Helping yourself out of depression? Exploring mindfulness and acceptance-based self-help techniques
31st May 2022
Written By Ellie Sullivan, Assistant Psychologist
In today’s busy world and the current, global ‘mental health pandemic’, there is critical need for effective interventions for people’s psychological well-being. In the UK specifically, a 7% increase has been observed between March 2020 – August 2021. Globally there has been a 27.6% increase in cases of major depressive disorders (Daly & Robinson, 2022). Interestingly the increase in depression rates globally and in the UK ran concurrent with the covid-19 pandemic; cases of depression more than doubled at the peak of the pandemic between January to March 2021 in the UK. Whilst the latest figures show a reduction since, the prevalence of depression in adults is still higher than it was pre-pandemic (ONS, 2021), showing that depression is still a difficulty for many adults. Covid-19 may have created the ‘conditions’ for depressive episodes; change and upheaval were outside of people’s control whilst uncertainty regarding the future prevailed. However, it is worth considering that the rise in depression was correlated with the pandemic and causal mechanisms could vary considerably. Moreover, it may well be that the increase is a transient response to the pandemic with an increasingly reducing relationship between covid-19 impact and depression (Daly & Robinson, 2022). In general, other risk factors for depression include biochemistry, genetics, and personality (Torres, 2020). Nevertheless, the need for solutions to help individuals overcome psychologically difficult times in their lives is paramount. In this two-part blog we explore the prevalence of depression, common routes of intervention, mindfulness, and acceptance-based approaches, finally focusing on ‘self-help’ guided techniques and their feasibility in the treatment of psychological distress.
Typically, adults with depressive symptoms are initially seen by their GP and use of anti-depressant medication is common. Modern anti-depressant medication (SSRI’s) which limit the re-absorption of the neurochemical, serotonin, in the pre-synaptic cells; the resulting ‘feel good’ effect is variable and some individuals appear to benefit significantly more than others. The ‘serotonin hypothesis’ may be an oversimplistic view of depression as a simple neurotransmitter deficiency does not necessarily explain the complex nature of depression (Lacasse & Leo, 2005). Whilst there is a definite place for these medications and they can of course serve as a good ‘short-term’ solution in certain cases, they do not necessarily address underlying causes, even serving to obscure the complexity of depression and its causality. Moreover, there are broader ethical questions whether we should ‘medicalise’ individual emotional responses which are often valid and reasonable in relation to their causes e.g. profound loss, deprivation or abuse. One would argue that rather than ‘escaping’ our emotions should we not be encouraging genuine human experience and emotional expression. We live in a society where there is stigma surrounding mental health and perhaps less tolerance for negative emotional states. Moreover, anti-depressants can be associated with significant side effects including stomach aches, nausea, weight gain and heart rhythm problems (NHS, 2021) often undermining benefits. Withdrawing from anti-depressant use can also prove problematic, making it difficult to stop, encouraging long-term use and potentially delaying long-term healing from psychological distress.
Psychological therapy is another common route for the treatment of psychological distress with cognitive behavioural therapy (CBT) being a widely researched and available form of therapy. CBT is based on helping an individual overcome habitual and automatic negative thinking and associated behaviours (e.g., inactivity and avoidance) which can contribute to the maintenance of depressive symptoms. However, some evidence suggests that CBT is not always effective in providing relief from long-term depressive symptoms (Cuipers et al., 2010). However, cognitive and behavioural interventions are in their ‘third wave’, indicating how these interventions have been ‘evolving’. Acceptance and commitment therapy (ACT) is one such evolution and increasingly well evaluated, contributing to a new direction within the field, based on a more open approach than its predecessors; it focuses on the acceptance of experience with ‘mindful awareness’ (Hayes, 2004) as opposed to directly trying to change thoughts as CBT would propose. This, in turn, may help an individual develop a healthier relationship with their experiences, possibly leading to a reduction of psychological distress (Hayes, Follette & Linehan, 2011). ACT has been applied to a range of conditions and has growing evidence of its efficacy (Sharp, 2012). Acceptance and mindfulness are conceptually similar; mindfulness has been defined as ‘paying attention in a particular way, on purpose, in the present moment and non-judgementally’ (Kabat-Zinn, 1994, p.4). There are two pioneering and established ‘third wave’ approaches based on the concept of mindfulness: Mindfulness-Based Stress Reduction (MBSR; Kabat-Zinn, 1990) and Mindfulness-Based Cognitive Therapy (MBCT; Segal et al., 2013). Both are similar in content, yet MBCT focuses on depression specifically and MBSR on stress more generally. Among the numerous associated benefits related to these interventions include improved psychological well-being in non-clinical groups (Erberth & Sedlmeier, 2012) and also a reduced likelihood of depressive relapse after active treatment ends (Ma & Teasdale, 2004).
