Zindel Segal Addresses NJ-ACT on
Mindfulness-Based Cognitive Therapy
By Lynn Mollick
On April 13, eighty-five individuals attended NJ-ACT’s 12th Master Lecture, Zindel Segal’s “Mindfulness-Based Cognitive Therapy” (MBCT). Dr. Segal and his collaborators John Teasdale and Mark Williams originally developed MBCT to reduce the high relapse rate for Major Depression.
Everyone experiences negative emotions, but negative emotions often precipitate depression in susceptible individuals. Mindfulness is an alternate way of experiencing negative emotions that can prevent these emotions from precipitating depression.
Mindfulness means being fully aware and accepting of one’s thoughts and emotions, without judging or trying to avoid them, and without planning, ruminating, or worrying about the future, or judging and regretting the past. Mindfulness is a way of attending to emotions, especially unpleasant emotions, that people ordinarily ignore or push aside. Mindfulness is an antidote to experiential avoidance which maintains depression and other psychopathology.
Emotions have a physiological component. According to MBCT, if we learn to attend to our physiology, we can learn to accept our emotions rather than criticize and fight against them.
At the Master Lecture, Dr. Segal led participants through some basic mindfulness exercises – mindfulness of eating (an almond) and mindfulness of the breath. The Mindful Way Through Depression (Williams, Teasdale, Segal, & Kabat-Zinn, Guilford, 2007), describes the entire MBCT program and includes a CD which guides readers through the program.
Below is a list of the most important mindfulness exercises, arranged from least to most difficult, the order in which they should be practiced:
1. Mindful Breathing (lying down or sitting) is being aware of the physical sensations created by breathing. Mindful Breathing may be experienced as relaxing. However, awareness, not relaxation is the goal of all mindfulness exercises.
2. Mindful Walking means paying attention to the physical sensations of slowly walking. Mindful walking is especially helpful when agitated or fidgety.
3. Body Scan begins with attending to the sensations in the belly from breathing, and then moves on to attending to sensations throughout the body, area by area. This exercise develops body awareness and acceptance of discomfort. It separates bodily sensations from thoughts about those sensations. Body scan also demonstrates that negative sensations and emotions eventually change.
4. Mindful Standing Yoga coordinates movement and breathing. Yogic stretching further develops acceptance of unpleasant sensations. Mindful standing yoga encourages turning toward unpleasantness. This exercise promotes curiosity rather than rejection and avoidance of unpleasant emotions.
5. Mindfulness of Breath & Body extends the practice of Mindful Breathing to the entire body. When patients notice physical discomfort, they can “breathe into” it by focusing their full attention on their breathing, or they can “breathe with it” by simultaneously focusing on the physical discomfort and their breathing. After learning Mindfulness of Breath & Body, patients will be able to apply increased awareness and insight to traditional CBT interventions, such as pleasant and unpleasant events exercises.
6. Mindfulness of Hearing and Thinking begins with attending to sounds in the environment and noticing how they come and go, how they wax and wane. The exercise then shifts to awareness of thoughts, allowing thoughts to float through awareness. Since it is easy to be drawn into ruminative thinking rather than observing thoughts, patients should initially perform this exercise for
no more than 5 minutes. The goal of Mindfulness of Hearing and Thinking is to be accepting of whatever thoughts are present, even negative ones, and to observe how thoughts develop and change when they are accepted rather than suppressed or criticized.
7. Three-Minute Breathing Space combines basic mindfulness skills into a technique that can be used in daily life. This exercise has three components which should be practiced in sequence for approximately a minute per component:
a) Awareness of present thoughts, emotions, and body sensations;
b) Redirecting attention to the breath;
c) Expanding awareness of the breath to awareness of the whole body, including posture, and facial expression.
8. Three-Minute Coping Space refers to using the 3-Minute Breathing Space in times of distress. This technique short circuits unacknowledged emotions and thoughts that can trigger depression.
9. Inviting in Difficult Situations asks patients to imagine unpleasant situations and experience them mindfully. (This is beginning to look a lot like desensitization, isn’t it?)
The MBCT program encourages an attitude of curiosity, acceptance, and loving kindness toward all inner experiences. Mindfulness makes intolerable emotions (e.g. unhappiness, anger, self-hatred) tolerable. It offers acceptance as an alternative to the demand to rid oneself of unpleasant emotions. When mindfulness is achieved, automatic, mindless behavior ceases, and patients experience the freedom to take control of their lives and choose from a variety of possible behaviors.
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