Mindfulness and Depression: A Matter of Acceptance?

Are you able to accept depressed mood as it is? Being more accepting of negative thoughts and emotions does not necessarily mean to give up. In the contrary, it can be the first step toward change. In one of our recent mindfulness meditation group sessions in Hillcrest some participants noted that “depression” is not necessarily a “bad thing.” This was a keen statement that made me think about mood disorders in new ways.

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There is something I would call the “depression paradox” in America. On the one hand, people feel depressed perhaps more than ever before in human history, on the other hand, it seems to have become ever more unacceptable to feel down.

In the American popular culture there is a tacit imperative to claim that everything is fine even if that’s simly not true.  Particularly in Southern California to smile and be happy all the time can be an expectation that is not conducive to wellbeing. Feelings of sadness are commonly not talked about. Above all, it is unacceptable to display them in public even though going inward and being unhappy can be an important way of processing life events.

As a family therapist I meet many people who have difficulties to accept that symptoms of depression such as hoplessness, irritability, loss of energy or interest in daily activities, and fatigue may come and visit for various reasons. The result of avoiding negative feelings is often rigid emotion management based on social conventions in which any negative feeling must immediately be reframed and turned into something positive. Sometimes this is promoted by psychological self-help literature that asks people to smile or engage in positive self-talk when there is actually a need to acknowledge a moment of suffering.

If the symtoms become severe and last longer than two weeks it is important to seek professional help, but even then, the first step towards healing is to accept the fact that you are hurting. This sounds more simple than it is.

In the 1980s, the Stanford anthropologist Gananath Obeyesekere claimed that in Buddhist cultures, i.e. in Sri Lanka, the renunciation and withdrawing from the world is considered a way to enlightenment rather than a sign of psychopathology. He argued that the Western psychiatric diagnostic category of Major Depressive Disorder does not necessarily apply to people who follow Theravada Buddhism. Although this is a bold assertion, it remains a fact that in countries where Buddhism is commonly practiced, the psychiatric prevalence of depression is very low.

This makes sense if one considers the first Noble Truth of Buddhism, namely, that life means suffering and that suffering stems from attachment to transient things. From this point of view depressed mood can be a normal consequence of human craving and aversion. Perhaps it becomes more prevalent in neo-liberal consumerist cultures that make us obsessed with ‘progress’ and ‘success.’ To what extent does our longing for the latest and most cutting-edge style, body image, product, degree, or job make make us prone to ‘depression’?

Ultimately, I believe that whole-hearted acceptance of where I am at right here and now can lead to new actions rather than fatalism or the believe that nothing can be changed. With a little bit more awareness of what is going on, I’m more prepared to notice that change is inevitable. But maybe acceptance is too big of a word. As the meditation teacher Jason Siff argues, “tolerance” may be all we can hope for in the face of dispair. In an open meditation practice it is important how we relate to negative thoughts and rumination rather than to pull ourselves out of them. Simply denying that they are there and wishing that they would be gone has never served me in reaching greener pastures.

Seven Pillars of Mindfulness

In the Mindfulness-Based Stress Reduction (MBSR) program developed by Jon Kabat-Zinn there are seven pillars of mindfulness. These attitudes and committments set the stage for effective mindfulness practice in MBSR.

 

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1. Non-judgment is about not getting caught up in likes and dislikes that keep us stuck in a rut.

2. Patience is concerned with the understanding of the fact that sometimes things must unfold in their own time.

3. Beginners Mind means that we see everything as if for the first time.

4. It is important to develop basic Trust in ourselves and our own capabilities.

5. Non-striving is about trying less and being more who we already are.

6. Acceptance means to come to terms with things as they are right here and now.

7. When we are Letting Go of things we recognize them and just don’t pursue them any further.

There are several other helpful attitudes but this is it when it comes to Kabat-Zinn’s Seven Pillars.

Mindsight: How to Switch on your Seventh Sense?

Have you ever tried to figure out how your mind works? Switch on your your Seventh Sense and practice what psychiatrist Daniel Siegel calls “mindsight”. There is nothing mystical about it. It can help you to become aware of the mental activity in your brain. According to Siegel, “Mindsight is the ability for the human mind to see itself. It is a powerful lense though which we can understand our inner lives with more clarity, transform the brain, and enhance our relationship with others.” We can all do it and have done it sometimes perhaps without even noticing.

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Step 1: Observation

First of all, become aware of your awareness through observation. Just try out this mindsight experiment: Tell yourself right now to focus on your breath. Just watch how the air enters and leaves your body naturally. See how long your intention permits you to not have a thought. Tell yourself to focus on the breath. Nothing else. The ability to observe is important for mindsight because it enables us to perceive what is going on as we experience an event. Thoughts can be seen as nothing else than mental events. Through observation we can see their context. This is a vital skill that can only be developed by making a conscious effort.

