Use Mindfulness to Recover From Depression | Being Well Podcast, Dr. Zindel Segal

hello and welcome to being well i'm forrest  hansen if you're new to the podcast this is   where we explore the practical science of lasting  well-being and if you've listened before welcome   back i'm joined today as usual by dr rick hansen  rick is a clinical psychologist and a best-selling   author and he's also my dad so dad how are you  doing today most excellent and looking forward to   this yeah today we're very excited to be joined by  a very special guest a clinical psychologist and   a researcher who has had an enormous influence  on the adoption of mindfulness-based practices   in therapy dr zindel siegel dr siegel is a  distinguished professor of psychology at the   university of toronto scarborough and one of the  creators of mindfulness-based cognitive therapy or   mbct alongside doctors john teasdale  and mark williams he specializes in   mood disorders particularly depression and has  had a enormous influence truly on the clinical   adoption of mindfulness-based approaches and  their addition to more conventional forms   of cognitive therapy so zindal it's great to  have you with us today how are you doing i'm   good it's a real pleasure maybe even an overdue  pleasure i'm really looking forward to this   we are as well and people don't know this but  before we were able to start this podcast we were   jumping through a fair amount of technical hoops  based on issues of different kinds on different   ends and and i just thought you were exemplary  and i wish we could have uh videoed that part as   a model for grace under pressure and not getting  depressed when things don't go that well so anyway i've known of and respected  your work for a really long time   i got to know one of your colleagues mark  williams a bit at oxford and then at a   conference in hong kong and just found  him to be a genuinely wonderful being   so some of that halo is extended to you uh in  anticipation here so i'm looking forward to it   well maybe we can start kind of concretely you're  well known for mindfulness based cognitive therapy   in particular for preventing relapse after  episodes of severe clinical depression and maybe   you could unpack the acronym mbct mindfulness  based cognitive therapy and kind of explain it for   people in a summary way and then we can build from  there yeah for sure i think it's really important   to understand origin stories and in a sense i kind  of see this as an invitation to talk about the   origin stories and i think in the origin story  that underlies it mindfulness-based cognitive   therapy there actually wasn't a lot of talk about  mindfulness um there's a lot of talk about therapy   and there's a lot of talk about antidepressants  and there's a lot of talk about biological   views of depression and so in the days when  we were beginning to think about this myself   and mark williams and john teasdale the real  debates at the time were whether psychological   treatments could have any impact on a disorder  that was conceived as being entirely biological   prozac had just launched the promise of  ssris we're really providing people with   an understanding of depression as a chemical  imbalance that antidepressants could address and   it's not to say that that wasn't true you know it  still is true but the eclipsing of psychological   therapies uh was a casualty of that and so a lot  of our work tried to make the case that there are   lots of things that people can do for themselves  to help them come out of a depression and then   as we became increasingly aware of how chronic  and recurrent depression was there was a lot that   they could do to stay well and one of those things  happened to be practicing mindfulness meditation   and so we introduced it at a time when um there  was a lot of skepticism about you know meditation   and a lot of baggage around that but we slowly  accumulated data that showed that it was effective   and people started to listen to us so inside of  that framework that you just offered there which   is a great kind of historical background for the  work and i do think that that historical grounding   is important like at the time that you guys were  initially doing the research and doing the work   to develop this series of interventions  mindfulness was not the like mainstream   concept a mainstream idea that it is  kind of today so i'm just wondering   what was it that drew you to that set  of interventions as somebody with a   very academic background like i don't know if  you have a personal practice or anything like   that like what took you in that direction were  you contemplating career suicide at the time that's a phrase that i heard that's a phrase  that i heard because in academic psychiatry   um you're talking about uh medication rather  than you know neurostimulation therapies or   adjunctive pharmacotherapies um but you know you  have to remember i came out of a cognitive therapy   tradition so did john so did mark and at the  time there was a really important element that   all psychotherapies sort of shared and were able  to generate for patients and that was people who   benefited from therapy were able to develop  some measure of psychological distance to view   and experience negative affect so not identifying  with negative affect but having a place to stand   and from which they could view anger rising  sadness developing fear building and then looking   at the choicefulness available to them in those  moments now psychotherapy was able to generate   that through um kind of a haphazard process  of when it goes well and you've got a good   narrative developing a good relationship with  your therapist you have a good chance of getting   that in cognitive therapy things are a little bit  more instrumental the use of thought records the   use of homework meant that you were building up  these skills in terms of psychological distance   and and the term psychological distance  has been called many things in different   uh therapy traditions like de-centering observing  ego cognitive diffusion but what really drew us in   was the possibility that we could train people  really really directly to develop this capacity   to watch and observe their experience and we heard  about jon kabat-zinn's work in chronic pain where   he was doing that and we kind of recast what john  was doing because he was doing a lot of things and   mbsr has so many elements but what really