By MIKE GROPPERA woman meditating (illustrative photo)(photo credit: INGIMAGE)
Estee, a woman in her early 50s, suffered from anxiety and depression and sought my help. She was married for the second time and she said that her marriage was falling apart.She realized, as did her grown up children, that she had made a terrible mistake in her choice and she wanted to end the marriage. After listening to Estee’s complaints, I concluded that she indeed was in a very dysfunctional relationship with an abusive and insensitive man. He was not motivated to find work and she felt that all of the economic responsibility fell on her shoulders. In the initial stage of seeing her, it became clear that she was clinically depressed and very anxious about her current reality and future.She also felt like a loser and feared that she would never be able to find a suitable man.I suggested to Estee that while psychotherapy could help her solve the problems that she was facing, she needed some immediate relief from her stress, depression and anxiety. I recommended mindfulness-based cognitive therapy (MBCT) to help her decrease her depression and anxiety.So what is Mindfulness- based Cognitive Therapy? MBCT was developed by Jon Kabat-Zinn of University of Massachusetts Medical School in Worcester, in the 1990s. Kabat- Zinn, originally trained as a molecular biologist, was a practitioner of Yoga and Zen meditation.He believed that the principles of mindfulness mediation found in Zen Buddhism could be taught to people in order to help them cope with both psychological and physical ailments. A decade later, psychotherapists in Canada and the UK took Kabat-Zinn’s ideas and developed Mindfulness Based-Cognitive therapy and in 2002 they published a book on the topic. In the last decade, the numbers of psychotherapists and psychiatrists who learned and use MBCT in their practices has grown exponentially.Furthermore, there are several thousand publications showing that MBCT to be an excellent treatment tool to help people with depression, anxiety, fibromyalgia, and many stress-related symptoms including panic disorder, eating disorders, and even trauma.Mindfulness is being aware of or bringing attention to the present moment in time, deliberately and without judging the experience. MBCT incorporates this cognitive skill in the following way. I introduced the technique to Estee by asking her to close her eyes and try to focus on her breathing through her nostrils, counting each inhalation and exhalation as one and counting until 10.I explained to her that while focusing on her breathing, that is being mindful of this simple act, she would probably be distracted by thoughts that keep popping up in her head, and that this is normal. Cognitive therapists call these thoughts “automatic thoughts” and even when we try to focus on something such as breathing, the thoughts keep popping up. I asked Estee if she could describe some of her negative thoughts. She stated that she kept on thinking that she would never find a man to be happy with and that she was a relationship loser.This made her very sad and anxious. I taught her to just accept the thought as it is, and not to judge it, and return to the mindfulness of focusing on the present breathing exercise. I also encouraged Estee to try to use all of her senses when practicing mindfulness.We worked on this type of skill training with several different mindfulness exercises for three months combined with problem solving counseling. To this day, Estee can’t explain why this therapy helped rid her from her depression and anxiety, but it clearly worked. She also continues to practice mindfulness exercises regularly. And, in spite of the fact that all of her problems have not yet been solved, she is no longer depressed and anxious.How does mindfulness work? Studies have identified four major components that explain how this technique works.1. Focusing on the here and now directs someone away from past, present, and future worries that are associated with depression and anxiety.2. Selective attention teaches that self-monitoring and guiding distractive thoughts back to a here and now focus helps people refrain from overly investing in those negative thoughts.Just accept them, don’t judge them, and go back to focusing on the present.For example, Estee believed that she would never find anyone to spend her life with. What really helped her was to learn to selectively focus away from those intrusive and disturbing thoughts and refocus on the here and now.3. Decreased rumination which is usually present with anxiety states such as “I will never find the right guy” or “I am a loser” also creates a state of tension and more worry. By acknowledging these negative beliefs, but then letting go and returning to putting her attention on the present moment, Estee’s negative and self-critical ruminating decreased tenfold.Estee liked to take walks through the park near her home, but was so stressed with worries that she could not stop obsessing about how bad things were. Once again, I encouraged her to acknowledge the thoughts, but try to focus on the present; the smells from the trees and the plants, the pretty sky, the good feeling of walking in the park and her rumination just gradually went away.4. Enhanced-self compassion. Studies have shown that people who practice mindfulness have more gratitude not only for others but for themselves as well. There is no doubt that the MBCT exercises helped decrease Estee’s self-critical inner talk or thoughts and focused her attention to more positive things that she could enjoy, thereby enhancing her self-esteem.What therapists who practice MBCT can teach clients is that thoughts are very powerful and they can change our reality. Clients can learn to feel better by getting into the positive side of the moment and focusing positive energy on what is really out there to enjoy.The writer is a marital, child and adult psychotherapist, with offices in Jerusalem and Ra’anana; he also provides online videoconferencing psychotherapy. drmikegropper@gmail.com, www.drmikegropper.weebly.com
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