Ten Percent Happier with Dan Harris - 413: The Science of Depression | Sona Dimidjian

Episode Date: January 19, 2022

This episode features one of the world’s leading experts in depression and how meditation can help. Dr. Sona Dimidjian is a professor in the Department of Psychology and Neuroscience and the director of the Renée Crown Wellness Institute at the University of Colorado, Boulder. This episode explores the seasonal impacts on depression, the research on how meditation can help depression, and what she calls “behavioral antidepressants.” Content Warning: There are a number of references to suicide in this conversation. Be sure to check out TPH’s newest show, Childproof, available wherever you get your podcasts. Full Shownotes: https://www.tenpercent.com/podcast-episode/sona-dimidjian-413See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

This is the 10% happier podcast. I'm Dan Harris. Hey, everybody, it's Winter. It's dark out and it's been dark inside my head at many times over these past few months. I've personally struggled with depression since I was a kid whose parents sent them to a shrink a bunch of times and Winter can often be tricky for me. If you've had similar experiences, you're in luck because we've got one of the world's leading experts in both depression and in how meditation can help.

Sonya Dimogen is a professor in the Department of Psychology and Neuroscience at the University of Colorado Boulder. She's a close colleague of Zindel Siegel who was on the show Ways Back. That was an extremely popular episode, as I suspect this will be. In this conversation, we cover seasonal impacts on depression, the research on how meditation can help depression generally, and what she calls your behavioral antidepressants, which is a fascinating subject. She'll go into that in a pretty deep way, as you're about to hear.

So now, is Loki in her presentation, but she is truly an ninja when it comes to the science around this extremely common mental health challenge. Heads up on a few issues. There are a number of references to suicide in this conversation just so you know. And on a much lighter note, you're going to hear Sonia make a quick reference to the 30 seconds of silence at the start of the interview, which is a quick break we take before we start the interview and in that quick break we record what is called room tone. This is a technical thing

I've never understood but I do use it as a time to quickly meditate before I start firing questions and so I just didn't want you to be confused when you heard her reference to it. One more thing before we dive in, we are launching a new podcast. We've actually launched it already. One of the most intense, important and astonishingly difficult things that has ever happened in my life is having a child. I think this is true for many of us who have kids. Parenting can be one of, if not the most transformative events of a lifetime. And while there are all sorts of resources out there for helping you do a better job as a parent, there aren't many shows about how to take care

of yourself as a parent. We here at 10% happier have now made that show. It's called Child Proof, and it's available now. It's hosted by an amazing person named Yasmin Khan, a recovering news reporter and mom of two young children. On the show she tackles big questions, such as, how do parents take care of ourselves while taking care of our kids? How do we not lose our crap with our children?

How do we give ourselves a break? How do we not pass on our own various forms of dysfunction to our kids? Childproof is available now for free wherever you listen to your podcasts, including Apple podcasts, Spotify, and for 10% happier app subscribers inside the app. Add free. Check it out today. Okay, we'll get started with Sonia Dimogen right after this. Before we jump into today's show, many of us want to live healthier lives, but keep bumping

our heads up against the same obstacles over and over again. But what if there was a different way to relate to this gap between what you want to do and what you actually do? What if you could find intrinsic motivation for habit change that will make you happier instead of sending you into a shame spiral? Learn how to form healthy habits without kicking your own ass unnecessarily by taking our healthy habits course over on the 10% happier app. It's taught by the Stanford psychologist, Kelly McGonical, and the great meditation teacher

Alexis Santos to access the course. Just download the 10% happier app wherever you get your apps or by visiting 10% calm. All one word spelled out. Okay, on with the show. Hey y'all, it's your girl, Kiki Palmer. I'm an actress, singer, and entrepreneur. I'm a new podcast, Baby This is Kiki Palmer. I'm asking friends, family, and experts,

the questions that are in my head. Like, it's only fans only bad. Where did memes come from? And where's Tom from, MySpace? Listen to Baby, this is Kiki Palmer on Amazon Music or wherever you get your podcast. So, no Dimitian, welcome to the show. Thank you so much, Dan. It's wonderful to be here. Great to see you again. It's winter, it's getting dark. I can see that impacting my mood a little bit.