drew  us in there the lure if you will that we bid on   was direct training and de-centering  skills and then we thought well if people   can train themselves this way through the practice  of mindfulness meditation how can we combine that   with cognitive therapy to help people become more  agentic in looking after themselves when they've   recovered from mood disorder so again just doing  kind of a little bit of quick background here   we've mentioned cognitive therapy a couple of  times we've talked about cbt cognitive behavioral   therapy on the podcast a number of times in  the past what is it about a mindfulness-based   approach that distinguishes it from more kind  of traditional forms of cognitive therapy   well in cognitive therapy i think you have  to understand that there are different   phases of a disorder and different types  of cognitive therapy might be helpful for   different phases so if someone is very  very depressed then it might be useful   to have them examine the validity of certain  negative beliefs certain negative assumptions   to actually look at evidence that supports or  doesn't support their framework and so you get   into a view where thoughts become really important  and the degree of belief in those thoughts is   something that you and your therapist can work on  if people are in recovery we find that mindfulness   allows people not to engage in the content  of their thinking but to simply learn how to   watch thinking arise in the mind rest in the mind  and pass through the mind so that they can watch   thinking as a process without having to engage  well is this thought true is this thought not   true what does this mean about me what does that  not mean about me and so for those people for whom   the negative thoughts and the negative judgments  may not be as loud as they are in the acute phase   the practice of mindfulness can be very helpful  now practice of mindfulness carries a lot more   with it the compassion um the non-judgment  all of those things but you can get people   to relate differently to their thoughts without  having to eliminate them or to disprove them   if they can just see them as oh these are the same  old suspects showing up for me again oh here's   the same old judgment or you're the same old um  doubting and discouragement that shows up and then   you have a different relationship to that then  it's here and i've got to get rid of it otherwise   it's going to take me down i want to highlight two  things you've said and then ask you a question so   first in effect cognitive therapy and i i'm also a  practicing therapist too so i borrow some of those   methods myself i draw upon them in cognitive  therapy you're challenging pathogenic beliefs   and so forth you know you're just like you're  saying you're trying to disrupt or argue against   or even gradually replace certain kinds of beliefs  perspectives and so forth while with mindfulness   you're not trying to disrupt particular thoughts  per se you're actually stepping back from the   whole streaming of consciousness in a in a  way and witnessing and being with it without   being swept away by it so that distinction  there second just for people in general   as you well know major depression is understood in  terms of episodes that have a beginning a middle   and a kind of end maybe with a fair amount of  dysthymia or other kinds of issues in between   them but there's a sort of an episodic quality  to it and you're talking about that really   important between phase since episodes of major  depression kindle and facilitate and increase the   likelihood of future episodes trying to prevent  getting sucked in again okay great so in that   context then my question what is it particularly  about depression and all that comes with it that   maybe i'm saying this incorrectly but in effect   makes people particularly susceptible to getting  sucked back in based on their reactions to   the feelings and thoughts that are arising within  them right yeah this is really a key question   we had really good evidence to suggest  that mood congruent memory has a lot to   play with what determines um accessible mental  content for people that have been depressed   and mood congruent memory is the finding  and it works the same in anxiety as well   it once you've been sad there are ways in which  the memories and the experiences of sadness become   encoded in a way that makes them much more easily  reawakened when these people start to feel sad   again so there's a lot of evidence that if you  have people who have recovered from depression   and you make them feel temporarily sad like with  a mood induction that lasts five or ten minutes   some of those people in that sadness are going  to start endorsing old views of themselves   that are very depressogenic and if you follow  those people for 18 months they're the ones with   a much higher risk of relapse than people  who they've recovered they can feel sad   it doesn't sort of bring them down and so i think  one of the big insights in mindfulness-based   cognitive therapy is that we can't escape feeling  sad but what we want to try to do is to activate   a different pattern of relationship to sadness  that doesn't involve a re-emergence of all of   these old views of ourselves we can watch them  arise and try to relate to them differently   versus promising if you've recovered from  depression you know you're going to just be   euthymic and feel good for the rest of your life  there's this saying in buddhist practice uh it   draws on the ancient word and pali the language  of early buddhism and i i suspect you know all   this already the word for suffering often or  translates it's the translation of the word   dukkha and then there's this phrase dukaduka  we suffer that we suffer and it seems so much   that your work is involved with helping people  break that link in the chain you know unhappiness   sadness suffering may arise but then we don't  need to react to that reaction and in that space   there's a kind of freedom i think that that's what  we're trying to suggest to people and to help them   um approach it so that when it does show up  they can see a certain choice choicefulness   that opens up for them i think that's really well  said and i would love to get into kind of the how   of that in terms of the practices that people  do what actually happens when you're engaging   these uh these different kinds of difficult or  pathogenic beliefs however you want to