 

Step 2: Openness

Perhaps you are successful to focus your attention on your breath for a couple of minutes or just seconds. The thoughts don’t go away just because we want them to stop, even less so if we get angry at them, or try run away from them. They are bound to come up again and again. If you are able to notice and observe internal commentary, images, and associations as they arise on their own, you are connected to your Seventh Sense. Be open to your experience as it is. Often we are our own worst critique. Openness helps us to accept what is going on in the moment without getting swept away by negative judgements about our mental activity.

Step 3: Objectivity

A lot of the time, we cannot distinguish our sense of self and identity from our mental activity that arises as a result of past experiences that have been ingrained into our brains through childhood experiences and cultural conditioning.

However, we are not helplessly exposed to inner autopilots that steer us in accordance with habits that we may not consciously choose or like. You can take the streering wheel into your hand and turn on your Seventh Sense. When you practice mindsight you will notice that a thought is not all you are. Mindsight as a way of taking up a more objective perspective helps you to become aware of the fact that it is not “me” who is doing the chatter. At least it is not a unified “me”. Rather there are parts, programs, or mental schemata that become dominant in particular moments. If a particular part was all that there is, how could we be aware of it as something that tries to get hold of our attention?

As you will see, the distance that comes with making a distinction between awarenss and mental activity opens up new choices. If you can see and observe the whole menue and the different “foods” available in your brain you can start to choose what you want to eat. Try it out and start to watch your thoughts. Become more mindful of them and see what effect it has on how you relate to other people.

 

Three Things about Mindfulness

Three Things about Mindfulness

Sometimes, it is helpful to break down what’s mindfulness. Mindfulness is about at least three things: our intention, attention, and attitude. First, mindfulness is said to be based on intention or making a conscious choice, a decision to shape one’s experience. This includes the intention to practice, as well as the intentionality one brings to directing, sustaining or switching attention. The intention to consciously focus attention on a object such as the breath is the basis of mindfulness.

Second, focused attention itself is a defining feature of mindfulness. It includes focused, broad and sustained attention, and skills in switching attention from one stimulus to another. Attention is tied to the ability to pay close attention to details in tasks or activities and not to be overwhlemed by extraneous stimuli. Attention can be considered a form of self-regulation and can help us to deal with difficult emotions. Evidently, sensations, emotions, and thoughts can never be kept from coming up. This brings us to the next dimension.

Third, mindfulness is not merely about focusing attention but about a focus in a particular way. It is grounded in particular attitudes that allow for acceptance of whatever arises in the mind. These attittudes commonly include non-judgment, acceptance, trust, patience, non-striving, curiosity, and kindness. They are developed by intentionally sustaining attention to internal and external stimuli without immediately evaluating them as either “good” or “bad” through an awareness of their transitional and changing nature. It involves a stepping back from mostly unconscious habits that shape what we do, feel, and think in everyday life. This does not mean that we have to just accept everything that happens to us or other people. But more about that later.

Stuck in Thoughts? A Way Out

Mindfulness is more than becoming aware of things around us. It is about becoming aware of thoughts and stories that get us stuck. Rumination or automatic negative thoughts can keep us in a rut. Counter to what I expected, they are often changed most effectively through a stance of acceptance. When I am merely trying ot get rid of unpleasant things going on internally I cut myselves off from the possibility to actually change them. If I react to my own negative thoughts and feelings with aversion and annoyance then my body tenses up more. I start to become more irritable and so forth. For a long time, I treated my negative moods and feelings as enemies and as a result made them worse. Mindfulness practice helped me to stay with them until they dissapear on their own.

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Negative feelings and thoughts are often interlinked with stories about ourselves and others that are not necessarily true. They maintain our problems rather than to solve them. Today, I’m certainly not free from them but I can say that there were times in my life when I felt like caught up in a hamster wheel. Just thinking about the future and what I still have to accopmplish without getting anywhere. Often this was also tied to what is often called the “doing mode”.

Some problems we cannot solve through analytical thinking. When I critique, judge, and compare myself with others, it usually increase my discomfort. No doubt, the “doing mode” of the mind can help to solve technical problems in everyday life and to transform external world through action. However, I become unhappy when I focus on the glass being half empty. “Oh, I haven’t changed my world yet, and I’m still sometimes struggling with my marriage. I could do so much better. What’s wrong with me?”

The focus on goals and the mismatch between who I could be and who I appear to be right now often made me miserable. One way I jump out of the stories and assumptions of who I should be is to just be aware of what is going on right now in my body. Can I feel my heartbeat? How does the sofa smell? The “being mode” gives us other way of relating to thoughts, bodies, emotions than the “doing mode”. We all have it already. I can remember, as a child and even a teenager I was more in touch with it. Now I’m working on getting back there again. Let’s get out of head and experience world directly without the running commentary.