I can see that impacting my mood a little bit. Is that in my head or is there any link between the seasons and depression or the blues? Yeah, that's a great question. There is a link for some people, their experience of depression is actually quite directly influenced by seasonal shifts. For other people, depression is something that they contend with throughout the year and for some people in a waxing and waning manner throughout their lives. And

so there are a lot of things that happen at this time of year. You noted that the change in our access to light, which itself can have a powerful impact on people's biological rhythms, but also can disrupt routines in daily life that can also have an important impact on how people feel. And then this is also a time of holidays, which can bring great joy for many people and can also bring stress and challenge to. So there's a lot going on and if you notice ways in which that is impacting how you're feeling emotionally and physically, you're not alone in that. Are there techniques for remediating this in particular? I sometimes hear people recommend getting a light box or somehow getting more sunlight, either naturally or artificially

do endorse that kind of approach? So when we think about depression, you know, it's this really broad category. And there are lots of different ways in which depression shows up in people's lives. For some people, light boxes and ways of addressing directly their circadian rhythms and the connection between mood can be extremely helpful. As you know, a lot of the work that I have done has focused on ways in which people can learn to work with sort of the habits and the patterns of their mind in a way that can help protect people from the experience of depression and particularly for people who have experienced depression in the past, whether or not that's connected

and seasonal patterns and changes or more generally, we have learned over the past many years that people have the capacity to learn skills that can be quite powerful in terms of protecting them from the intensity of depression and from depression's return. When you talk about habits of mind, what do you mean? Yeah, that's a great question. So when we think about what are the ways in which people can get stuck in episodes of depression?

And there's a large body of research that looks at what are the differences between people, for example, who have experienced depression in their lives and people who haven't. And some of this research points to the idea that there are two kinds of processes that happen in the ways in which we experience thoughts and emotions and situations in our lives that have focused on one process that is called rumination, which is the tendency to elaborate, to tell stories, to engage in this kind of mental narrative mode. So that's one piece. The other piece is this process of what's been called fixation, which is the tendency to like dwell on the negative.

So when you get these two together, you can probably imagine the ways in which that can create vulnerability. So that people who have experienced oppression, there's evidence that they have a greater likelihood of orienting to the negative and getting caught there by these patterns of rumination or elaborating. there by these patterns of rumination or elaborating and that these processes can predict the likelihood that people will experience relapse of depression. What's helpful about knowing this is that it actually helps to focus our efforts on what are skills that people can learn that can counter the risk of getting pulled into either of these processes. So what are ways in which we can learn to intentionally bring awareness to the full range of experiences in our lives and to notice when we're getting

caught in the negative. And then what are ways that we can, rather than getting caught by thoughts and tending to add to them in a way, we can notice thoughts as thoughts or sensations or emotions as sensations or emotions and have this capacity to step back from them in a process that researchers have called de-centering, which is that capacity to step back from them in a process that researchers have called desentering, which is that capacity to step back and to see or to develop a kind of meta-awareness, to hold thoughts, metaphors,

people often use like clouds passing in the sky or leaves floating along a stream, rather than getting pulled into the weather pattern or pulled down the stream. So that within minutes, you might have traveled miles away from where you started without even realizing it. I have a million questions. Can one experience fixation and or rumination without being depressed? Oh yeah. So a lot of the studies that have been done actually are with people who have been depressed in the past and are not necessarily experiencing depression in the moment. But what can happen is that in the presence of some kind of challenge. So in research studies, sometimes people will be asked to listen to sad music or watch a sad movie

that tend to elicit the kinds of emotions, just in response to everyday events. And so these kinds of patterns can be present even when we're not experiencing an episode of depression. And so that's where for me and the work that I've done, the practice of mindfulness can be so powerful, because this is a practice that we can build into our lives on a daily basis our lives on a daily basis, that in a sense we are strengthening these alternative ways of engaging with difficulties that then are available to us in times when we may be at risk for falling back into a time of depression.

Sometimes when I share these kinds of research findings with people, the initial response is like, well, can we just like not have those challenges? We could just avoid all the sad movies and not listen to sad music and want that sort of take care of the problem. And I think there are two responses to that. One is the capacity to experience sadness or fear, some of these basic emotions is also part of what makes us human. And so if we did have a magic wand, would we really want to wave all that away? And then the second is that it's also really important

to take action in the context of our lives that help to reduce stress and the ways in which stressors disproportionately affect individuals or groups of people. And that's not the world that we have right now. One that is completely free of challenges, stress, adversity. So given that these kinds of practices can help to bolster our protection against some of those challenges and can help to provide alternatives and choices in those moments when we are faced with difficulties that are outside of our control. What's the mechanism by which mindfulness helps us not get owned by fixation and remination.