say it   and as a way kind of into that classic question  that we get is some version of well if i'm mindful   of my sadness won't that just make me more  sad it's a fair question you know people um don't want to get too close in contacting  things that make them feel miserable   and that's in in some ways what you're  inviting so when i think of that one of   the things that i think of as a teacher is i  i wonder how well people know their sadness   when they say i don't want to you know  feel sad they don't want to feel the   idea of sadness or to what extent are they  really feeling it in their bodies are they   able to recognize the signature of sadness  and if they are are they willing to explore   what those sensations are actually doing on a  moment-by-moment basis noticing their qualities   and is there a discrepancy between what their  experience of sadness is in that moment and the   thoughts and the predictions and the mind states  that tell them that this sadness is unbearable   it will last forever there's nothing they can  do about it very often the lens of watching   it in the body moment to moment may suggest a  different relationship to sadness that's possible   and that's a starting point for knowing sadness  differently not for pushing it away but for   moving out of only knowing it through you know  a concept or an idea based vision of sadness   that's remarkable you're focusing on or in effect  saying it's not the sadness that's the issue   it's the thoughts about the sadness or other  kinds of reactions to the sadness that's really   the issue and in effect you're helping people  tolerate the sadness without engaging all that   other baggage about it right right and and and in  a way moving into the sadness and and to do that   in session five of mbct for example  we talk about allowing and letting be   as a stance and really it's about approaching  aversion and and whether that aversion is in the   mind because of ideas about what sadness is versus  the actual experience or other other things that's   what we're encouraging people to um to meet and  to approach with curiosity and kindness to be   able to tolerate their sadness and probably other  things as well without moving into quote-unquote   aversion the fighting of it or the pushing away  of it or getting alarmed by it and and if they   do recognizing that that there's a choice that  they could make even in those moments and it's   an ongoing process of engagement with kindness and  curiosity those two stances are antithetical to   aversion kindness and curiosity being antithetical  to aversion yeah would you apply this to other   emotions as well such as despair or irritability  force has made the point that younger people tend   toward more irritability in their presentation  of depressed mood yeah could you say more about   that i would i mean i think it's a universal  principle i think what we've done is to try to um you know wrap it up inside the world of  mood disorders and speak about it there we   haven't gone like really big and wide-casted  as something that's applicable to everything   but i think in many ways it is when it comes to  the world of emotions we can know our emotions   through the cognitive labels we place on them  and very often that bypasses an experience of   an emotion in the body which can actually give us  a different readout on what's happening compared   to what our minds are telling us and and you  you both probably know in in the zen world   there's a huge emphasis on bypassing the mind to  provide its commentary on what your experience is   and much more of a uh an appetite for  direct experience so you know you wake   up in the morning the first thing you do is  you don't lie in bed and think about what's   on your schedule for 10 or 15 minutes you  put your feet on the ground and you stand up   and it's that direct experience of of you  know waking up um that i think we're trying   to aim for here when it comes to depression  or sadness or irritability being present   the mind will offer its commentary what does  it feel like in the body where in the body can   you be curious can you be kind about what you're  finding and then that's your starting point that's   really lovely and i think is a great framing for  everything we kind of talk about from here on out   because of course like you were saying the the  research that you did was focused in the arena   of mood disorders and specifically depression and  sadness and bct as a treatment for these things   but these are general principles also and i we  might be having we might have people listening   right now who don't hit the formal qualifications  for major depressive disorder but people go   through periods of sadness in the course of just  about every human life these are general skills   that can be applicable for those periods there are  also general skills that can help people deal with   anxiety anger fear variety of different common  sensations that tend to to steal the language   from buddhism that tend to invade the mind  and remain it's one of my favorite quotes um   and to kind of get us into that i would love to  ask just a little bit more about the structure   and of mbct and what people actually do when  they engage in these practices you mentioned for   instance in session five or in week five of mbct  it's an eight-week program in general in terms   of how it's set up as far as i'm aware um both in  terms of helping somebody determine whether or not   this sort of a program might be good for them  but also just in the pursuit of teaching general   skills what are some of the major headlines  in terms of the practices that people take on   and the skills that you try to teach so i  think that's great and i really appreciate the   opportunity to talk in a bit more detail  one of the core insights that we had was   we want to give people a chance to practice on  a daily basis something that may or may not be   saturated with negative affect but would still  provide them with the tools to respond to negative   affect even if it showed up in their lives once  our course was over or six months down the road   so the practice of mindfulness  meditation is built in from the get-go   and we'll start with mindful eating and then  we'll start with a body scan and in some ways   you could say that the first four weeks of  mindfulness-based cognitive therapy is devoted   to increasing the awareness of automatic pilot   to um highlighting experientially