Original subtitles

So welcome to

These three short presentations to set the scene

for the upcoming MBCT specialist.

Training.

The intention.

Is to stimulate questions.

And wonderings, likely pointing to

some of the material that you'll already be familiar with and perhaps.

Some that's new.

So they introduce the.

Theoretical underpinnings of the root program.

MBCT for depression.

And we consider it essential.

That you're familiar.

With this root.

Program, even if you're not going to be teaching MBCT within a clinical setting.

So we might see this material as the soil

for our explorations and our days together as we go.

Through the eight week and MBCT Course.

So over the four days we will be examining.

When and how.

These theoretical concepts and themes show.

Up in the curriculum.

So those

invitations to reflect at the end of each of the sessions.

But of course, since it's a.

Recording, you can pause whenever you need to.

So really taking care.

Of body and mind as we go through the material.

And there is a copy of the slides available.

On the learning platform.

As well as.

The recommended reading for the training.

There are some other resources that are offered as part of this.

Presentation and they may be helpful in.

Particular aspects that you.

Want to look at further.

So you might already be familiar.

With this paper. It's a really.

Good way of of of really defining what we're going.

To be exploring.

So we use it uses this concept of the.

Warp and the. Weft that's used in. Weaving.

So the warp are those fixed threads.

Running vertically on the loom.

And so these are the features that we.

Would recognize.

As a mindfulness based program.

So the sort of.

Essential ingredients you might.

See of the the practices.

The embodiment of the teacher.

Sort of arc of. The eight week course.

And we're assuming that.

You're already quite familiar.

With this aspect, with. Guiding. Practices, with leading.

Inquiry, having a general. Sense of the.

Of the eight week program embodiment of the teacher.

So we're not going to be focusing on those aspects.

So much over the four days.

So the weft.

Are those horizontal threads.

So those are the threads that sort of give the fabric its.

Color and create the pattern.

If you like.

So these are the these are the specific.

Elements for a particular population and in a particular context.

Sort of the.

Unique elements that are. Adapted.

For a particular population.

So these are the parts that we're going to be particularly focusing.

On over our. Days together.

These particular aspects that make it and BCT.

So this.

Slide in a way shows another way of looking at.

This.

So we could see that the top.

Part, the journey of the eight week.

Course is like the. Warp

bit that we're familiar with, the typical.

Eight weeks, the way that it develops over time.

And the way that we inquire together with.

Our participants as we go through. The curriculum together.

And the bottom part.

Might represent what we what the weft.

And this is the bit we'll be focusing on.

So in a way, this, these maybe two key aspects

that are picked up in particular weeks where we're.

Looking at the.

Focus on, on thoughts and. Thinking.

And, of course, the nature of depression.

And then the bottom line is to indicate.

This idea of the three step reading space as the spine of the.

Program.

And so we pick up the three step breathing space all.

The way through.

It's introduced initially at week three comes and again at week four, five.

Six and seven.

So we use all. The way through.

So it's these two bits at the.

Bottom that we're going to be particularly.

Focusing on.

Nature of

depression and thinking and exploring how in the.

Three step breathing space.

Becomes recognized.

As the spine. Of the program.

We'll also be discussing, as we go through the four days adaptations.

That we might make.

And for offering MBC.

To a mainstream population.

So we're assuming that you'll be.

Quite familiar with John Kabat Zinn’s

original program in MBSR.

So originally you'll know developed in a medical.

Context for.

People living with pain and chronic.

Illness.

At this. Educational.

Focus, with this focus on the landscape.

Of general vulnerability and human suffering.

Particular emphasis on emergent learning.

And often taught in quite large groups.

Whereas the original MBCT for depression.

Was developed

within the health care setting.

And so considered a sort of intervention.

In a way, for people with recurrent depression.

So very specifically.

Focusing on.

Vulnerabilities of recurrent depression.

Much more explicit in.

The teaching points.

And generally, working with.

Smaller groups

so we could see MBCT as.

Coming from.

These two parents MBSR on the one side and CBT.

