Medication -> mediation -> meditation

Anyone who visits regularly will know that I’m interested in the therapeutic benefits of meditation and, serendipitously, Vaughan at Mind Hacks recently posted an overview of a roundup detailing cognitive science studies on meditation. There’s a growing body of clinical evidence to add to my own entirely subjective experience that meditation, particularly mindfulness meditation, can be extremely helpful in continuing efforts to remain, for want of a better term, “depression-free”.

Jean has already written about attending a course with a view to embarking on the path of teaching meditation techniques to others. We were originally intending to attend the same course together with the same goal in mind, but childcare considerations meant I have ended up on a different course. And here I come upon the first of many questions which have arisen (and will no doubt continue to arise).

I’m currently attending a Mindfulness Based Cognitive Therapy (MBCT) course.

MBCT is based on the Mindfulness-based Stress Reduction (MBSR) eight week program, developed by Jon Kabat Zinn in 1979 at the University of Massachusetts Medical Center. Research shows that MBSR is enormously empowering for patients with chronic pain, hypertension, heart disease, cancer, and gastrointestinal disorders, as well as for psychological problems such as anxiety and panic.

Mindfulness-based Cognitive Therapy grew from this work. Zindel Segal, Mark Williams and John Teasdale adapted the MBSR program so it could be used especially for people who had suffered repeated bouts of depression in their lives.

The course Jean is attending is Mindfulness Based Stress Reduction (MBSR), the name given to the original eight-week programme developed by Jon Kabat-Zinn. What then is the difference between her MBSR course and my MBCT? As far as we’ve managed to discover by comparing notes after each of our sessions, almost nothing.

This is not entirely surprising. The basic MBSR programme is being used to treat a variety of different health problems.

However I have a few reservations about my experience of this particular MBCT course so far.

The first is my sense, entirely unverified (although I think I should ask her) that the teacher herself has never experienced severe depression. Her descriptions of the thought processes of the depressed mind bear almost no relationship to my own experience of depression. She originally took an MBSR course to help tackle chronic pain.

The second is that although everything I’ve read about MBCT (including the flyer for the course I’m attending) says it is not suitable for people who are currently depressed one of the participants in our group is obviously currently depressed, on medication, broke down during one of the sessions, failed to attend the following week, returned the next week and announced that she’d been feeling so terrible that she’d had to increase her medication. And yet she was not advised that the course might well not be suitable for her and has not, as far as I’m aware, been told that it might be better for her to stop.

The third is that the course information does not say where (or indeed if) the trainer gained a qualification to teach MBCT. Or MBSR.

Given that depression is a life-threatening disorder I think it’s important that preventive action – which is what MBCT is good at – is very clearly kept separate from active treatment of the illness itself.

It concerns me that people who are not qualified to treat depression may be exacerbating an already difficult situation:

When meditation can make depression worse

Although meditation can be very helpful in relieving depression or in preventing depression from arising, the act of focussing inwards can actually heighten feelings of despair. I would suggest not trying to meditate when you are extremely depressed, and especially not at times that you are having any thoughts of self-harm.

As one experienced meditator said, “Meditation while clinically depressed can result in intensification of feelings of despondency, hopelessness, and negativity generally. The metta practice (where the meditation is focussed on the development of loving kindness towards yourself, and others) is theoretically a good thing, but in practice it can be a nightmare if all you feel is self-hatred!”

Regulation and accreditation of training and practitioners would seem to be very important.

This leads on to an important conviction I have come to. It is that, as another western meditation maestro Jack Kornfield put it, meditation is not psychotherapy.

Meditation and spiritual practice can easily be used to suppress and avoid feeling or to escape from difficult areas of our lives. Our sorrows are hard to touch. Many people resist the personal and psychological roots of their suffering; there is so much pain in truly experiencing our bodies, our personal histories, our limitations. It can even be harder than facing the universal suffering that surfaces in sitting.

It is my opinion, unverifiable of course, that I would be unable to meditate at all never mind gain any benefit from it if I had not tackled a large number of underlying issues, which I feel either caused or significantly worsened my depression, through psychotherapy. And I would probably (possibly?) have been unable to undertake the therapy without medication.