The dissemination/delivery of mindfulness and acceptance-based interventions requires adequately experienced practitioners (Mental Health Foundation, 2010). However, access to these interventions in a timely manner may be compromised in view of the continuing pressures on NHS resources and long waiting times for face-to-face therapy referral. Additionally, pursuing private treatment(s) may prove difficult for some individual’s requiring treatment for their depressive symptoms due to the potential length of treatment and associated financial barriers; the recommended course of treatment is anywhere between 5- 20 x 1-hour sessions priced at least £40 to £100 per session (NHS, 2019), generating significant questions regarding affordability for many people. Recently, the possibility of extending the reach of mindfulness and acceptance-based approaches has been explored; a potential way to make mindfulness more accessible and economical is the development of ‘low intensity’ or self-help interventions that include acceptance-based approaches as well as mindfulness components. Cavanagh and colleagues (2014) were motivated to address the potential use of guided and unguided self-help interventions that include these components. A meta-analysis explored the evidence for the efficacy of mindfulness and acceptance-based self-help interventions to date. In the second part of this blog, we will consider this evidence, what is meant by ‘self-help’ and its effectiveness. We will be evaluating the current evidence base, considering whether it provides a feasible and accessible means of addressing depression and the current mental health ‘crisis’.
References
Cavanagh, K., Strauss, C., Forder, L., & Jones, F. W. (2014). Can mindfulness and acceptance be learnt by self-help? A systematic review and meta-analysis of mindfulness and acceptance-based self-help interventions. Clinical Psychology Review, 34, 118-129.
Cuijpers, P., Smit, F., Bohlmeijer, E., Hollon, S. D., & Andersson, G. (2010). Efficacy of cognitive-behavioural therapy and other psychological treatments for adult depression: meta-analytic study of publication bias. TheBritish Journal of Psychiatry, 196(3), 173-178.
Daly, M., & Robinson, E. (2022). Depression and anxiety during COVID-19. Correspondence, 399(10324), 518.
Erberth, J., Sedlmeier, P. (2012). The effects of mindfulness meditation: a meta-analysis. Mindfulness, 3, 174-189.
Hayes, S. C. (2004). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioural and cognitive therapies. Behaviour therapy, 35(4), 639-665.
Hayes, S. C., Follette, V. M., & Linehan, M. M. (2011). Mindfulness and acceptance: expanding the cognitive-behavioural tradition. Guildford Press, New York.
Kabat-Zinn, J. (1990). Full catastrophe living: how to cope with stress, pain and illness using mindfulness meditation. Dell, New York.
Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in everyday life. Hyperion, New York.
Lacasse, J., & Leo, J. (2005). Serotonin and Depression: A Disconnect between the Advertisements and the Scientific Literature. PLoS Med, 2(12).
Ma, S. H., & Teasdale, J. D. (2004). Mindfulness-based cognitive therapy for depression: Replication and exploration of differential relapse prevention effects. Journal of Consulting and Clinical Psychology, 72, 31-40.
Mental Health Foundation (2010). Be mindful report. London: Mental Health Foundation.
NHS (2019). Overview – Cognitive behavioural therapy (CBT). https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/talking-therapies-and-counselling/cognitive-behavioural-therapy-cbt/overview/#:~:text=If%20you%20can%20afford%20it,to%20%C2%A3100%20per%20session.
NHS. (2021). Side effects – Antidepressants. https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/medicines-and-psychiatry/antidepressants/side-effects/
Office for National Statistic. (2021). Coronavirus and depression in adults, Great Britain: July to August 2021. Office for National Statistics. https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/articles/coronavirusanddepressioninadultsgreatbritain/julytoaugust2021
Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2013). Mindfulness-based Cognitive Therapy for depression: A new approach to preventing relapse, 2nd Ed. New York: Guildford Press.
Sharp, K. (2012). A review of acceptance and commitment therapy with anxiety disorders. International Journal of Psychology and Psychological Therapy, 12, 359-372.
Torres, F. (2020). What is Depression? https://www.psychiatry.org/patients-families/depression/what-is-depression