Depression and Mindfulness

Depression and anxiety are two of the most prevalent mental disorders in the United States (Anxiety and Depression Association of America, 2016). Depression is one of the worlds most urgent health problems, affecting an estimated 350 million people (World Health Organization; WHO). Moreover, depression is the leading cause of disability, and by the year 2030, depression is projected to be the number one cause of global disease burden (WHO).

Depression and anxiety are affecting more and more people from various age groups, socio-economic statuses, and professional backgrounds. In order to meet the needs of various patient populations from various stages of the diseases, it is necessary for mental health professionals and those who working in healthcare fields to explore and examine full treatment options beyond traditional pharmacological and cognitive behavior treatments, as they may not be the ideal treatment for all. Among the various alternative treatments, studies on mindfulness-based therapy have yielded promising results and received increasing attention.

For example, a Mindfulness-Based Stress Reduction (MBSR) program is an 8-week, group-based psychoeducational program where participants practice a variety of mindfulness exercises in a secular format. MBSR has been shown to positively impact stress management, psychiatric symptoms, and quality of life for diverse patient groups as well as non-clinical populations. Mindfulness-Based Cognitive Therapy (MBCT) was developed to reduce the risk for relapse in previously depressed individuals. It incorporates exercises aimed specifically at enabling awareness of and disengagement from depressive cognitive processes.

Acceptance-based behavior therapy (ABBT) was developed specifically for the treatment of generalized anxiety disorder, and aims to decrease experiential avoidance through increased awareness and willingness to carry out valued actions in important life domains. All of these mindfulness-based therapies emphasize changing the individuals relationship to experience, enabling a present-centered and non-evaluative stance that can help to decrease emotional reactivity and to facilitate the ability to instead respond with thoughtful action in the face of distress (Vollestad et al., 2012).

A recent study by Fuchs, Evans, Weisberg, Haradhvala, Nash, and Uebelacker (2016) followed patients with depression and anxiety in an urban family medicine clinic in the northeastern U.S. as they participated in 60-min acceptance and mindfulness-based groups twice a month. Over the course of 19 months, the 29 patients experienced a significant decrease in depression and anxiety symptoms in just the first four visits attended (d=-.26 and -.19, respectively).

In another study by Smith, Metzker, Waite and Gerrity (2015), 23 patients in an inner-city, racial/ethnic minority population attended a four-week long, group-based MBSR course at a federally qualified health center. A quasi-experimental design was used to assess the impact of participation on self-reported anxiety, stress, mindfulness, and quality of life. Among all the dependent variables, only anxiety showed a statistically significant decrease (as measured with the seven-item Generalized Anxiety Disorder Scale Score: 7.8-4.4; p=.005).

In 2015, 322 adults of another population, primarily made up of well-educated white women, enrolled in an eight-week, community-based MBSR program. Roughly half of the study participants had experienced symptoms of depression. The participants completed a secure online survey before and after the intervention, showing statistically significant (p<0.01) reductions in depressive symptoms regardless of affiliation with a religion, sense of spirituality, trait level of mindfulness before MBSR, sex, or age (Greeson, Smoski, Suarez, Brantley, Ekblad, Lynch, & Wolever, 2015).

In a quasi-experimental study of the effects of yoga exercise conducted in Spain by Roche, Barrachina, & Fernandez (2016), 16 participants in the yoga group showed a statistically significant increase in mindfulness and decrease in both anxiety and depression symptoms, as compared to 22 participants that had no significant change. The study was conducted based on Douglasss (2009) finding that yoga practice has a positive effect on neurotransmitters associated with mood, increasing the levels of melatonin, dopamine, and serotonin that enhance positive mood and reducing the level of cortisol that is associated with reduction in experiencing stress (as cited in Roche et al., 2016).

In summary, mindfulness-based practices have proved to be helpful in promoting mental well-being, especially by reducing the symptoms of depression and anxiety in various populations. For people with medicine noncompliance issues or people unwilling to start formal psychotherapy, mindfulness-based therapies could be a beneficial alternative to consider.

References

Falsafi, N. (2016). A randomized controlled trial of mindfulness versus yoga: Effects on depression and/or anxiety in college students. Journal of the American Psychiatric Nurses Association, 22(6), 483-497.

