MBCT and Suicide – how to extend MBCT and treat those at risk

Mark Williams and his co-authors show how to adapt Mindfulness-Based Cognitive Therapy (MBCT) for people who have struggled with suicidal thoughts and impulses, and were in remission from Major Depressive Disorder at least 8 weeks.
This is an important work, extending on the understanding that MBCT is helpful to those most at risk for depressive relapse.

The book is Mindfulness-Based Cognitive Therapy with People at Risk of Suicide. The authors are J. Mark G. Williams, Melanie Fennell, Thorsten Barnhofer, Rebecca Crane, Sarah Silverton. A previous edition was titled Mindfulness and the Transformation of Despair: Working with People at Risk of Suicide.

Mark Williams, lead author, in 2003 moved from Bangor University in Wales to Oxford University to begin a 10-year research program, putting together a team that would together be able to research psychological processes underlying mindfulness and how they could “apply to those who suffered depression so severely that they became suicidal.” P 4

He continues the research tradition of MBCT. While basing changes on research slows things down (the 3 creators of MBCT began work in 1993, and the first edition of their treatment manual came out in 2002) the result is a treatment that is well understood both in what it does and what is not yet researched.

This book will be most useful for active MBCT practitioners who want to extend their range, but also offers gems for others. As Williams puts it,”MBCT is particularly useful for those people who are at the greatest risk of relapse or recurrence [of depression].” (P 302)

This book takes that understanding a big step further.Here are a few examples:

• How the authors refined the intake process to reduce dropouts and increase the numbers of people helped
• How to address 5th session teacher doubts (a frequent phenomenon related to the delicate nature of inquiry, in which it’s easy for the teacher to feel “I haven’t taught anything”)
• How to adjust a session after one that had absences
• An essay on the role of the curriculum, balancing first the need to stay close to the content of each session, against, second, the nature of inquiry, which requires flexibility
• A short essay on a potential direction for future research: adding in measures of the positive effects of MBCT (e.g. Increasing well-being) rather that focusing solely on reducing suffering.

• Description of the international training path
• How to work with “at risk” people
• The story of ‘Jane’, one participant, described in detail from intake through the 8 th week and 2 follow-up sessions; a very helpful illustration of how transformation can happen in MBCT
• Guided meditations recorded by Mark Williams, Zindel Segal and John Teasdale
• The role of individualized mentorship in preparing new MBCT teachers around the world (full disclosure: Donald Fleck is a recognized MBCT mentor)
• Accessing the doing and being modes of mind in the teacher, while teaching: using self awareness to be fully present, and most effective, during inquiry

• Insights into clients with suicidal depression
• Review of the extensive research on MBCT, which is rich with information for therapists developing a mindfulness-based practice

The Experience of Being an MBCT Teacher is explored creatively in a chapter I haven’t seen elsewhere. Teachers present and future can gain from this exploration of the subject to teaching MBCT. In includes
*The teacher’s own doing and being state of mind in teaching
*The role of supervision
*What makes a skillful teacher
*Responding in moments of discovery
*Holding the curriculum loosely and firmly at the same time (an adaptation of the increased focus in inquiry, in which the moments of learning are less controlled)
*Teacher doubts
*How to effectively use recordings of yourself teaching, for self-evaluation

The book is available at Amazon and other places. It is pubished by Guilford.

Mindfulness Meditation Therapy Researched

Psychologists research Mindfulness Based Cognitive Therapy (MBCT) and variations for alcohol relapse prevention, social anxiety, panic, PTDS, OCD, Bi-Polar and other conditions.

We’re far beyond the oooohs and ahhhhs of tv celebrity shows announcing that mindfulness offers miracles of personal growth.

There is now a vast amount of research on the importance of learning mindfulness, and a lot of clinical experience supporting that. Personally, I have been teaching mindfulness in a mental health context for 5 years. Continue reading

CD for Mindfulness-Based Cognitive Therapy (MBCT)

Guided Meditations for Mindfulness Based Cognitive Therapy, by Donald Fleck

You can buy and download a complete set of guided meditations for Mindfulness-Based Cognitive Therapy, tracks by Donald Fleck, from CD Baby.

Note: clicking on the graphic below takes you to CD Baby, my distributor. At their site you can see the listing of tracks and album description, and decide if you want to buy certain tracks, or the whole CD.

Donald Fleck: Mindfulness- Based Cognitive Therapy tracks by Donald

Mindfulness to prevent depression relapse?

Mindfulness may be a viable alternative to anti-depressants, for people at risk of relapsing into depression, according to research just published in The Journal of Consulting and Clinical Psychology.

The researchers used Mindfulness-Based Cognitive Therapy (MBCT), something I have been offering in New York City for the past year.  Participants in the 8-week workshops learn a special form of mindfulness or Vipassana meditation along with cognitive skills to better deal with depressing thoughts.

Many participants have gained immensely from taking the workshop.

In research published several years ago MBCT was found to cut relapse rates in half. It was effective for people with chronic depression (3 or more episodes).

Now it appears that people on maintenance anti-depressants can consider learning MBCT and ending their medication. (Medical decisions need to be made with a medical doctor.)

The new research was published in the Journal of Consulting and Clinical Psychology, a highly-regarded publication of the American Psychological Association (APA), in its December 2008 issue.  A summary of findings was published by the Utne Review, citing an article in the  Shambhala Sun:   http://www.utne.com/2008-12-05/Spirituality/Tackling-Depression-with-Meditation.aspx?blogid=28 .

MBCT has created quite a stir in the healing community.  As I write this, researchers are studying application of MBCT to conditions other than depression. Published research can be accessed at www.PubMed.gov, searching under MBCT.

It is important to note that MBCT is not necessarily an alternative to anti-depressants. People can be on anti-depressants and still take MBCT.  People often need anti-depressants when suffering from major depression.  The purpose of MBCT is to reduce the risk of relapse into another period of major depression. It has been found effective for people who have had 3 or more episides of major depression. Subsequent study indicated that a way of understanding this is that it can be effective for people whose depression relates to mental processes such as rumination, and is not effective for people whose depression is more caused by a major negative life event.   Finally, MBCT generally is offered to people who are between depressions, as participants need the energy to do 30 to 60 minutes of home practice daily. The practice consists mainly of mindfulness exercises that are a core of this treatment. The cognitive elements tend to be learned in the workshop setting.

This summary is my own understanding of MBCT, and does not necessarily represent the opinions of the authors. I have studied MBCT with one of the authors during a 5-day retreat at Omega Institute, and have taught 3 of the workshops so far.  The authors have websites that are available for access. One of them is www.MBCT.com.  It lists related sites on MBCT.

Information on the MBCT workshop I offer in NYC is available at www.DonaldFleck.com, on the Mindfulness page.