1 00:00:00,420 --> 00:00:03,530 Hello and welcome to the new psychology of Depression. 2 00:00:03,530 --> 00:00:10,140 A series of programmes with me, Dr. Danny Penman and Professor Mark Williams of Oxford University. 3 00:00:10,140 --> 00:00:17,100 In this programme, we'll be looking at mindfulness based cognitive therapy, a new approach to preventing depression. 4 00:00:17,100 --> 00:00:25,860 That was code developed by Professor Mark Williams. Mark, how did you first become interested in mindfulness? 5 00:00:25,860 --> 00:00:28,410 Well, it was almost by accident. 6 00:00:28,410 --> 00:00:37,350 My colleagues Zindel Seagle and John Teesdale and I came together in order to try to find a way of dealing with recurrence in depression. 7 00:00:37,350 --> 00:00:46,620 It was already known by then that if you gave certain forms of psychotherapy, not only in the acute phase, but as a maintenance treatment, 8 00:00:46,620 --> 00:00:55,020 perhaps once a month for a year after that acute treatment, it could reduce the risk of relapse even further than the original treatment. 9 00:00:55,020 --> 00:01:01,110 And the MacArthur Foundation in America had a psychobiology depression initiative, 10 00:01:01,110 --> 00:01:06,720 and they wanted to come up with the similar sort of maintenance form of psychotherapy, 11 00:01:06,720 --> 00:01:11,340 which came out of the cognitive therapy tradition and the accidental Seagle to get that together. 12 00:01:11,340 --> 00:01:18,840 And he invited John TSL and myself to join him to come up with a new form of cognitive therapy, a maintenance form of cognitive therapy. 13 00:01:18,840 --> 00:01:26,820 So we met and we reviewed the evidence and it actually seemed like if cognitive therapy worked for people, 14 00:01:26,820 --> 00:01:33,900 their risk of relapse was already pretty low. There was very slim chance that we could do better than that. 15 00:01:33,900 --> 00:01:37,920 I mean, you know, there's always a chance you might decrease it by a few more percentage points. 16 00:01:37,920 --> 00:01:42,210 But if you want to evaluate a clinical trial, you need huge numbers to do that. 17 00:01:42,210 --> 00:01:48,060 And so we asked permission of the MacArthur Foundation and Professor David Kupfer, who is leading this initiative, 18 00:01:48,060 --> 00:01:54,270 if we could change the focus to try to prevent a new episode of depression in people who were well. 19 00:01:54,270 --> 00:01:58,920 In other words, we knew depression was episodic. There are periods of wellness in between. 20 00:01:58,920 --> 00:02:03,630 Could we find the critical vulnerability mechanisms and try to, as it were. 21 00:02:03,630 --> 00:02:07,800 Stop the depressive slide before it actually started? 22 00:02:07,800 --> 00:02:16,470 So were you in effect, trying to encapsulate the effective components of cognitive therapy and then then try and enhance them in some way? 23 00:02:16,470 --> 00:02:21,480 Exactly. I mean, cognitive therapy was developed for people who are right now depressed. 24 00:02:21,480 --> 00:02:27,210 You search for you look out for you, catch your negative thoughts and so on when you're not depressed anymore. 25 00:02:27,210 --> 00:02:29,880 There are no negative thoughts. Not many around. 26 00:02:29,880 --> 00:02:37,530 So it means that psychotherapy developed for the acute episode doesn't necessarily work for people when they're actually between episodes. 27 00:02:37,530 --> 00:02:39,390 But it's exactly as you say. 28 00:02:39,390 --> 00:02:48,270 Could we find out what it was that was making people vulnerable and change those risk conditions even when there wasn't an episode around? 29 00:02:48,270 --> 00:02:51,900 So you had this idea. How did you run with it? 30 00:02:51,900 --> 00:02:55,380 Well, originally, we didn't think that mindfulness was the issue. 31 00:02:55,380 --> 00:03:00,210 But John Teesdale had some experience of certain forms of meditation. 32 00:03:00,210 --> 00:03:06,480 He also had been speaking to a colleague of ours who had visited our unit in Cambridge where John and I worked. 33 00:03:06,480 --> 00:03:12,930 Somebody called Marsha Linehan, who had used something called mindfulness as part of what she called dialectical behaviour 34 00:03:12,930 --> 00:03:18,690 therapy in her treatment of people who had a diagnosis of borderline personality disorder, 35 00:03:18,690 --> 00:03:25,080 people who were chronically suicidal. I knew her because of our mutual interest in trying to find ways of preventing suicide. 36 00:03:25,080 --> 00:03:29,400 And she had talked about one component of her treatment was mindfulness. 37 00:03:29,400 --> 00:03:36,930 Now, John had an interest in this, but he'd never sit with thought of a way of applying and applying mindfulness. 38 00:03:36,930 --> 00:03:41,490 But what Marsha added was this a personal John Cupboard's in. 39 00:03:41,490 --> 00:03:45,540 John's already heard of him, even seen him, I think, once in a workshop. 40 00:03:45,540 --> 00:03:54,660 But what Marcia said was he's got an eight week programme which does virtually nothing but mindfulness, and he's developed a chronic pain. 41 00:03:54,660 --> 00:04:02,730 Why did you go and consult him? Well, that's what John suggested to Zengel and I that we should do. 42 00:04:02,730 --> 00:04:07,710 And I take it you weren't very enthusiastic about this? I was very sceptical, actually. 43 00:04:07,710 --> 00:04:14,280 I mean, for a number of reasons. For a start, I thought that meditation was simply relaxation training. 44 00:04:14,280 --> 00:04:17,700 After all, there'd been some evidence from the 60s that Transcendental Meditation, 45 00:04:17,700 --> 00:04:22,380 or TMD, produced big effects on psychophysiology on the body and so on. 46 00:04:22,380 --> 00:04:28,350 But deep relaxation had the same effects. So I thought meditation, relaxation, same thing. 