Buddhism and Science

March 2010

Mindfulness in Clinical Psychology

Mark Williams
University of Oxford
Department of Psychiatry

Collaborators: Zindel Segal, John Teasdale, Jon Kabat-Zinn

Oxford Team: Melanie Fennell, Thorsten Barnhofer, Catherine Crane,
Danielle Duggan, Adhip Rawal, Emily Hargus, Wendy Swift

www.mbct.co.uk
 Outline
• Clinical psychology and cognitive science
– Depression recurrence
– Outcome evidence
• What is going on?
– Modes of self-focus
• Conceptual vs experiential
• Exploring modes of self-focus
• in eating pathology
• through neuroimaging
• Mindfulness and relapse signatures
Age of onset of major depression
(N = 4041; Zisook, 2007, Amer. J. Psychiat)
 Depression recurrence

 More than 50% who do recover will have at least one

further episode
 Those with history of 2 or more episodes have 70-80%
chance of recurrence
 Mindfulness-based Cognitive Therapy (MBCT)

 Designed for patients in remission

 to prevent relapse/recurrence
 Format
 Pre-class interview
 Eight weekly classes. Each 2 hours.
 Around 12 in each class
 Teaching meditation
 sustained attention on breath and body
 thoughts as mental events
 Home-based practice, up to one hour per day, 6 days a week -
mostly CDs of mindfulness meditation practice
 Teasdale, Segal & Williams, et al.,2000 Survival
Curve (for patients with 3 or more previous episodes - 60 weeks)

1.00

MBCT: 37%

0.5

TAU: 66%
10 20 30 40 50 60
Procedural replication (Ma & Teasdale,
2004, J.Consult.Clin.Psychol.)
Kuyken et al (2008) MBCT vs m-
ADMs
 Outline
• Clinical psychology and cognitive science
– Depression recurrence
– outcome evidence
• What is going on?
– Modes of self-focus
• Conceptual vs experiential
• Exploring modes of self-focus
• in eating pathology
• through neuroimaging
• Mindfulness and relapse signatures
 Automatic vs strategic processes
• Darwin (1872)
• What we seen in humans is a combination of
– evolutionary old, automatic reactions
• Switch on AND OFF depending on contingencies

– evolutionary newer, strategic, representational and symbolic

reactions (working “off-line”)
Two Modes of Self-focus: Conceptual and
Experiential

Labeling
Elaborating
Environmental Input

Conceptual Analyzing
/ Simulation Judging
Goal-setting
Planning
Comparing
Remembering
Experiential
/ Direct Self-reflecting

Seeing Tasting Touching

Hearing Smelling
Visceral sensations
Proprioceptive sensing
• Conceptual mode useful
– To complete meanings
– To complete tasks

• But when it becomes over-used

– Preoccupied by meaning
– Planning (even when not wanted)
 Consequences of conceptual mode
(from the Mindful Attention and Awareness Scale; Brown & Ryan, 2003)

•I find it difficult to stay focused on what’s happening in the

present.
•I tend to walk quickly to get where I’m going without paying
attention to what I experience along the way.
•It seems I am “running on automatic” without much awareness
of what I’m doing.
•I rush through activities without being really attentive to them.
•I get so focused on the goal I want to achieve that I lose touch
with what I am doing right now to get there.
•I find myself preoccupied with the future or the past.

•Cf Cornell Campus experiment

 …in depression

• Key maintaining factor

PERSISTENT OVER-USE OF CONCEPTUAL MODE
– “adhesive pre-occupation”
(rumination)
&
Attempts to stop it
(avoidance)
» lack of interest in anything else
 For example

• Focus on
• Feelings of tiredness
 Mindfulness training: Shifting mode of self-focus
Environmental Input - from conceptual to experiential

Conceptual/
Simulation

Perceptual
/Direct

B
 Outline
• Clinical psychology and cognitive science
– Depression recurrence
– outcome evidence
• What is going on?
– Modes of self-focus
• Conceptual vs experiential
• Exploring modes of self-focus
• in eating pathology
• through neuroimaging
• Mindfulness and relapse signatures
 (Adhip Rawal’s DPhil thesis)