I think that there are two parts of that and they're kind of held within a broader context. So, the two aspects are this capacity to intentionally direct your attention. And the other is the capacity, as we were just talking about, to sort of step back to take a seat on the bank of the river and notice the leaves moving by rather than getting pulled into the water. So those are the two specific skills that most mindfulness-based programs specifically for mental health reasons that they train. And both of those, Dan, are held within this wider context of kindness and gentleness.

And that, I think, is a really critical piece to emphasize because what I often see with people who are just learning some of these practices is that there's also a risk that they can get sort of absorbed into these habits of being really hard on ourselves. And so people can experience frustration with like, this is really hard, or I can't do this,

or I sat down to practice mindfulness, and I had to jump back up after two minutes because I felt so antsy or impatient or frustrated or my mind was all over the place or challenges with, you know, just simply like I intended to practice this yesterday and the day before that and the day before that and then I don't even know where the last few days went. So there can be a lot of guild and self-recrimination, I think, as people are in the learning process. And so it's really critical to bring that attitude of kindness towards oneself in the process of learning. And that can be in a single practice session, save, or maybe the invitation is to pay attention to the

sensations of breathing, and you notice your attention is anywhere but on the sensations of breathing, and so bringing that quality of kindness and in noticing that that's the nature of one's mind, as well as more broadly with the intention to practice or make these practices a part of one's daily life. We can give ourselves a really hard time and it's really important that as people are learning mindfulness practices that they don't become just another tool by which one criticizes or judges oneself. by which one criticizes or judges oneself. I want to, as the kids in the office these days say, I want to double click on that because it's incredibly important in my opinion.

I've mentioned this before in the show, so I apologize to everybody if I'm being repetitive, but one of the biggest developments in my contemplative career, such as it is, has been moving from a kind of clinical mindfulness, a clinical awareness where I'm noting the arising of anger or selfishness or impatience with an unseen sheen of aversion to actually welcoming it in with an attitude that was nicely summed up by the great teacher Jack Cornfield of, oh yeah, this, whatever, this aspect of my ugliness is just the organism trying to protect itself. So yes, I really agree with you, and I can hear people asking, okay, you're calling for kindness.

By the way, these calls for being kind during meditation, they washed over me for many years because it just sounded like, okay, that sounds nice, I guess, or I don't know, maybe like a public service announcement, or I don't know, but I just wasn't able to do it. I was ignoring it for any number of reasons, maybe unseen sexism, who knows? But I wasn't doing it. And then when I started to do it, my life and my practice got a lot better. However, I think a lot of people might be asking,

how do I do that? How do I bring kindness in to these situations when I'm seeing the same sad or angry thoughts I've been seeing since I was, you know, a kid. Yeah, so that experience, you just said a couple of minutes ago of like, I have a million things to say about that. I'm having that now. Maybe just to like work backwards in what you're saying, because I think it's so important. There's so many sneaky ways in which these habits of self-judgment and harshness can creep in. This idea that like even as you said at the end, like my practice got better,

like that would be one I would bring even like curiosity to, which is what does that mean for our practice to get better. And if something can be better, can it also be worse? And who kind of holds the yardstick for that? It is in the air and the water, this tendency to judge. And there are ways in which it's helpful, right? Like our capacity to make discriminations about what and discernment with respect to like what is helpful and what is harmful. That's a critical skill that we have as human beings. And yet, when we begin to conflate that with our essential value, so that our essential value as human beings then becomes conditional on how we perform,

that's a really slippery slope and it's a place where that tendency to judge, to blame, it really can fester and grow there. So that's one piece I would say is like to notice the ways in which these value judgments can sneakily creep in to how we approach our practice and learning. You already have these skills and capacities within you. And so the practice really is about reminding yourself of these capacities that live within you. The other piece that I was reminded as you were sharing your experience in like that journey

of like hearing, I heard these, you know, be gentle with yourself and let that go and come back with kindness to your breath. Like, I heard them as like public service advertisements, but they weren't really going in, right? And how many times we can hear these invitations or even guidance or recommendations to be kind with ourselves? It's like we hear them, but they kind of wash over us in a way. And I was reminded that I had this experience a few years ago when I was presenting at a mind and life event in Dharmasala in India and I was sharing with his holiness, the Dalai Lama, some of the research

that I and my colleagues have been doing on depression and the ways in which mindfulness can help people develop protection from depression relapse and in that case specifically with of protection from depression relapse, and in that case specifically with women during pregnancy. And he said, at the end of this, and sharing these data, he kind of turned to me and said, you have a very important role. And with that important role, you also have more responsibility.

