Breathing Space London

mindfulness for health

The Financial Times

The Financial Times, 5 April 2008

Meditation or medication?

By Emma Jacobs

Alice Cook would like to dispel some myths about meditation. "It's not colours and hippies. Really it is only closing your eyes and breathing." The 33-year-old, 6ft actress from east London believes meditation has helped her to stop sliding into depression, a condition she had struggled with recurrently since her teens. "It really came to a head in my mid-20s. Everything was tinged with heaviness. I couldn't see pleasure in anything... I couldn't remember what it was to be happy or enjoy life. I couldn't believe [happiness] would ever come back. Every thought was negative."

She sought psychiatric help and took anti-depressants, which restored her ability to function day-to-day. But the depression kept coming back. At the beginning of last year she began to feel anxious and was unable to sleep, warning signs that she was about to nosedive. But this time was different; she was determined to break the cycle. "I was sick of it. I knew I had to change."

So she paid £120 ($239) to go on the Mindfulness-Based Cognitive Therapy course (MBCT), a novel form of treatment for depression located at the London Buddhist Centre, a converted Victorian fire station in Bethnal Green in east London. It is based on a programme established by medical researcher Professor Jon Kabat-Zinn, of the University of Massachusetts Medical Centre, which combines modern cognitive behavioural therapy - a form of psychotherapy based on changing negative assumptions and behaviour - with "mindfulness meditation". Mindfulness is a technique, central to Buddhist practices, which helps people become more aware - without making judgments - of their thoughts and feelings.

Cook found visiting the centre, a maze of rooms arranged around a courtyard, provided a calm refuge amid the capital's rush-hour traffic jams. Along with 30 others, she attended eight weekly, two-hour sessions delivered by an instructor in a wooden-floored room presided over by a golden Buddha figure. She was surprised to discover the first session's meditation exercise - lying on mats and doing a mental "body scan" was tricky: "You have to bring your attention to your left big toe, then up your leg, trying to observe what each body part feels like. As the course progressed I found it much easier."

For the uninitiated, meditation can unleash a rather un-Zen-like competitive streak, remarks Paul Brimmer, another participant. The 52-year-old charity worker also found the course difficult at first. "A hallmark of a depressive can be having high expectations. You can give yourself a thrashing if you do a bad meditation. It's very common for depressed people to berate themselves. People think they aren't meditating right."

Participants are set daily homework that encourages them to focus on thoughts and breaths, observing the impact that pleasant and unpleasant experiences have on their bodies. Cook explains: "We did walking meditation, which allows you to take your time to feel your body, how your feet feel on the ground. We had to do a daily activity mindfully, like brushing your teeth or having a shower."

According to Maitreyabandhu, the director of Breathing Space, a well-being centre at the London Buddhist Centre, the point of these exercises is that participants learn to recognise when their mood is starting to sink by identifying the patterns the mind goes through, such as ruminating on negative thoughts: "With depression there are traps about going down paths of repeat feelings and thoughts. MBCT teaches you to get off these paths." He speaks from personal experience. In the 1980s, Maitreyabandhu was plain old Ian Johnson and worked as a nurse at the Walsgrave Hospital in Coventry. He was, he quips, an "habitual misery". After being introduced to meditation and Buddhism he found his way to "something you might call happiness". He is keen to point out that MBCT is not about converting people to Buddhism: "We are explicit that this is not a Buddhist course. There's no pressure to become Buddhist. In fact, Buddhism won't work through pressure."

Shazia Ghani is the commissioning officer for mental health services at Tower Hamlets, the local authority which has funded 20 locals to go on the course. She says she wouldn't have been allowed to do so if Buddhism was part of the course. Ghani has found the programme attractive to people who see going to a GP for mental health issues as holding a stigma. "It often seems very daunting to go to clinical services. They worry about the implications of having mental health issues on their family, friends, work and neighbours." She believes that MBCT is not tainted with the same stigma as medical services.

The appeal of the course to Ghani is that, for some people, it can be a way of heading off depression before they have to be admitted to acute mental health services. According to a study by the Cognition and Brain Sciences Unit at Cambridge University, MBCT significantly reduced the risk of relapse among patients with three or more previous bouts of depression, although it was less effective among people who had experienced one or two episodes. The research concluded that MBCT offers a promising cost-efficient psychological approach for "recovered recurrently depressed patients".

In Ghani's borough of Tower Hamlets, an estimated 4,500 people are on incapacity benefits because of mental illness, including a high proportion who suffer from depression, stress and anxiety.

Helping people to become productive is not simply an act of kindness but can be economical - an argument promoted in the Depression Report: A New Deal for Depression and Anxiety Disorders produced by Professor Richard Layard, among others, at the London School of Economics (2006). This study put forward the economic case for government funding of preventative measures for depression. It estimated the total loss of output due to depression and chronic anxiety to be about £12bn a year or 1 per cent of total national income.

Such arguments are welcomed by Maitreyabandhu, who worries about meditation's "floppy image".

Tim Segaller, who manages the Breathing Space, underlines the course's expediency: "MBCT might seem very alternative. But I would challenge anyone who has been on the course to say their experience is like that ... It's very pragmatic."