Mindfulness in Depression Relapse Prevention – Thoughts are not facts

I’m taking part in a research study for CAMH into the use of mindfulness in preventing depression relapse. The study comprises of eight weekly sessions and in this post I’ll cover Session 6 and the subsequent daily practices. Use the links at the end to access posts on previous sessions and more on the background and premise of the study.

“Who is Kevin?”

This session began with an exercise:

We were presented with one statement at a time and asked “Who is Kevin?”

Kevin was on his way to school – Who is Kevin?

He was worried about the math lesson – Who is Kevin?

He was not sure he could control the class again today – Who is Kevin?

The exercise demonstrated how quickly and automatically our minds fill in the blanks, positing stories around the bare facts and providing a running commentary. The problems occur when we rely on this commentary to answer more personal questions. We treat a stream of ideas as fact, and they crystallize into negative thoughts that become difficult to step back from. This session looks at ways of having a different relationship with our thoughts – how we can observe them from a distance and learn from them.

Introducing a difficulty into the practice

I began the sitting meditation by settling into a comfortable yet alert position and becoming aware of the sensations of sitting, before bringing the focus of my awareness to breathing. After some moments, bringing my mind back to the breath whenever it wandered, I expanded my awareness again to include all physical sensations, so that I now experienced and acknowledged my body as a whole, “a body, sitting, breathing”, before narrowing my attention again to concentrate on sounds. I explored the qualities of what I could hear; was it near or from far away? Was it high or low in pitch, continuous or momentary? There was no need to search them out. I was surrounded by the clock ticking, the refrigerator whirring, the tap dripping (must get that seen to!) and the sounds of traffic on the road outside.

From this place of restful observation it was easy to move to the next stage: surveying my flow of thoughts. I was advised to view them as images on a movie screen or clouds in the sky – objectively, non-judgmentally, from the position of detached observer – letting them roll by at their own pace without allowing myself to be carried along with them. Sometimes my mind was momentarily blank, but something always appeared to occupy it. I was asked to think of something that I found difficult or unpleasant – on a scale of 1-10, about a 3 – and as I explored this subject, looking deeply into it, to note the resultant physical sensations; any tightening or tensing, facial expression, quickened breathing, etc. Once I’d allowed myself to explore all the overlooked or avoided areas of this thought, the audio encouraged me to accept my feelings, to reassure myself that they were already here and it was ok to approach and investigate them.

The practice lasted approximately thirty minutes and is similar to one covered previously in Session 5.

Reactions to the exercise

After watching video footage of the group reacting to the experience, and hearing their overview of it, I found myself wishing I could immerse myself in mindfulness to better help my understanding, rather than catching glimpses and straining to hang onto them. It’s so enlightening I want to concrete it into my psyche so I don’t lose my tenuous grip. I imagined some kind of mindfulness retreat, but realized that it’s practicing mindfulness as a part of daily life that brings the most benefit.

Seeing alternative viewpoints

Next, I was asked to imagine a scenario where I experienced two consecutive interactions, each with a different person. The first was negative, the second, positive. I was asked to note my thoughts following each one and it was surprising was how heavily my thoughts/feelings about the first interaction influenced the second. Negative thoughts fed more negative thoughts, while positive ones elicited a positive outlook.

The group review of this exercise was hugely helpful in understanding how thoughts behave. It’s often easier to grasp someone else’s description of their behavior/response than it is to notice, or verbalise, your own. Here’s what I learned:

We have a capacity to globalize – one thought can colour all other experiences. A mind preoccupied by sadness focuses on the self and on negatives with a lot of certainty. In both scenarios, the difference in mood impacted on subsequent thoughts.
When sadness is present thoughts seem fixed, factual and absolutely certain, yet in a positive situation they’re much more pliable and fluid. Negativity intensifies over time as thought upon thought compounds it. You don’t realize depression for what it is because it feels like “Life” – this is just “how things are”, this is truth/reality.

Making it work

Despite how positive I feel about learning how my mind functions, I’m still insure of whether I’d be able to draw enough from this if I was enveloped by depression again. If I didn’t catch it early on and stick with it, I don’t know that mindfulness would penetrate the fog and hopelessness of an established episode. The mind, certainly my mind, tends naturally towards a downward spiral in the relationship between thought and emotion. I’ve always been sensitive to the melancholy in life; a sad song, a tragic tale.