47 00:04:28,350 --> 00:04:34,140 And I knew that that was some evidence that relaxation alone for depression didn't actually work. 48 00:04:34,140 --> 00:04:39,100 So that was the first thing. Secondly, it came out of a Buddhist tradition. 49 00:04:39,100 --> 00:04:47,160 You know, I don't object to Buddhist religion or any religion, but my own particular growing up had been in the Christian tradition. 50 00:04:47,160 --> 00:04:53,460 And although this wasn't a problem for me to, as it were, experiment with another tradition, 51 00:04:53,460 --> 00:04:58,080 I had always kept religion in my private life and my professional life. 52 00:04:58,080 --> 00:05:01,900 I was a psychologist and I thought the. These two things were getting too close together. 53 00:05:01,900 --> 00:05:09,580 If you start meddling with meditation as part of a clinical treatment. So I was a bit reluctant to consider going down this road. 54 00:05:09,580 --> 00:05:15,460 So why did you persevere then if you had no personal and professional reservations about this? 55 00:05:15,460 --> 00:05:22,780 We, first of all, found out more about what John Covington was actually doing rather than just, you know, the label that he put. 56 00:05:22,780 --> 00:05:26,500 We found that mindfulness meditation was different from transcendental meditation. 57 00:05:26,500 --> 00:05:36,910 TMD teaches a focus as sort of a focus, concentrated awareness, and is very good for deep relaxation, as I said, and for other things as well. 58 00:05:36,910 --> 00:05:41,110 Lots of evidence now, long term evidence that it has great health benefits. 59 00:05:41,110 --> 00:05:50,140 Mindfulness meditation is in some ways much more similar to the cognitive therapy in that it teaches people not just to focus their attention, 60 00:05:50,140 --> 00:05:59,860 but to broaden their attention and begin to see things happening in the internal external world with greater sense of perspective, 61 00:05:59,860 --> 00:06:08,410 compassion, kindness and accuracy. Now, there's something about cognitive therapy, about being accurate that has a great deal of overlap. 62 00:06:08,410 --> 00:06:12,310 For example, John Camenzind gives the example in his book Full Catastrophe Living, 63 00:06:12,310 --> 00:06:19,530 which he wrote in 1990 of a person who came to his classes and he had a heart problem. 64 00:06:19,530 --> 00:06:25,060 I he had a heart attack and he was coming for re as part of his rehab to learn how to deal stress. 65 00:06:25,060 --> 00:06:29,980 He said that something had happened during the week that had been really transforming for him. 66 00:06:29,980 --> 00:06:35,770 He'd had a list of things he had to do that day and he hadn't got round to everything on the college list. 67 00:06:35,770 --> 00:06:39,970 For example, he hadn't got round to washing his car yet. Now it's 10 o'clock at night. 68 00:06:39,970 --> 00:06:45,070 He found himself getting out the car, putting on the floodlights and preparing to wash his car. 69 00:06:45,070 --> 00:06:53,150 And suddenly he thought, I must wash. My car is just a thought and I don't have to be a slave to my thoughts. 70 00:06:53,150 --> 00:06:58,270 You know, I should be hit his head as a master of the thoughts rather than slave to them. I don't have to do this. 71 00:06:58,270 --> 00:07:03,730 And that was a hugely liberating insight that many of his thoughts were just mental events. 72 00:07:03,730 --> 00:07:10,150 He didn't have to act on them. And now when we read that, we thought that is rather similar to cognitive therapy. 73 00:07:10,150 --> 00:07:14,350 It was enough to give us a theoretical basis for going ahead. 74 00:07:14,350 --> 00:07:21,460 And also, Cabot's in had done some work on chronic pain, showing that in one of the most difficult conditions of chronic pain, 75 00:07:21,460 --> 00:07:24,730 this had been this approach had been transformative for many people. 76 00:07:24,730 --> 00:07:30,220 And actually, of course, chronic depression, chronic pain and very similar things in many ways. 77 00:07:30,220 --> 00:07:38,110 And so we we thought, let's buy his books, let's see the videos, and let's eventually go and meet him and find out what he actually does. 78 00:07:38,110 --> 00:07:48,760 So what exactly is mindfulness? Mindfulness itself is a translation of an ancient word that simply means awareness or non forgetfulness. 79 00:07:48,760 --> 00:07:54,100 It's a bit like doing things just as you're doing them, but knowing that you're doing them. 80 00:07:54,100 --> 00:07:57,520 So it's eating, knowing that you're eating, being aware of what you're eating. 81 00:07:57,520 --> 00:07:59,830 It's walking. Knowing that you're walking. 82 00:07:59,830 --> 00:08:09,220 Now, that sounds really trivial, but actually the awareness is so silent that we're hardly aware that we're aware, 83 00:08:09,220 --> 00:08:15,400 as John Cabazon has said many times, and yet awareness can be cultivated. 84 00:08:15,400 --> 00:08:20,950 If we're on automatic pilot all the time, that is, we just blindly sort of sleepwalking through life, 85 00:08:20,950 --> 00:08:25,690 just rushing from one task to the next, yet hardly aware of what we're doing, what we're thinking. 86 00:08:25,690 --> 00:08:30,100 We don't taste our food. We don't notice the sights and sounds and so on. 87 00:08:30,100 --> 00:08:35,050 What tends to happen is we deplete ourselves rather than nourish ourselves. 88 00:08:35,050 --> 00:08:42,530 We get into old mental and behavioural grooves where old habits just keep coming back. 89 00:08:42,530 --> 00:08:46,750 You know, we might be driving the car down the highway for miles, miles and miles. 90 00:08:46,750 --> 00:08:48,940 And we're hardly aware of even driving. 