The mindful way through depression: Zindel Segal at TEDxUTSC

The mindful way through depression: Zindel Segal at TEDxUTSC

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Translator: Daniela Wahlers
Reviewer: Maricene Crus 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 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. What do we notice? So, purposely attending
to the present moment, without judgment. Turn out this is
a very useful skill to have, because it can reveal
aspects of our experience that have already been
and are continuing to be present for us, but we are just not able to access them,
we’re not focusing on them. Let me just stop for a second, because words have
a sort of limited utility when you’re talking about mindfulness. And let’s see whether we can have
a chance to experience this directly. If you’re willing,
maybe just pause for a sec. Make yourselves comfortable
in your chairs, and start by thinking about your feet. See if you can just do that, just let your mind
start thinking about your feet. How your feet have carried you
a fair distance today. Where they’ve taken you, walking, driving, sitting? Maybe comparing one foot to the other. Noticing any judgments or evaluations. Seeing whether you like one foot — or the other foot. Seeing whether there are
any worries about your feet, any things that are medically
oriented, or undescribed, sensations. Whether you have any future oriented
things relating to your feet, like maybe you’ve got
a pedicure that’s scheduled, or you need to redo your toe nail polish. Continuing to think about your feet and just letting whatever
comes up in your mind — be there. Just thinking about your feet. And then stopping. And now redirecting your attention, and taking your attention
back to the feet, but this time just becoming aware of whatever sensations are present
in this part of your body. So maybe feeling the way the feet
are pressing down against the floor, through the soles of your shoes. Perhaps feeling the points
of contact for the big toe, the little toe, the heel, the ball of the foot. Noticing any sensations
between the toes, any moisture, any heat, even the foot itself encased in the shoe. Any sense of tightness, pressure, throbbing. And just allowing whatever
sensations come to mind as you’re experiencing
your feet in this way. And then stopping, pausing… and looking for a moment Thinking about your feet,
directly experiencing your feet. at these two different ways
of having an experience of your feet. The practice of mindfulness allows you to take all of this information
into account. Allows you to be focused on directly
feeling what you’re going through, as well as having, or noticing,
thoughts about the experience as well. And this, we felt at the time,
was an answer to the question of how can people work with sadness,
not by eliminating it, but by being able to have
a different relationship to it. We’ve use a fairly
mundane example of feet, but what happens if we try to tune
this into sadness when it is present, negative emotions when they are present. And thankfully, at the same time
we were doing this, we were aware of Jon Kabat-Zinn’s
pioneering work with mindfulness meditation with patients that had chronic pain. He was doing this very thing. People who had chronic pain
training themselves to attend to the sensations
of physical discomfort. Not pushing pain away, but finding
a way into their physical discomfort, that allowed them to see more room
and more space inside it, than simply thinking about it,
than trying to worry about it, trying to eliminate it,
trying to distract themselves from it; being present with it. And he was showing remarkable outcomes, more and more of these people’s lives
could be reclaimed, and that the chronic pain features
of their lives became less and less of a primary concern. And so what we tried to do
was to develop the same training program for people who had recovered
from depression, based on his seminal eight-week program,
which he developed, much of which featured extensive training
in mindfulness meditation, mindful movement, and we also added in bits and pieces that were relevant to living
with a depressive disorder. And we called it
mindfulness-based cognitive therapy. It became manualized,
it became evaluated, and it had very little of the baggage associated with contemplative
meditative practices. You didn’t have to enter
the world of meditation. I dressed like this, I didn’t wear robes
when I came into a class. And opened the door as wide as possible for people to see this as a very
pragmatic health practice — for regulating emotions. So it wasn’t about finding God,
it wasn’t about transcending reality, this is about learning
how to harness attention in the agenda of self-care. Now, mindfulness-based cognitive
therapy essentially tries to work starting with concrete examples
of how to pay attention and how to be mindful. We did this with the feet, we start in our course with raisins,
with eating, with breathing, with other kinds of activities, and eventually we work our way up
to dealing with negative emotions. What we’re trying to get people to do is
to anchor themselves in their experience, so that when a negative emotion comes up
in the mind it can wash over them, it doesn’t totally destabilize them, neither does it necessarily bring to mind
all of the negative associations that for some people can happen
very automatically. Instead they can find a different place for standing and working