Cognitive behavioral therapy on the other.

And so this might raise some questions about, you.

Know, what will happen to.

Integrate these. Two traditions.

Perhaps concerns about something essential being lost.

You might also notice.

Where you are in the spectrum, whether you lean more towards.

MBSR

that's your background or.

Whether perhaps you come more.

From a CBT perspective.

Maybe just noticing, does it raise any concerns for you about integrating.

These two.

What might seem on the surface.

Quite different.

Approaches?

So MBSR

You drawing on very different.

Streams of.

Learning insight, meditation.

Which although it's embedded.

In most contemplative.

traditions , MBSR.

Primarily drawing on the.

Buddhist psychology.

So drawing on these teachings from, you know.

2600 years ago

was, of course, modern psychology, just a little over.

100. Years old.

So neuropsychology.

Even younger. Still.

So Beck’s, CBT

was developed in the 1960s.

So it's a relatively.

New in.

That sense.

So we're going to be exploring how MBCT

is this confluence of ancient Buddhist.

Psychology with modern.

Psychological science and.

Neuroscience, and looking on how it.

Draws. From.

Both of these. Traditions.

And just being curious, you know.

Although different.

Traditions, is there the same intention.

So this slide.

May be pointing to some of those similar intentions.

The main one maybe being. This.

Intention to understand and.

Relieve suffering.

And perhaps there's a common mechanism.

Maybe it has to do with this what we.

Call metacognitive.

Awareness, this this capacity to to step back a bit

and observe.

So to see cognitions or thoughts mental as mental events.

Rather than reflective reflections of objective truth.

We might also use the term decentring

This idea of stepping.

Back from rather than getting caught.

With.

There's also similarities

iin terms of the focus on the present moment.

So although there's.

An underlying theory for cognitive therapy that connects.

To past experience primarily CBT is focusing on change.

In the present.

Both traditions are about.

Learning from the difficult.

So seeing.

That learning can come right out of.

Perhaps some of our most difficult.

Or challenging moments.

Also seeing that it's.

Quite an interactive process.

So it's this process of investigation.

Of inquiring into.

And also an emphasis

on systematic, extensive practice.

So rather.

Than being told what to do.

Both of these traditions are about, well, testing it.

Out for oneself.

The learning comes from.

Testing it out and discovering if it's true for us

rather than someone else telling us what it should.

Be like.

So just being curious about the similarities

and perhaps also the differences.

In these two traditions.

So we.

All know that in mindfulness.

Based approach, there's a particular set of attitudes.

That are really integral to the.

Mindfulness based approach.

So this is what. We talk about often being.

Embodied by the teacher, the sense of kindness,

care, curiosity.

And I suppose.

Maybe when we initially think of cognitive therapy.

We might see it as is quite.

Different in terms of the attitudes.

Might be seen as quite.

Cold, analytical, factual,

maybe more modern to being quite protocol driven.

So that can be one of the criticisms of CBT today.

However,

this is far from Beck’s initial intention.

So if. We go back and read. About his.

Ideas behind cognitive therapy.

As he called it, he always saw it as a humanistic therapy.

So he indeed did see.

That the relationship between the.

Therapist and.

The patient. Was central.

To the work.

The sense. Of warmth.

And acceptance.

His point was that the therapeutic relationship in and of itself.

Wasn't enough to bring about change.

So it wasn't that he didn't see it important.

But what he saw was the.

The relationship. Was.

Crucial to how we introduce the patient to the theory and the.

Techniques themselves.

So it was this.

Combination between the therapeutic relationship.

And the particular cognitive therapy.

Theory and techniques that brought about change.

So in therapy.

We tend not to talk so much about embodiment, but

we talk more about modeling.

So as the therapist, we're.

Modeling. The qualities of curiosity.

And kindness and warmth that we're hoping then that the patient will begin to pick.

Up for themselves and begin to view themselves.

And with these same attitudes.

So before we take a closer.

Look at MBCT.

Let's gain a little.

Bit of understanding about the nature of depression.

So this was the focus of attention.

