Depression and Anxiety: Your Old Enemies, Your Best Friends| Zindel Segal
This episode features Zindel Segal, a clinical psychologist from the University of Toronto, who discusses using mindfulness for depression and anxiety. He highlights the importance of routines as antidepressants, differentiates between depression and anxiety, and offers the counterintuitive approach of treating depression like an old friend.
Deep Dive Analysis
21 Topic Outline
Introduction to the Series and Guest Zindel Segal
Zindel Segal's Path to Mindfulness for Depression
Overcoming Resistance to Mindfulness in Clinical Research
Empirical Evidence for Mindfulness-Based Cognitive Therapy (MBCT)
MBCT's Efficacy Compared to Antidepressants
Understanding Mindfulness-Based Cognitive Therapy (MBCT)
Mindfulness as a Tool for Everyday Emotional Regulation
Zindel Segal's Early Experiences with Meditation
Differentiating Depression and Anxiety and Their Co-occurrence
How MBCT Addresses Both Depression and Anxiety
Clinical vs. Dimensional Perspectives on Mental Illness
Befriending Difficult Emotions in Mindfulness Practice
The Power of Investigating Experience Without Fixing It
Cultivating Friendliness and Spaciousness in Awareness
Coping with Winter During the Pandemic: Importance of Routines
The Role of Social Connection in Mental Health
Antidepressant Benefits of Spending Time in Nature
Mindfulness Counteracting Self-Centeredness in Depression
Kristen Neff's Self-Compassion Practice with an Added Step
Guided Practice: The Three-Minute Breathing Space
Expanding Access to MBCT Through Digital Platforms
7 Key Concepts
Mindfulness-Based Cognitive Therapy (MBCT)
MBCT is a treatment developed for individuals who have recovered from depression, aimed at preventing relapse. It teaches mindfulness skills to develop metacognitive abilities, allowing people to observe their mental contents like negative thoughts without identifying with them. This approach helps individuals relate differently to depressive thought patterns.
Metacognitive Abilities / De-centering
This refers to the capacity to step back and observe one's own thinking without becoming fully identified with it. Mindfulness meditation directly trains this ability, enabling individuals to watch mental contents, such as negative thoughts or judgments, from a detached vantage point, rather than being swept away by them.
Tachyphylaxis
Tachyphylaxis describes a phenomenon where antidepressants, after initially being effective for a period, gradually lose their potency and stop working for an individual. This highlights a limitation of long-term antidepressant use for some patients, necessitating alternative or complementary treatments.
Clinical Depression/Anxiety (Psychiatry perspective)
From a psychiatric viewpoint, clinical depression or anxiety are discrete illness syndromes characterized by specific symptoms like disordered sleep, appetite changes, and social withdrawal. These symptoms must persist for a minimum of two weeks to a month and cause significant impairment in daily functioning to qualify as a clinical diagnosis.
Dimensional View of Mental Illness (Psychology perspective)
This psychological perspective suggests that mental health conditions, like sadness or anxiety, exist along a continuum, rather than as distinct illnesses. It posits that everyone experiences these emotions to varying degrees, with some individuals simply being further along the dimension, arguing against rigid categorization into discrete syndromes.
Befriending Suffering
This MBCT approach encourages individuals to approach and investigate elements of their depression or anxiety without the goal of fixing them, but rather with a strategy of learning about them. By doing so, people can develop a different, less aversive relationship to their difficult experiences, fostering acceptance and new ways of responding.
Three-Minute Breathing Space
A core mindfulness practice in MBCT, this is a structured way to respond to difficult experiences. It involves three steps: first, noticing current thoughts, feelings, and bodily sensations; second, gathering attention to the breath in the belly; and third, expanding awareness to the whole body and the surrounding space to cultivate a sense of spaciousness.
9 Questions Answered
He followed his empirical research, recognizing that mindfulness meditation reliably helps people practice states of mind antithetical to depression and anxiety, providing a direct way to develop metacognitive abilities.
Studies showed that adding MBCT to usual care resulted in a 35% lower rate of relapse for people in recovery from depression compared to usual care alone. It also performed as well as maintenance antidepressants in preventing relapse over 18 months to two years.
Yes, a good approach is to sequence them: use an antidepressant to help someone get better, and then introduce mindfulness-based cognitive therapy to help them stay well.
Depression is characterized by mind states related to loss and critical self-judgment, while anxiety is characterized by threat and catastrophe. They can feed into each other and often co-occur.
Yes, MBCT is effective for anxiety because it addresses underlying processes common to both depression and anxiety, such as learning to relate differently to rumination, worry, and catastrophization.
While the mindfulness practice itself may be similar, MBCT specifically uses mindfulness to investigate depressive states of mind, helping people confront and befriend aspects of their suffering, rather than just general stress reduction.
It's crucial to hold onto established routines, such as exercise, meditation, and social connection, even if they seem insignificant. These routines act as a form of antidepressant and help counteract feelings of disconnection.
Spending time outside can increase recognition and recall memory, enhance one's ability to see themselves from a wider perspective, and has antidepressant benefits, helping to loosen the grip of entrenched self-views.
Mindfulness shifts focus from the self as a problem to solve to experiencing moments for their own intrinsic sake, using brain networks that deal with sensation rather than self-narrative. This creates a larger attentional field where difficult thoughts are not all-encompassing.
21 Actionable Insights
1. Practice Mindfulness for Mental Health
Engage in mindfulness meditation to cultivate states of mind that oppose the automatic negative patterns associated with depression and anxiety.
2. Apply Mindfulness Universally
Practice mindfulness in every possible moment, not solely for negative thinking or self-judgment, to develop metacognitive abilities.