91 00:08:48,940 --> 00:08:57,010 And when we're on autopilot about the patterns of our mind can begin to go down some very painful and depressing themes. 92 00:08:57,010 --> 00:09:03,610 And when we wake up, we're already halfway to depression. We don't even notice that the mind has begun to do this. 93 00:09:03,610 --> 00:09:07,060 And we've missed huge swathes of our life anyway, 94 00:09:07,060 --> 00:09:15,370 which means that we don't have the nourishment that we could out of the taste of food and the sight of our children and the sight of flowers or trees. 95 00:09:15,370 --> 00:09:22,900 We just take everything for granted. Mindfulness is about waking up to that and dealing with our own minds and with other 96 00:09:22,900 --> 00:09:28,270 people with much greater kindness and compassion than we might have previously. 97 00:09:28,270 --> 00:09:35,920 So is that mindfulness the cause of depression, or is it just that mindfulness is a very effective way of preventing depression 98 00:09:35,920 --> 00:09:40,540 and mindfulness or lack of mindfulness is caused by a whole range of things? I mean, stress can do it. 99 00:09:40,540 --> 00:09:51,040 Just general living in a frantic world. And what you find is that much of what you might call on mindfulness or automatic pilot is actually 100 00:09:51,040 --> 00:09:56,140 due to the fact that our mind is continuing to problem solve even when we're not on the case. 101 00:09:56,140 --> 00:09:59,730 So that when we're driving the car, it's solving some problems in the past or on. 102 00:09:59,730 --> 00:10:04,320 Dissipated probably the future now that itself is not a problem. 103 00:10:04,320 --> 00:10:08,760 But interestingly, we don't often choose the mind just automatically. 104 00:10:08,760 --> 00:10:12,420 It's one of the wonders of the mind that when we're not doing anything else, 105 00:10:12,420 --> 00:10:16,890 the mind goes off and tries to solve a problem from the past or a problem for the future. 106 00:10:16,890 --> 00:10:23,640 And that even that maybe isn't a problem, except, of course, we don't taste our food, but maybe we don't need to taste our food. 107 00:10:23,640 --> 00:10:27,570 But and this is where it relates to what we're saying in the last episode. 108 00:10:27,570 --> 00:10:35,970 If that problem solving mode of mind turns up and starts to act on any slight deviation in our mood when we're feeling a bit sad, 109 00:10:35,970 --> 00:10:38,520 then that's where the problem can arise. 110 00:10:38,520 --> 00:10:45,870 Because before we know it, the problem solving mode of mind has tried to solve the problem of our mood, just like it solves the problem of, 111 00:10:45,870 --> 00:10:51,960 you know, driving across town or the email we mean to send tomorrow or the last e-mail we got from that person. 112 00:10:51,960 --> 00:10:58,500 It treats them all equally and where it might be very good at solving the problem of what to say in an email. 113 00:10:58,500 --> 00:11:03,750 It can actually begin to drive our mood further and further down if we're not aware of it. 114 00:11:03,750 --> 00:11:08,910 And that's what mindfulness can help with, to wake us up and then to give us the choice. 115 00:11:08,910 --> 00:11:16,740 Do we want to carry on thinking of this or do we want to actually do something more skilful when it's actually relating to our mood? 116 00:11:16,740 --> 00:11:25,260 So is it that the doing mode of mind, that the rational mind, as it were, when it tries to solve a problem, 117 00:11:25,260 --> 00:11:31,500 solve our emotions, is that the cause of depression is the cause of the escalation of depression? 118 00:11:31,500 --> 00:11:38,370 That is that sad moods are part and parcel of life. We can't ban depressed mood, sad mood, hopeless mood from time to time. 119 00:11:38,370 --> 00:11:44,220 We all feel like that. What we can do something about is how we react, 120 00:11:44,220 --> 00:11:48,390 how the mind reacts to their sad moods and what the discoveries that have been 121 00:11:48,390 --> 00:11:54,630 made are telling us is that all of us may suffer sad moods from time to time. 122 00:11:54,630 --> 00:11:58,710 But the difference is what happens next. And that's something we can treat. 123 00:11:58,710 --> 00:12:04,870 So the cause of repeated depression is how people react in different ways to sad mood. 124 00:12:04,870 --> 00:12:08,010 And if people react by this Problem-Solving mode, 125 00:12:08,010 --> 00:12:17,130 then that depression will escalate and we will soon find ourselves completely preoccupied with the problem of ourselves and how to get out of this. 126 00:12:17,130 --> 00:12:22,590 And the a toxic rumination will go round and round and round. 127 00:12:22,590 --> 00:12:26,370 Mindfulness itself, how do you go about cultivating it? 128 00:12:26,370 --> 00:12:30,170 Well, one of the things I could try a one minute meditation now, if you'd like, 129 00:12:30,170 --> 00:12:35,970 and illustrate some of these things, because talking about meditation is a very curious thing to do. 130 00:12:35,970 --> 00:12:42,660 It's just that idea in the mind. And so the trouble is, we're just talking about it is it becomes another problem solving mode. 131 00:12:42,660 --> 00:12:47,310 It doesn't actually help because it just becomes. Oh, right. Okay. I will meditate. 132 00:12:47,310 --> 00:12:56,190 So the idea is that we offer practises that people can do on a daily basis that range from a minute to half an hour to 45 minutes. 133 00:12:56,190 --> 00:13:04,340 For many of our patients who come. But if you want to illustrate this, then why not sit now and do a one minute meditation? 