For the developers of MBCT

So really important to take good care of yourself as we.

Look at this information.

It's quite.

Likely that we may have.

Experienced depression ourselves.

Or certainly know from friends or family or.

Colleagues who've experienced depression.

So it. Can be quite a tender and vulnerable.

Topic to explore.

So really pausing or.

Taking a break, stepping back from the information if you need to.

So this slide.

Looking a little bit at the.

Th scale of the problem.

So these these stats are actually gathered a few years ago.

But when I checked, it didn't seem that they.

Changed very much.

So depression.

Can happen to any one of any age gender, nationality.

Ethnicity.

So these statistics worldwide.

suggest that

around one in four. of us will be affected at some

point in our. lives.

According to the World Health. Organization.

major depression will be the

world's leading cause of disability by 2030.

And this is particularly because it tends to start

In late adolescence or early adulthood.

And so it can

run then this

recurrent course throughout a person's life.

So it has particularly debilitating effects.

And one of the things we're noticing, quite alarmingly

is that the onset seems to be increasingly younger.

So now quite young children being diagnosed with depression, which.

Means then potentially there's a.

Life, a longer life span of suffering.

And unless there's some intervention.

One of the other.

Aspects to consider, which of course, is what led the the authors to develop

MBCT is this high risk of relapse and recurrence.

So after

having one. experience of. depression.

Someone is 50% likely to have a second

after two is 70% likely to have a

third and after

Three is 90%

likely to have another episode.

So we can see it exponentially increases the likelihood of further episodes.

And the last boxes point to something in the. UK.

context that I suppose helps

me to understand the prevalence.

So at least one person a day

with significant depression.

is seen by every

GP during each day.

of their practice.

So we often think of depression,

in fact, it's considered a sort of mood disorder.

So we think of it initially as it's about sad mood, but we also know that it's

much more than that.

So depression impacts

on every aspect of one's being.

It alters intimate bodily functions,

such as appetite and sleep.

Undermines motivation,

affects thinking and memory.

So we know that it's

syndromal in nature.

So it's this combination of

elements

rather than a single feature.

And so many

clients will describe it as all

consuming.

And so the slightest kind of using

the metaphor of cogs and seeing how all these cogs interlink.

So that impact

on one affects the other and so on.

So it can become.

This yeah, this multi syndromal

impact.

So in the 1970s

Beck was particularly interested in looking at depressed mood.

So he was a psychoanalyst by training, but he started to

become intrigued by

the distressing patterns of thought, which he was noticing were relatively,

relatively readily evident in therapy

sessions, or maybe just under the surface

of the patients conscious awareness when he was working with

people with depression.

So it was this interest in thoughts and

thinking

that grew into this new systemic

therapeutic approach, which was initially for depression.

So cognitive therapy

or what later became known as cognitive behavioral therapy.

So CTE or.

CBT presents a theory about how

historically depression develops.

And of course, later we'll be talking about MBCT,

which is interested in how it's triggered

and perpetuated.

So cognitive

therapy is an example of a psychological theory.

So psychological theories

are like maps.

They help us to understand the.

terrain of the mind and how to navigate it.

So through psychological science, we have quite

detailed maps of

particular domains of the mind.

So cognitive theory offers an

explanation of what brings about common mental health

difficulties, such as

depression, and explores what maintains and perpetuates them.

And of course, these maps

help us then, or theories help us then develop

bespoke psychological treatments that then target

these particular processes of the mind.

So Beck was beginning to notice this

notion.

of the centrality of thoughts and thinking.

So it's not events themselves that seem to be

the problem. But it's our interpretation of them.

It’s how we

perceive these experiences.

That can be the problem.

What's really important is that he was always saying

that these processes were exaggerations of

usual human processes.

So in a way, we could see

that cognitive therapy

is a

framework for understanding how human beings function

in a broad sense.

So of course, as you

probably know, cognitive therapy

has since been developed

and adapted to help in a wide array of conditions.

Since we're seeing that this

underlying theory

is probably the same

for all of us as humans.

