It is my honor to interview Zindel Segal, Ph.D., a specialist in depression and creator, along with Mark Williams, Ph.D. and John Teasdale, Ph.D, of the increasingly popular program for depressive relapse, Mindfulness-Based Cognitive Therapy (MBCT). He is also the Morgan Firestone Chair in Psychotherapy in the Department of Psychiatry at the University of Toronto and has co-authored the books Mindfulness-Based Cognitive Therapy for Depression: A New Approach to Preventing Relapse, and The Mindful Way through Depression: Freeing Yourself from Chronic Unhappiness.
MBCT is an 8-week program that is an adaptation of Jon Kabat-Zinn’s Mindfulness-Based Stress Reduction that has been proven effective for issues such as stress management, anxiety, chronic pain, and more. MBCT integrates methods of mindfulness and Cognitive Therapy throughout the 8 weeks to help us become more aware of, and shift our relationship to, the thoughts and actions that often lead us to depressive relapse. With this awareness, we are able to change our relationship to them, and have a greater opportunity to not relapse and live a life of greater self acceptance, freedom, and joy.
Question: Why are mindfulness and cognitive therapy such a good marriage for mental health?
Zindel: Both these approaches help the person changes their relationship to thinking. In cognitive therapy, using the Thought Record allows a thought to be considered as an idea or a hypothesis that can be examined from different viewpoints – evidence supporting it and evidence not supporting it. This may suggest that our thoughts, when we notice them, are provisional and that we do not have to engage with them at the level of content. In mindfulness practice, watching thoughts arise, rest and move through the mind allows a similar awareness of thinking as something that can be observed and does not have to be engaged with. Recognizing that we can choose to step out of unhelpful automatic and habitual thought patterns, helps reduce our reactivity and allows us to deal more skillfully with challenges in our lives.
Question: What is the current state of affairs with MBCT and where do you hope to see it progress to?
Zindel: I would say that the evidence base for MBCT is strong and growing. In the next 5 years we will see new data on questions of relapse prophylaxis compared to maintenance antidepressant medication, the benefits of MBCT for treatment refractory depression and modifications of the program for Bipolar Disorder and Anxious children. The longer term challenge is to find ways to disseminate MBCT, since at present, qualified instructors are relatively few in number and those that practice are limited to urban settings.
Question: If you were to give any advice to the people out there who have suffered with depression in the past, what would you say?
Zindel: One of the things we know about depression is that it is a recurrent disorder. So getting well is no guarantee of staying well. Too often folks are willing to look after themselves on a long term basis if they have diabetes or another type of physical condition, but less willing to do the same for a mental health problem. If you have been depressed, putting in the time to look after yourself on a daily basis can pay huge dividends down the road. Making some time to check in with yourself each day, through practicing mindfulness for example, is important. This is because doing so erodes one of the residual effects of depression, namely, subtle messages that you don’t count or are not worth it.
Question: What is the best way for people to find an MBCT group?
Zindel: Do a Google search using the terms ‘mindfulness based cognitive therapy’ and ‘your city name’. There are additional resources listed at mbct.com or mbct.co.uk. As I said earlier, access to MBCT is still a challenge but I am confident that we will see some new delivery formats emerging in the coming years.
Thank you for reading this interview. As always, please share your thoughts, stories, and questions below. Your interaction provides a living wisdom for us all to benefit from.