WEBVTT

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Thank you.

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It's a pleasure to be here.

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I've worked in the field
of mood disorders for over 30 years

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and I've witnessed a number
of advances in treatments.

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I've witnessed new generations

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of antidepressant medications
being developed.

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The use of magnetic coils
to stimulate the skull

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and affect different brain regions.

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The implantation of electrodes
into the brain

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in regions that are thought
to promote recovery from depression,

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and even the customization
of talk therapies

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to address certain subtypes of depression.

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But let's face it,

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the concept of meditation
was never high on that list.

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And there's a good reason for that:

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the reason is that these are treatments
that were developed

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to alleviate depression,
to alleviate the suffering of patients

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who are trying to get
their lives back on track

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and also to reduce
the capacity for self-harm

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that is often carried by untreated
and undiagnosed depression.

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But the complex challenge
that depression provides us with

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is to do more than allow people
to let go of symptoms

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and returning to their lives.

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The complex challenge involves
helping people recover from depression

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and to stay well.

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What we now understand about depression

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is that it is an episodic
and recurrent disorder.

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Getting well is half of the problem,
staying well is the other half.

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And this is really where
my work in the area started,

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I was tasked with addressing
the problem of relapse and its prevention.

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And I was a card-carrying member
of a cognitive therapy group

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working in an outpatient clinic
at a hospital.

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My work was quite distant from meditation
and other contemplative practices.

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I received a small grant
from the MacArthur Foundation

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to try to modify an existing
treatment for depression

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so that it could prevent relapse.

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And what I did with that money was
to bring together two colleagues of mine,

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Mark Williams, who is at Oxford,
John Teasdale, who is now at Cambridge,

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and we sat together and thought about
how would we go ahead and do this,

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modify this treatment,
provide something to people

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who are in recovery
to help them stay well.

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We kind of hit the pause button,

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because we didn't want to take
a treatment that was designed

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to help people come out of depression

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and just continue to sort of spool
it forward to people in recovery.

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We wanted to understand
if there were specific risk factors,

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specific triggers, that helped people
who were in recovery get depressed

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and maybe see whether we could design
a treatment around those specific triggers

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to try to undo
their sort of pathological influence.

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The really cool thing
about working with Mark and John

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is that they had done seminal work
in the area of mood dependent memory.

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The way in which moods and thoughts
come together and influence each other,

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bringing moods that are negative
to mind much more easily

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if one is thinking in a depressive way,

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and depressive thoughts bringing moods
together that are depressed more easily.

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One of the things that we found
was that when people are depressed

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and they're feeling sad,
this is a symptom.

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But when they are
no longer feeling depressed,

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sadness can function
as an important context

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to bring to mind judgmental, critical,
and harsh ways of viewing the self

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that can sometimes tip people over
into a new episode of depression

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and cause relapse.

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And so we stood back
and thought to ourselves:

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what if we could, first of all,
test out this model,

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what if we could find a way to modify

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this effect that sadness
has on mood and memory?

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And then what if we could
teach this to people?

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Wouldn't it be possible that this would be
a more efficient and a more direct way

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of helping people stay well?

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And it happened
that our theory led to a model

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and very supportive data
for our conjectures.

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People who were well, had recovered
from depression, had been treated,

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but were experimentally induced
into a brief state of sadness

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found that they could very easily start
to recall experiences from depression

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and that the folks who did that the most

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were the ones that had
the highest rates of relapse

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when we followed them for 18 months.

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We had some very important evidence here
that suggested that our model had legs.

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That the ability to work with sadness,

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in people that had recovered
from depression,

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may determine whether
they are able to go on

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and sustain the benefits of treatment

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or whether they are going to relapse.

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But how do you work with a trigger
of relapse like sadness,

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when sadness is also a feature
of our universal human experience?

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We weren't interested
in trying to eliminate sadness,

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we weren't interested in trying
to get people not to feel sad.

