For many people, depression is a lifelong battle. If you have one episode of depression, there is a 30 percent chance of recurrence within 10 years, increasing to an 80 percent chance after two episodes. Only about one-quarter of people achieve remission after six months of antidepressant medication treatment.
While these statistics are alarming, there is some good news: Mounting research points to the promise of mindfulness—paying attention to your present thoughts, feelings, and sensations without judging them—in helping people alleviate depression. Studies have suggested that mindfulness-based cognitive therapy is just as effective as medication in preventing depression relapse among adults with a history of recurrent depression, and in reducing depressive symptoms among those with active depression.
In his new book “When Antidepressants Aren’t Enough: Harnessing the Power of Mindfulness to Alleviate Depression,” Stuart Eisendrath, former director of the UCSF Depression Center, explores how people can use mindfulness to develop a healthier relationship with their depression. The goal, he writes, is not to get rid of depression completely—as this may be unlikely for many people—but to accept it and detach from it enough to live a happier, healthier life.
Eisendrath reminds us that we don’t have to be completely free of depression to accomplish our goals. His book provides practical tools for people suffering depression. Here are a few of them.
Distance Yourself From Depressive Thoughts
Eisendrath emphasizes that depression-fueled thoughts are just thoughts and not facts. Leaning into them often triggers negative thought spirals, where you keep replaying the same thoughts over and over. However, learning to distance yourself from these self-critical or catastrophizing thoughts through mindfulness can help you choose to react differently the next time they bubble up.
One exercise he recommends is what he calls “thought detachment,” where you imagine your thoughts are drifting clouds or leaves floating by and then practice not engaging or becoming attached to them.
Practices like this can strengthen your “observing self,” a stance where you engage with emotionally charged thoughts in a less reactive way. For example, instead of thinking, “I am worthless,” you may reframe it as “I am having a thought that I am worthless.” Creating this bit of distance from your thoughts may help soften their potency and help you let go of judgment, criticism, and ruminations about the past.
Accept Depressive Feelings and Thoughts
Instead of actively avoiding or resisting depression and depressive thoughts, which may worsen symptoms, Eisendrath recommends trying to accept them. Acceptance does not mean being resigned or giving up—it means acknowledging and embracing what feelings or thoughts are present, and letting go of the desire to change what happened in the past. Research suggests that practicing acceptance can help improve your symptoms of depression, quality of life, and ability to function.
To help with acceptance, Eisendrath suggests the RAIN technique:
- Recognize when a strong or upsetting emotion is present.
- Accept the emotion without judgment.
- Investigate the feelings, thoughts, and sensations you are experiencing. Think about how you might react to them, if at all.
- Nonidentify with your emotions and shift to your observing self.
Focus on the Present
Rumination about past failures and catastrophizing about the future take up a lot of mental space in depression. Eisendrath recommends mindfulness practices that can help you focus on the present, break your attention away from these thought spirals, and, over time, change these tendencies. Present moment awareness and counting breaths are two ways to practice mindfulness.
Present Moment Awareness:
- Sit upright and comfortably. Close your eyes or allow your gaze to fall down. Notice the sensations throughout your body.
- Shift your attention to your breath.
- After a few minutes, shift your attention to the sounds around you.
- After a few minutes, shift your attention to your thoughts. Notice them arise, then drift away.
Counting Breaths:
- Focus on your breath moving in and out of your nostrils for a few minutes. Then, begin counting each inhalation.
- Start from zero and go up to ten, then go back down to zero. Repeat.
- If you notice your mind wandering, shift your attention back to your breathing and start from zero again. You can try this exercise for 5-10 minutes or as long as you are comfortable.
Self-Compassion
Self-compassion helps you practice self-kindness and recognize your common humanity with others (vs. feeling isolated and ashamed). Self compassion also helps you avoid overidentifying with your perceived faults. It can also help you manage your inner critic and lessen its impact—all of which may buffer against depressive symptoms. Eisendrath recommends several practices to improve self compassion, including a loving-kindness meditation and finding your common humanity.
Loving-kindness meditation: There are different variations of this practice, but Eisendrath suggests that you start by sitting comfortably in a quiet place and notice your breath. Place your hand over your heart and repeat the following with each breath:
May I be safe
May I be healthy
May I be happy
May I live with ease
If you are not comfortable directing these phrases at yourself, you may direct them toward somebody else (e.g. a loved one, a pet, or an infant).
Common humanity: Throughout your day, observe other people with whom you cross paths. Bring your attention to a stranger, and practice saying to yourself:
Just like me, they want to be happy.
Just like me, they make mistakes and suffer, too.
Just like me, they are doing their best in the world.
While Eisendrath encourages people to try self-compassion when managing depression, he also reminds them to be self-compassionate when practicing mindfulness. Often when people first begin practicing mindfulness, they feel like they’re failing because their minds wander and they are easily distracted. However, mind wandering is a common, natural part of mindfulness practice and happens even to the most advanced practitioners; it is not a sign of failure. Mindfulness is a skill to be honed at your own pace over time.
While mindfulness may not replace other types of therapy for depression for everyone, it can help people in conjunction with or after other treatments, providing lifelong tools for taking control of depression. If you are suffering from depression—or even if you’re just someone wanting to be happier in life—it might help to pick up Eisendrath’s book and try out some of these practices yourself.
Deborah Yip is a medical student at the University of California–San Francisco, a former GGSC research assistant, and a contributor to Greater Good, which first published this article.