The western world is relatively new to the practice of mindfulness, which derives from ancient ideas most notably linked to the Buddha some 25 centuries ago. The suggestion is that we create our own suffering because of our expectations that we will get what we want and that it will remain. Unfortunately, unwanted things happen frequently in our lives and wanted things, when they do arise, soon change. Also, we change, so how we perceive ourselves and our lives also changes. We quickly become used to what we have, and are soon dissatisfied again. Mindfulness involves awareness of these simple, but far reaching universal realities (everything changes and nothing is satisfying forever), in a way that can free us of the suffering associated with our constant desire for things to be a different way, and our disappointment when our satisfaction wanes.

Mindfulness approaches are now formally being integrated into a range of traditional therapies, and are used to treat a wide array of human suffering from physical pain, health recovery and stress, to many psychiatric disorders. Mindfulness practice is also used to enhance everyday life and develop genuine lovingkindness towards oneself and others.

The practice of mindfulness has been defined as “paying attention in a particular way – on purpose, in the present moment, and non-judgementally”. Usually this is done in a meditation in a seated position and attention is focused on the sensations within the body, with a gentle removal of all evaluations of those sensations. Practicing this way helps to train us to be less judgemental, and less engaged with the desire to seek pleasure and avoid pain.

In our lives, a negative event may occur. We may become upset and may focus on the idea that we have been wronged in some way, building up miserable feelings as we become trapped in our thoughts. Our own reactions, full of judgements and recriminations and emotional pain, hold us in a habit of ‘attaching’ to this method of problem-solving which frequently leaves us with unresolved pain. Alternatively, when we suffer unexpected loss or trauma, we may remain stuck in processing the emotion and avoiding situations linked to the trauma. In effect, we have trouble integrating the different aspects of experience (thoughts, emotions and body sensation) and gaining perspective.

Mindfulness suggests that thoughts and physical sensations have the same characteristics of arising and passing away – as if they are the ripples on the surface of the ocean. When we take the stance of a scientific observer of ourselves, we are better able to perceive our thoughts and judgements as ripples, accepting that they will pass, and therefore developing mastery over our reactions and our lives. The practice of mindfulness develops the capacity to “see with wisdom” – without judgement, evaluation, or prejudice.

Research evidence suggests that when we engage in evaluations – negative or positive – stress responses are activated and the body experiences sensations. The body’s sensations also arise from external environmental sources and exist at all times throughout the body above and below our level of awareness. Our unhelpful behaviours are maintained by our reactions to these sensations. If we are to adequately process stressful information, we require the pathways to be strengthened between the brain’s deep emotional centres and the more controlling areas of the brain, thereby preventing the brain’s emotional centres ‘hijacking’ all of our attention. Regular mindfulness practice, by strengthening these pathways, enhances mental and behavioral flexibility and resilience. You can learn more about Mindfulness at these websites www.aboutmindfulness.com and; www.mindfulness.net.au.

Prue Fanselow-Brown is a registered clinical psychologist working at the Child and Family Psychology Centre. Visit www.christchurchpsychology.co.nz to learn more about Prue and her work.

More people are suffering from depression than ever before. Life is getting more challenging all the time, with increased demands on our time and our energy for work and other commitments, increasing complexity in the way we have to deal with the world, and increasing pressure to live “perfect” lives. We know that anxiety and depression usually go together, and if we’re constantly worrying about whether we’re succeeding at our work or our relationships, plus feeling that we can’t meet the standards being set for us, plus thinking that this will never get easier – we’re heading for depression. I often talk about the “four cornerstones of mental health” with my clients, which refers to sleep, nutrition, exercise, and pleasure.

We all know that, when you’re not getting enough sleep, life gets a whole lot harder. If you’re not eating regularly and sensibly, your body has fewer resources to draw on when stress arrives. We also know that regular exercise (and I don’t mean running a marathon or sweating at the gym – I just mean a 30-minute fast walk) does good things to our bodies and our brains. Finally, we know that having pleasurable activities in our lives helps protect us against depression. Doing things that make you feel happy and that bring you pleasure each day is really important. Achieving balance in these four areas of our lives helps prevent depression. However, despite our best efforts, you or I (or one of our children or one of our parents) could become depressed. If that happens, it’s even more important to attend to the lifestyle factors referred to above, but it’s also important to seek treatment.