And then he talked about the importance of these practices and the benefit of mental training and one's interstate. And then he said, and I just, you know, it was like one of those moments, right, that's like the message was so clear. And he said, from one person to 10 people, to 100 people, to 1000 people, to 100,000 people, that is a way to change humanity's way of life. And I heard that in that meeting,

and I thought about it, you know, for weeks and months after that, after I came back to Boulder and continued to do the work I was doing. And for the longest time, I heard that guidance as connected to a lot of the research that I have been doing around how can we increase access? And I thought his message is to say, you start with one person with these kinds of programs, and you find a way to increase the scale and reach

of these programs so that they are available to hundreds of thousands of people. And then there was this moment when I realized that there was another way to hear that. And the other way to hear what he had said was that it wasn't just about the work that I or others could do in the world, that it also was that I am one of the one. If we're starting from one and we're going to 100,000, we can't forget that we are also one of the one. So in this story that you shared, Dan, if part of the message that you're sharing with the world is around the importance of kindness and gentleness was oneself, it's a reminder that we also

are one of the one for practicing that. So I thought about that experience and that guidance from him many months before I made that connection. I'm one of the one. I need to bring these practices into my own life and to remember that in a way that's really deep and authentic. If I'm to have any benefit when I look outward to the 100,000. So you're also not alone in hearing frequently often and powerfully important reminders and kind of needing to learn it again and again. important reminders and kind of needing to learn it again and again.

You know, I've been doing this work for many years and that reminder towards self-compassion and kindness with oneself is a daily practice for sure. How to do it though. How do we make this practical and not just some sort of platitude that washes over people. Well, I think that there are a couple of ways we can do that. I do think intention is a really powerful force. I think simple brief practices, like clarifying, setting an intention for the day. So one of the teachers I think who is part of the 10% happier community, Sharon Salzberg, has beautiful practices. And she actually recorded the mindfulness and compassion practices that we used in the study that we did with women during pregnancy in the

postpartum. And so some of those practices are formal loving kindness practices where you work with the repetition of phrases, like may I be well in that study? May my baby be well? May my baby be filled with loving kindness? May I be filled with loving kindness? So we can dedicate specific times, five minutes, 10 minutes, 20 minutes on a regular basis

to doing practices like that led by teachers like Sharon. The great thing about that is that when we're in moments that are more challenging, they're available to us. They're there as resources and support. So I have, you know, for all of my life, despite all of the kind of public speaking and podcasts and teaching that I do, had an intense fear of public speaking. And so even though I've learned to work with that in many ways over time, I still before this conversation, I can feel those sensations of fear and anxiety

arising. So when we had those 30 seconds at the start, the first thing that came to me was Sharon's voice in some of those audio guided practices. So that what was available was, may I be well? May you be well, Dan, and may this work have benefit. That's just one example of something that literally took 30 seconds. We were going to do this 30 seconds anyway. It wasn't carving out in the additional time. But it was bringing that skill of mindfulness to noticing, what am I feeling in this moment,

what's present in my experience, and then responding to that with some of these tools that are about self-kindness, kindness for others, and an intention to be of benefit in the world. Much more of my conversation was shown at Dimitrium right after this. Life is short, and it's full of a lot of interesting questions. What does happiness really mean? How do I get the most out of my time here on Earth? And what really is the best cereal? These are the questions I seek to resolve on my weekly podcast, Life is short with Justin Long. If you're looking for the answer to deep philosophical questions like, what is the meaning

of life? I can't really help you. But I do believe that we really enrich our experience here by learning from others. And that's why in each episode, I like to talk with actors, musicians, artists, scientists, and many more types of people about how they get the most out of life.

