MIND MOVES On of the greatest problems in adult mental health is that while people recover from emotional difficulties like depression, the likelihood of relapse is extraordinarily high, writes Dr Tony Bates.
We've been fairly successful, it seems, at reducing acute distress and sending people home symptom free, but we've failed abysmally to teach people how to stay well.
We offer services for mental illness but do very little to promote mental health.
A recent and exciting development in psychotherapy called Mindfulness-Based Cognitive Therapy is at the cutting edge of an effort to remedy this problem.
This programme originated in the University of Massachusetts, and was developed by a psychologist, Jon Kabat-Zinn, (described in his book, Full Catastrophe Living). For over 20 years he has been offering a mindfulness-based stress- reduction programme for the seriously medically ill.
In the past eight years this course has been adapted for people who suffer from depression by two pioneers in the treatment of depression, Mark Williams and John Teasdale.
Results of a multi-site international study have shown their approach to be the most successful psychotherapeutic attempt to date to reduce relapse among sufferers of recurrent depression.
On the strength of this evidence and following training from the authors of this research, we have introduced this programme in St James's Hospital as part of an overall strategy to prevent relapse among our most vulnerable repeat customers.
While this programme is designed for groups of eight to 10 'patients', its authors emphasise that its success is dependent on disciplined mindfulness practice by the group leaders, who have also much to gain from it.
Mindfulness teaches us a different way of relating to our upset. Rather than constantly trying to block it out, control it or beat ourselves into positive thinking, it invites us to pay attention to whatever is happening with us in this present moment, and to let ourselves be, without judgment.
Attention to the breath is a very helpful way to ground oneself in the present moment and find a place to rest.
By following the rhythm of our inbreath and our outbreath, we gradually slow down and become aware of all that is going on for us right now.
By cultivating this habit of checking in with ourselves, we find that we catch negative thoughts and sensations before they have a chance to congeal into bad moods, which in turn can trigger relapses into depression.
Of course, our minds will wander off on well-worn paths, but that's OK.
When that happens we simply notice it and gently escort our attention back to the breath, allowing whatever is happening in our bodies and minds to unfold in its own way.
We notice how most of our days are spent being dragged back into the negativity of our past or being pulled anxiously into the future by worries and fears of what might happen.
The experience of being mindful is glimpsed when we are doing something we love that engages our concentration. In such moments we are alert and focused.
Mindfulness is the art of being present to the ordinary activities that constitute our day. Since this is hard for many of us, it requires practice.
And we call this practice meditation.
By learning to sit quietly and bring our attention back to the present, we achieve a state of feeling relaxed, alert and stable. We learn to relate to our inner life in a different way.
The practice of mindfulness gives us a way of reacting to symptoms of anxiety and depression without being drawn by our distress into a downward spiral of self-criticism and despair.
As well as using simple meditation practices, we incorporate relaxation and yoga exercises in our mindfulness groups.
Each person needs to find their own particular way to reconnect with themselves and keep their calm in the face of chaos. We use video, audio clips, music and poetry to develop particular themes that form the focus of our weekly group sessions.
Each week we explore some particular way of building resilience and mental health and help participants to identify where they may be vulnerable to lapsing into depression.
We provide weekly handouts for each session and homework for the week ahead.
The programme takes only 10 weeks but asks a lot of participants in that short time.
While we cover a lot of ground, the focus of the group keeps coming back to the simple idea of cultivating a more attentive and compassionate relationship with our personal vulnerabilities.
The ethos of the group is gentler and less analytic than many other forms of group therapy we offer.
We are careful to include only those individuals who have been through some course of treatment or therapy and who have achieved remission from their initial presenting symptoms.
It will take further groups and research to confirm the value of this programme but so far the feedback has been extremely encouraging.
And one of its strongest features is that mindfulness-based cognitive therapy has been as satisfying for the group leaders as it has been for our service users.
Tony Bates is principal clinical psychologist in St James's hospital and author of Depression: A Common Sense Approach (Newleaf)