Thursday, September 30, 2010

Book Review: The Mindful Way Through Depression by Mark Williams et al.

Hello Friends:

This book gets four out of five 'wings' from your Adventure Hostess.

As you know from my previous posts, I've been trying to include meditation and mindfulness regularly in my life. I got the idea from reading about BPD (Borderline Personality Disorder) and DBT (Dialectical Behavior Therapy). I don't happen to have BPD - I exhibit only a few of the characteristics, but I do exhibit some of them. And I was raised by a person with BPD. So I figured I would plumb the workings of DBT and see if there were pieces I could successfully apply to myself. The mindfulness component struck me immediately as portable to therapy for almost any mental illness (or really to anybody for any reason at all).

I promised to review this book over a year ago, I think.  So here, finally, is the always-glorious, never-trivial, certain-to-be-mind-bogglingly-useful review.  

The Mindful Way Through Depression by Mark Williams et al. was published in 2007, and spans 273 pages. It presents the reasoning behind, and the basic course for, MBCT (Mindfulness Based Cognitive Therapy). MBCT was developed by Zindel Segal, Mark Williams and John Teasdale, working from Jon Kabat-Zinn's already existing MBSR program (Mindfulness Based Stress Reduction). 

Mindful Way, as I am going to call it in this review, appears to be the popular level incarnation of a previous book, Mindfulness Based Cognitive Therapy for Depression: A New Approach to Preventing Relapse, that was published in 2001. This earlier book was directed more towards psychologists and such, including discussion of the research supporting use of MBCT in the arena of depression.

Some of What's in the Book

This book falls into four sections, and includes a final list of resources and an accompanying CD.  The sections are "Mind, Body, and Emotion", "Moment by Moment", "Transforming Unhappiness", and "Reclaiming Your Life". The CD has guided narration for six practices, including "The Body Scan" at 29 minutes, and "Mindful Standing Yoga" at about 11 minutes.  Overall, the CD is more than 77 minutes long.

The first section describes the authors' ideas behind the connection between mind, body, and emotion - how our moods and feelings are influenced by thoughts - and how becoming more aware and mindful can make a difference. The second section details the meditation focus points, such as the body and breath, and how to become more mindful of them. The third section is anchored by the passages that point out how our own thoughts are creations of the mind, are neither 'true' nor 'untrue', and that they do not define who we are. The final section brings together all the points from the book and tries integrate them into a coherent plan. This includes a breakdown of the full eight week program, with exercises, worksheets, and meditations on the CD.

The time commitment for the full program is substantial, as much as an hour a day some weeks, to do the required meditations, worksheets, and whatnot. Much of this is the Body Scan meditation, taking almost a half hour.

What I Liked

The authors recognize that we can't begin to think in new ways without new tools. Using what you have always used, you'll get what you have always gotten. Their eight week plan is designed to provide the necessary tools, by way of a step-by-step immersion into the world of meditation and mindfulness. This is a huge improvement over other CBT approaches, since mindfulness really does alter your perception of the world, and your place in it. And the authors offer their program as a way to manifest this opportunity.

For a systematic approach, I feel like all the pieces are in place. Specifically, the included CD makes it trivial to follow along with the specifics of what they want you to do. While you might wonder if the therapy is "working" you won't have to wonder what it is you are supposed to be doing today to be on track.

The personal anecdotes from people who have done the program are very useful, and show a good range of possible reactions to each stage.

Some of what they present helped me to make sense of certain things for the first time. While I disagree with some of their cause-effect reasoning, at least in two cases I was struck with a new idea that helped me a great deal. The first was one I have written about before, the idea that avoiding something is exactly what makes it impossible to avoid (Suppressing Does Not Work Part I and Part II). This is the whole "spend a minute and don't think about a white bear" thing that makes it clear you will spend that minute thinking about nothing but white bears. Mindful Way helps the reader to understand that engaging painful thoughts with a gentle curiosity is actually better at getting rid of them than trying to avoid them completely.

The second thing that grabbed me was the discussion of a list of automatic thoughts of those who are depressed (Kendall and Hollon, 1980). Although the list is a classic in the literature for depression, I simply had never considered the implications. They present this list of thirty automatic thoughts, like "What's wrong with me?", "I hate myself", "It's just not worth it", and "I can't finish anything." The program participants are asked how many of the thoughts they believe right now, and how many they believed in the middle of their last deep depression. The book goes on to say, "When they all answer 'Yes - all of them' ... something remarkable happens. A moment of realization that, 'This is depression, not me.'" I had the same realization when I read it. My negative thoughts are actually the symptom of an illness, and all depressed people have them. This list a chance to stare directly at that truth, and it was liberating.