We explore how they felt during the highs. And sometimes more importantly, the lows of their careers. We discuss how they felt during the highs and sometimes more importantly, the lows of their careers. We discuss how they've been able to stay happy during some of the harder times. But if I'm being honest, it's mostly just fun chats between friends about the important stuff. Like, if you had a sandwich named after you, what would be on it? Follow life is short wherever you get your podcasts. You can also listen ad-free on the Amazon Music or Wonder a App. So, if people have heard you talk about using mindfulness to not get hung up in fixation

or rumination, whether you have a tendency to or depression or not, if people heard you talk about that and heard your exhortation to view whatever's coming up with some level of kindness, the answer to how do I actually do that, Sono Dimension, is, well, there are practices designed to boost your capacities to do that. They're sometimes known by their other grandiose title of the Divine Abodes, or the Brahma Viharas, and they include skills such as loving kindness or friendliness also compassion and Sharon Salzburg you mentioned is really I would say the principal proponent in the West of these

practices can turn up the dial on the warmth in our own practice and everything I'm describing I've seen for myself for sure but am I summarizing you correctly? You are summarizing me correctly and the piece I would add to what you're saying is that we have evidence from rigorously designed and conducted research studies that attest to the fact that doing those practices and learning those skills for many people can provide benefit in the moment

and also enduring benefit for studies where we have continued to stay in touch with people and to learn from them about the extent to which these benefits persist for up to a year after doing a course where they have learned some of these core practices. Even if they're not doing the practices anymore. Well, what's interesting is, so in some of the work that we did with women during pregnancy was that we found that,

in an eight week program, where they participated two hours per week in the class, and were asked to practice on a daily basis. On average, women reported that they practiced in the class and were asked to practice on a daily basis. On average, women reported that they practiced for about 15 minutes, three times a week. So in that study, over that eight week period, that's their context for learning and practice.

On average, two hours a week for eight weeks, and then to practice about 15 minutes, three times a week. They were significantly protected from the return of depression throughout their entire pregnancy and up to six months postpartum. In another study that we did with adults in the general population, so this is 460 adults

who had histories of depression. We're not currently in an episode of depression, but had residual symptoms, so like their depression had lingered. They participated in an eight session program that my colleague Zindel Siegel and I developed called Mindful mood balance that was delivered all digitally. So in eight session program, they had 12 weeks in which they could complete it. And it was with people in that study that we compared the impact on depression and anxiety relative to what was the usual care pathway within the Kaiser Permanente system here in Colorado.

And we found that those significant benefits in terms of their reduction of their residual depressive symptoms, that those also persisted for an entire year that benefit after the course of learning this Mindful Moon Balance program over the course of 12 weeks. And interestingly, Dan, we also have some data that are under review that we've been looking at, which is a secondary analysis. So the study wasn't planned to do this, but it addresses, I think, an important question,

which is, what about people for whom not just depression, but also thoughts of suicide or suicidal behaviors are part of their experience or their history? What is this digital platform of mindful mood balance? What is the benefit for them? And by the end of that 12 week period, what we found is that there were significant benefits for the people who did the mindful mood balance program compared to usual care in both the

extent to which people reported any suicidal ideation. So as well as people who were in the, what we call the high suicidal ideation group, was only 10% of people in the Mindful Mid-Balance Program, relative to almost a quarter of people in the usual care group. So I think these data are important because they are indicators that these practices are

powerful and they also can be enduring in their benefit. And it is possible to both learn and practice in a way that can be integrated in the part of regular daily life. The first practice that we do in the Mindful Moved Balance program is mindful eating, is bringing these qualities of awareness and kindness that we've been talking about to something that you do multiple times a day

that doesn't require planning, scheduling, doing anything different than what's already happening in the ebb and flow of daily life. I just want to be clear about something this 8 or 12 week program you're saying there are during benefits for people who just do the program and stop practicing with the programs over their benefits you see months later. stop practicing when the program's over, there are benefits you see months later. We have focused most on characterizing the practice that people do during the program period, less so during the follow-up period, but that gives you an indicator of the extent to which people are practicing

during the program period. You don't know the, whether the folks who are seeing the enduring benefit if there's any correlation to whether they're continuing to practice. Yeah, it's that's a great question. We do know that there's a correlation between the extent to which people practice during the program period, the eat or the 12 weeks depending on the studies. There is an association there for the mindful mood balance program, like the number of sessions that people complete in the program is associated with the benefit that they receive.