134 00:13:04,340 --> 00:13:08,250 And I'll perhaps illustrate this. What people actually do. 135 00:13:08,250 --> 00:13:13,920 Yeah, that sounds perfect. People are in a position to do this now. I mean, if you're driving your car, obviously, what we have to close your eyes. 136 00:13:13,920 --> 00:13:20,250 But if if you're sitting at home, you could just adjust your posture so that your spine is straight but not stiff. 137 00:13:20,250 --> 00:13:26,220 And if you can, you can close your eyes if that feels comfortable to you or just lower your gaze, but not do this. 138 00:13:26,220 --> 00:13:29,790 If you're doing anything that needs your eyes open. Just waiting to do this later. 139 00:13:29,790 --> 00:13:31,950 If you if you want to. 140 00:13:31,950 --> 00:13:42,250 And then when your posture is embodying a sense of waking up, a sense of being aware of being awake, then bringing your attention to your breathing. 141 00:13:42,250 --> 00:13:53,540 So gathering the attention and placing it on one place where you feel the breath moving in and out of the body is maybe the tip of the nose. 142 00:13:53,540 --> 00:14:00,740 Well, down in the chest. Well, down in the abdomen. 143 00:14:00,740 --> 00:14:03,420 And we're not trying to control the breath in any way, 144 00:14:03,420 --> 00:14:20,670 just tuning into the sensations that accompany the breath as we breathe in and as we breathe out. 145 00:14:20,670 --> 00:14:26,040 And one of the things you may notice is that the mind begins to wander. 146 00:14:26,040 --> 00:14:31,410 And if you notice that it's not a mistake. That's simply what minds do. 147 00:14:31,410 --> 00:14:36,540 So when you notice your mind has wandered off the breath, simply acknowledge where it went. 148 00:14:36,540 --> 00:14:44,400 And then very gently escort the attention back to the breath wherever you are following the breath. 149 00:14:44,400 --> 00:15:08,710 And doing this over and over and over again, as many times as the mind wanders, simply acknowledge where it went and bring it back very gently. 150 00:15:08,710 --> 00:15:17,320 And continue to do this as as long as you wish. Or at a certain point. 151 00:15:17,320 --> 00:15:26,880 Beginning to move fingers and toes. And then when you're ready, opening your eyes, if they've been closed and taking in the room again. 152 00:15:26,880 --> 00:15:37,280 I'm taking a few moments to acknowledge where you are. 153 00:15:37,280 --> 00:15:42,350 So I'd be interested in any anything you noticed when you were doing that, Tony. 154 00:15:42,350 --> 00:15:48,050 It's profoundly powerful. It doesn't matter how many times I do mindfulness meditations. 155 00:15:48,050 --> 00:15:54,160 I'm always surprised at how focussed and relaxed I become, even after a minute. 156 00:15:54,160 --> 00:15:58,040 Hmm. Is interesting, isn't it? Did you find your mind wandering at any point? 157 00:15:58,040 --> 00:16:01,740 Yeah. I mean, that's that's as you said, that's what minds do. That's what minds do. 158 00:16:01,740 --> 00:16:06,830 You know, my legs work. My mind wanders. That's a really good way. 159 00:16:06,830 --> 00:16:11,030 And one of the interesting thing is, is to notice that meditation is not about clearing the mind. 160 00:16:11,030 --> 00:16:14,540 Many people think, well, I can't I can't do this because my mind is all over the place. 161 00:16:14,540 --> 00:16:18,620 And actually, the thing is. Absolutely. That's exactly what meditation is. 162 00:16:18,620 --> 00:16:23,570 It's waking up to the fact that your mind has a mind of its own. And most people don't know that. 163 00:16:23,570 --> 00:16:29,060 Most people don't know that. They're driven by thoughts that are, as John Cabot's insights, not subliminal. 164 00:16:29,060 --> 00:16:34,010 They're just below the surface of awareness, but they end up driving a lot of what we do. 165 00:16:34,010 --> 00:16:43,760 Much of the day without being aware of it. So if we want to wake up and make more choices, we have to wake up to what's going on inside our mind, 166 00:16:43,760 --> 00:16:48,460 inside our thoughts, inside our our feelings without obsessing about them. 167 00:16:48,460 --> 00:16:54,350 But just notice them. And that's an incredible. It gives us incredible advantage. 168 00:16:54,350 --> 00:16:59,870 So is it just the act of observing your thoughts as they appear in your mind? 169 00:16:59,870 --> 00:17:03,680 Is that where the therapeutic effects come from? 170 00:17:03,680 --> 00:17:07,430 There's all sorts of things that go on when you do this. Notice what we were doing. 171 00:17:07,430 --> 00:17:13,730 The first thing we were noticing, the patterns of the mind. So, yeah, noticing mind wandering is a very powerful thing. 172 00:17:13,730 --> 00:17:16,940 I'm not dealing with them by criticising yourself. 173 00:17:16,940 --> 00:17:22,760 It turns out a very powerful component of this is dealing with mind, wandering with kindness and compassion. 174 00:17:22,760 --> 00:17:25,790 If you learn to be more kind to your own mind, 175 00:17:25,790 --> 00:17:33,470 you end up being kinder to other people as well and having more compassion for other people with whom you share your life. 176 00:17:33,470 --> 00:17:38,330 But it's not just the wandering mind that's important. It's not waking up to that. 177 00:17:38,330 --> 00:17:45,230 Waking up and dealing with it with compassion. But one thing we did there, and of course, many of our meditations go on a little longer than that. 178 00:17:45,230 --> 00:17:49,030 You're actually training as sort of a mind muscle if you want. 179 00:17:49,030 --> 00:17:58,520 It's rather like a mental form of martial arts. You're training yourself to attend and to attend and keep your attention in one place. 