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What we really needed to do

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was to help people develop
a different relationship to their sadness.

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And what does that mean in terms
of trying to teach people certain skills?

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This is really the point in which
mindfulness comes into the picture.

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Mindfulness is really the awareness
that comes to mind,

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the awareness that arises
when we pay attention in a particular way.

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We're bringing our attention
into the present moment

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and we're not judging.

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What do we notice?

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So, purposely attending
to the present moment, without judgment.

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Turn out this is
a very useful skill to have,

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because it can reveal
aspects of our experience

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that have already been
and are continuing to be present for us,

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but we are just not able to access them,
we're not focusing on them.

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Let me just stop for a second,

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because words have
a sort of limited utility

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when you're talking about mindfulness.

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And let's see whether we can have
a chance to experience this directly.

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If you're willing,
maybe just pause for a sec.

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Make yourselves comfortable
in your chairs,

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and start by thinking about your feet.

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See if you can just do that,

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just let your mind
start thinking about your feet.

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How your feet have carried you
a fair distance today.

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Where they've taken you,

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walking, driving, sitting?

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Maybe comparing one foot to the other.

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Noticing any judgments or evaluations.

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Seeing whether you like one foot --

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or the other foot.

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Seeing whether there are
any worries about your feet,

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any things that are medically
oriented, or undescribed,

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sensations.

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Whether you have any future oriented
things relating to your feet,

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like maybe you've got
a pedicure that's scheduled,

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or you need to redo your toe nail polish.

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Continuing to think about your feet

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and just letting whatever
comes up in your mind --

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be there.

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Just thinking about your feet.

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And then stopping.

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And now redirecting your attention,

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and taking your attention
back to the feet,

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but this time just becoming aware

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of whatever sensations are present
in this part of your body.

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So maybe feeling the way the feet
are pressing down against the floor,

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through the soles of your shoes.

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Perhaps feeling the points
of contact for the big toe,

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the little toe,

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the heel,

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the ball of the foot.

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Noticing any sensations
between the toes, any moisture,

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any heat,

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even the foot itself encased in the shoe.

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Any sense of tightness,

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pressure, throbbing.

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And just allowing whatever
sensations come to mind

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as you're experiencing
your feet in this way.

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And then stopping, pausing...

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and looking for a moment

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Thinking about your feet,
directly experiencing your feet.

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at these two different ways
of having an experience of your feet.

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The practice of mindfulness allows you

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to take all of this information
into account.

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Allows you to be focused on directly
feeling what you're going through,

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as well as having, or noticing,
thoughts about the experience as well.

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And this, we felt at the time,
was an answer to the question

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of how can people work with sadness,
not by eliminating it,

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but by being able to have
a different relationship to it.

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We've use a fairly
mundane example of feet,

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but what happens if we try to tune
this into sadness when it is present,

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negative emotions when they are present.

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And thankfully, at the same time
we were doing this,

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we were aware of Jon Kabat-Zinn's
pioneering work

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with mindfulness meditation

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with patients that had chronic pain.

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He was doing this very thing.

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People who had chronic pain
training themselves

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to attend to the sensations
of physical discomfort.

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Not pushing pain away, but finding
a way into their physical discomfort,

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that allowed them to see more room
and more space inside it,

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than simply thinking about it,
than trying to worry about it,

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trying to eliminate it,
trying to distract themselves from it;

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being present with it.

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And he was showing remarkable outcomes,

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more and more of these people's lives
could be reclaimed,

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and that the chronic pain features
of their lives became less and less

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of a primary concern.

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And so what we tried to do
was to develop the same training program

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for people who had recovered
from depression,

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based on his seminal eight-week program,
which he developed,

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much of which featured extensive training
in mindfulness meditation,

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mindful movement,

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and we also added in bits and pieces

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that were relevant to living
with a depressive disorder.

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And we called it
mindfulness-based cognitive therapy.