We haven't looked at associations in the follow-up windows. So you've described a couple of programs that you teach mindfulness mindfulness-based, cognitive therapy, MBCT, and then also mindful balance. What is the difference between what you're teaching in these programs, these eight or twelve week programs, and what the rank and file meditator who uses an app or who basically knows the beginning instructions and practices for five, 10, 15 minutes, most days or as many days as they can muster. What's the difference between a regular meditator and what the folks are getting in MPCT

or the mood balance program? Yeah, that's a great question. So the Mindful Move Balance program, which is essentially a digital version of what you would experience if you were in Mindfulness-based cognitive therapy in-person class. One of the reasons that we did that was because the availability of those classes is so limited and there are so many barriers for people to accessing those. And actually the idea for developing that digital program came when Zindel and I, you know, the sort of gold standard for instructors of NBCT in their learning is to participate

in a five dayday residential immersion training, where you both go through the whole program and then you teach it with feedback and opportunity for practice. We were leading one of these residential trainings in Joshua Tree, and kind of looking out at this beautiful scenery and these long days of practice and learning that we had with a group of people who wanted to learn to be facilitators and realize both that it was an incredible experience and privilege to do that kind of work

and that if we actually wanted to have the capacity to bring benefit to the lives that if we actually wanted to have the capacity to bring benefit to the lives of the literally hundreds of millions of people around the world who struggle with depression, that was not the way to do it. And so that led to thinking about how can we bring the exact same kind of learning experience in a digital format?

And so where it differs, I think, from some of the other kinds of mindfulness programs that are available to people, is that it's a synthesis of expertise in both the teaching and the practice of mindfulness with what do we know about depression and the territory of depression and what I think of as like depression's close cousins, anxiety and stress and what are some of the most well supported with really good science strategies

also from cognitive and behavioral therapy. And what the Mindful Moon Balance Program does is it's an integration of these different streams of knowledge and skill. And I think that integration is really critical. The other piece is that there's a very intentional arc of learning in the Mindful Moon Balance Program, which again is rooted in MBCT, then moves along a very clear sort of gradient of attention, starting with ways to strengthen the capacity of focus attention in places that are more based in the body and that are more neutral. So like we were just talking about eating, but then moves over time and a systematic kind of arc towards the kinds of thoughts and

emotions and situations that are most difficult and painful and likely to trigger an episode of depression for people. And so the sequence, I guess I would say within the program to build in a kind of systematic way that scaffolds people so that you're not just kind of thrown into the deep end in the places where you're most vulnerable, but you're also not, you're not avoiding those either. So that kind of systematic progression that's informed by a deep understanding of the ways in which people can be and are vulnerable to depression and stress and anxiety, I think is really important. The other piece is that we designed the program in a way that you have the experience of participating as part of a group of people who also are learning with you.

All the learning starts with your own experience, so it's really learning through doing. So every component starts with a guided practice and the opportunity to learn from your own experience. And then to also be able to access other people's experiences by listening and watching videos of other people who have learned the same practices, who can talk about the challenges and opportunities and benefits that they've experienced. So, and I think that sense of being part of a community of people is a really critical

aspect of learning mindfulness and self-compassion practices and also specifically bringing them into spaces like depression and anxiety. Because again, to go back to our earlier conversation, there's so much stigma and there's so much guilt and shame that those spaces can be really isolating for people. How do I know whether I need something like MBCT or mindful mood balance? Because I think a lot of us, I mean, I've had episodes of depression since I was a child and then I maybe get a flavor of it for a few days now

and again. That's me, but I think a lot of other people maybe just get sad once in a while and, you know, we see a therapist and or we do a little bit of meditation and or we aspire to do either of the above. How do you decide what lever to actually pull? So what you're describing about the experience of depression in your own life, Dan, is very much what most people who have experienced depression, how they might describe. Like this, how they might describe, like this, they may experience an episode of depression that there are times in life when it really recedes, you know, it's not part of one's daily life,

and then there are times when it comes back. And then for some people, there are aspects, there are, that's when we talk about residual depression symptoms, that what we mean is that you may not be in a full episode of depression, but there are some elements and it could be the sadness or a lack of interest that persists, but at a lower level. It could be some of the thoughts that we've been talking about. Thoughts of one's own inadequacy or deficiencies, it could be challenges

with concentration. As I was talking about earlier, for some people, thoughts of suicide that can persist. The places where we have studied and others have studied programs like mindful mood balance or mindfulness based cognitive therapy have been mostly with people who are not in an acute episode of depression. So we're not in the kind of intensity of the depths of the suffering of acute episode of depression, but are in those in between times that you're describing. So, people who have experienced prior episodes of depression, who may be having some lingering symptoms, but have the sort of resources in the moment to engage in a program like this,

and to the inner resources of energy and concentration that are available to them. Those inner resources are can be very depleted when one is in a full episode of depression. And a lot of the other research that I have done has really focused on what do people need when they're in the depth of those times of depression. And those skills can work in concert with the kind of mindfulness and self-compassion skills we're talking about now. But when you are in an acute episode of depression, the skills that I think are more critical to those times are skills that focus on action.