CBT has a here and now focus

And what's really important.

is evaluation is very much a central part.

So it's this open and explicit investigation to see whether this is true.

For you, rather

than just taking something as read

So I won't go into this in

too much

detail, but just a

brief, very brief overview of

Beck’s Cognitive Model.

So this idea of the theory

of how depression comes about in the first

place.

So it hypothesizes that early experiences in

childhood and early

adulthood, maybe things such as loss or trauma.

So any event with

with a negative implication.

So these experiences influence

our beliefs, our beliefs about ourselves.

The world and the future.

So we develop what he called these

negative beliefs, a sense of all this is how it is.

And if we believe that this is how it is.

Then we're going to develop a way of dealing with it, of responding to it.

Here's what I need to do to cope.

So we develop these rules for living

So what we're doing

in developing these rules or setting up these

rules for ourselves is we're trying to

avoid similar bad things happening again.

Or trying to protect ourselves if these things should

happen again.

So we manage the best.

we can to navigate our way through life

with these rules for living.

Generally speaking, most of us do

Okay the

rules for living sort of help to get us by.

However, if a critical event happens or a series of

critical events,

and it's usually something that links back to

these early experiences or it

somehow has a connection with these

negative beliefs, or perhaps it's another loss,

or a trauma that's similar to the original one.

Well, then this will

trigger the underlying. unhelpful system.

So just just to say that this process

you might know is called a formulation.

And in CBT, we would typically construct

an idiosyncratic version of this with each client.

So we would develop this with their specific experiences in mind.

So once these systems are activated,

they impact all aspects of experience with

what we might call these feedback loops.

So experience in

one realm

influences the whole system.

So you'll notice that the arrows

Are going in both directions, highlighting that each factor

Influences the other.

And in

turn is influenced by the other factors.

So iCBT.

often includes

this visual representation

of feedback. loops.

So we're making the process quite explicit

we're developing this between the therapist and the client.

So I'm sure many of you will be familiar with this.

So in the. UK we often call

this a hot cross bun.

So this idea is that the arrows

connect all of the different

parts of our experience.

So cognitive therapy presents this coherent

theoretical framework.

It's a collaborative,

therapeutic alliance.

As we develop this

model for each individual patient

and it has this emphasis

on empirical investigation.

So we're setting up this

idea of how we think things are working.

And then we're encouraging the client to

the patient to test it out and see

if, in fact,

if that's what's true.

for them.

So although by the 1980s

there were effective treatments such as CBT and antidepressants,

that that helped to treat depression,

the recurrence of the disorder was a major problem.

And interpersonal therapy in 1990

had produced a very useful maintenance

treatment.

So in 1992, Zindel Segal, Mark Williams and John Teasdale,

who were all cognitive therapists, they were turning their attention

to developing a maintenance form of cognitive therapy.

So they were recognizing that many patients were benefiting

initially from a course of cognitive therapy.

But it didn't seem like the cognitive therapy

was doing anything to to reduce this risk of relapse.

So in this diagram, it sort of shows the the sort of

course and the outcome.

So this, from the point of

on the left hand side, from

wellness of the mood dipping,

down into the initial, depressive episodes.

And then the curve beginning to turn upward again, as there is this some improvement.

Some response to treatment.

Many people. will describe

before they fully reach recovery,

there are relapses,

as they sort of have setbacks.

And then eventually coming to

a sort of stable position again, back to the same

point they were at before.

A sense of wellness.

But then, sadly, this

recurrence of a

new episode

And they also began to notice that about 20% of people

also didn't respond at all to

the acute treatment of depression.

So their

investigations into the

mechanisms of recurrence of depression

yeilded some

really key findings.

So what they noticed was during a depressive episode,

the brain seems to make an

association between

depressed mood

and negative thinking.

And in future, the occurrence of

one element, the mood

brings about the other

this change in thinking patterns.

So John Teasdale and

his colleagues were investigating through mood induction studies.

So this was

working with people who had been depressed before

and comparing them with people who had never been

depressed and using, in their case,

particular music pieces, sad music to induce a low mood.

