I’m taking part in a research study for CAMH into the use of mindfulness in preventing depression relapse. The study comprises of eight weekly sessions and in this post I’ll cover Session 4, and the subsequent daily practices. Use the links at the end to access posts on previous sessions and more on the background and premise of the study.
Over the past few weeks I’ve developed a foundation of mindfulness. Now I’m ready to extend this skill to the thoughts and feelings I experience when depression is lurking. Being aware of these, despite their unpleasantness, is one of the most important elements of staying well and preventing relapse; simple in nature, but a lot harder in practice. Still, I’ve built up my mindfulness muscle – now it’s time to flex it and see what it can do.
In this session, we’re going to explore the territory of depression more directly. Understanding depression is vital to recognizing it and preventing it from taking hold. It’s much easier to fight it early in the process.
Recognising the signs
A well-known effect of depression is the way it changes how you think. It makes you feel inadequate, pessimistic and self-critical. Often, these thoughts occur without my realizing and I fall into a pattern of negative thinking that’s self-sustaining. These are Negative Automatic Thoughts. If you’re familiar with depression you’ll have your own personal playlist, even your very own Top Ten – those old favorites that pop up so often they’re like a Greek chorus in your head…
Below are a few examples of negative thoughts people might experience when they’re depressed:
- I feel like I’m up against the world.
- I’m no good.
- Why can’t I ever succeed?
- No one understands me.
- I’ve let people down.
- I don’t think I can go on.
- I wish I were a better person.
- I’m so weak.
- My life’s not going the way I want it to.
- I’m so disappointed in myself.
- Nothing feels good anymore.
- I can’t stand this anymore.
- I can’t get started.
- What’s wrong with me?
- I wish I were somewhere else.
- I can’t get things together.
- I hate myself.
- I’m worthless.
- I wish I could just disappear.
- What’s the matter with me?
- I’m a loser.
- My life is a mess.
- I’m a failure.
- I’ll never make it.
- I feel so helpless.
- Something has to change.
- There must be something wrong with me.
- My future is bleak.
- It’s just not worth it.
- I can’t finish anything.
Any of these sound familiar? As an exercise in recognition, I picked out my personal Top Ten. Just recognizing these thoughts for the signal that they are, can help shift the grip they have. Somehow, once we see them this way, they seem less true. Viewing them as signposts on a highway, indicating we’re entering the territory of depression, helped me to see them as an external marker that could be used in a positive way.
Clinical Depression is diagnosed when at least five of the following symptoms are present for a minimum of two weeks and interfere with a person’s work/personal life:
- Tearful, feel sad
- Loss of interest in things you previously liked
- Appetite much less/greater than usual
- Trouble sleeping or sleep too much
- So restless or slowed down that others notice
- Tired and have no energy
- Feelings of guilt and worthlessness
- Trouble concentrating/making decisions
- Thoughts of wanting to die or killing yourself
Viewing depression as a “package” of symptoms and not blaming ourselves for any one part helps to relieve some of the pressure. Many people experiencing depression make it worse by blaming themselves for what they’re feeling – I certainly did. For example, poor sleep and loss of appetite are seen as “real” depressive symptoms, while negative thoughts like, “You’re worthless” or “Nobody cares”, are usually taken at face value, and believed to be true. We need to recognize ALL these signs for what they are. I had never thought of it like that before but it’s so true.
As part of our continued exploration of the various types of mindful meditation, we were introduced to mindful walking, using the sensations of movement to focus the mind on moment-to-moment awareness. In this case it’s the movement, not the breath, that’s the anchor – bringing us back to the present moment.
All you need is a little space to move; a clear path of ten to fifteen feet is fine. I walked around our table in the dining room. It’s best done in bare or socked feet so that you can feel the floor more easily. I was asked to focus my awareness on the bottoms of my feet to get a direct sense of the physical sensations of the feet in contact of the with the ground. I found that although I started walking slowly, I also needed to shorten my stride to keep my balance. I focused my attention on the way weight shifted from one leg to the other and the sensations running from the moment when I placed my heels to the floor, through the step as the entire foot makes contact with the floor, to the point where just the tips of the toes are left as the weight transfers to the other leg. I found it helpful to imagine my foot as an inverted triangle with the big toe and the little toe as parallel points joining up with the heel. As I walked I focused my mind on lifting the foot, planting the foot and shifting my weight from one leg to the other; lifting, planting, shifting – lifting, planting, shifting.
Mindful walking is helpful for when you’re feeling agitated or restless and can’t bear the stillness of the sitting meditation. It’s rhythmic and restful, although it takes a little adjustment to walk so slowly just for the sake of walking rather than for the purpose of getting somewhere as quickly as possible. I realized that walking isn’t the smooth motion I thought it was – more of a stop/start rocking motion. Although I enjoyed the mindful walking, I found it harder to keep my focus than in the sitting meditation, but this was possibly down to my being new to the practice.
When the novelty wears off
During the session we were reminded that we’re now approaching the halfway point and it’s not unusual for enthusiasm for the program to fade. We were told the study organisers had run many groups and had seen how challenging it was for people to put the effort into the daily home practices. When they asked people, “What’s the one piece of advice you would like to give someone in the middle of the program?” the most consistent reply was, “Stick with it as best you can,” and “Don’t worry if you’re having difficulty completing the home practice; it’s very, very normal.”
It was encouraging to hear this. Although my enthusiasm for the study hasn’t waned (I’m seeing results, so that keeps me keen), the hard part for me is finding the quiet time in a busy home with three young children. Sometimes a weeks practice stretches into the next week because I’ve missed a day, or because I haven’t found the quiet time to participate in the next session. With each weekly session lasting around an hour and a half, I don’t always have the energy at the end of the day once the kids are in bed. My Borderline Personality makes me want to ditch anything I can’t do to my exacting standards, but the encouragement helped me to ease the pressure I put on myself.
Sit up and take notice
The daily home practice for the week was to continue practicing the 3-Minute Meditation three times a day, and to alternate between a daily practice of either the Sitting Meditation or the Mindful Walking.
I’ve reached a new awareness of my old negative experiences, seeing them now in a different light. They no longer hold the same dread they once did and I can view them more philosophically. Although Borderline Personality Disorder (BPD) has gifted me with certain challenging tendencies; difficulty accepting criticism, relating to things in extremes (they’re either amazingly fab or absolutely diabolical) I’ve learnt to use the tools practiced in this program to fight them. Now, when negative feelings press down, I stop what I’m doing and do the 3-Minute meditation. By the end of it, I’m calm and better able to keep my perspective.
Increased awareness of myself has led to better posture and more confidence. Before, I felt as though I existed mainly through my thoughts. If those were negative, so was my whole being. This relationship with my body has made me feel more grounded. If my thoughts turn against me, I still have the reassuring physical presence to support me. I can focus instead on the ways my body registers comfort; the softness of an easy-chair, the relaxation of rest, the invigorating feeling of wind in my hair.
The biggest thing for me has been realising the importance of a relationship with myself – it sounds so egocentric when I put it like that, but it’s a vital part of how you relate to the world around you. It’s not about navel-gazing self-aggrandizement – it’s about becoming aware of the need to acknowledge, care for and listen to myself; in spite of whether others do or not. Earlier acceptance of my body and its messages might have prevented me going to war on mine with anorexia and self-harm.
Next week, join me as we begin “Facing Difficulties”…
Research into the prevention of depression relapse
Mindfulness in Depression Relapse Prevention – 1 Autopilot & Raisins
Mindfulness in Depression Relapse Prevention – 2 The Body Scan
Mindfulness in Depression Relapse Prevention – 3 The Breath