the differences  between doing and being activities that have an   outcome activities that really have no outcome  other than their own intrinsic participation and   the curiosity and observation of phenomena in the  body and in the mind and in the movement of these   experiences when they are being observed  without judgment and the themes of resting   arising resting and passing through the  mind starting with sensations in the body   moving to sounds moving to thoughts moving  to thoughts that have an emotional charge   and then we start to layer in cognitive therapy  practices related to educating people about   symptoms of depression so you know there's some  quote legitimate symptoms like um loss of appetite   increased sleepiness or restlessness  but other symptoms of depression such as   negative and judgmental thoughts about  self are seen not as legitimate they're   not neuro-vegetative but they actually often  precede new episodes of depression and people   need to recognize that as the possibility of  not something about me that needs to be fixed   but something of a warning sign that hey my  depression may be coming back maybe i need to   check in with someone about this not a personal  weakness but part of like an overall package of   symptoms that might be kind of knocking at my door  so there's that some some of that education and   then there's a little bit of relapse planning well  like what happens if i do relapse what can i do   and we get people to make lists of activities  and we even get them to write a letter   this non-depressed version of yourself speaking  to a potentially um depressed version of yourself   what advice would you have what would you say  to them so there's a lot of how can i best   take care of myself you gave in that a great  overview of different practices that i think   people could probably add to their lives just as  a general principle sort of thing for a variety of   different challenges i'm not trying to ask you to  choose from among your children here but if there   was kind of a single practice that you think most  people would be benefited by adding to their day   their daily routine you know something that they  can do in 5 to 15 minutes most days what would   it be so if you'd asked me this question 20 years  ago i'd have a different answer for you than one i   have today uh 20 years ago it would have been you  know 40 minutes sitting meditation pretty hardcore   yeah yeah just like the basic basic and i've  been taught through interactions with a lot of   people in our groups that um that rarely happens  yeah totally groups are over the reality is   and so why continue to dream about  something that actually doesn't really   um come about so i would say it's really the  three-minute breathing space which is a portable   encapsulation of much of the attention training  that we've um taught people in mbct and that has   the capacity to be uh anywhere to range anywhere  from a basic grounding practice to a practice that   allows people to anticipate or recover from  uh challenging events this is a big ask but   would you be willing to teach it to forest to me  right now yeah just kind of walk through it you   know what i was i was just about to suggest that  we do it as a practice and then we can you know   kind of see what it's like from the inside that'd  be great yeah thank you okay so how i would guide   it is actually to say that the first thing we  want to do and i can see you're both already   doing it on camera here is we want to shift our  bodies we want to sit in a way that allows us to   embody the intentions even for these three minutes  of being awake and being alert so that might mean   just adjusting your body a little bit maybe  sitting up a little bit or just just noticing   even how you're sitting if you feel comfortable  letting your eyes close or maybe just finding   a spot a few feet in front of you and watching  it or holding it with a soft and steady gaze and tuning into sensations of  sitting just as you find them and the first step of the  three-minute breathing space asks you to look into the mind perhaps becoming curious about  your experience right now noticing any thoughts that are  here any feelings that are present any bodily sensations that  might make themselves known and just holding them in awareness watching  and observing them from one moment to the next   not needing to change or alter them in any way and now seeing if you can let go of the contents  of mind and bringing your attention to a   single-pointed focus on the breath of the belly  and feeling breathing in this part of the body   with the belly rising as you  breathe in lifting expanding and the belly falling as you breathe  out contracting and returning and seeing if you can stay with this gentle  rhythm of rising and falling breathing in   and breathing out moment by moment as best you can and now seeing if you can expand your attention  around the breath and around the belly allowing   your attention to radiate  outwards into the whole body   and feeling the whole body sitting  and feeling the whole body breathing   from the crown of your head to the soles of  your feet one whole breath one whole body and then when you feel ready  just allowing your eyes to   gently open and returning your  attention back to the room what did you notice about that practice you  want to go first for us you're there yeah   you're more of a guinea pig here a little bit  more exactly right so no i mean really loved it   for starters very similar to like you were kind  of describing the sort of condensed version   of some of the sitting meditations and  sitting practices that i've done before   i have a semi-regular morning practice and  i'm kind of the classic example of that person   who you know 30 40 minutes of sitting is a big  ask but i could probably rally myself toward this   three-minute practice which had the benefits of  feeling lovely and getting me into a lot of the   body sensations that i generally associate  with those longer-term meditative practices   of course not quite the same thing but a  lot of the similar body sensations and um for me i just notice because i'm somebody who has  a little bit of a higher tone personality i tend a   little bit more toward anxiety is that initially  when i'm entering into practices like that   there's often this little kind of anxious  flutter that comes up in the body um this   little like bird or this little uh you know it's  almost