with this feelings and as a result have much more
of an option for selecting a response and influencing what happens next. Mindfulness-based cognitive therapy
has performed very well in clinical randomized trials. About a thousand patients
have been evaluated using this approach across seven studies world wide. And what we are finding is
that, compared to usual care, mindfulness-based cognitive therapy
reduces relapse by about 43 percent. And compared to antidepressant medication it provides equal protection against
relapse as continuing on an antidepressant for long periods of time. The other positive thing
about this treatment is that it enhances
people’s ability to feel reward, and to feel positive affect,
positive emotions, in the course of their everyday lives. Which is vital because
this is a tough sell for many patients, for many people with depression who are feeling well and feeling
as if their depression is behind them, they don’t need to continue to engage
in ways of looking after themselves, why should they invest the time, space,
and often very busy lives for doing this? The capacity to reward and to feel
reinforced for practicing mindfulness allows these health benefits to continue. And another way in which we know
these heath benefits can get locked in is the fact that mindfulness
also changes the brain. It changes the brain
in very meaningful ways by allowing people to access
what’s been called the present moment pathway. Now, on the face of it, it makes sense, we are training people to pay attention
to the present moment, maybe there’re some parts of the brain
that get tuned up to be able to do this. But we’ve got some fairly good data to suggest that part
of this present moment pathway, the region that is very active
in training in mindfulness is the insula. And the insula is a part
of the brain on a network that allows signals from the body
to be more carefully attuned. Signals of present moment, sensations, what’s happening in the body,
in this moment, not thinking about the body,
but right now, sensations. And people are better able to tune into
the state of the body by doing this. And what we’re finding is that as the present moment
pathway gets activated people that have been
trained in mindfulness are able to really increase
the activation in the insula, more than people who haven’t been trained. So, mindfulness trains awareness
in this present moment pathway, and, it turns out,
this is vitally important for working with sad mood states. So what happens if you put
someone into an fMRI scanner and induce a mild state of sadness, and they haven’t had
training in mindfulness, they will activate a part of the brain
called the executive control network, which is sort of like the thinking
about your feet network, if you want, a network of brain regions
that are involved with evaluating: What do I need to do about this sadness?
Is this sadness relevant to me? Is this a threat? How can I problem
solve it? How can I eliminate it? So you’re thinking
and thinking about sadness, and what happens is, as that network is stronger,
the present moment pathway gets weaker. So, one is stronger, one is weaker, and you’re getting very little signal
from what’s happening in your body, how this emotion is actually
impacting you in this moment, and you’re getting a lot more about
the conceptual workings of the mind around what is sadness,
what do I need to do about it, what else is it also calling to mind. Now, after people
have been trained in mindfulness you’re getting this rebalancing
between both networks coming online. Executive control network
gets inhibited a little bit, the present moment pathway
increases its activation a little bit, and now the person feeling sad
has access to two channels of information. A channel of information
about the meaning of sadness, but also a channel about the present
moment state of the body that is working
with sensations of sadness, and both of these channels of information
can lead to more effective responses and selections of activities
in terms of dealing with sadness. This is a movement away from
a kind of automatic activation of the previous contents that would be
brought to mind when sadness was present, and widening into a much more
spacious view of sadness, and the choicefulness
that comes with that. And what we find in our work is that our treatment
is eight-weeks in length and yet we’re asking people
to take this on board as a way of continuing
to look after themselves. About 75 to 80% of our patients — continue some form of mindfulness practice for about a year, two,
to three years afterwards. And what happens is that although
the portal that brought them in to us in the first place had to do with a disorder, depression,
had to do with getting treatment, more and more people recognize
that through the practice of mindfulness they are able to connect
with an inner resource that allows them to take care
of themselves in a way that touches greater moments
of wholeness in their days, and allows us to permeate more moments
of their lives as they go forward. It becomes less about a treatment,
it becomes more about a way of life and looking after themselves. And this has really been the pinnacle
of the work that we’ve conducted, to move from a juxtaposition
of two approaches for depression, that seemed seemingly unconnected, into developing a coherent,
and empirically supported way, of delivering this type of care, and allowing people to take over
once the course is over. Thanks very much for your time! (Applause)

