Two Practices That Combat Suicide

In the wake of the most recent celebrity suicides, I want to speak about two practices that we can learn that combat depression. I am convinced of the value of these practices not just from the fact that research (particularly Cognitive Behaviour Therapy Research) has confirmed their value, but because my patients have consistently told me that these tools helped them the most to survive. The tools are mindfulness practice and behavioural activation.

I will start by describing behavioural activation, because this is the easier of the two to describe. I also think that, of the two practices, it can be more fun for people to develop. Behavioural activation is based on the knowledge that our behavior can affect our emotions. We can all think of situations where this has been true. For example, we avoid visiting Aunt Jane because we’re worried that she is angry with us. However, the longer we avoid her, the more likely it is that Aunt Jane will become angry at us.

Often when people are depressed, they isolate themselves, finding it too difficult to participate in activities they value, like visiting Aunt Jane. Behavioural activation helps us to figure out how to work toward positive, mood enhancing activities even when they’re difficult and our anxiety or depression interferes with our efforts. There are three ways that behavioural activation can help improve mood:
1. By helping us to increase our participation in activities that improve our mood or validate our self-worth.
2. By helping us to decrease the times when we engage in activities that cause us to feel more depressed.
3. By helping us to find solutions to issues that keep us from participating in validating activities or circumstances that keep us entrenched in negative activities.

What is great about behavioural activation is that there are many books and online tools that can help us to begin this practice. I like this online tool for my work with patients in Behavioural Activation. If you’re looking for books, anything written by or with Christopher Martell would be a good bet.

Now let’s consider mindfulness. Once people learn the practice of mindfulness, they find it valuable. Time and time again, however, we hear back from patients that they “don’t get it”. In each of our programs, at least once per day in the daily programs, we provide a mindfulness exercise and encourage patients to develop this practice. We are always providing different exercises because one mindfulness practice will not suit everyone. I have found that we each have to find the exercises that suit us best. I do secretly think that the reason I struggle so much to assist patients with this practice is that I struggle personally with daily mindfulness practice. I am certain lots of people can identify with this. Don’t you have days when it seems that the last thing you have time for is fifteen minutes for a mindfulness exercise? The problem is that it is exactly on these days that we need to STOP and reset, bringing our minds back to the most important things: peace of mind, health, safety…peace. The key is to make time and to find a mindfulness exercise that you like and find helpful. Then you will work it into your day and the long term evidence is that this will alleviate anxiety and help improve mood.

As with behavioural activation, the research, and particularly some meta-analyses, show that mindfulness has a positive impact on both anxiety and depression. Of all the definitions of mindfulness, I like Jon Kabit Zinn’s best. Zinn says that mindfulness is “the ongoing moment to moment awareness that arises when observing the present non-judgmentally.” This definition gently captures the notion of awareness in the moment and reminds us that to be “nonjudgmental” is essential to good mindfulness practice.

Of all the people in the world who suffer from depression, Anthony Bourdain and Kate Spade could have had access to the best treatments in the world, and it still was not enough. In considering this, rather than feeling hopeless, I suggest finding out about the tools of behavioural activation and mindfulness. You can do this inexpensively and both only become more helpful with practice.

I am not saying that developing these tools is the antidote to suicide, but they will give you practices that are proven to combat depression.

Let me close with some pictures of one of the places that I often go to for mindfulness practice: my garden. This month, there are flowers that bloom for only a week or two, like peonies or irises. Enjoying them when they are at their best is one way to practice awareness in a moment, one way to be mindful. Knowing that they will not be blooming one week from now, I enjoy the moment of their beauty.

Mindfulness and Marmalade

About one month ago I made marmalade with the Seville oranges that are imported to Canada from Spain in the late winter. Seville oranges are said to make the best marmalade and so, every March, I buy five oranges, add the right amount of sugar and water and one lemon and make a dozen jars of bittersweet marmalade. While stirring the marmalade, watching for the point at which the consistency is the perfect mix of soft but not runny, it occurred to me this year that making marmalade is one of many homemaking activities around which mindfulness can be learned.

Mindfulness is all the rage in mental health these days. It is probably about twenty years since the Buddhist practice of mindfulness began to emerge as helpful in dealing with stress and stressful situations, but its popularity as a treatment for conditions from hypertension to self harm has really developed as the research demonstrating its efficacy has solidified. This short Research Spotlight article from NIH’s National Center for Complementary and Alternative Medicine outlines some of the research that has been most convincing: http://nccam.nih.gov/research/results/spotlight/012311.htm What contributes to the credibility of this research is that mindfulness appears to lead to structural changes in the brain when a patient’s symptoms improve.

Mindfulness exercises help patients learn to focus their attention on the present and, in fact, there are many homemaking tasks which require a focus on being so aware of a process that you notice the moment when it is complete – a moment that quickly moves from perfect to overdone. Many who like to cook can acknowledge the times when attention to the present is required. These include the moments when a sauce is about to thicken or marmalade about to gel.

In acquiring mindfulness, one is often instructed to take note of certain recurring signals or events, like clock chimes or a certain time of day, and use those as a particular reminder to stay focused in the present. I like to think of finding those circumstances when observation in the moment actually assists in the task at hand. So many of our daily chores fit the bill that our routines should make it easier to live in the present. As an exercise, I find that having a patient record an outline of their day will actually assist them in finding times to practice mindfulness.

In my own day, such routines as my morning exercise and prayer, my systematic review of my schedule when I get to work or my short walk home all urge me to live in the moment. Who hasn’t been annoyed by those instructions on phone calls to “enter the first few letters” of a contact’s name or to “hold for the next available operator”? Now I see these as an opportunity to let go and enjoy a break from difficult conversations or tasks like writing a report that require consideration beyond the present.

As I write this, I have an image of myself stirring marmalade and lifting up the spoon to see how the liquid forms into drops. Is the liquid moving so slowly that two drops will form on the spoon before the first one drops off? This is one test for “doneness”; another involves putting hot marmalade on a freezing cold plate to see if it congeals. In between tests, I stir and focus on breathing.

I do not know that the marmalade I make tastes any better than that I could buy off a grocery store shelf but I do feel that making my own marmalade contributes to a feeling of satisfaction with my life. The chores of homemaking keep me grounded in what is important – another facet of mindfulness. Why is it for me that mindfulness is linked to housework? Well, is it not curious that the Latin word for hearth is focus? http://www.etymonline.com/index.php?term=focus That puts mindfulness – and marmalade – in just the right perspective.