3. Investigate Sensations with Kind Curiosity
When investigating bodily sensations, bring kind curiosity to them, recognizing that you are bigger than these sensations and providing an attentional space for them to exist without defining you.
4. Practice 3-Minute Breathing Space
Engage in the 3-minute breathing space: 1) Notice thoughts, feelings, and sensations without judgment, 2) Focus attention on the breath in the belly, and 3) Expand awareness to the whole body and surrounding space.
5. Practice 4-Step Self-Compassion
When experiencing suffering, follow a 4-step exercise: 1) Notice the suffering, 2) Connect to shared humanity (you’re not alone), 3) Send yourself friendliness, and 4) Recognize that these thoughts are just nature, not solely ‘you’.
6. Befriend Depression for Better Management
Approach depression as you would an old friend, recognizing its presence without aversion, which can create more options for how to react to it.
7. Investigate Problems, Don’t Fix
Approach challenges with a strategy of investigation through mindfulness, rather than immediately trying to fix them, to discover undervalued aspects and new perspectives.
8. Experience for Intrinsic Sake
Practice experiencing moments for their own intrinsic sake, taking the ‘self’ out of the equation, and simply noticing qualities, movement, and intensity of sensations.
9. Notice Flux in Experience
Step into the present moment of experience to notice the flux and change within seemingly static feelings like anxiety, revealing a discrepancy between the mind’s narrative and actual experience.
10. Maintain Routines as Antidepressant
Establish and maintain your routines, as they can act as a form of antidepressant, especially during difficult times.
11. Preserve Routines Amidst Difficulties
Be aware that negative feelings may try to persuade you to abandon helpful routines; hold onto these routines, as they are crucial for self-kindness and connection.
12. Resist Undermining Your Routines
Resist thoughts that suggest your routines are ineffectual or won’t make a difference, as these routines are often the best course of action during restrictive periods.
13. Adapt Activities, Don’t Discontinue
Adapt and continue activities you enjoy, even if the adapted version is a ‘pale facsimile’ of the original, rather than discontinuing them entirely.
14. Regularly Get Outside
Regularly spend time outside, as it can be extremely helpful for mental well-being, enhancing memory, and providing a wider perspective of self.
15. Take Nature Walks for Well-being
Engage in nature walks, as they have antidepressant benefits, enhance memory, and provide an experiential sense of spaciousness that loosens the ego’s grip.
16. Utilize Video Calls for Social Connection
Continue to use video conferencing platforms, not just for work, but also for social connection, like weekly calls with family, to maintain relationships.
17. Sequence Antidepressants with MBCT
Consider sequencing care by getting better on antidepressants first, then transitioning to Mindfulness-Based Cognitive Therapy (MBCT) to help maintain well-being.
18. Train Mindfulness in Daily Life
Utilize everyday moments, like eating an orange or observing self-judgment, as opportunities to practice mindfulness, slow down, and build decentered awareness.
19. Curate Negative Thoughts Playlist
Imagine curating a ‘Spotify playlist’ of your most popular negative thoughts to approach and hold them with a different relationship than aversion.
20. Access Digital MBCT Program
Access a digital, asynchronous version of Mindfulness-Based Cognitive Therapy (MBCT) at mindfulnoggin.com, offering the same treatment as clinical trials.
21. Submit Questions for New Year Series
Participate in the New Year series by submitting questions or reflections via voicemail at 646-883-8326 by December 7th.
7 Key Quotes
My way in came through sort of following my empirical nose and at some point recognizing that mindfulness meditation can be a very direct and reliable way of helping people encounter and practice states of mind that can be entirely antithetical to the places where depression, anxiety, and other kinds of mental health challenges automatically take their minds.
Zindel Segal
We never really set out to be better than antidepressants or get involved in sort of polarized arguments about, you know, we're good, they're bad, or whatever. But there are so many people for whom antidepressants really are no longer an option once they've recovered.
Zindel Segal
Mindfulness provides them with a way of both grounding the mind, stabilizing the mind, and then allowing them to approach almost like you're pushing a little bruise in your thigh to feel how bad it is. You don't push it too hard because you don't want to re-injure yourself, but you can approach a certain degree of unpleasantness. And then you learn a different relationship to it.
Zindel Segal
There is this notion of slaying the dragon in Western myth, but actually hugging the dragon is a much more effective form of disarmament.
Dan Harris
My own worst enemy, my oldest friend.
Zindel Segal
So much of what the mind does when people are depressed is that self becomes a problem to solve, a domain to fix.
Zindel Segal
Mindfulness offers this entirely different perspective, which is you can work at having an experience for its own intrinsic sake and not how that experience will serve self.
Zindel Segal
2 Protocols
Three-Minute Breathing Space
Zindel Segal- Look into the mind: Ask yourself, 'What thoughts are here? What feelings are present? What bodily sensations are making themselves known?' Hold them without needing to change them.
- Gather attention to the breath: Let go of mental contents and bring attention to a single point of focus on the breath in the belly, feeling it rise and fall.
- Expand attention to the whole body and space: Expand attention around the belly and breath into the whole body, feeling it sitting and breathing. Then, allow attention to move beyond the body to the air, clothes, and the space of the room itself, holding all in a wider awareness.
Kristen Neff's Self-Compassion Exercise (with added step)
Dan Harris- Notice suffering: Acknowledge that this is a moment of suffering (e.g., using the phrase 'This sucks').
- Connect to common humanity: Recognize that you are not alone; untold millions are having similar painful thought patterns.
- Send yourself friendliness: Offer kindness to yourself (e.g., 'May I be free from suffering,' or phrases from loving-kindness meditation).
- Recognize as nature: View these painful thoughts as simply nature, not inherently 'you,' resulting from beginningless causes and conditions, fostering a more expanded perspective.