I recently wrote about the fifth week of meditation practice - chapter nine in Mark Williams & Danny Penman's book.  This post is about the sixth week of practice and chapter ten "Trapped in the past or living in the present?" (pp. 183 to 208).  The week-by-week programme summary (p. 60) comments "Week six develops this process (turning towards difficulties) even further, exploring how negative ways of thinking gradually dissipate when you actively cultivate loving-kindness and compassion through a 'Befriending Meditation' and acts of generosity in daily life.  Cultivating friendship towards yourself, including for what you see as your 'failures' and 'inadequacies', is the cornerstone of finding peace in a frantic world." 

The practices for this week involve a daily (approximately 20 minute) meditation, and the 3 minute "Breathing Space" exercise done two or more times daily, and one or both of two "Habit Releaser" suggestions involving kindness for oneself and for others.  The request is to do the formal 20 minute meditation practice six days weekly.  Start with either track 1 - "Mindfulness of Body & Breath" - or track 4 - "Breath & Body" - of the CD, before moving on to track 7 - "Befriending".  They suggest using the CD as a guide or " ... if you feel able, without the help of any tracks at all."  Here is a downloadable practice record you can keep and also a reflection sheet to help digest the overall material in the chapter. 

The more general information discussed in chapter ten is fascinating.  I wonder a little though whether there is "too much" here.  The key idea is about the importance of being kinder to ourselves and I'll return to this central theme in the next paragraph.  We also get an introduction to over-general autobiographical memory research, an area that Mark is a pioneer in.  It is well established that a tendency to over-general personal memories is associated with increased vulnerability to emotional disorders (particularly probably depression & posttraumatic stress disorder) ... see, for example, the free full text paper Mark & Danny mention in the chapter notes "Autobiographical memory specificity and emotional disorder" or for a more recent review there is "Overgeneral autobiographical memory as a predictor of the course of depression: A meta-analysis" (also available in free full text).  It seems likely that over-general memories are due to a number of mechanisms including rumination and trying to avoid becoming emotionally upset.  Various attempts have been made to treat over-general memories directly; an example is Mark & colleagues' paper "Reducing cognitive vulnerability to depression: A preliminary investigation of MEmory Specificity Training (MEST) in inpatients with depressive symptomatology."  Results are intriguing but it's still unclear how practically useful such interventions may become.  The potential gains seem relatively minor but they could lead to more fine-grained memories with increased access to relevant information and hence improved problem-solving (and possibly updated & more positive internal narratives & beliefs).  Post-traumatic stress disorder (PTSD) is mentioned as a difficulty that also involves memory problems.  I think that the clinical implications of over-general memories in PTSD have been thought through more fully than in depression.  So I am off to a workshop in April specifically about "Memory-focused approaches in cognitive therapy for adults with PTSD".  I doubt if there's anyone in the world currently running regular workshops on memory-focused approaches for depression.  It may come, but not yet.  Interestingly it overlaps with "the stories we tell ourselves about our lives" - see my post on "Narrative therapy and trauma processing".  And possibly more immediately relevant for people doing this mindfulness training, you have already probably reduced your tendency to over-general autobiographical memories without realising it!  Relevant research includes "The effects of mindfulness on executive processes and autobiographical memory specificity" and "Effects of mindfulness on meta-awareness and specificity of describing prodromal symptoms in suicidal depression".  In the latter paper the authors write "These results suggest that mindfulness training may enable patients to reflect on memories of previous crises in a detailed and decentered way, allowing them to relate to such experiences in a way that is likely to be helpful in preventing future relapses" and this links to the increased ability to "turn towards difficulties" that we explored in last week's mindfulness practice.

So, to an extent, the relevance of knowing about over-general memories in a mindfulness training is possibly just to note that the training helps in this area as a beneficial "side-effect" of the practices we are working on.  It seems that a more key theme to pay attention to is the issue of encouraging increased kindness and self-compassion.  In their important recent research paper - "How does mindfulness-based cognitive therapy work?" - Willem Kuyken & colleagues showed that mindfulness based cognitive therapy (MBCT) training could allow the majority of people on long-term antidepressants to come off their medication and (using their mindfulness skills) function better than a comparison group who simply stayed on their medication.  This is a hugely fascinating and encouraging finding.  How did the training allow this to happen?  The researchers looked carefully at what mechanisms were involved and they wrote "MBCT's treatment effects are mediated by augmented self-compassion and mindfulness, along with a decoupling of the relationship between reactivity of depressive thinking and poor outcome. This decoupling is associated with the cultivation of self-compassion across treatment."  I remember being at the conference where Willem Kuyken reported these results (before the research paper was published).  I found the findings really interesting and I still do.  See the report I wrote at the time - "BABCP spring meeting: the conference - a highlight".  If you would like to measure your self-compassion and get a sense of whether you score low, high or about average, you can download a good short form of the self-compassion scale by clicking here and for more detail see too the post "A better way to measure self-compassion".  This is clearly highly relevant territory even if you are fortunate and are not troubled by vulnerability to depression.  Raes et al in their papers "Rumination and worry as mediators of the relationship between self-compassion and depression and anxiety" and "The effect of self-compassion on the development of depression symptoms in a non-clinical sample" showed that higher levels of self-compassion are associated with lower current & future levels of depression & anxiety.  And there is a wealth of research showing many other benefits of increased compassion both for oneself and for others.  See, for example, Kristin Neff's "Self-compassion" website, Paul Gilbert & colleagues' "Compassionate mind foundation" and Stanford university's "Center for compassion & altruism research & education".  There's also much material that you can access by clicking this blog's "compassion tag" or visiting the "Compassion & criticism" handouts page. 