180 00:17:58,520 --> 00:18:03,380 And then when it wanders off to bring it back, wanders off. Bring it back once and bring it back. 181 00:18:03,380 --> 00:18:11,330 You're actually training attention now. One of the things we know that goes in emotional problems is your attention is one of the first things to go. 182 00:18:11,330 --> 00:18:18,080 You can't attend. Your attention gets hijacked by your concerns, whether it's obsession analogy, whether it's depression, 183 00:18:18,080 --> 00:18:24,050 whether it's anxiety going off and worrying, you actually find it very difficult just to focus on one thing. 184 00:18:24,050 --> 00:18:28,700 We know from the brain studies that actually the the mind is always the brain is always us. 185 00:18:28,700 --> 00:18:34,440 We're looking to find an association and therefore taking you off track. 186 00:18:34,440 --> 00:18:36,590 The one thing we do is to trade attention. 187 00:18:36,590 --> 00:18:44,630 And many of the benefits that come from meditation come from the ability to keep your attention in one place. 188 00:18:44,630 --> 00:18:50,150 The analogy that some people use, if you're looking at the stars through a telescope, you don't want to be on a rowing boat. 189 00:18:50,150 --> 00:18:59,150 Yeah, because there's no stability there and you won't be able to focus. You want to make the thing you're basing yourself on, as it were, grounded. 190 00:18:59,150 --> 00:19:02,090 You've got some stability. Then you look at the stars. 191 00:19:02,090 --> 00:19:09,410 You can't gaze at something and really attend to it and really pick up everything that there is to be picked up while you're in a rocking boat. 192 00:19:09,410 --> 00:19:16,580 So by training your attention, you're grounding things and then you're much more likely to notice when your attention wanders off to something else. 193 00:19:16,580 --> 00:19:20,750 And that noticing that awareness gives you a choice. 194 00:19:20,750 --> 00:19:26,690 You might want to go and pursue that daydream. You might want to go and solve the problem in the future or think of a problem in the past. 195 00:19:26,690 --> 00:19:33,230 There's nothing wrong with a future in the past, but at least you can bring yourself back to the present moment and make choices. 196 00:19:33,230 --> 00:19:40,040 And that coming back to the present moment gives you more choices. Let's go back a couple of steps. 197 00:19:40,040 --> 00:19:49,160 What precisely is mindfulness based cognitive therapy? It's a combination of mindfulness, which is from an ancient meditation tradition, 198 00:19:49,160 --> 00:19:54,590 secularised taken out of its religious context and made into a form of mental training. 199 00:19:54,590 --> 00:20:00,920 So it's using ancient spiritual exercises in a secular form of mental training that allows you to train your 200 00:20:00,920 --> 00:20:08,810 attention to be where you wanted to be intentionally and without harsh judgement coming up all the time. 201 00:20:08,810 --> 00:20:16,160 So it's about wise and discerning judgement rather than harsh, self-critical judgement. 202 00:20:16,160 --> 00:20:20,660 And it's about intention and training. Attention. Moment by moment. 203 00:20:20,660 --> 00:20:24,800 So if you had to define mindfulness, how would you define it? 204 00:20:24,800 --> 00:20:28,160 Mindfulness is a form of awareness. It comes from an ancient parly word. 205 00:20:28,160 --> 00:20:37,080 Sarti, which originally meant memory or non forgetfulness, comes from a Sanskrit word Myrtie, which meant memory, but rapidly. 206 00:20:37,080 --> 00:20:43,940 In the way that the historical Buddha used it, satti, it became broader than memory to this sort of awareness. 207 00:20:43,940 --> 00:20:48,710 So, for example, if you had your children in a large church or cathedral, you're looking around. 208 00:20:48,710 --> 00:20:54,260 They started Adua stamping their feet. You might say to them, remember where you are now. 209 00:20:54,260 --> 00:20:56,870 You're not actually ask them to do a memory exercise. 210 00:20:56,870 --> 00:21:02,960 You're asking them to do an awareness exercise or as you say, remember where you are is being aware of where you are. 211 00:21:02,960 --> 00:21:04,610 That's what I mean by awareness. 212 00:21:04,610 --> 00:21:11,120 Of course, usually that backfires with children because they then make more noise and you end up making more noise as a parent yourself. 213 00:21:11,120 --> 00:21:18,020 But it illustrates the point that mindfulness is is awareness and therefore it's nothing esoteric, is nothing mysterious. 214 00:21:18,020 --> 00:21:22,460 It's just that in our Western world, we don't cultivate it. 215 00:21:22,460 --> 00:21:25,130 We're cultivate the rational thinking mind. 216 00:21:25,130 --> 00:21:33,110 We don't cultivate the awareness that surrounds the rational thinking mind, but is much more than thinking. 217 00:21:33,110 --> 00:21:40,970 So is it is MBC TV effectively 90 percent mindfulness and 10 percent CBT. 218 00:21:40,970 --> 00:21:50,270 It's 90 percent mindfulness. And then it's adapting the John Cabot Zen MBA as our programme, which is mindless based stress reduction. 219 00:21:50,270 --> 00:21:57,140 It's adapting that. So it's focussed on serious mental illness, of depression, of recurrent depression, 220 00:21:57,140 --> 00:22:07,370 and therefore it takes the basic elements of of of mindfulness and drops into that vessel, into that pot, so to speak, into the mix. 221 00:22:07,370 --> 00:22:12,020 Some elements we know are particularly useful for people who are recurrently depressed. 222 00:22:12,020 --> 00:22:16,190 And there is an emphasis, for example, on thoughts and feelings and how connected they are. 223 00:22:16,190 --> 00:22:20,420 In session two of the eight week session with MDD, eight week programme. 224 00:22:20,420 --> 00:22:26,870 Basically, it's eight weeks, two hours a week, and people come to do a two group or two class. 