We know that mild to moderate depression can be effectively treated with psychotherapy, or the “talking cure”. Cognitive Behavioral Therapy (CBT) has been shown to be effective in the treatment of depression around the world. CBT teaches people how to alter negative thinking patterns, how to manage the symptoms of depression, and how to protect against relapse once the depression has lifted. CBT is a relatively brief, focused treatment that depends on a good relationship between the therapist and the client so that they can work well together. There are many variants of CBT available, with some treatment even available online (http://www.thelowdown.co.nz for young people, and http://moodgym.anu.edu.au for adults).

CBT can be used with adults, adolescents, and children, and there are therapists who specialize in each age group. People who are suffering from severe depression may need medication to help lift their mood before they can benefit from psychotherapy. We know that antidepressant medication can be very effective in treating severe depression, and for some people, this involves life-changing benefits. Obviously, treatment of any kind – psychotherapy or medication – must be administered by a qualified health professional, so make sure that you ask any health practitioner about their training and experience, and what professional organisation they belong to (which keeps an eye on the standards of practice they use).

As adults, feeling a little “off colour”, feeling a little “blue”, is a normal part of life, something we are all likely to experience from time to time. When we talk about feeling “depressed” often what we are describing are feelings of unhappiness, disappointment, or sadness. And this may be in reaction to a whole variety of life experiences, such as a missed promotion, argument with a loved one, or failing an exam. Generally these reactions are time-limited. If these feelings persist, then we may be moving into the realms of what may be called clinical depression. Our depressed mood has become severe enough and persistent enough to now be regarded as an illness. If clinical depression is present, mood will be predominantly and persistently low. Other changes are likely to be noticed, such as a decrease in energy levels, difficulty concentrating, disrupted sleep patterns, and a loss of interest and pleasure in activities that would typically be rewarding. Other changes might also include changes in appetite and weight, feeling chronically tired, unable to make decisions, being more easily moved to tears, and more irritable than usual. A person who is depressed may also express feelings of worthlessness, and sometimes guilt about past events. Thoughts about death or suicide may also occur along with depressed mood.

Having outlined the more significant markers of depression, it is important to note that you do not need to have all of these signs and symptoms in order to be diagnosed as having a clinical depression, (known in formal psychiatric terms as a Major Depressive Episode). But this can cause some confusion for a person who is querying whether or not he/she might be depressed, or a concerned friend or partner is pondering the same question about a friend or family member. Simply put, depression can present in a variety of ways. And the severity of symptoms can vary significantly; at one end of the continuum we may describe most of the typical markers of depression, and the symptoms are of such severity we struggle to get out of the bed in the morning, we are almost completely shut down to the outside world, and the thought of going to work and interacting with others may trigger severe anxiety and panic; and our partner or friends may express confusion and grief about having “lost” their partner/friend as the depressed person becomes increasingly more withdrawn and emotionally inaccessible. Towards the other end of the continuum the symptoms are not so debilitating, and so may be described as of moderate or mild severity. In this case, the person may continue to work, continue to go to the gym, or pottery class; but what is noticeable is that there is not the same degree of enthusiasm, focus, or enjoyment as there once was. Also, some people may describe feeling more anxious or worried than normal; this anxiety in turn can cause various physical symptoms including headaches, rapid pulse, and hyperventilation. These anxiety-related symptoms may in fact be the reason we seek assistance because they are more “obvious” as well as being distressing and uncomfortable, and at the same time being unaware that the anxiety symptoms may be secondary to an actual depression. When experiencing a milder form of depression we may find ourselves more concerned about our level of performance at work for example (even though we are maintaining our normal standards), and we may be more vulnerable to feeling hurt or offended by others. With mild depression, whilst we are able to continue caring for our family and go to work, mood-wise we are not our “normal old selves” – our spirits are down somewhat, it is not as easy to see the funny side, and our spontaneity is often blunted. We may be more likely just to do the necessities simply because we feel more tired and less energised than normal.