like there's a part of the body that's like   hanging on to that sort of an experience and  doesn't really want to relax into the practice   and so that's something that i often  feel which is really interesting and   makes me ask a lot of questions internally about  the nature of that part and what its function   is i don't know how about you dad well i loved  it i was very struck zindal by the clarity and sort of essential summary  nature of your instructions   i think i was particularly struck by was the  progression from establishing basic mindfulness   you know sustained present moment awareness  internally directed then moving into a focused   body sensation in the in the belly okay and  then the movement out to the body as a whole   i've been very struck by that and i've learned  something about what happens neurologically   when we go out to the gestalt to the thing as a  whole including ways that that tends to disrupt   activity in the default mode network thus negative  aztec rumination that could lead people into a   depressive spiral so that sense of the body  as a whole and breathing as a whole is just   really powerful it just feels really different the  mind gets my mind at least i think the mind gets   quieter and more at ease and less self-referential  when we go out to the sense of things as a whole   including the body as a whole yeah i mean i think  that's it's it's really interesting it's always   interesting to get feedback from people even even  people who struggle with it because um i i think   two things that you said rick the precision and  also the three steps i think you also commented   on that for us the three steps are they're all  there for a reason because as we're trying to   work with mindfulness meditation we're  trying to give people a message that   there are ways of practicing two different types  of attention so of course when you sit for 30 or   40 minutes there are ways in which your attention  initially may be a little bit more concentrated   settling grounding getting present and then you  might allow your mind to kind of open up in a   way where it's open monitoring choiceless you're  letting things go in this practice an image that   i sometimes use when i teach is to think of an  hourglass an hourglass has a very wide opening   and then it's got a narrowing at the middle  and then it's got a wide opening again   and the two types of attention that we're  cycling through here in three minutes   give or take although i have to say on the cd the  three minute breathing space is more like five   minutes in real time but we'll not we're gonna  we're gonna keep that three minute uh label so   basically you're giving people a chance to cycle  through two different types of attention open and   concentrated and open again and that can be as i  think you know you've talked about default mode   network that can be a way of helping people step  out of automatic pilot by being more deliberate   in how they're paying attention and because it's  three minutes you know people can do it anywhere   i've i've heard a lot of people doing it in very  interesting places including toilet stalls at work   i i want to follow up on what you're saying here's  the just like right now because uh also my dad   said something a second ago that just really  cued me into this when he started as you were   saying to talk about the default mode network and  what's actually going on inside of us functionally   when we're doing practices like that one of the  things that you really emphasized in research you   did back in the 90s is this role of attentional  control i dug up some research of yours from 1995.   and you mentioned attention several  times right there in terms of these   different kinds of attention this aspect  of attentional control why is that such an   important tool for somebody particularly who  suffers from recurrent depressive episodes   so this actually gets me back to the career  suicide comment rick that you made our first grant   that we received from nih had the  title um attentional control training   we didn't have the guts to right mindfulness  because we also thought we'd never get funded   so what we did was we put attentional control  and then in parentheses mindfulness training   for prevention of depressive  relapse and we had a model of   attentional selectivity and automatic pilot and  we dependent memory basically um any mood disorder   and a lot of the emotional disorders um have  a way of very efficiently hijacking attention   and bringing it to a conceptual  representation of what is our experience   and then if your resources are going there and  that's being played out in the mind then there's   very little potential resources that are left to  actually investigate in the body in this moment   what's really happening moment moment by moment  sensation by sensation and so trainings like the   body scan enable people to do that for themselves  you know and they can be boring and they can be   tedious but at the same time they're asking  people to spend a little bit of time feeling   anything that might be a sensation in your calf  muscle or in your thigh or in your lower abdomen   places where people often don't attend but very  often are the first place that emotions do show up   so a tightness in the neck might be quickly  labeled as oh that's from carrying my stress   but a tightness in the neck  can also be an invitation   i wonder what this really feels like if i  pay attention to it and i'm curious about it   and then you can develop a different  relationship to the tightness this is maybe a way for me to segue  to something i've been wondering about   in terms of attentional control so we have  both the capacity to disengage our attention   from what's problematic what's harmful such as  getting hijacked by or as you put an automatic   pilot by depressogenic thoughts  ruminations and related emotions okay   so we have the ability to pull attention away  achieved in part a lot through mindfulness turning   great then we have the related capacity through  attentional control training to sustain attention   to what's helpful and useful and i was  thinking about the vulnerability of many   people who are prone to depression to feelings  of inadequacy and as you said the ways in which   thoughts about self-criticism can be an early  indicator the prodromal subtle movement into   the depressive episode and how to deal with that  and so i started to wonder to what