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The Effectiveness of Mindfulness in Treating Depression
Introduction
Derived from an Eastern Buddhist tradition, mindfulness is a broad and multidimensional concept which is at once a theoretical construct, a meditative practice and a psychological process (Williams and Kabat-Zinn, 2013). To be mindful is to be supremely self-aware and experientially orientated towards the present (Ivtzan et al, 2011). However, while the term has become integrated into mainstream social and psychological discourse, there is little by way of consensus as to what mindfulness means for those who practice it and, more importantly, how effective mindfulness is in a therapeutic context. This is an issue which this essay intends to explore in greater depth. In particular, the essay will assess the effectiveness of mindfulness in treating depression. Drawing upon the insights afforded by conceptual and empirical literature, the essay will demonstrate that there is a wealth of scientific evidence to support the hypothesis that mindfulness is an effective intervention for treating depression.
Depression
Depression is a common mental health disorder which, according to the World Health Organisation (2017), affects over 300 million people (4.4% of the world's population). There are a variety of factors that can trigger depression including genetic and hereditary causes of mental illness, and environmental factors, particularly exposure to stress (Beck and Alford, 2008). Depression has an adverse effect upon the moods, motivations, cognitive functioning and behaviour of the sufferer with symptoms varying significantly both in severity (from relatively mild to severe) and duration (from several weeks to years) (Beck and Alford, 2008). Depressive episodes are associated with feelings of loss, hopelessness and inadequacy which, in turn, are exacerbated by the individual's propensity to ruminate upon past failures and negative experiences (Segal et al, 2012). As Segal et al (2012:245) attest, rumination impedes the individual's capacity for objective and rational reasoning, and acts as a form of propaganda "directed against the self." In addition, empirical research has shown that while some people may experience only one depressive episode during their lifetimes, for many others the risks of recurrence are especially high. Burcusa and Iacono (2007), for instance, estimate that at least 50% of people who recover from depression will experience another depressive episode while approximately 80% of people with a history of two episodes will experience a further recurrence. As a consequence, depression is characterised by embedded patterns of negative thinking and relapse/recovery (Segal et al, 2012).
Mindfulness
Mindfulness is generally agreed to be an attribute of consciousness (Brown and Ryan, 2003). Phenomenological research reveals that there two primary modes of conscious processing: the natural state and the phenomenological state. In the natural state, phenomena are experienced subjectively (Thompson and Zahavi, 2007). As a result, values, judgements and concepts are assigned according to the individual's previous life experiences and expectations (Teasdale et al, 2002). The natural state therefore yields a deterministic interpretation of events (Thompson and Zahavi, 2007). In the phenomenological state, phenomena are experienced objectively; thus, events and experiences are perceived as they are happening (Lambie and Marcel, 2002). The phenomenological state is the apex of mindfulness: a non-judgemental space free from the prejudices and biases of discriminatory cognitive filters (Warren Brown and Cordon, 2008). Understood in this way, mindfulness can be described as: (1) a non-discriminatory observation of facts; and (2) a mode of consciousness unconditioned focused upon the present (Siegel et al, 2008). Thus, the two most widely acknowledged attributes of mindfulness are, firstly, awareness and attention and, secondly, acceptance (Germer, 2005). Moving from a natural to a phenomenological mode of mind is facilitated through meditative practices, which encourage the individual to focus upon the present and block out everyday emotional stressors (Williams et al, 2007; Teasdale and Chasklason, 2011).
The Effectiveness of Mindfulness in Treating Depression
The literature which has been published on mindfulness reveals a causal link between mindfulness and emotional wellbeing. For instance, Brown and Ryan (2003) undertook empirical research into the effectiveness of mindfulness with a sample group of 327 first year university students. Mindfulness was measured through the 15-item Mindfulness Attention Awareness Scale (MAAS) while the researchers examined five dimensions of wellbeing including: traits and attributes; emotional disturbance; emotional subjective wellbeing; eudemonic wellbeing; and physical wellbeing (Brown and Ryan, 2003). Scores from these self-report instruments were cross-validated with a general adult sample of 239 adults. The results revealed that higher scores on the MAAS are associated with heightened awareness of and receptivity to inner experiences and overt behaviour, and a greater acceptance of emotions and feelings (Brown and Ryan, 2003). Conversely, individuals with higher scores in the MAAS are less prone to social anxiety and self-consciousness than participants with low MAAS scores (Brown and Ryan, 2003). The results therefore indicate that mindfulness is an effective means of treating depression because it reduces the scope for rumination (Brown and Ryan, 2003).
