MEDITATION IN PSYCHOTHERAPY FORUM ARCHIVE
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Depressive Disorders
Jim Spira · 10/24/98 at 6:30 PM ET
Meditation for Depressive Disorders:
I find that meditation is an essential part of the treatment for depressive disorders. I especially have found the following approaches useful.
Zen Meditation: Becoming fully absorbed in sensation helps patients disengage from habitual, depressive, and distorted thinking. For example: "when you find yourself thinking in terms of (images/words/feelings), notice that distraction, let it go, and absorb yourself as completely as possible in what you (see, hear, touch). When you inhale, allow what you (see/hear/feel) to fill your consciousness completely, until there is nothing but what is (seen/heard/felt). When you exhale, give yourself completely to what you (see/hear/feel), until at the bottom of the exhale, there is nothing but what is (seen/heard/felt)." At first, patients should focus on one sensory channel (whichever predominates their thinking). After a while, all sensations can simultaneously arise and release with the breath. Most all patients can do this, and if practiced throughout the day (at least 20 breaths at a time) they can begin to make significant changes.
Chi Kung: Standing Chi Kung and sitting Chi Kung are especially helpful for mental engagement (and disengagement from depressive imagery) and self-comforting. Since it is unrealistic to expect that most patients will take the time and effort to learn the TaiChi form. But a simplified version where one move is repeated for a dozen repetitions with the breath is easy to learn and do. An example of sitting Chi Kung is non-forced, awareness of three relaxed breaths at the nose, then chest, then abdomen, then pelvic floor, then lower back, mid back, upper back.
Major Depression: Especially troublesome for these patients are thoughts about the past and worries about the future. Zen Meditation geared toward being fully present in the moment helps a patient detach from focus on depressive cognition and affect. A modified approach meditation (such as is practiced by Vipassana/mindfulness can also be practiced. I find it useful to first have patients engage their "vigilant" consciousness by describing what they see or hear or touch. For example, "tell me all the yellow things you see in the room," or "tell me what sounds you are hearing," or " describe the texture of that chair." The patient should avoid all reactions to what they describe ("I don't like that shirt. It reminds me of . . ."). Patients can extend this to daily activities, stating to themselves what they are engaged in (without reactions to the activity). These types of exercises are very helpful during the first 10 weeks that medication is attempted. In many cases of situational/reactive depression, patients may find that these exercises, along with empathic cognitive therapy, is sufficient. Meloncholic Depression: Chi Kung is useful as a precursor other approaches mentioned above, as it will begin to comfort and soothe the person. Anxious Depression: Tai Chi followed by Chi Kung followed by the Vipassana method described above is helpful to focus and soothe the patient.
Dysthymia: I find that Tai Chi / Chi Kung is the best adjunctive therapy along with psychotropic medication.
Bi-Polar: For many patients with bipolar I and II, Zen Meditation is helpful as a daily practice to help patients both become more aware of and regulate changes that occur prior to the onset of a manic episode. It also seems to help minimize hypomanic phases. While most patients can probably not use these methods in the midst of a manic phase, there are reports from some patients that practicing Tai Chi during non-psychotic manic phases helped reduce the duration and intensity of the occurrence.
I rarely use these meditative techniques without integrating them fully with psychological counseling. But I also rarely use psychotherapy without the integration of these meditative techniques.
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