extent have   you found it useful to deliberately help people  sustain attention to typically simple everyday   genuine factually based good news or positive  emotions or emotionally positive experiences   so that increasingly they're able to rest there  and they're not so afraid of resting there and   also potentially through positive neuroplasticity  they gradually cultivate a more positive resting   state in their mood altogether do you find that  that is helpful alongside the mindfulness training um um so i think there's an explicit  and an implicit answer to that question   i think the implicit answer is that there's  some good data that mindfulness actually   enhances the capacity for hedonic tone so people  can very naturally start to take pleasure in   things that are simple and available to  them but i think that there's such a um i guess it's kind of like a taboo now  that i think of it in our classes to promise or direct people towards the positive  versus getting them to simply observe and   catalog and then make choices for themselves  that we tend not explicitly to push them there   it's much more about whatever's showing up uh  not that's good let's have more of that it's   like oh you're noticing that or you're noticing  that and then what choices do you have in front   of you yeah i had a conversation about this  actually with mark williams a while ago and   i was kind of nudging him also a little bit in  this direction which is very on brand for me   as far as would put it and uh he said well a fair  number of people in this population are extremely   vulnerable to self-criticism and feelings of  failure so in effect mindfulness just sustained   open presence is a fairly easy ask although  there's definitely some training there but to go a   step further like with regard to those feelings of  inadequacy and socially centered shame let's say   that is so common among people who are depressed  to particularly direct people toward paying   attention to ordinary experiences of positive  connection with others in which they're caring   toward others and others are caring toward them he  said you know rick for some people that's too much   of an ask that's too much of an ask so i really  took that on board and i've thought about it a lot   since i do wonder though for the people for whom  it's not too much of an ask you know they're more   stabilized they're out of the depressive episode  they've been increasingly resourced in other ways   it just seems to me that it would be helpful to um  to engage a practice essentially of cultivation in   which there's an openness to authentic beneficial  positive experiences especially if social support   and self-worth to gradually slowly but surely  build up a kind of layered emotional memories of   that kind with associated beliefs of that kind  particularly for those who can do that without   turning it into a big performance agenda that then  they feel like they're falling short of yeah they   can't live up to i mean we do hear a little bit  of that in session eight which is the last session   where we ask people to develop positive reasons  to continue their practice once the course is over   we try to have a way of um recommending something  beyond the course that's going to continue to   be live for them and often they'll say the the  incentives for practice would be connecting with   other people or being a better parent or being  more available to um you know for my partner   often their social incentives and and we try to  emphasize that and then get people to make note   of them as supporting their practice talking a  little bit here about things that help people   maintain the practice keep on doing the work a  lot of what you've been describing so far are   very active skills you know you are actively doing  the three to five minute meditation practice or   the watching the breath the three phases the  whole thing um and one of the major features   of depression is lethargy and disinterest of  different kinds like difficulty getting out   of bed in the morning difficulty engaging  with regular habits that you find positive   um lack of engagement lack of interest so on  how do you work to motivate and kind of inspire   people who experience depression to engage these  practices for long enough to get to change i might   not have them do any of these practices until  their executive functioning you know control   networks are actually available to them if they're  shut down by depression the last thing i'd want to   do is ask someone to sit for 30 minutes i can't  concentrate or read a paper but but i think it's   a great question because what i might suggest  is how about five minutes of mindful stretching   how about mindful walking things  that are engaging not through   a cognitive cortical uh capacity but just through  the body walking and moving and then paying   attention to the sensations that are created with  that for no other reason than just you know having   the experience those are smaller dose things  that i might do um and it sort of falls along   the line of activation behavioral activation do  you turn people towards social support very much um yeah yeah that's a big thing and in some  ways you know there is even a debate in the   mindfulness-based cognitive therapy groups  how much of it is the practice of meditation   and how much of it is just people sitting  together in a room with other folks who   look just like them by and large uh and then  start talking about you know suicidal ideation   or unworthiness or or embarrassment  or shame um or failure and they are   feeling a sense of normalization of the way their  minds work because they're able to see that many   people in a sense have the same mind and also  de-stigmatization because everyone is working to   to deal with something which we i think try  to message to them is is seen as a clinical   disorder it's not the fact that your personality  is a bit inadequate you just need to change or   fix it it's like it's like the common cold there  are a bunch of symptoms that are going to show up   you're going to be in bed sneezing with a fever  for a couple of days and then you'll be you know   able to go back to work depression also can be  seen as a package or a syndrome and when it shows   up it's going to show up in these different ways  it has already shown up in your life what are some   of the warning signs or the signatures that  you can recognize that kind of stuff do you   teach