Cognitive psychologist Zindel Segal discusses The Mindful Way Through Depression at TEDxUTSC – Transcript
Zindel Segal – Cognitive psychologist
Thank you. It’s a pleasure to be here. I’ve worked in the field of mood disorders for over 30 years and I’ve witnessed a number of advances in treatments. I’ve witnessed new generations of antidepressant medications being developed — the use of magnetic coils to stimulate the skull and affect different brain regions; the implantation of electrodes into the brain in regions that are thought to promote recovery from depression, and even the customization of talk therapies to address certain subtypes of depression.
But let’s face it, the concept of meditation was never high on that list. And there’s a good reason for that — the reason is that these are treatments that were developed to alleviate depression, to alleviate the suffering of patients who are trying to get their lives back on track and also to reduce the capacity for self-harm that is often carried by an untreated and undiagnosed depression. But the complex challenge that depression provides us with is to do more than allow people to let go of symptoms and returning to their lives. The complex challenge involves helping people recover from depression and to stay well.
What we now understand about depression is that it is an episodic and recurrent disorder. Getting well is half of the problem, staying well is the other half. And this is really where my work in the area started. I was tasked with addressing the problem of relapse and its prevention. And I was a card-carrying member of a cognitive therapy group working in an outpatient clinic at a hospital. My work was quite distant from meditation and other contemplative practices.
I received a small grant from the MacArthur Foundation to try to modify an existing treatment for depression so that it could prevent relapse. And what I did with that money was to bring together two colleagues of mine, Mark Williams, who is at Oxford, John Teasdale, who is now at Cambridge, and we sat together and thought about how would we go ahead and do this, modify this treatment, provide something to people who are in recovery to help them stay well.
We kind of hit the pause button, because we didn’t want to take a treatment that was designed to help people come out of depression and just continue to sort of spool it forward to people in recovery. We wanted to understand if there were specific risk factors, specific triggers, that helped people who were in recovery get depressed and maybe see whether we could design a treatment around those specific triggers to try to undo their sort of pathological influence.
The really cool thing about working with Mark and John is that they had done seminal work in the area of mood dependent memory. The way in which moods and thoughts come together and influence each other, bringing moods that are negative to mind much more easily if one is thinking in a depressive way, and depressive thoughts bringing moods together that are depressed more easily.
One of the things that we found was that when people are depressed and they’re feeling sad, this is a symptom. But when they are no longer feeling depressed, sadness can function as an important context to bring to mind judgmental, critical, and harsh ways of viewing the self that can sometimes tip people over into a new episode of depression and cause relapse.
And so we stood back and thought to ourselves: what if we could, first of all, test out this model, what if we could find a way to modify this effect that sadness has on mood and memory? And then what if we could teach this to people? Wouldn’t it be possible that this would be a more efficient and a more direct way of helping people stay well? And it happened that our theory led to a model and very supportive data for our conjectures. People who were well, had recovered from depression, had been treated, but were experimentally induced into a brief state of sadness found that they could very easily start to recall experiences from depression and that the folks who did that the most were the ones that had the highest rates of relapse when we followed them for 18 months.
We had some very important evidence here that suggested that our model had legs — that the ability to work with sadness in people that had recovered from depression, may determine whether they are able to go on and sustain the benefits of treatment or whether they are going to relapse.
But how do you work with a trigger of relapse like sadness, when sadness is also a feature of our universal human experience? We weren’t interested in trying to eliminate sadness, we weren’t interested in trying to get people not to feel sad. What we really needed to do was to help people develop a different relationship to their sadness.
And what does that mean in terms of trying to teach people certain skills? This is really the point in which mindfulness comes into the picture. Mindfulness is really the awareness that comes to mind, the awareness that arises when we pay attention in a particular way. We’re bringing our attention into the present moment and we’re not judging.