225 00:22:26,870 --> 00:22:32,180 And it's much more like a class than a therapy group. It's not a group that people have to speak or share their problems. 226 00:22:32,180 --> 00:22:38,960 And so it's a skills training class, much more akin to a yoga class than a therapy group. 227 00:22:38,960 --> 00:22:43,640 And so people come and learn the skills of meditation and then they take c.D home 228 00:22:43,640 --> 00:22:48,110 with them to practise at home for up to an hour a day if they come to our clinic. 229 00:22:48,110 --> 00:22:51,590 So it's 90 percent the mindfulness based work. 230 00:22:51,590 --> 00:22:58,610 But there are these small but important differences, really significant differences from generic mindfulness training, 231 00:22:58,610 --> 00:23:03,230 which have been designed for people who have a recurrent problem with depression, 232 00:23:03,230 --> 00:23:11,000 especially illustrating the connexion between thoughts and feelings, the way in which when you're depressed, you often have no energy. 233 00:23:11,000 --> 00:23:17,600 What you can do about that? The way in which you deplete yourself all the time when you're when you're in danger, getting depressed. 234 00:23:17,600 --> 00:23:20,990 And the way you can build nourishment back into your life. Lots of elements. 235 00:23:20,990 --> 00:23:30,290 Most class is out of the eight week class have some things which are common, mostly common to mindfulness based interventions all over the world, 236 00:23:30,290 --> 00:23:35,320 but some critical things that are specifically designed for recurrent depression. 237 00:23:35,320 --> 00:23:42,680 Okay, so mindfulness itself is I think you have a definition of it paying attention in 238 00:23:42,680 --> 00:23:46,910 the moment to things as they actually are rather than as you wish them to be. 239 00:23:46,910 --> 00:23:54,250 Is that correct? Yeah. And it's based on John Covington's definition of mindfulness being a way of paying attention in this special way. 240 00:23:54,250 --> 00:23:58,550 Intentionally. Moment by moment. And without judgement. 241 00:23:58,550 --> 00:24:02,690 And this has been modified in very slight ways over the years. 242 00:24:02,690 --> 00:24:08,180 And we now say exactly the same mindfulness as a way of paying attention intentionally without judgement, 243 00:24:08,180 --> 00:24:16,220 moment by moment to things as they actually are. And absolutely, as you say, rather than just all the time focussing on things as you wish them to be. 244 00:24:16,220 --> 00:24:20,990 So you become aware of this gap focussed processing of discrepancy, focus processing, 245 00:24:20,990 --> 00:24:27,590 and you take account of it in skilfully managing your your life on a day to day basis. 246 00:24:27,590 --> 00:24:31,400 I mean, most people are going to quite rightly say, well, I do pay attention. 247 00:24:31,400 --> 00:24:35,640 I'm acutely aware of everything that's going wrong in my life. 248 00:24:35,640 --> 00:24:42,050 You know, how does that type of awareness differ from mindful awareness? 249 00:24:42,050 --> 00:24:46,430 There are people who would say that, you know, unaware. I want to be less aware and fair enough. 250 00:24:46,430 --> 00:24:52,940 If being less aware works. Fair enough. If distracting yourself works, if anything else works, do it. 251 00:24:52,940 --> 00:25:00,860 We're not saying you've got to do this. However, many people find distraction only works for a short time and that it keeps coming back. 252 00:25:00,860 --> 00:25:06,500 Now, the question is, why does that happen? And it usually happens because although people think that they're attending, 253 00:25:06,500 --> 00:25:11,330 that they're aware of their problems, what is happening is that they attend to their problems. 254 00:25:11,330 --> 00:25:15,860 But then very quickly, they're getting entangled in self blame about their problems. 255 00:25:15,860 --> 00:25:22,150 So they're saying, you know, oh, okay. I'm acutely aware that that meeting didn't go well, for example. 256 00:25:22,150 --> 00:25:27,920 And they might think I want to be less aware. So fair enough. They try to blanket hand, but they find it comes back. 257 00:25:27,920 --> 00:25:32,810 Why did it come back? Because it wasn't just that the problem with the meeting didn't go well. 258 00:25:32,810 --> 00:25:39,320 They now tell themselves and that just shows I'm not up to this. Lots of meetings go well, or it's that other person's fault. 259 00:25:39,320 --> 00:25:43,960 They're always undermining me and I'll never do well while they're around, et cetera, et cetera. 260 00:25:43,960 --> 00:25:52,480 And they soon lose touch, actually, with their original feeling of anxiety, depression, sadness or loneliness. 261 00:25:52,480 --> 00:26:00,340 And it becomes entangled in this network of language based rumination about what they can do better next time or whatever. 262 00:26:00,340 --> 00:26:04,240 And they're not then dealing with the original problem. 263 00:26:04,240 --> 00:26:10,960 If it was possible for them to stay with the sadness of a meeting, didn't go well, simply notice the sadness. 264 00:26:10,960 --> 00:26:18,790 Whereas in their body, I mean, we can do another meditation on that in a moment if you wish, but stay with where they are acknowledging it, 265 00:26:18,790 --> 00:26:27,160 then that can change the whole thing because the very thing they think is acute awareness is not actually wise awareness. 266 00:26:27,160 --> 00:26:34,750 It's just entanglement. That's the difference. So in a way, it's taking a step back and surveying the landscape. 267 00:26:34,750 --> 00:26:39,100 It's surveying the landscape. In fact, I'll do a meditation which can illustrate this really well. 268 00:26:39,100 --> 00:26:42,730 It's called a three minute breathing space or a three step breathing space. 