people self-compassion we do um not in  the explicit way but i think from the get-go   what our practices are infused with saturated  with and i think the instructors try to embody   is this kindness and curiosity which if people are  able to practice on themselves there's already a   massive honoring of their experience and so using  language in the meditation itself things like   and now if you're willing and when you feel ready  and then you know the emphasis on non-judgment   all of these things drip into every practice  that we guide and in accepting people who um   when they're talking about struggle or even asking  explicitly in the group did anyone struggle with   the three-minute breathing space because there  are a lot of people who say oh this is great and   you know i feel wonderful so making room for  all of that is i think an important implicit way   now what we don't do is use more explicit means  of generating self-compassion so mbct the way you   do it is an eight-week group-based program right  okay good just to make that clear for people and   around it and after it what do you find  that people might also do to build on what   they've gained from mbct maybe to enhance  it or bring in other elements that are not   foregrounded in mct mbct itself because you have a  finite amount of time in these eight weeks and the   groups you have to make choices what else helps  i think for us um you know it might be a bit of   a myopic focus but we we try to find out what type  of ongoing mindfulness practice or contemplative   practice people might engage with after the group  so you know maybe they'll end up going to like a   yoga class maybe they'll sit maybe they'll just  be able to connect with their breathing or before   they eat a meal just stop those are some of the  things that i hear people doing more frequently   then there's the weekend warriors you know  who maybe once a week might sit for 40 minutes   and then i think that the other  types of supports that people have   some of them might pursue a  self-compassion group or go into therapy um   i i think what's really interesting  is that um what people do afterwards   is it's not what we think they do i mean we  used to have graduate groups that we offered   once a month i would be leading them you know what  uh what what what better attraction could that be   yes and then yes right and then you have one or  two people showing up and we treated 200 people   and 100 and like one or two people showed up  eight people maybe showed up seven people like   there wasn't um a lot of traction that those  kinds of graduate groups provided and i don't   know whether it was because people had to come  back to the hospital i don't know whether it's   because they weren't looking for another group  they were looking for something more customized   i don't think we've really figured that  out yet how to how to sort of maintain   uh over and above people's own ingenuity um  some way of of keeping them you know boostered   up and keeping the work going yeah so you just  asked a big question there you know how do we   get from treating them in the moment to sustaining  those gains over time or even adding more good   stuff in and one of the questions that i really  like asking people who come on the podcast that   we talked to who come from a background relatively  similar to yours like you're so involved in the   research and the thinking about this and  frankly like the thought leadership around   it whatever you want to call it um what are some  of the questions or maybe like what's a question   that's really kind of drawing your attention  these days like what do you what do you hope   that we'll be able to figure out in the next five  to ten years having to do with these questions   i hope that we can figure out the puzzle of access  mm-hmm yeah access is like super limited yeah   super limited you know i mean during the election  the u.s election even here in canada we were glued   to cnn and uh i don't know if you and my wife's  an american so we were also watching it for that   reason but in the bottom left-hand corner of the  cnn coverage of the election there was a little uh   thumbnail pad by calm and it said do nothing for  30 seconds and it would just be a countdown timer   and you know that's like that's some pretty  expensive advertising real estate yeah totally   yeah that's easy for people to access com  headspace these are but there's a message inside   that which is meditation is a way of relaxing  meditation is a way of getting to like chill place   and mbct is really not about that i mean yeah you  will be able to feel calm and relaxed if you close   your eyes and sit and um but it's much more about  this approaching the aversion that is carried by   negative affect and finding a way of working with  it and and right now there's not a lot of access   to these programs and so we've been working  to try to bring some of these resources online   and i think that for for me and i think for other  people that's the that's going to be the next   revolution i think in a weird kind of upside-down  world way kovit has helped to legitimize the   remote delivery of care so having access that  way is an option but i think that's the big nut   to crack going forward no i think you're totally  right on i can agree with you more it's a it's   something that in our extremely small way on the  podcast we're trying to help with to a degree in   terms of yeah psycho education all of that and  podcasts are a great way to do it totally mutual   thank you very much a pleasure to meet you i want  to add that i actually got personal value from   this in a way that touched my heart and budged my  own you know my own messy mind so i want to thank   you for that at a very human level yeah that's  great thanks very much keep up the good work   today we had a fantastic time talking with dr  zindel siegel he's a professor of psychology and   one of the creators of mindfulness-based cognitive  therapy mbct is an eight-week group therapy   program aimed specifically at helping people who  suffer from depression and depressive relapse   that being said one of the points that we began  the conversation with was the idea that while   these skills are aimed at people who suffer  from depression the tools that are taught in   a mindfulness-based cognitive therapy context are  broadly useful tools they can help you out if you   are struggling with anxiety or anger fear whatever  else