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It became manualized,
it became evaluated,

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and it had very little of the baggage

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associated with contemplative
meditative practices.

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You didn't have to enter
the world of meditation.

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I dressed like this, I didn't wear robes
when I came into a class.

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And opened the door as wide as possible

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for people to see this as a very
pragmatic health practice --

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for regulating emotions.

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So it wasn't about finding God,
it wasn't about transcending reality,

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this is about learning
how to harness attention

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in the agenda of self-care.

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Now, mindfulness-based cognitive
therapy essentially tries to work

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starting with concrete examples
of how to pay attention

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and how to be mindful.

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We did this with the feet,

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we start in our course with raisins,
with eating, with breathing,

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with other kinds of activities,

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and eventually we work our way up
to dealing with negative emotions.

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What we're trying to get people to do is
to anchor themselves in their experience,

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so that when a negative emotion comes up
in the mind it can wash over them,

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it doesn't totally destabilize them,

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neither does it necessarily bring to mind
all of the negative associations

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that for some people can happen
very automatically.

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Instead they can find a different place

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for standing and working
with this feelings

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and as a result have much more
of an option for selecting a response

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and influencing what happens next.

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Mindfulness-based cognitive therapy
has performed very well

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in clinical randomized trials.

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About a thousand patients
have been evaluated using this approach

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across seven studies world wide.

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And what we are finding is
that, compared to usual care,

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mindfulness-based cognitive therapy
reduces relapse by about 43 percent.

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And compared to antidepressant medication

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it provides equal protection against
relapse as continuing on an antidepressant

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for long periods of time.

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The other positive thing
about this treatment

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is that it enhances
people's ability to feel reward,

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and to feel positive affect,
positive emotions,

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in the course of their everyday lives.

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Which is vital because
this is a tough sell for many patients,

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for many people with depression

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who are feeling well and feeling
as if their depression is behind them,

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they don't need to continue to engage
in ways of looking after themselves,

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why should they invest the time, space,
and often very busy lives for doing this?

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The capacity to reward and to feel
reinforced for practicing mindfulness

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allows these health benefits to continue.

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And another way in which we know
these heath benefits can get locked in

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is the fact that mindfulness
also changes the brain.

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It changes the brain
in very meaningful ways

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by allowing people to access
what's been called

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the present moment pathway.

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Now, on the face of it, it makes sense,

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we are training people to pay attention
to the present moment,

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maybe there're some parts of the brain
that get tuned up to be able to do this.

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But we've got some fairly good data

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to suggest that part
of this present moment pathway,

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the region that is very active
in training in mindfulness is the insula.

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And the insula is a part
of the brain on a network

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that allows signals from the body
to be more carefully attuned.

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Signals of present moment, sensations,

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what's happening in the body,
in this moment,

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not thinking about the body,
but right now, sensations.

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And people are better able to tune into
the state of the body by doing this.

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And what we're finding is

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that as the present moment
pathway gets activated

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people that have been
trained in mindfulness

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are able to really increase
the activation in the insula,

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more than people who haven't been trained.

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So, mindfulness trains awareness
in this present moment pathway,

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and, it turns out,
this is vitally important

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for working with sad mood states.

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So what happens if you put
someone into an fMRI scanner

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and induce a mild state of sadness,

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and they haven't had
training in mindfulness,

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they will activate a part of the brain
called the executive control network,

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which is sort of like the thinking
about your feet network, if you want,

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a network of brain regions
that are involved with evaluating:

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What do I need to do about this sadness?
Is this sadness relevant to me?

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Is this a threat? How can I problem
solve it? How can I eliminate it?

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So you're thinking
and thinking about sadness,

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and what happens is,

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as that network is stronger,
the present moment pathway gets weaker.