Practicing mindfulness has to be a full-time commitment, like keeping fit. A couple of sessions at the gym won’t make much difference if you’ve gained a few pounds and you may feel defeated by the long road ahead, but if you’d kept a regular gym attendance you wouldn’t have gained weight in the first place. Attempting to practice mindfulness, after a long lapse, when in the depths of depression may not seem achievable, whereas daily practice from a position of well being could prevent that depression occurring.

What you think influences how you feel – and vice versa

A penny for your thoughts…Dollars for your thoughts – NARA – 513735 (Photo credit: Wikipedia)

We already covered how thoughts can influence feelings when we looked at the ABC Model of Emotional Distress in Session 2. Anyone who’s waved to a friend on the street and felt confused or anxious when they failed to respond (not realizing that they genuinely didn’t see) can relate to this. Your mind supplies possible reasons for the perceived snub: they’re angry/offended/upset with you, and you experience corresponding feelings of anxiety.

Now we’ve learnt that it can work in both directions – your thoughts can be determined by the mood you’re in when you’re thinking them and can prevent you from seeing other explanations. Hence, it’s important to treat thoughts as INTERPRETATIONS and not FACTS.

4 tips for taking your thoughts out of a tailspin

When thoughts get the better of you there are things you can do to regain your composure:

Take a breathing space – This should always be the first recourse in a troubling situation. A 3-Minute Breathing Space will help distract you from the thoughts by focusing on the body, giving you a chance to pause and gather yourself.
Write your thoughts down on paper – This helps you to take a step back and adopt a more objective standpoint.
Get curious about your thinking – Sometimes examining it brings distance.
See what happens when you ask yourself what your motives might be:

Are you…

judging yourself?
blaming yourself?
confusing thought with fact?
expecting perfection?
thinking in black-and-white?
jumping to conclusions?

The 3-Minute Coping Breathing Space

This is similar to the 3-Minute Breathing Space but it’s been modified to help in moments of difficulty rather than neutrality.

As before, there are three steps:

IDENTIFY: Bring the troubling thought to mind. Identify/describe what arises in the mind; anger, self-criticism, sadness, etc.
ANCHOR: Next, bring your attention to the physical sensations of the breath at the belly – all the way in and all the way out – using it to anchor you in the present moment.
EXPAND: Lastly, expand your awareness to include the body as a whole. Breathe into any areas of tension and reassure yourself by accepting your experience as it already is and allowing yourself to open to it.

The longer formal meditations I’ve been doing as daily practice make it easier to use the Breathing Space as a support or resource when things are tough.

Further help

Sometimes, negative thoughts persist after the 3-Minute Breathing Space so another step is required. The choices we have are like four doors we could use to help us move from a negative place to a more positive one. Here are the four options as they were described:

Re-Entry – Awareness can sometimes shift your experience so that what was troubling doesn’t seem so bad anymore. Approaching a difficulty by gently grounding yourself and allowing your reactions to be what they are can make all the difference.
The Body Door – This is all about attending to physical sensations. Difficult emotions often show up as tension, tightening and aching. Bring your attention to the areas with the most intense sensations and either breathe into them or explore specific elements of them; where they begin and end, where they’re at their most intense, if they change from moment to moment. You can also apply these questions to difficult emotions.
The Thought Door – If, after the Breathing space, you realize thoughts are the driving force of your current experience, apply a gentle curiosity to them. Ask yourself “What am I feeling right now, specifically, in this moment?” Identifying the feelings might help you to stand behind the cascading waterfall of negative thoughts and be able to see their force more clearly, without being dragged down by them.
The Door of Skillful Action – We don’t have to deal with difficult experiences passively. After acknowledging you’re experiencing difficulty, sometimes taking action helps; do something pleasurable or nourishing: a bath, a walk, a chat with a friend, OR something that gives you a boost, a sense of achievement/mastery: returning a phone call, doing the laundry, sorting out the filing.

Stick with it!

The session ended with an acknowledgement of the challenges of mindfulness practice and there were some VT’s from participants about common obstacles and how they dealt with them. It was heartening to hear from people who had persisted in the face of tedium and difficulty and were emphatic about how much it had paid off.

Join me for the next session, when we’ll talk about “Building Your Plan of Action”.