269 00:26:42,730 --> 00:26:46,030 And if people want to do it now, again, if they're in a position to do it now, that's fine. 270 00:26:46,030 --> 00:26:50,140 If they're not in a position, do it now because they drive in their car, then they can try this later. 271 00:26:50,140 --> 00:26:55,270 But let's just focus on the three minute breathing space and I can illustrate the point that you make. 272 00:26:55,270 --> 00:27:05,140 So once again, if you if you're in a position to this now, then find a place where you can sit with the spine being straight but not stiff. 273 00:27:05,140 --> 00:27:10,780 The head and neck balanced on the shoulders, shoulders themselves can be dropped and relaxed. 274 00:27:10,780 --> 00:27:18,880 Feet flat on the floor. So if you could uncross the legs and put down your papers and just put the feet on the floor, flat on the floor. 275 00:27:18,880 --> 00:27:25,590 And this posture then embodies the sense of being awake, being aware. 276 00:27:25,590 --> 00:27:36,680 And then having prepared yourself, taking the first step of the breathing space and the first step is to acknowledge what's going on. 277 00:27:36,680 --> 00:27:47,350 To notice what's going on in your mind and body right now. May become aware of thoughts. 278 00:27:47,350 --> 00:27:59,940 Or feelings, emotions going on. They become aware of body sensation. 279 00:27:59,940 --> 00:28:06,230 And see if it's possible to let go of the tendency that we all have to want things to be different. 280 00:28:06,230 --> 00:28:11,030 And allow things in our mind and body to be just as we find them. 281 00:28:11,030 --> 00:28:20,430 Just for this moment. Seeing clearly what's here. 282 00:28:20,430 --> 00:28:35,220 Right now. Our thoughts, feelings, sensations. 283 00:28:35,220 --> 00:28:42,670 Notice any reactions, we have, any sense that these are unpleasant or not wanted and just allowing that to be here as well? 284 00:28:42,670 --> 00:28:58,390 Just acknowledging. Not wanting. And then letting these fade into the background as we take the second step of the breathing space, 285 00:28:58,390 --> 00:29:09,440 gathering our attention and placing it on the breath. Perhaps focussing on the breath in the abdomen. 286 00:29:09,440 --> 00:29:15,050 Noticing the rising on the in breath and the falling way on the outbreath. 287 00:29:15,050 --> 00:29:39,140 And if the mind wanders away from the breath, just noticing where it went and gently escorting it back to the breath. 288 00:29:39,140 --> 00:29:53,640 No matter how many times the mind wanders. Noticing it, bringing it back again and again. 289 00:29:53,640 --> 00:30:00,040 And then the third step of the breathing space, expanding the attention to the body as a whole. 290 00:30:00,040 --> 00:30:05,020 As if the whole body were breathing, now, noticing all the sensations in the body, 291 00:30:05,020 --> 00:30:11,560 so noticing the contact with the floor, contact the body on the chair or whatever you you're sitting on. 292 00:30:11,560 --> 00:30:18,260 Perhaps the hands on your lap, if that's where they are. Your whole posture. 293 00:30:18,260 --> 00:30:32,490 Your facial expression. Aware of all the sensations in the body, the whole landscape of sensations. 294 00:30:32,490 --> 00:30:39,720 And seeing if it's possible to allow the body to be just as you find it. 295 00:30:39,720 --> 00:30:51,040 Opening to everything that's going on in the body as you sit here breathing. 296 00:30:51,040 --> 00:31:06,930 Her sense of coming home to the body. Just as it has. 297 00:31:06,930 --> 00:31:21,180 And then when you're ready. Beginning to move fingers and toes. And if your eyes have been closed, allowing us to open and taking in the room again. 298 00:31:21,180 --> 00:31:31,050 And the experiences that you noticed that. The usual degree of relaxation and focus. 299 00:31:31,050 --> 00:31:34,830 And this sense of beginning the breathing space, not by actually going to the breath. 300 00:31:34,830 --> 00:31:40,270 That's the ironic thing. We call it the breathing. But the first step of the breathing space is acknowledging. 301 00:31:40,270 --> 00:31:48,630 And this relates to what you said earlier about that the important thing about mindfulness and one of its essence is taking perspective, 302 00:31:48,630 --> 00:31:55,620 sort of having a place to stand that you firm up your firm, up the foundations with his attentional training. 303 00:31:55,620 --> 00:31:59,490 And then you look inwardly and outwardly with a firm place to stand. 304 00:31:59,490 --> 00:32:05,940 So you can take a perspective on thoughts, feelings and body sensations on the whole package. 305 00:32:05,940 --> 00:32:13,610 Now, we ask people to do this three times a day at set times for a whole week from week three of the AP programme. 306 00:32:13,610 --> 00:32:20,910 And it's written up in the mindful way through depression in the book that myself, my colleagues wrote in 2007. 307 00:32:20,910 --> 00:32:28,840 He's also written up in the Frantic World book that you and I wrote, as you know, in 2011, Mindfulness and Finding Peace in a Frantic World. 308 00:32:28,840 --> 00:32:36,390 And in both books, we emphasise again and again that the first step is acknowledging what's going on, 309 00:32:36,390 --> 00:32:44,040 what's coming up just now, maybe even labelling it, noting it are thinking, thinking, are worrying, worrying. 310 00:32:44,040 --> 00:32:53,160 And then a feeling of sadness has arisen. What that does is allow people to stay with the sadness instead of do what the mind usually does. 311 00:32:53,160 --> 00:32:57,170 Which is it? It actually starts to solve the problem of our sadness. And guess what? 312 00:32:57,170 --> 00:33:03,190 It then gets entangled. And that's where just coming back to your original question, that's where people feel that they're too aware. 