• Choose a condition where self-focus most problematic

– Students with high eating concerns
– Anorexic in-patients
 Induction of processing modes
(Watkins & Teasdale, 2004)

• Sample item:

• the physical sensations in your body

• the way you feel inside
• how awake or tired you are

• Mode induction
– Conceptual:
• Think about the causes, meanings and consequences
of……
– Experiential:
• Focus your attention on the experience of ……

• 8 minutes
 Stress test for Eating Concerns

• Imaginary meal procedure (Shafran et al.,1999)

• Participants asked to imagine eating a fattening

food for a period of 2 minutes.
 Outcome measures
• Estimate of actual weight “How much do you think you weigh right now?”
• Moral wrongdoing:
– How morally unacceptable/wrong do you feel (0-100%) it was to think
about eating the food
• Urge to reduce/cancel effects:
– “How strong do you feel is your urge (0-100%) to reduce or cancel the
effects of thinking about the food?”
• Neutralization
– imagining exercising
– imagining eating celery
– checking shape in a mirror
 Analogue study: Pre and post stressor difference in
weight estimate (in kg) for high ED group

0.3 Condition, p < .05

0.2

0.1
Mean Weight

0
change

-0.1

-0.2

-0.3
Conceptual Experiential
 Mean ratings for moral
wrongdoing/unacceptability post stressor for high
and low ED groups

35
Analytical
30
Experiential
25
Moral Wrongdoing

20

15

10

0
High ED Low ED
Proportion of neutralisers and non-neutralisers post stressor for
the high ED group

Neutralisers
Non-neutralisers
18
16
14
12
Frequency

10

8
6
4
2
0
Analytical Experiential
 Anorexic patients?

• N = 13 in-patients
• BMI=17.2
• Matched controls
Patient study: Pre vs post stressor difference in weight
estimate (in kg)

1.4
1.2
1
0.8 Ano re xic

0.6 Co ntro ls

0.4
0.2
0
Co nc e p tua l Exp e rie ntia l Fille r ta sk
Patient study: Proportion neutralised after
stressor in each condition

12

10

Ne utra lise rs
6 No n- ne utra lise rs

0
Co nc e p tua l Exp e rie ntia l Fille r
 Mindfulness training increases ‘viscero-somatic’
processing and uncouples ‘narrative-based’ processing (Farb et al,
07)

Farb, N., Segal, Z.V., Mayberg, H., Bean, J., McKeon, D., Fatima, Z., & Anderson, A. (2007).
Attending to the present: Mindfulness meditation reveals distinct neural modes of self-reference.
Soc Cog Aff Neurosci., 2, 313-322.
 Outline
• Clinical psychology and cognitive science
– Depression recurrence
– outcome evidence
• What is going on?
– Modes of self-focus
• Conceptual vs experiential
• Exploring modes of self-focus
• in eating pathology
• through neuroimaging
• Mindfulness and relapse signatures
 Relapse signatures (Emily Hargus’s data)

• Individual patterns of prodromal features that warn of onset of

episode
• Very important for self-management (schizophrenia, bipolar
disorder, suicidal behaviour)
• Not just whether noticed, but how we relate to them –
– enmeshed
• “I’m not ever going to be able to sleep again”
– with meta-awareness (“decentered”)
• “I felt life was getting difficult, but it was my own inability
to cope at that time”
 Meta-awareness of relapse signature

2.6

2.2
MBCT
1.8 TAU

1.4

1
Pre Po st
 Summary
• Mindfulness training can reduce depression recurrence
• Training in experiential mode of self-focus
- can prevent over-use of conceptual mode
• Impact of mode of self-focus
– also seen in eating pathology
– can be explored through neuroimaging
• Encouraging evidence for MBCT in decentring from
suicidal thinking
 Thank you

• www.mbct.co.uk