I do not wish to undervalue my experience of meditation. It is, in a very real sense, what keeps me going. Medication and psychotherapy are like the plaster cast that enables a broken bone to heal. But that is worthless if immediately you fall over and break the limb again. Meditation allows me to keep my balance. Meditation is like a dog. It is for life, not just for Christmas.

I would like to share this knowledge, these techniques. The way in which this might happen is still not clear to me. One thing, however, is. I still have a very, very great deal to learn.

5 Replies to “Medication -> mediation -> meditation”

  1. You raise a LOT of good points! I am a psychologist who is also trained both in MBCT and MBSR. And, yes, there are formal training programs for both of these interventions (although there is no formally required certification that would prevent a person from saying s/he is qualified to offer MBSR, absent the available training). With respect to MBCT, in most states in the USA, a person would have to be a licensed mental health provider, and (ethically) SHOULD undergo, and complete, formal training in MBCT in order to claim competence to offer that type of therapy.

    As to whether MBCT can/should be used for people who are currently depressed: that is very much an open question. Highly qualified clinicians and researchers are looking at that question, right now. I tend to think that it CAN be an effective intervention, both for persons who are currently depressed, as well as for other disorders (especially, anxiety disorders).

    And as to the qualifications of the teacher/therapist: In terms of training and credentials, every consumer should inquire about this before purchasing services. In terms of whether the provider has personally experienced the symptoms of any particular disorder that is the focus of treatment… that is, for obvious reasons, not always going to happen. BUT the provider SHOULD be very, very well-versed in any condition that s/he claims to be treating!

    Best wishes, thanks for writing about this, and I hope that your experience with MBCT ends up being valuable and helpful.

    Delany Dean, PhD

  2. Yes, I’ve known both quiet meditation and (especially) tong len practice to worsen depression. This is actually one of my reservations about tearing meditation from its religious context: there’s a great deal of traditional lore about what practices are appropriate when that has been cavalierly tossed aside. A tendency to view the secrecy of “secret practices” as priestly self-aggrandizement. Which they sometimes are, no doubt; but sometimes also they simply are not good for everyone all the time.

  3. So do I. Thank you for the information. It isnt possible for me to attend anything like this in person because of where I live. Is there a book that you have found useful and could recommend for someone starting out?

  4. Rosie – yes! Jon Kabat-Zinn, for example, has written several very useful books. “Full Catastrophe Living” was the first to detail the basis of the MBSR programme; the most recent is “The Mindful Way Through Depression”, in collaboration with the three people who adapted MBSR to MBCT and it includes a CD of guided exercises narrated by J K-Z.

    Dale – I deliberately didn’t get into the secular meditation v Buddhist meditation debate since I’m not qualified to comment but I’m aware it exists and that there are people who feel very strongly that to remove meditation from its spiritual context (and similarly other disciplines such as yoga) is to denature it/them. However the forms of therapeutic meditation being most widely practiced are vipassana (the practice of which of course predates Buddhism) and metta meditations which are found in all schools/lineages of Buddhism. The more esoteric practices of Vajrayana, such as the tong len you mention, are not, as far as I’m aware, used in a secular therapeutic context.

    Delany – thanks for your considered response. In the UK where our National Health Service is prescribing and providing MBCT and MBSR (free) to patients in various therapeutic contexts I am sure, or would hope, that the quality of the provision and the provider are carefully monitored. However outside that very specific context there’s no regulation that I’m aware of and while there’s clearly an ethical requirement for people to be qualified to do what they say they do but when something becomes popular and there is money to be made… In the case of meditation being of use to people who are severely depressed I’m can see that it could be possible in a highly controlled individual therapeutic situation with a highly skilled mental health practitioner. What I’m concerned about is the possibility of depressed people attending unsuitable group events (“oh, come along to this class, meditation’s good for depression, everyone knows that”) which could make their condition worse. Teachers/healers do not, of course, have to experienced the ill they are trying to prevent but they do of course have to have sufficient knowledge of and insight into it 🙂

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