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Mindful : August 2016
“No, for real sustainable change to happen, the insights need to be married to skills that can be put into action—successively. And that is something mindfulness provides par excellence. We all love that moment of insight, and it keeps people com- ing back to therapy sessions. But the working-through part, where you encounter a challenge again and again and learn to embrace it, nonjudgmen- tally, that’s where you put the insights into effect in your life.” Segal points out that he did not come to mindfulness as part of a personal life quest, so he doesn’t feel any need to proselytize for the practice. He came to it as a researcher and clinician hoping to find ways that more people could get better. In particular, his work focused on the problem of how people who had recovered from depression could still relapse easily if something triggered a sad mood, which in turn would bring on feelings of inadequacy—the downward spiral of depression. “The experience of depression can establish strong links in the mind between sad moods and ideas of hopelessness and inadequacy,” Segal told Sharon Begley for the book Train Your Mind, Change Your Brain. “Through repeated use, this becomes the default option for the mind.” Finding means and methods that might interrupt that “default option” became Segal’s paramount concern, and starting in 1992 it brought him to a collaboration with John Teasdale and Mark Williams, both of Cambridge University at the time. If mindfulness practice did indeed provide the kinds of skills in working with thoughts that advo- cates claimed, this form of medita- tion—particularly as carried out in a secular, reg ularized program like Mindfulness-Based Stress Reduc- tion—could be powerfully combined with cognitive therapy. Many had long regarded cognitive therapy as the gold standard treatment for depression. A skills-based approach, it asks patients to inquire into, famil- iarize themselves with, and redirect How do we so suddenly find ourselves trapped inside a painful mood? Let’s take a closer look. Cognitive Behavioral Therapy is noted for developing the ABC model of behavior. One of the many versions of the model posits an Activating Event (an event or experience that sets off the cascade), Beliefs (we evaluate what we’ve experienced, either rationally or irrationally), and Consequences (what happens in our mind, or our emotions, or action we take as a result). The ABC model is an impor tant part of MBCT. As it says in Mindfulness-Based Cognitive Therapy for Depression, in “the ABC model of emotional distress,” the main point is that “our emotions are consequences of a situation plus an inter- pretation.” We find ourselves in emotional distress—we’re screaming at our spouse— and we’re clueless about how we so suddenly got there! We start with a SITUATION (A). And end up with a FEEL- ING (C). But often we miss the THOUGHT (B) that links them. So, how does that hap- pen? Automatic emotional reactions occur because we have a running commentary, a steady stream of thoughts that we barely notice if at all. And these thoughts dictate how we end up feeling. For example: A You run into a good friend at the coffee shop before work. She’s with other people and barely notices you. B You think, “She hates me, just like everybody hates me.” C You feel sadness, bordering on depression. But it doesn’t end there. It’s a cycle. Now that you are in a sad mood, it may color your perception of the next event you encounter when you get to work. Your boss asks you to fix a small mistake you made, and before you know it, you are at C, deeper sadness, skipping over the interpreting thought, “He thinks I’m really bad at what I do, and I am.” By the time our friend texts us to say, “Sorr y I didn’t get a chance to say hello. I was tied up in a con- versation about my career,” we’ve already been caught in a very low mood all day. Mindfulness’ strength is in helping us to see B more clearly, by giving us the room to not be so quickly reactive. And over time the event does not have to jump to emotional distress, like a grasshopper leaping over a stream. THE ABCs OF THOUGHTS AND FEELINGS ILLUSTRATIONBYKEVINVANAELST 50 mindful August 2016 psychology