The findings from Brown and Ryan's study have been corroborated by a wealth of empirical literature. Gouda et al (2016), for example, assigned a sample of 29 students and 29 teachers to an eight week mindfulness-based stress reduction (MBSR) programme to assess improvements across a variety of psychological and emotional variables. Gouda et al (2016) found that, compared to the control group, the sample of students and teaches reported significant improvements in stress, emotional self-regulation and perceived self-efficacy. Consequently, the study suggests that mindfulness is an effectiveness means of treating depression because it tackles the environmental and situational causes of mental ill health (Gouda et al, 2016). However, it is prudent to recognise the limitations of research into the effects of mindfulness. Two issues are salient. Firstly, studies which measure mindfulness through empirical instruments fail to distinguish between dispositional mindfulness (i.e. an innate predisposition towards phenomenological modalities) and trait-based mindfulness (i.e. mindfulness which is learned through tuition and practice) (Rau and Williams, 2013). This is an important point to acknowledge because only trait-based mindfulness is applicable in treating depression (Segal et al, 2012). Secondly, sample groups in these research studies do not suffer from a diagnosed mental health condition. Consequently, results merely show the potential effectiveness of mindfulness in treating depression.
Therefore, to assess the effectiveness of mindfulness, it is essential to examine research which has been conducted with participants who have been diagnosed with depression. For instance, Teasdale et al (2002) conducted research with a sample of forty adult psychiatric outpatients diagnosed with major depression in the previous eighteen months. The sample group was subjected to a mindfulness-based cognitive therapy (MBCT) intervention, which combines the principles of mindfulness with the psychotherapeutic practices of cognitive-behavioural therapies (CBTs) in order to combat self-defeating thoughts and behavioural patterns. The researchers measured depressive symptoms through the 17-item Hamilton Rating Scale for Depression (HRSD) and the 21-item Beck Depression Inventory (BDI), and awareness and coping through Measure of Awareness and Coping in Autobiographical Memory (MACAM) vignettes (Teasdale et al, 2002). After comparing the results with a control group of twenty adults sampled from the general population, Teasdale et al (2002) found that: (1) MBCT enhances meta-cognitive awareness by focusing the mind upon feelings and sensations which are occurring in the present; and (2) increased meta-cognitive awareness reduces the risk of relapse in depression because negative thoughts and feelings are experienced as transient mental events rather than part of an ongoing self-narrative. The study therefore indicates that mindfulness facilitates cognitive decentring, thereby freeing the individual from restrictive thoughts and patterns of behaviour (Teasdale et al, 2002).
The findings from Teasdale et al's study have been replicated across a range of empirical literature. Ma and Teasdale (2008) found that MBCT reduced relapse rates from 78 to 36% in 55 patients with three or more depressive episodes. Likewise, Godfrin and Van Heeringen (2010) reported the findings of a randomised controlled study in which 106 recovered depressed patients with a history of at least three depressive episodes were assigned either to a MBCT group or a treatment-as-usual (TAU) group. Godfrin and Van Heeringen (2010) found that periods of relapse/recurrence were significantly reduced for the group which had undergone MBCT in comparison to the TAU group. These results were corroborated by a meta-analysis of previous research undertaken by Galante et al (2013) who found that, after a one-year follow-up, MBCT reduced the rate of relapse in patients with three or more depressive episodes by 40%. As a consequence, there is a wealth of scientific literature which supports the assumption that the pattern and prevalence of depression can be managed through: (1) self-awareness; and (2) the regulation of emotions through mindfulness interventions (Van Aalderen et al, 2011). Nevertheless, it essential to acknowledge that the effectiveness of mindfulness in treating depression is determined by the quality of mindful awareness (Olendzki, 2016). This, as Olendzki (2016) attests, is influenced to a considerable degree by the therapist's capacity for communicating in a nonjudgmental, accepting and compassionate manner and, likewise, the client's willingness to accept negative experiences as they occur.
Conclusion
Depression is a common and debilitating mental disorder which is characterised by embedded patterns of negative thinking and relapse/recovery. Mindfulness is an effective means of treating depression because, in focusing the mind upon the present, it encourages a non-discriminatory observation of events and experiences. This, in turn, reduces the scope for ruminating upon past failures and directing negative thoughts against the self. Research has shown that, in a clinical setting, mindfulness is most effective when it is combined with CBT. In particular, empirical research with patients who have been diagnosed with clinical depression has consistently demonstrated that mindfulness substantially reduces the prevalence of relapse and recurrence of depression. Mindfulness is an effective means of treating depression because it enhances awareness, attention and acceptance of events which exist outside of the individual's control.
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