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Lions Roar : March 2008
SHAMBHALA SUN MARCH 2008 113 write down their self-condemning thoughts as they arise, label them (“magnification” or “all-or-nothing thinking” are two com- mon labels), and then write out a rational thought to replace the dysfunctional one. For example, “I’m a failure” is an exam- ple of all-or-nothing thinking and might be met by a reply of, “I’m good at some things and not so good at others, just like all hu- man beings.” The therapist’s job is to teach patients the technique and then give them “homework assignments” designed to help them meet the challenges of everyday life. This isn’t just good psychotherapy, it’s also good Buddhism. In a meeting last year with Beck at a cognitive therapy confer- ence in Sweden, the Dalai Lama compared cognitive therapy to Buddhist analytical meditation used to combat “toxins” such as anger, envy, and cravings. Beck later wrote that he was struck by the importance in both systems of acceptance, compassion, knowledge, and understanding. Zindel Segal was also struck by these similarities when he and colleagues John Teasdale and Mark Williams began study- ing how Kabat-Zinn’s hugely successful Mindfulness Based Stress Reduction cours- es at UMass Medical Center might prevent depressed patients from relapsing. Through mindfulness meditation, Kabat-Zinn and his colleagues at the Cen- ter for Mindfulness in Medicine, Health Care, and Society were teaching patients with serious illnesses to neither ignore their pain nor compound it by struggling against it. This compassionate attention, Segal and his colleagues realized, might be the perfect medicine for patients who had suffered three or more bouts of serious depression. Studies have shown that more than 90 percent of these patients will have a relapse at some point in their lives. In MBSR, patients learn a range of mindfulness practices, such as scanning their body sensations, following their breath, and watching their thoughts and feelings as passing events in the field of their awareness. By applying moment- to-moment, non-judgmental attention to their perceptions, body sensations, emo- tions, and thoughts, patients experience a new and more accepting way of being. Interestingly, although they are not trying to fix or change anything, things often do change—on their own and for the better. “In cognitive therapy, relapse prevention is dealt with by getting patients to pull out their therapy materials if they notice that symptoms are beginning to reappear,” Se- gal says. “On the other hand, mindfulness is something that can be practiced anywhere.” Subsequent studies have confirmed the usefulness of mindfulness for depressed patients. People who had suffered three or more depressions and who were taught the principles of mindfulness meditation expe- rienced a 50 percent lower rate of remission. Segal is currently recruiting patients for an NIH-funded study to see whether patients who are weaned from medication are less likely to relapse if they practice MBCT. There is a caveat. “MBCT works best when patients are no longer in the throes of a depression,” Segal says. “People who are very depressed find it very hard to sit.” Curiously, MBCT had no effect on patients who had suffered only two ma- jor depressive episodes. The less-afflicted patients, Segal says, are less likely to faith- fully continue doing MBCT after they’ve completed a course of instruction; more afflicted patients have what he calls the “gift of desperation”—the certainty that despair will return. Cognitive therapy helped me survive the worst of a depression by using the an- tidote of “good thoughts” to offset the de- spair of “bad thoughts.” My best hope for not suffering another major depression lies in accepting my propensity for it—neither imagining I’m free of it nor dreading its ar- rival. In an absolute sense, depression and other manifestations of the suffering mind aren’t good or bad, desirable or undesir- able, bearable or unbearable. They are sim- ply ruts in the path that some of us take through life. We may trip and fall more than some people. But if we meditate, we’re more likely to keep our eyes on the road. ♦ MICHAEL STROUD is a writer and reporter whose articles have appeared in the New York Times, Los Angeles Times, and many other pub- lications. He is now the CEO of a small trade show company he founded in Los Angeles, where he prac- tices Buddhism with the InsightLA community. MAR 108-120.indd 113 MAR 108-120.indd 113 12/19/07 2:22:22 PM 12/19/07 2:22:22 PM