00:15:18.239 --> 00:15:20.353
So, one is stronger, one is weaker,

00:15:20.354 --> 00:15:24.313
and you're getting very little signal
from what's happening in your body,

00:15:24.314 --> 00:15:27.105
how this emotion is actually
impacting you in this moment,

00:15:27.106 --> 00:15:30.585
and you're getting a lot more about
the conceptual workings of the mind

00:15:30.586 --> 00:15:33.236
around what is sadness,
what do I need to do about it,

00:15:33.237 --> 00:15:35.307
what else is it also calling to mind.

00:15:35.308 --> 00:15:37.778
Now, after people
have been trained in mindfulness

00:15:37.792 --> 00:15:43.626
you're getting this rebalancing
between both networks coming online.

00:15:44.959 --> 00:15:47.668
Executive control network
gets inhibited a little bit,

00:15:47.675 --> 00:15:51.841
the present moment pathway
increases its activation a little bit,

00:15:51.842 --> 00:15:56.844
and now the person feeling sad
has access to two channels of information.

00:15:56.845 --> 00:16:00.303
A channel of information
about the meaning of sadness,

00:16:00.304 --> 00:16:05.157
but also a channel about the present
moment state of the body

00:16:05.158 --> 00:16:09.154
that is working
with sensations of sadness,

00:16:09.155 --> 00:16:15.051
and both of these channels of information
can lead to more effective responses

00:16:15.052 --> 00:16:19.599
and selections of activities
in terms of dealing with sadness.

00:16:19.600 --> 00:16:23.328
This is a movement away from
a kind of automatic activation

00:16:23.329 --> 00:16:28.890
of the previous contents that would be
brought to mind when sadness was present,

00:16:28.891 --> 00:16:33.619
and widening into a much more
spacious view of sadness,

00:16:33.626 --> 00:16:36.668
and the choicefulness
that comes with that.

00:16:37.023 --> 00:16:39.872
And what we find in our work

00:16:39.873 --> 00:16:43.479
is that our treatment
is eight-weeks in length

00:16:43.480 --> 00:16:46.275
and yet we're asking people
to take this on board

00:16:46.276 --> 00:16:48.742
as a way of continuing
to look after themselves.

00:16:48.751 --> 00:16:52.001
About 75 to 80% of our patients --

00:16:53.866 --> 00:16:55.876
continue some form of mindfulness practice

00:16:55.905 --> 00:17:00.378
for about a year, two,
to three years afterwards.

00:17:00.379 --> 00:17:04.698
And what happens is that although
the portal that brought them in to us

00:17:04.699 --> 00:17:05.844
in the first place

00:17:05.845 --> 00:17:10.291
had to do with a disorder, depression,
had to do with getting treatment,

00:17:10.292 --> 00:17:13.707
more and more people recognize
that through the practice of mindfulness

00:17:13.708 --> 00:17:17.501
they are able to connect
with an inner resource

00:17:17.502 --> 00:17:20.675
that allows them to take care
of themselves in a way

00:17:20.676 --> 00:17:25.111
that touches greater moments
of wholeness in their days,

00:17:25.112 --> 00:17:30.405
and allows us to permeate more moments
of their lives as they go forward.

00:17:30.406 --> 00:17:34.376
It becomes less about a treatment,
it becomes more about a way of life

00:17:34.377 --> 00:17:36.347
and looking after themselves.

00:17:36.348 --> 00:17:41.951
And this has really been the pinnacle
of the work that we've conducted,

00:17:41.952 --> 00:17:47.772
to move from a juxtaposition
of two approaches for depression,

00:17:47.773 --> 00:17:50.356
that seemed seemingly unconnected,

00:17:50.357 --> 00:17:54.996
into developing a coherent,
and empirically supported way,

00:17:54.997 --> 00:17:56.800
of delivering this type of care,

00:17:56.801 --> 00:17:59.929
and allowing people to take over
once the course is over.

00:17:59.930 --> 00:18:01.656
Thanks very much for your time!

00:18:01.657 --> 00:18:03.047
(Applause)