What I Didn't Like

I am so, so glad I read Brach's book Radical Acceptance before I read Mindful Way (here's my review of Radical Acceptance). If I had read Mindful Way first, I think I would have looked at it as just another self-help book, with another five or eight or ten week course of stuff, another worksheet to fill out, and another eight steps to follow to cosmic enlightenment or optimum turbo libido or whatever (okay that last is just me being snarky). Either way, I'm sick of those kinds of books.

Fortunately, I had read Radical Acceptance, which artfully presents meditation, mindfulness, and compassion in a way that feels whole, connected, and meaningful. Radical Acceptance successfully walks the line between the mysterious/spiritual side of mindfulness, and the practical/daily side. In comparison, Mindful Way feels sterile. It presents only the clinical aspects of meditation, broken down into the authors' idea of a workable course/schedule. It cuts out much of the more compelling, mysterious, and motivating context to be found in Buddhism, and thereby saps the practice of an integral source of vibrancy.

I do not agree with some of the authors' ideas about the relationship between mood-thoughts-feelings-body. They very nearly fall into the whole trap of "you are depressed because you keep thinking depressed thoughts, so depression is your fault." They try to avoid this by blaming rumination and such on the "critical thinking part of the brain volunteering for a job it can't do",  and by admitting that thinking new things is really hard.  Yet it is still thinking = depression.  Too close to "it's all in your head" for my taste. I shouldn't be surprised, given the CBT roots of this kind of therapy, and even some of the worksheets that go with it.

They could have missed this near-accusation entirely had they included the important aspects of brain chemistry in the book. They say they recognize the existence of thinking ruts, patterns, and habits.  But they miss the opportunity to say how this manifests in brain chemistry, and how that in turn links directly to overall body chemistry. Thinking is, after all, nothing more than biochemistry. It is hard to think in new ways because our old thought patterns are actually "burned" in biochemically by past trauma, trauma responses, and years of repetition. Early childhood trauma can even inhibit development of certain aspects of the brain. These things are not mentioned.

Yes, we can change the path our thoughts follow from more negative ones to more positive ones by working for extended periods with the variables that alter brain chemistry.  Over time, this allows new preferred thought pathways to be electrochemically "burned" into our brains.  Successfully making those changes requires a complex combination of many possible approaches, including: good nutrition, stable sleep, social connections, support networks, talk therapy, meds, exercise, meditation, body knowledge, somatic therapies, massage, and on and on.  While I personally believe that mediation is a hugely powerful tool, this book presents it too disconnected from all other possible sources of an integrated plan for mental wellness.  The old CBT message of "just think your way out if it" remains, and I am very wary of that message.

Summary and Final Comments

Overall, this is a very good book. I would not recommend it as the first book to read about meditation or mindfulness. Read Radical Acceptance first if you are new to all of this, then Mindful Way. I just think Radical Acceptance is more robust, more compassionate, and more meaningful. Meditation and mindfulness are great, but not everyone is going to approach their practice in the same way. What Mindful Way offers is one possible plan for integrating mindfulness practice into your life. It is systematic, and tailored to those who have suffered at least one major depressive episode. If you respond well to structure, then the one presented here could be very helpful. If you do get the book, make sure the CD is included, since it is critical to the program. Mindful Way underscores the idea that mindfulness is a life-long practice, not an end goal, and offers some new options for developing the tools for dealing with the mental struggles of daily life. Anyone might benefit from reading the book and doing the program, but there is some evidence that for those with depression, it really might prevent another deep episode, or at least help limit its length and severity.

Your Hostess With Neuroses


Amy said...

This is a fantastic review. It's interesting to me that CBT lives on so powerfully, even as it is integrated into more ancient practices such as meditation. I wonder how an experienced yogi would approach the whole idea of meditation and mindfulness as a way to control thinking, as opposed to a way to observe and let go of thinking.

I really do like the idea of a guided practice on CD, though. It's one mental hurdle taken down, which is really important when one is depressed.

The Blue Morpho said...

Amy, glad you liked the review. I'm still trying to see how to fit this program into my current crazy life. When I do try it for real I'll post more about what worked for me and what didn't.

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