100 thoughts on “The mindful way through depression: Zindel Segal at TEDxUTSC”

  1. I find mindfulness so difficult because I find focus img on my body unbearable mostly because it just reaffirms how empty I feel. Then again I haven't really practiced it consistently either

  2. TEd needs to start featuring tougher guys. Not saying he's a wimp when it comes down to it, I don't know him, but I see the women they feature and they love the strippers and like pole dancers, they include women like that. With guys it's always scientists. What about the football players, the boxers, the firemen, the cops? Yea, the rougher guys? Do they have nothing to say?

  3. Life is just hard without God. Satan challenged whether humans would be better off without God's direct headship. We can't do it. We can't take care of ourselves adequately.

  4. Faith as in believing in God is paramount! No, faith does not cure depression, however it helps more than can be analyzed. Please know that depression is a disease and needs to be treated. Please do not ignore the symptoms contact your doctor or mental health center as soon as possible. Suicide is not ever an option.

  5. Being mindful has been a great help to me, but it has not cured my depressions.

    Real long time studies (as in a decade or longer) strongly suggest that neither pharmaceutical drugs nor talk therapy are effective in the long run. Depressions almost always find their way back

    I'd like to see a similar longitudinal study on mindfulness cognitive therapy. Eighteen months is bare enough for one of my depressive cycles.

  6. i ave been suffering since 1991 so today in 2016 (at age 45), it makes it 25 years or more that I am suffering. The repeated low performance at various jobs, the rebukes, the harsh words, the ridicule both behind my back & in my presence has been telling me to end my life for years now. The only reason I am still hanging in here is because no one would be there to bring up my 2 children who I love dearly. This disease is the very worst any living thing can bear. The very worst.

  7. too bad the audio is so quiet my 300watt sound system still wouldn't help me hear properly. that is quite an accomplishment. -.- way to go.

  8. Count each breath till 10 than start over, this keeps you in the NOW!

    PAIN also keeps you in the now, OUCH!!

  9. The secret of the mind is that you can actually change every state of mind that you have, even depression is a state of mind. Trying mindfulness will only help temporary because you do not change the nature of the mind though meditation. You change the nature of the mind by repetition, walking a deep mental path. But you have to know what you must repeat and learn to change the badstates of the mind permantly. You must learn the big picture of life in every facet, learn the real truth about life and the mind in general, it will change your view thus your mind in the best way possible. Google TruthContest read the Present

  10. A brilliant guy who contributed significantly to early mindfulness research as it relates to mood… one of my heroes.

  11. The sound is extremely low on this video, had to skip it unfortunately. If it's had low views this could be why.

  12. SERIOUS QUESTION: Add a physical chronic pain to the subject…. so in their present moment sensation of the body… there is chronic pain… the cause of the depression…. does presence work then?

  13. I have depression since I was in junior high school, and when I was in senior high school, I came across a book about this kind of mindfulness and how to deal with life.
    It really helped me back then, except, as soon I plunged into college, I kind of forgot how to deal with life, and I fell into deep depression again.
    I'm glad I finally come across this video, it reminds me again the mindfulness that I used to have back then. I'm going to practice it again. For my own good.

  14. The religious freaks are over abundent in this comment section. Preying on people in personal crisis for easy conversion. Really disgusting.

  15. Thank you so much for the amazing, informative talk! I have learnt a lot, realising depression could be episodic for me. I have been practicing mindfulness to deal with anxiety but didn't realise that it could also help with depression. Your examples and statistic has certainly shed some light onto how our thoughts could manifest itself and with practice we can have more control and rewards. 🙂

  16. Anybody suffering from depression, really wanting to find the strength to apply all of this amazing knowledge, but feels it's just easier to be depressed?😩 Cause same😅

  17. From my experience as a mindfulness therapist, the most important changes begin when you make friends with your depression rather than trying to suppress it. The best way to do this is through mindfulness training.

  18. i have drug resistant major depressive disorder, i have a degree (i am educated and can do research!), i have studied and employed CBT… id like to punch this dude in the face.

  19. There are several suggestions to try
    Work out why you suffer from depression – the first step to solving an issue is understanding why you have it.
    Be comfortable about yourself – this makes it less difficult
    Just do it – you will feel better by doing things – especially by doing activities that stretch your boundaries.
    (I learned these and more ideas from Martos magic method website )

  20. its called consciousness….the stillness which is awareness….which exists at the base of every human being.Its called Atma in India.The bhagwat geeta is all about this.

  21. I'm getting back into meditation. Twenty minutes a day, every day. I really need to know the science as I find it motivating. I recommend getting an app for your phone that will record your meditation sessions. Thanks to this guy and all the other researchers like Mark Williams and John Teesdale.

  22. A quarter of a century living with clinical depression, going to therapy for years and taking medication, all with bland results, hearing this talk makes me hopeful.

  23. Meditation and Mindfulness training are what finally gave me the tools to help overcome the episodic depression/mania that I suffered from. I still have mild depression, but thanks to the coping skills I have learned, I am no longer suicidal.

  24. I feel the speaker did a poor job of conveying his point. Still, being able to adjust how your mind perceives the depression triggering emotions through this treatment without using pills and getting positive outcomes is great, but suggests that some kind of conditioning through outside influences could be causing people to feel depressed in the first place.

