Before I start these final two blogs, it’s worth reminding ourselves that all the work in the latter part of the treatment is based on mindfulness and these skills take ongoing practice. Although I haven’t always mentioned them, we started and finished each week with a long meditation and our homework included regular breathing spaces as well as a longer meditation each day. Through regular practice, we were starting to find a more mindful approach to life was becoming embedded in our daily lives.
This week the emphasis was on taking action in our lives to take care of ourselves. After all, although mindfulness is the emphasis in MBCT, it is also based in cognitive behavioural therapy (CBT). CBT is a very action-oriented approach to managing depression. CBT therapists recognise that depression can cause reverse motivation. Usually we want to do something and then we do it. When depressed we sometimes have to do something in order to want to do it - the motivation comes second.
I really like this way of putting it. I know that sometimes I end up feeling better by making myself put one foot in front of the other and doing something that initially I really don’t want to do - often exercise, visiting friends or getting to work. But it can be hard to persuade myself when in a very low mood.
In the session today we didn’t just think about what helps when you feel bad, but what actively makes us feel good. We were asked to break down our day into small parts and identify what helps us feel good, nourishes us and increases our sense of being alive and present. We also had to identify what drains us and does the opposite. Have a go.
I’ve spoken a bit about the things that help me feel good before, they include writing and sharing my writing, sewing, gardening or just being outside, stroking our dog, reading in the bath, talking to friends, my first cup of coffee at work and my tea in bed in the morning, exercise, volunteering and playing with children, thinking about and solving problems, sitting down for dinner, learning new things and completing work satisfactorily.
Some of the things that drain me include: having to do work I don’t believe in, getting into arguments with people who argue irrationally, feeling powerless, feeling bored, when I don’t feel useful or purposeful, when technical or mechanical things break or need fixing, spending too long inside or in a city environment, being alone for too long, analysing my food and weight and drinking alcohol.
After we have started to identify these activities, we can start to consciously choose to increase the time given to the 'up' activities and decrease the time given to ‘down’ activities. We can also start to discover activities that we can use as tools when we do have periods of worsening mood. With awareness that depression can cause thoughts such as 'this is pointless' or 'I can’t be bothered' we are also more likely to persist with 'up' activities even in the face of these negative thoughts.
Using the breathing space
MBCT says that bringing awareness to the breath should be our first response to unpleasant experiences. We change our relationship to the experience through approach and acceptance. We may choose to focus on our thoughts or we may choose to take some considered action. We can ask ourselves: "What do I need for myself right now? How can I best take care of myself right now? These feelings are happening now, but won’t be there always - what can I do for myself to help me get through this low period?"
In the session, the leader suggested three types of activities that can be useful for depressed feelings - doing something pleasurable, doing something that gives you a sense of satisfaction or just focusing your attention on exactly what you are doing right now. All these are things that depression can undermine and stop you from doing.
One of the things our leader emphasised was that we shouldn’t expect miracles, put extra pressure on ourselves or expect that we should feel a certain way afterwards. The best way is to try and do something as an experiment, to see if it might help. Things might not change dramatically but taking some action can help you feel that you are maintaining some control.
Creating an early warning system – preventing relapse
The next part of the session was another practical task for us. We had to try and create our own early warning system. We thought about the sort of changes that might show that depression is trying to take hold again.
For me, these are things like feeling irritable, postponing social engagements, eating too much in an 'out of control' way, sleeping badly and wanting to go to bed in the day, feeling as though I am behind a glass wall or in a fog, feeling my thoughts are running 'wild' and getting very emotional at small things.
These are things that we can ask family, friends or partners look out for too - to help us notice and respond to these signs in a better way. We involve other people because one of the hardest parts of depression is that we stop feeling as though anything can help. We even start feeling that heeding the signs is pointless.
We need to be able to make sure that, when we are in a positive frame of mind, we can set up systems to encourage us when we are depressed.
Writing things down is an obvious one. We were encouraged to make a list of these early warning signals to pin on the wall, for ourselves or for our partners/families too. We added to this some of the actions we could take that we know can help.
Depression can stop us doing anything to help ourselves. To overcome this we were also encouraged to speak to the frame of mind we would be in at the time - writing things like: "I know you probably don’t feel much like doing this right now, but please do try and give it a go anyway."
We also included some suggestions for actions to take when our mood changes without any warning, and feeling low comes out of the blue. These could be: taking a breathing space and using it to work out what actions might help us look after ourselves. It felt very positive to be combining the meditative and learning side of the sessions with some possibilities for practical action. By joining the two together it felt more likely that both elements would more easily embedded in my daily life and management of my mind.
Next week would be the final session. It would be a summarising and rounding up session called 'Using what we’ve learnt to help us deal with future moods'.