate
attention, Segal and his colleagues realized, might be the perfect
medicine for patients who had suffered three or more bouts of serious
depression. Studies have shown that more than 90 percent of these
patients will have a relapse at some point in their lives.
In MBSR, patients learn a range of mindfulness practices, such as
scanning their body sensations, following their breath, and watching
their thoughts and feelings as passing events in the field of their
awareness. By applying moment-to-moment, non-judgmental attention to
their perceptions, body sensations, emotions, and thoughts, patients
experience a new and more accepting way of being. Interestingly,
although they are not trying to fix or change anything, things often
do change--on their own and for the better.
"In cognitive therapy, relapse prevention is dealt with by getting
patients to pull out their therapy materials if they notice that
symptoms are beginning to reappear" Segal says. "On the other hand,
mindfulness is something that can be practiced anywhere."
Subsequent studies have confirmed the usefulness of mindfulness for
depressed patients. People who had suffered three or more depressions
and who were taught the principles of mindfulness meditation
experienced a 50 percent lower rate of remission. Segal is currently
recruiting patients for an NIH funded study to see whether patients
who are weaned from medication are less likely to relapse if they
practice MBCT.
There is a caveat. "MBCT works best when patients are no longer in the
throes of a depression" Segal says. "People who are very depressed
find it very hard to sit?"
Curiously, MBCT had no effect on patients who had suffered only two
major depressive episodes. The less-afflicted patients, Segal says,
are less likely to faithfully continue doing MBCT after they've
completed a course of instruction; more afflicted patients have what
he calls the "gift of desperation"--the certainty that despair will
return.
Cognitive therapy helped me survive the worst of a depression by using
the antidote of "good thoughts" to offset the despair of "bad
thoughts?" My best hope for not suffering another major depression
lies in accepting my propensity for it--neither imagining I'm free of
it nor dreading its arrival. In an absolute sense, depression and
other manifestations of the suffering mind aren't good or bad,
desirable or undesirable, bearable or unbearable. They are simply ruts
in the path that some of us take through life. We may trip and fall
more than some people. But if we meditate, we're more likely to keep
our eyes on the road.
MICHAEL STROUD is a writer and reporter whose articles have appeared
in the New York Times, Los Angeles Times, and many other publications.
He is now the CEO of a small trade show company he founded in Los
Angeles, where he practices Buddhism with the InsightLA community.