To illustrate the difference between a mild depression and a more severe depression, a person may be trying to decide which pair of shoes or which tie to wear to work, and where the mildly depressed person might give such a decision little thought because they just don’t care that much, the more severely depressed person may spend a long time trying to make a decision and in the process becomes increasingly more agitated and stressed, may become tearful, and often feelings of uselessness and despair are set in motion.

Being mildly to moderately depressed has been described as a mental water torture. It is a condition which typically creeps into our life in a somewhat subtle and insidious way, and over time we tend to adapt and accommodate the various changes in our functioning. At the same time the condition is slowly, over time, wearing us down. We might label these changes as “burnout” or “stress” and initially this might be a quite accurate and rational explanation. But, as the condition persists and gradually grinds us down, then depression – of whatever severity – may well evolve, and this process could go on for many months or even years. Mild depression can go unnoticed, or remain unattended to, because we are not feeling sufficiently unwell enough to talk to somebody about it, professionally or otherwise. And, the more depressed we become, the less likely it is that we have the energy or inclination to do anything about it, and so the downward spiral continues on.

Because the symptoms of mild to moderate depression are often experienced by the sufferer as ill-defined, confusing, and therefore not really worthy of attention, the ongoing untreated condition will typically relentlessly undermine our quality of life.

Depression is a serious matter. Thus, whatever the level of severity of the symptoms, it is important to seek assistance, and a family doctor may be a very appropriate first step. Treatment-wise, there is no one formula. Any person experiencing a depression will present with a unique clinical picture, and the role of the health professional is to decide what might be the most appropriate way of addressing the depression. If a diagnosis of depression is made, at the very least we now know what we are contending with – that there is a name for this group of symptoms – and hopefully be there will also be some therapeutic intervention which will address the depression.

As a final note, there are many myths and misconceptions about depression (or what Winston Churchill referred to as his “Black Dog”). Probably most hurtful or damaging is the notion that a diagnosis of depression implies that we are mentally incompetent, weak, and that all we need to do is “pull ourselves together”. Such beliefs or misunderstandings can sometimes lead to tragic consequences.

The spate of celebrities, such as Brooke Shields and Courtney Cox, who have publicised their experiences, has been very positive in that it has helped women realise that ‘it can happen to anyone’. However, there are still a number of barriers that prevent women from seeking help. Often women realise something is not right, but find it difficult to distinguish between normal levels of distress or tiredness and distress that warrants help. Women also don’t want to say that they are having difficulty coping, and therefore struggle on alone.

Maintaining good mental health in the postnatal period can help both prevent, and recover, from postnatal depression or anxiety. It’s important to plan regular weekly time without the baby. Often things reach crisis point before everyone rallies to help. It’s much better to take a preventative approach. Often just knowing that you have, for example, a couple of hours break each Sunday morning, can keep you going. Physical activity is also a helpful way to manage low mood and anxiety even if this is just a short morning walk with the baby. Usual household chores and outings can feel overwhelming, so by planning activities for specific times in advance, most important things get done. The more social support you have from friends and family, the less vulnerable you will be to anxiety and stress. Mothers’ groups can be a good way to connect with other mothers. But it is important to seek out like-minded others who are willing to be honest. If you’re in a mothers’ group where everyone is saying things are perfect, you won’t relate to them. Develop a list of what works best for you for those times when you feel down or anxious. Your list might include; going for a walk, a bath, being outside in the sunshine, or putting on some music. Most importantly tell someone, such as your partner, a family member, midwife or GP if you are finding it difficult to cope. There is well researched treatment available for Postnatal depression and anxiety that does not necessarily include medication. There are also a number of support agencies and health professionals in Christchurch who work in this specific field. Further information about postnatal depression and anxiety can be obtained from www.mothersmatter.co.nz

Dr Michelle McCarthy is in private practice. She can be contacted at The Anxiety Clinic and Centre for Cognitive Behavioural Therapy.

Also go to Depression NZ
and the SANE website