  25. In my experience medication and drugs only numbs the pain. Working out and meditation only distracts it. Im convinced the only way to cure it is to reboot the brain much like a computer. I don’t know how, but there must be a way

  26. I feel like I have really bad depression. If you can help me please. I know that the internet can be harsh, but I have gotten to the point with a knife to my chest. Once again if you can may you pleas help me. Pleas, and thank you

  27. so how did they get into depression and what point are they talking about, what exact symptoms did people have, this is all a bit too vague!

  28. This dude should not be the one sharing this info
    He took nearly 11sminutes talking feet
    Seriously such potential but Id rather poke my eyes out than endure the last 6 minutes

  29. For those of you who wanted something more prescriptive than the (admittedly wonderful) book "The Mindful Way Through Depression," This group also wrote "The Mindful Way Workbook". After decades of depression, anxiety and self-criticism, this stuff has started to work for me. Working through this book took me longer than the 8 weeks specified in the title, but at some point I really started to get it! It's amazing when you realize that all your negative, anxious and critical thoughts . . . ARE JUST THOUGHTS. Daily meditation makes my mind much more flexible and able to return to the current moment when I'm not meditating. I've gotten to the point of welcoming thoughts that used to panic me, telling them, "Come on over to the present! It's nicer here!"

  30. I try so hard NOT to go down that depression highway, 'cause I really NEED to be strong right now. /ciao from italy

  31. Nice Video! Excuse me for the intrusion, I would love your opinion. Have you considered – Lammywalness Erase Depression Guide (should be on google have a look)? It is a smashing exclusive product for beating depression fast minus the headache. Ive heard some unbelievable things about it and my friend Sam after a lifetime of fighting got amazing results with it.

  32. Here's the thing. I bought his co-written book. I am anxious since I was 3 years old and it made a lot of sidetracks like attention disorder, socializing problems, depression waves. I don't have a lot of friends, I don't go to parties, I don't enjoy my youth. I am 22 now, and I want to take my life in my hand and LOVE it. The problems' root became from my mother, my aunt and their mother and I don't want to live my life full of negativity,agression and prejudice. I want to be confident and empathetic that doesn't feel like acting. If anybody could know that MBCT is a solution, let me know.

  33. Great video content! Forgive me for the intrusion, I would appreciate your initial thoughts. Have you thought about – Lammywalness Erase Depression Guide (probably on Google)? It is a great one off product for beating depression fast minus the headache. Ive heard some decent things about it and my mate at very last got amazing success with it.

  34. When will the so called experts realize that depression is not situational. It occurs regardless of external circumstances. It is also not behavioural. No amount of therapy will cure depression. Meditation and mindfulness can relax the depressed mind just as it can the normal mind. But this doesn't cure depression, it just increases the time you spend away from "normal life."

  35. this might be hard for people to follow but listen to it a few times if you have too. seriously, this speech, this is amazing. thank you

  36. Seguiremos trabajando desde nuestro espacio para que la realidad sea lo que siempre debió ser. Gracias por vídeos tan instructivos.

  37. I am one of the many individuals who got depressed and it occurred to me years back after divorce. But thankfully I discovered the solution to my illness which is “fetching kafon press” (Google it). Within weeks of reading your book and putting your advice into practice, my depression had totally lifted and my self-confidence began to return..

  38. I had the most terrible days of my life 5 years ago. I believed if ever I have a new sweetheart I will return to who I am in the past but I was incorrect. After follow this depression therapy “fetching kafon press” (Google it), I have kept my depression away since that time. And I am delighted today since I am not going thru depression any longer..

  39. When your mind is absorbed by depression..all you experience is the the effects of that mindset & you don't have the self awareness to introduce new thought patterns to change the negative image that you have of yourself.

  40. I've had severe depression for 45 years, I've tried mindfulness for 2 years. It hasn't made any difference. I think the only cure is death. I wish I could buy a gun, as wrist-slashing or hanging takes too long and is too painful.

  41. Mindfulness is overrated as a cure for persistent Depression. It is just one tool to use during the day.

  42. For me, being 41 and having depression and anxiety issues since I was about 15, I found an odd comfort in my depression. Sounds ridiculous, but I'm a routine guy and my depression became normal and familiar. I was miserable, but at the same time, I had to be drug out of my depressive episodes. The alternative to feeling depressed (and suicidal at times), while much better for me in every way, was new and a bit scary to me. It's tough to make much sense out of, I know.

  43. Has anyone done research on this found any negative effects of MBCT or other MBT type treatments in those suffering from PTSD or other anxiety disorders? I'm doing a blog on this subject.

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