BERN - Behavioral therapy, a psychotherapeutic method based largely on the rules of learning, is not known for its spirituality. But increasingly, behavioral therapists have begun applying the ancient Buddhist concept of Mindfulness in helping patients overcome depression.

This follows an earlier advance in the behavioral field known as "cognitive behavioral therapy," which seeks to change perceptions and mindsets. Now the field is being transformed by a "third wave," which focuses directly on regulating emotions through mindfulness.

For the past four years, the University Hospital and Polyclinic for Psychiatry in Bern, Switzerland has been using mindfulness-based therapy with patients suffering from depression. During the course of eight weekly group meetings, patients learn how to be mindful in various ways. They learn to be in the moment and – sitting upright, in a comfortable position – to focus their attention on their body, their thoughts and their feelings. Their inner attitude should be neutral and non-judgmental, and they should also pay attention to breathing in and breathing out. The process aims not at changing feelings and thoughts but rather one's relationship to them. Negative feelings are not judged, just recognized as constructs -- so they lose their power.

Taking responsibility

"We have had good experiences with this therapy," says University Hospital psychologist and lecturer Zeno Kupper. The therapy is called Mindfulness-Based Cognitive Therapy for Depression (MBCT) and the hospital uses it to prevent recurrence of depression. Their program is conceived for groups of up to 12 people, most of whom live at home.

"Depressive symptoms that patients may still have, and negative thought patterns, decrease markedly during the eight-week program," Kupper says. "Patients are more alert and more together."

Patient reaction has largely been quite positive. "This is the best thing I've ever done," one noted. Another said: "I see the world in a completely different way." Many undergoing the therapy also say that they realize for the first time that they themselves play a role in how they feel and are thus in a position to assume responsibility.

"By practicing mindfulness daily and experiencing new things as a result, a patient's sense of effectiveness increases. MBCT is also an excellent way of complementing standard therapies," Kupper says. He cautions, however, that it is not a panacea, nor is it a replacement for individual psychotherapy.

The therapy was developed by British researchers working with Zindel Segal, Mark Williams and John Teasdale. It is geared especially for patients who had suffered three or more depressive episodes.

But the roots of the "third wave" of behavioral therapy can be traced back to John Kabat-Zinn, a molecular biologist and professor of medicine at the University of Massachusetts. When, in 1979, he developed Mindfulness-Based Stress Reduction (MBSR) and opened a clinic for patients with stress symptoms, his main interest was the connection between what was going on in the body and the activity of the mind. His eight-week program included some elements of Hatha Yoga and Vipassana and Zen meditation practices. 

No such thing as a quick fix

Both MBSR and MBCT have been tested empirically in recent years. An Anglo-American study published in 2008 showed that in preventing the recurrence of depression in a 15-month time-frame, MBCT was just as effective as treatment with medication. Research conducted at the University of Geneva and published in 2010 showed that patients who underwent both MBCT therapy and pharmaceutical treatment were free of depression for much longer periods of time than were people who had been treated with medication alone. The difference was approximately 3:1. 

One of the first Swiss to use MBCT is Daniel Hell, head of the "Depression and Anxiety" competency center at the Privatklinik Hohenegg and former director of Zurich's University Clinic of Psychiatry. Dr. Hell says psychiatry will benefit by opening up to elements from the realms of religion and philosophy. He also points out that mindfulness is not only a Buddhist concept, but is to be found in all mystical movements.

Dr. Hell also warns against having exagerated expectations for the method. What may prove very effective during the course of two months of group work may be harder to sustain once the patient is back on his or her own. Mindfulness-based methods are not quick fixes, he warns, nor are they suitable for acute stages of an illness. Instead Hell says they work best as complements to psychodynamic talk and behavioral therapies, or in conjunction with medication.

 "These methods aren't anchored in our culture," he says. "For them to work, you need to be able to listen to what is going on inside."

Read the original article in German

Photo - Wiertz Sebastien