313 00:33:03,190 --> 00:33:10,380 And actually, it's not too aware that too entangled. And it's a mistake to think that that entanglement is itself. 314 00:33:10,380 --> 00:33:15,390 Awareness. It's a ruminative entanglement. Have ruminative awareness rather than pure. 315 00:33:15,390 --> 00:33:20,550 A wise awareness, which is what we're talking about here. So it's like being trapped in quicksand. 316 00:33:20,550 --> 00:33:22,350 It's there like trapped in quicksand. 317 00:33:22,350 --> 00:33:29,360 And this analogy, which is, you know, we use in the mindful way and in the frantic world book like being in quicksand. 318 00:33:29,360 --> 00:33:33,120 You're trying to struggle. Thinking, if I struggle, this will help me. But what happens? 319 00:33:33,120 --> 00:33:35,040 The struggle only takes you further in. 320 00:33:35,040 --> 00:33:40,530 And we need to teach people the skills of what to do when they noticed the quicksand, which is different from struggling echoes. 321 00:33:40,530 --> 00:33:47,490 Struggling feels like the right thing to do. But it's an old habit and it's a habit that can, in fact, be broken. 322 00:33:47,490 --> 00:33:54,090 And I think probably the mindfulness based cognitive therapy is a way of actually breaking the habit. 323 00:33:54,090 --> 00:34:04,830 And in the next episode, we can begin to consider what actually happened when we invited people to do that, despite my scepticism. 324 00:34:04,830 --> 00:34:09,090 What happened when we began to practise this in our own lives? 325 00:34:09,090 --> 00:34:14,940 Get the theory together with the practise and invited people to come who are currently depressed. 326 00:34:14,940 --> 00:34:20,970 What would be the effect? What would be the impact of teaching this over eight weeks to people who'd been recurrently depressed? 327 00:34:20,970 --> 00:34:25,080 Where off they tried many, many different treatments and failed? 328 00:34:25,080 --> 00:34:29,760 What would happen when they actually tried this? Maybe we could tackle that in the next episode. 329 00:34:29,760 --> 00:34:37,170 Can you summarise in a few sentences what's the MBC TV programme entails? 330 00:34:37,170 --> 00:34:38,970 It's an eight week programme, 331 00:34:38,970 --> 00:34:47,040 skills training programme where people come to a class for two hours a week to learn the skills of mindfulness meditation, 332 00:34:47,040 --> 00:34:53,460 starting by focussing on body sensations, on direct experience of tastes and sounds and sights, 333 00:34:53,460 --> 00:34:58,000 but also on feelings from their own body, sensations from your own body. 334 00:34:58,000 --> 00:35:04,830 And people learn to directly, as it were, come into contact with things that they normally would take for granted. 335 00:35:04,830 --> 00:35:10,380 Learning this control of attention and then learning to take a broader perspective. 336 00:35:10,380 --> 00:35:18,000 So those key skills allow people to catch negative thought patterns before a tip cements her downward spiral. 337 00:35:18,000 --> 00:35:23,070 Precisely because we're not just focussing on the negative. 338 00:35:23,070 --> 00:35:25,890 We're focus on anything where the mode of mind is the doing mode. 339 00:35:25,890 --> 00:35:32,610 We call it the doing, though, because it's so helpful for doing this business about being on automatic pilot, on discrepancy based processing, 340 00:35:32,610 --> 00:35:41,760 the gap focussed processing this way in which it gets into verbal problem solving, how it knows what it wants to avoid, how it depletes you. 341 00:35:41,760 --> 00:35:44,790 All of that is very sensible problem solving. 342 00:35:44,790 --> 00:35:52,350 And the point is that we recognise that in day to day life and therefore people can learn to recognise even we are not depressed. 343 00:35:52,350 --> 00:35:58,440 So they begin to notice when sadness comes and that mode of mind is actually making things backfire. 344 00:35:58,440 --> 00:36:02,160 And they can notice it much, much, much earlier than it would have done otherwise. 345 00:36:02,160 --> 00:36:10,830 And that seems to be one of the key feature. And it stops people becoming trapped in the quicksand of depression abstracted down. 346 00:36:10,830 --> 00:36:16,530 Absolutely. I mean, if you're working in an area where there's quicksand, right. And you're not even aware of it, you might know this in quicksand. 347 00:36:16,530 --> 00:36:22,170 You want to know what the signs are and you won't have an expert to teach you what the signs are. 348 00:36:22,170 --> 00:36:29,760 So, first of all, you won't get not so likely to get trapped in quicksand because you begin to recognise when things get a bit mushy under your feet. 349 00:36:29,760 --> 00:36:36,630 But also, if you do start to sink, you're taught the skills are actually getting out without struggle. 350 00:36:36,630 --> 00:36:41,460 And that's a critical thing. So the critical thing is, does this work in practise? 351 00:36:41,460 --> 00:36:43,260 You can see the theory of it, 352 00:36:43,260 --> 00:36:49,950 but would it actually work in practise to invite people along to a class in which they learn these techniques would actually prevent depression? 353 00:36:49,950 --> 00:36:56,010 And that's the critical thing I think we need to consider in the next episode. And if people wish to know more. 354 00:36:56,010 --> 00:37:02,520 In the meantime, they can read Mark and his colleagues book The Mind Four Way Through Depression or our book, 355 00:37:02,520 --> 00:37:10,834 Mindfulness Finding Peace in a Frantic World. And if you're listening to this through I tunes you, you can click on the links on the series page.