it is that's bothering you these days that's   my belief i don't know if zindale would endorse  that view formally or not but i just think that   these tools are so generally useful and apply to  a wide variety of circumstances and situations one   of the things that was emphasized throughout the  conversation is the importance of the relationship   that a person forms with the challenging emotions  that they're experiencing a lot of the time when   an emotion appears in our mind or a thought  appears in our mind more generally we begin to   immediately label it and draw inferences about  it a zindal had a point toward the end of the   conversation where he mentioned something along  the lines of oh i'm feeling tension in my neck   that must be from stress but you can see how  that's a kind of leap there is tension that   must mean it's stress but what happens if instead  of attributing stress to the tension we're just   present with the tension we allow it to unfold in  our awareness we get curious about it and maybe we   even have a little bit of compassion or kindness  a kind of warm-hearted tone that's associated with   it can we hold all of those things in our mind  simultaneously without judging them negatively   everyone is going to have experiences in life  that cause them to get sad that's just part of   the normal human experience so the question isn't  how do we get rid of sadness but rather how do we   relate to our sadness when it appears one of the  things that mbct emphasizes is attentional control   the ability to control where our attention  rests and the reason for that as zindle said   is because mood disorders of various  kinds have this uncanny ability to grip   and control our attention for us the depression  starts to decide where our attention rests   so reclaiming control of that attention can be a  great way to form a different kind of relationship   with our sadness or with our depression altogether  and there are a variety of interventions in mbct   that rely on a person having a degree  of attentional control which is why   i thought it was really interesting  that when zindo talked about somebody   who was actively in a depressive episode and  maybe these cognitive skills that are taught   weren't as accessible to them for a variety of  different reasons he went to the body he went   to can you do some mindful walking can you be with  your somatic experience in a different kind of way   that's maybe accessible to you when those more  cognitive tools are beyond your reach xeno laid   out a variety of tools and practices that are  taught in mindfulness-based cognitive therapy   that people might find generally useful and he  particularly emphasized this kind of three-ish   minute three-minute five-minute who knows  breathing focused meditation that he then   walked rick and me through and i gotta say it was  really fantastic i found it personally useful i'm   probably going to add it to my morning routine  and i would recommend it to just about anybody   i had this interesting experience during  it where i found that about 60 seconds in   i had this sort of soft feeling somatically in  my body of anxiety kind of rising inside of me   like there was a part of me that didn't  want to let go of that and rest in a more   open soft relaxed attentional state i don't  know if that was because i was recording a   podcast while i was doing the practice  or if it says something else about my   mental state the way that i relate personally  to those kinds of relaxed states maybe it says   something about the kind of tone that i carry  in myself just habitually on a day-to-day basis   without really thinking about it and that's  definitely something that i'm going to reflect   on a little bit and i'm curious if maybe you  had a similar experience we talked for a while   about what's actually happening in the brain  when these mindfulness practices are going on   and i want to really just emphasize a key point  here it's pretty common for people to hear the   word mindfulness and think that they're going in  a kind of woo spiritual new age sort of direction   as i'm sure was apparent from our conversation  zindal is not a new agey type in his presentation   in his seriousness in the level of his academic  rigor and i think that it's really great to have   these conversations that are focused on the how  mechanisms of these practices that can sometimes   start to feel a little ephemeral at the very end  of the conversation zindle made a key point that   i just want to emphasize so many of the challenges  that we have in the mental health world these days   get to access how do we put these tools trainings  techniques in front of the people who need them   most it's something that we definitely are hoping  to help with in a small way through the podcast   but it is an immense challenge that is facing  the field of mental health as a whole i hope you   enjoyed today's conversation with zindel siegel  i'd also invite you to check out the website   mindful noggin which is where you can access a lot  of these mbct based tools trainings and techniques   i've included a link to that in the description  of today's podcast you can check it out there   you can also probably just google it  and hopefully it'll come up for you   if you've been enjoying the podcast we'd really  appreciate it if you would take a moment to   subscribe to it through the platform of your  choice maybe even leave a rating and a positive   review and hey tell a friend about it it really  does help us reach more people if you'd like to   support the podcast in other ways you can find us  on patreon it's patreon.com being well podcast and   for just a few dollars a month you can support the  show and receive a variety of bonuses in return   once again thank you so much for listening  to the podcast and we'll talk with you soon

Channel: Forrest Hanson

Views: 6,826

Keywords: Mental Health, Personal Growth, Self-Help, Psychology, Forrest, Forrest Hanson, Being Well, Being Well Podcast, Rick Hanson, Buddhism, behavioral psychology, most important, most important skills, key skills, limiting beliefs, act, cbt, mbct, cognitive therapy, acceptance and commitment therapy, just one thing, psychological, therapy, mindful, compassion, mindfulness, confident, confidence, resilient, calm, anxiety, anger, intimacy, intimate, forgive, forgiveness, family, meditation, trauma

Id: PfAXd4uh2fE

Length: 56min 13sec (3373 seconds)

Published: Mon Jan 03 2022