Fuchs, C. H., Haradhvala, N., Evans, D. R., Nash, J. M., Weisberg, R. B., & Uebelacker, L. A. (2016). Implementation of an acceptance-and mindfulness-based group for depression and anxiety in primary care: Initial outcomes. Families, Systems, & Health, 34(4), 386.

Greeson, J. M., Smoski, M. J., Suarez, E. C., Brantley, J. G., Ekblad, A. G., Lynch, T. R., & Wolever, R. Q. (2015). Decreased symptoms of depression after mindfulness-based stress reduction: potential moderating effects of religiosity, spirituality, trait mindfulness, sex, and age. The Journal of Alternative and Complementary Medicine, 21(3), 166-174.

Guillaumie, L., Boiral, O., & Champagne, J. (2016). A mixed-methods systematic review of the effects of mindfulness on nurses. Journal of advanced nursing.

Monteiro, L. & Musten, F. (2013). Mindfulness Starts Here: An Eight-week Guide to Skillful Living. Canada: FriesenPress.

Roche, L. T., Barrachina, M. T. M., & Fernández, I. I. (2016). Effect of ‘Exercise Without Movement yoga method on mindfulness, anxiety and depression. Complementary Therapies in Clinical Practice, 25, 136-141.

Smith, B., Metzker, K., Waite, R., & Gerrity, P. (2015). Short-form mindfulness-based stress reduction reduces anxiety and improves health-related quality of life in an inner-city population. Holistic Nursing Practice. 70-76.

Vøllestad, J., Nielsen, M. B., & Nielsen, G. H. (2012). Mindfulness- and acceptance-based interventions for anxiety disorders: A systematic review and meta‐analysis. British Journal of Clinical Psychology, 51(3), 239-260.

How to be more mindful:

Reminding yourself to take notice of your thoughts, feelings, body sensations and the world around you is the first step to mindfulness.

Notice the everyday

"Even as we go about our daily lives, we can notice the sensations of things, the food we eat, the air moving past the body as we walk," says Professor Williams. "All this may sound very small, but it has huge power to interrupt the 'autopilot' mode we often engage day to day, and to give us new perspectives on life."

Keep it regular

It can be helpful to pick a regular time – the morning journey to work or a walk at lunchtime – during which you decide to be aware of the sensations created by the world around you.

Try something new

Trying new things, such as sitting in a different seat in meetings or going somewhere new for lunch, can also help you notice the world in a new way.

Watch your thoughts

"Some people find it very difficult to practice mindfulness. As soon as they stop what they're doing, lots of thoughts and worries crowd in," says Professor Williams.

"It might be useful to remember that mindfulness isn't about making these thoughts go away, but rather about seeing them as mental events.

"Imagine standing at a bus station and seeing 'thought buses' coming and going without having to get on them and be taken away. This can be very hard at first, but with gentle persistence it is possible.

"Some people find that it is easier to cope with an over-busy mind if they are doing gentle yoga or walking."

Name thoughts and feelings

To develop an awareness of thoughts and feelings, some people find it helpful to silently name them: "Heres the thought that I might fail that exam". Or, "This is anxiety".

Free yourself from the past and future

You can practise mindfulness anywhere, but it can be especially helpful to take a mindful approach if you realise that, for several minutes, you have been "trapped" in reliving past problems or "pre-living" future worries.

Different mindfulness practices

As well as practising mindfulness in daily life, it can be helpful to set aside time for a more formal mindfulness practice.

Mindfulness meditation involves sitting silently and paying attention to thoughts, sounds, the sensations of breathing or parts of the body, bringing your attention back whenever the mind starts to wander

Yoga and tai-chi can also help with developing awareness of your breathing.

Is mindfulness helpful for everyone?

"Mindfulness isn't the answer to everything, and it's important that our enthusiasm doesn't run ahead of the evidence," says Professor Williams.

"There's encouraging evidence for its use in health, education, prisons and workplaces, but it's important to realise that research is still going on in all of these fields. Once we have the results, we'll be able to see more clearly who mindfulness is most helpful for."

Discussion:

What is your experience like with depression?

What methods have you tried to alleviate your struggle with depression?

Have you ever tried mindfulness to help you feel better?

Which methods of mindfulness have you tried, and does it make a difference?

Does the prospect of mindfulness give you some hope if other types of treatment options fail?

Can mindfulness be used as a tool to deal with feelings of sadness and mood disorders?