And what they started to notice

was and those that had been depressed before, there was this rapid

shift in mood and negative thinking.

So what they termed this cognitive reactivity, that happens very.

quickly.

So even with very mild normal

shifts in mood and to low mood.

It begins to acquire this negative significance.

It's seen as a threat.

So any. drop in

mood is seen as

threatening and it triggers the negative thinking.

And at the same time, old memories

old images seem to arise as if

they're happening again now.

So this process of cognitive reactivity is automatic.

So it's not the result of any deliberate decision.

It's something that happens automatically.

And as well as this cognitive reactivity, this change.

in mood, affecting changes in thinking,

there also seems to be a way that those with depressed mood

are more vulnerable in terms of the

way that they respond to this this cognitive reactivity.

So it seems to trigger what we call this discrepancy

monitoring function of the brain.

So this recognizing that there's a discrepancy or a difference

between how we want things to be and how they actually are.

So the low mood triggers this

old mode of mind.

This attempt to solve the problem.

Attempting to think our way out of it.

That has a sort of brooding,

repetitive nature,

what we might call rumination.

Which seems to be seems to be an extension

of this general

mode of mind that we could call doing mode.

It's come to be known

as doing mode of mind.

So in this case, it's an exaggeration

We might call. It this

driven doing.

So during this driven

doing,

the brain is continuing to

monitor how we are with how we want things

to be and trying to close the gap.

So it results in this overdrive and this overdrive

as it attempts to find a solution instead actually is what

perpetuates the cycle.

And as we continue to ruminate.

Emotions intensify.

And so then it becomes

more uncomfortable, more painful, and then we

need to do something to try and escape or

get away from the bad feelings.

Which we call this experiential avoidance.

So what happens is we seem to move into this oscillation

between the two.

Which is called depressive interlock.

So there’s this trying to think our way out of it, this

rumination.

Trying to find a solution,

which tends to make

it more painful, more uncomfortable.

So then we try to do something to

get away from the painful

feelings, which takes us back to trying to find a solution.

So we can kind of see that once

we get locked into this

pattern.

It pushes the mood further and further down.

Feels like there's no escape.

And this is what often people with depression will describe

where they start to feel hopeless and have a sense of despair.

We also know that it has a cumulative effect called the

kindling effect.

So over time,

it takes smaller and smaller

shifts in mood

to start off this whole process.

So it's as if the depressive

thinking program hasn't been wiped from the hard drive during recovery.

So that shifts in mood,

It's a bit like we reinstall it as if it's

never been absent.

So we certainly

can recognize

these similar experiences of discrepancy,

monitoring, rumination,

experiential avoidance.

So it's something we all do as humans.

But for those who are

vulnerable to depression

It's particularly dangerous to get caught in

these mental processes

So another way of thinking,

if this is a bit like the gears in a car.

So it's a bit

like each mode of mind

has its own set of characteristics and functions.

So it's just

like when we're in one gear in the car, we can't be in another.

We can only be in one gear at once.

So this seems to be so for these modes of mind

that we're in one mode,

It inhibits the other.

So this doing mode is about

getting things done.

So the currency is thinking and it's about helping us to

to survive, to solve problems.

To be able to navigate our way through the world.

Which is really necessary and useful and automatic.

Not a problem.

The problem is when it shifts into this

driven doing.

Where the discrepancy monitoring

is trying

to fill the gap in our mood.

So trying to

think our way out of a problem, like a mathematical problem.

then the thinking mode

Is really useful.

But with our emotions not so useful, we can't think our way out of

of how we feel.

So this

low mood is the trigger for all of

these aspects of this

mode of mind.

So this is an

important diagram and one that we might share with

Participants on an MBCT course, but

it’s a way of illustrating this process of cognitive reactivity.

So starting on the left hand side.

We'll see

at the time of depression there is negative thinking.

Then as the mood recovers.

Negative thinking subsides.

However, the recurrence of

further low mood.

So, seeing that yellow arrow coming up to the blue dot.