Back in my third post about Mark & Danny's book (the first post on actual mindfulness practice), I wrote "Remember though that a large slice of the benefit is carried by improvements in the mindfulness facets Non-Judge and Non-React. Mindfulness training is certainly about practising attending to what is occurring in the present (breath, body sensation, sound, thought, etc), but crucially it is also about practising reacting to our wandering mind with patience and kindness. It's as if we're going through a kind of inner parent-child training. Our "inner child" is being taught to get better at being present rather than wandering off into the past, future or other tangles of thinking. Our "inner parent" - often even more importantly - is being taught to respond to the "inner child's" wanderings with gentleness, compassion and encouragement. The recent research paper - "Self-compassion is a better predictor than mindfulness of symptom severity and quality of life in mixed anxiety and depression" - highlights that the "inner parent" aspect of mindfulness training is likely to be more powerful than the "inner child" aspect when it comes to improving anxiety and depression. Mark Williams's recordings do a very good job of teaching our inner, often over self-critical parent by modeling great patience, warmth & understanding."  This week's practice underlines the importance of these issues.  Maybe this would be a good time to re-look at your scores on the "Five facet mindfulness questionnaire (short form)".  It's worth noting that some people find the whole idea of compassion and especially self-compassion pretty off-putting.  Paul Gilbert & colleagues have been particularly active in looking at this area - see their paper "Fears of compassion: Development of three self-report measures" with its abstract noting "There is increasing evidence that helping people develop compassion for themselves and others has powerful impacts on negative affect and promotes positive affect. However, clinical observations suggest that some individuals, particularly those high in self-criticism, can find self-compassion and receiving compassion difficult and can be fearful of it ... Method. Students (N= 222) and therapists (N= 53) completed measures of fears of compassion, self-compassion, compassion for others, self-criticism, adult attachment, and psychopathology. Results. Fear of compassion for self was linked to fear of compassion from others, and both were associated with self-coldness, self-criticism, insecure attachment, and depression, anxiety, and stress ... Conclusion. This study suggests the importance of exploring how and why some people may actively resist engaging in compassionate experiences or behaviours and be fearful of affiliative emotions in general."

Do take this week's "Habit releaser" exercises seriously too.  Very interestingly - since Mark & Danny's book was published - the effects of the second "Habit releaser" (involving practising kindness for others) has been explored in a randomized controlled trial.  Myriam Mongrain & colleagues - in their paper "Practicing compassion increases happiness and self-esteem" - reported "The current study examined the effect of practicing compassion towards others over a 1 week period. Participants ( N = 719) were recruited online, and were assigned to a compassionate action condition or a control condition which involved writing about an early memory. Multilevel modeling revealed that those in the compassionate action condition showed sustained gains in happiness and self-esteem over 6 months, relative to those in the control condition. Furthermore, a multiple regression indicated that anxiously attached individuals in the compassionate action condition reported greater decreases in depressive symptoms following the exercise period. These results suggest that practicing compassion can provide lasting improvements in happiness and self esteem ..."  More specifically "Participants in the active condition were subsequently asked to act compassionately towards someone for 5-15 min the following day, by actively helping or interacting with someone in a supportive and considerate way. Several examples of compassionate actions were offered, including ‘‘talking to a homeless person'' and ‘‘simply being more loving to those around you.'' During the evening of their daily compassionate act, participants were instructed to log onto the website to report about their experience."  A few additional comments about this "compassionate action" exercise - reporting the experience might have added to the benefits of the action; motivation may be important; and these findings overlap with broader research on compassionate action in everyday life.  So for more on the benefits of writing or speaking about valued areas of our life, see "Therapeutic writing & speaking: inspiration from values".  Why we do kind acts is important in determing any benefits we obtain!  Self-interested kindness doesn't appear to have the same effects on us as acts that are more "selfless" - see, for example "Motives for volunteering are associated with mortality risk in older adults".  And as for broader research on compassionate action, a good place to begin would be the post "Recent research: egosystem & ecosystem" with its link to the Beatles' last lyric on the last album they recorded "In the end the love you take is equal to the love you make".

For a post on next week's practice, click here.