So when there's a period of

low mood, which will be inevitable in life.

There’s always something that's going

to bring our mood down.

This drop in mood will automatically trigger the negative thinking.

So the blue dot is this moment when it is

all reactivated again.

And this can't be changed.

So this is crucial to notice.

And we can't stop these periods of low mood.

We can't stop the recurrence of the negative thinking.

But it's what happens next

that is so important.

So this is this flash point

this blue dot.

If we can bring.

awareness right in this moment

then there's the possibility of breaking the cycle.

And if no awareness at that moment,

Then it's likely that the vicious cycle will be reestablished,

and move back into relapse.

So it's really about whether we react

or respond right at

that moment when the low mood

and negative thinking is reactivated.

So if we

can meet the low mood and negative thinking with

awareness,

then there's the possibility

of responding differently to that experience.

So it's this radical.

change of being with , rather than trying to get away from

that we're exploring.

Through a process of

Experiential and. Conceptual

Learning during the eight

weeks of the course.

So participants are

learning to nip the depression in the bud

as it were , as it's arising.

So the rationale in

MBCT is this this

Decentering or stepping back from

So learning to become aware of early warning

signs of this reactivity,

of low mood, of negative thinking.

And learning to respond

differently to these unhelpful patterns.

So it's really exploring

these specific vulnerabilities, as well as

Recognizing general vulnerabilities. Of what

It means to be human.

They also, the authors, of course, notice that it's cost effective

to offer MBCT in a group.

So as well as the many benefits of learning

in a group

context, in a therapy context, it's also cost efficient

to be able to offer this in

groups rather than individually.

And of course, really important to notice that this

notion of of rumination,

experiential avoidance, of discrepancy

monitoring.

We have a sense that this is this is what it is to be human.

So we might well apply

these same principles to other difficulties

in life, not just. depression.

So, in other words, trans diagnostic.

So we might use these same processes which in fact what's happened.

To apply MBCT to all sorts

of other conditions.

So I'm sure you'll be very familiar with what we often call the Green Book.

And certainly the first the first part of this book

you can read the story of how they developed

MBCT , and so you'll read that they discovered quite

quickly that you can't do a little bit of mindfulness.

So having gone

to spend time with John Kabat Zinn

And be part. of his MBSR classes

In UMass.

They discovered that

Mindfulness needs to be embedded in our

lives, needs to be part of how we live day to day.

So their

original program

was to call it attentional training.

And of course, we now know what became Mindfulness

Based Cognitive

Therapy , when they recognized that mindfulness.

was this integral part.

So in a way, if there was any possibility

Of recognizing when it was really needed, right

As that

low mood and negative thinking

was arising. again, we need to be

practicing mindfulness

every day, in order to be ready for that

very moment when at least when the mood drops and the

processes reoccur.

So the authors are describing that.

The ultimate aim of MBCT is to help individuals

make this radical shift

in the relationship

to thoughts, feelings, body sensations

that contribute to depressive relapse.

So we can see it's about stepping

out of the habitual automatic patterns of mind and body

that, left unchecked, will likely

produce this downward spiraling

of mood and eventually, to the

onset of relapse.

So really important for us as teachers and for our participants to to begin

to learn

that this isn't about getting rid of these processes, or clearing

the mind.

So we're not stopping that happening.

But it's about

recognizing when it when it. occurs.

And when we

start to tip into this automatic

rumination and experiential avoidance.

That's where the problems occur.

So it's bringing our awareness

right so that blue dot as it were, that's really

what

MBCT is hoping to support participants

to do

So, as we come to

the end of this first recording.

A time now to pause

and reflect, maybe just to. check in

with what's your understanding of what you've heard so far?

Where is your interest heading?

Are there any questions or wonderings?

So this was a fairly. brief run through

of the theory.

So it might be

That that you. Want to take more time

now to go back , or perhaps do some more reading for yourselves.

So yeah, so hopefully this has stimulated some interest for you.

And we'll certainly be picking up and connecting with

aspects of this theory as we work

our way through the eight week course, when we meet together.