They're skills that focus on engaging with the world around you and countering the tendency to avoid and withdraw. And so there's a connection between, I think, using the skills of action and engagement during episodes of depression that help reconnect people with sources of enjoyment and reward and relationships in their lives. And then these other skills that we've been talking about, this skills of focus on how to work with your mind skillfully, those I think can be particularly helpful in preventing episodes of depression from returning.

Does that make sense? It does, I think. So if you're in the depths of depression, you might not have the mental resources such as concentration required to do MBCT or any other sort of mindfulness-based therapy. So instead, you recommend engaging with the world by that or you referring to like

volunteerism? The answer to that question of what do I recommend is very individualized. And so for some people like engaging in volunteer activities might be exactly the thing that would be helpful for them. For some people, even the thought of that would drive them more deeply into for some people, even the thought of that would drive them more deeply into withdrawal or avoidance from the world around them, because we each differ in what it is that is rewarding, that keeps us engaged and active in our lives. And so where I was saying these skills, they do have a relationship with each other. So the approach that I and others have studied most widely as a robust Approach for treating and managing depression is an approach called behavioral activation and that begins with noticing and

times when people are experiencing depression noticing the Connections between what do you do and how do you feel. And so that's also a place where mindfulness shows up. It's not meditation, but it is awareness. It's noticing on a day-to-day hour-to-hour, in some cases, basis, what are you doing and how are you feeling?

And what are the connections so that what we begin to do with that approach is by bringing our awareness to what are the activities that are part of your daily life. And we're looking for the ingredients of a behavioral antidepressant in that case. And so for me, the activities that would make up my personalized behavioral anti-depressant might be really different than the ones that you might end up with. And that's why it's really important to start with that process of paying attention. What are the activities that bring me a sense of accomplishment, that bring me a sense of connecting with other people, a sense of enjoyment. And then to begin with support, so that you're not alone in this process,

with support of starting to structure and schedule those into your daily routine, in a way that is systematic and tuned to like, where is it feasible for you to start so that you're also not overwhelming yourself with trying to do too much too soon. Out of curiosity, what would be on your BA behavioral activation list? What would be on the list of things you would do to kind of pull yourself out of the depths of depression? For me personally. Yeah. So I have, I don't know if I could find it right in this moment, but I have on my computer a list that I created when I was in my early 20s. It's still

the same list. And that was in the context of experiencing depression after a client in the clinic where I worked early in my career, died by suicide. And that was one of those kind of crucible times in life that helped me develop awareness of exactly what you're asking, which is like, what's on my list. And also really powerfully fueled for me the commitment to go to graduate school and to focus on doing research that would ensure that like the best of what science can offer and that we were making sure that science was available for every person who needed it, no matter where they lived and what kind of resources they had access to. So my list at that point would be the same list I have now, which is being a nature,

is a really important one for me, exercise, running, or hiking, walking, cooking, spending time with close friends and family, reading, and then another one for me is a work, meaningful work that offers meaning and benefit to other people. What's on your list, Ann? Well, I was gonna say many of the same things. My son and I was seven. My

son and I recently invested in a great antidepressant, which is called a drum set. And that's been great for both of us. Not that I don't think he is depressed that I can tell, but it's a really fun thing to do individually and together. And if I had to put my finger on a potential common denominator among all the things on your list and probably among all the things I would list, is it kind of gets you out of your own head? There's a self-involvement with depression that kind of points to it, a happiness fallacy, which is that if we want to get happy, we need to start thinking about ourselves a lot,

but actually think about yourself is generally not the best route toward happiness. Yeah, I mean, that takes us back to some of the early topics we are exploring around rumination, and that narrative mode of the mind can often be very self-focused in ways that are also very negative. And so those kinds of activities that help support us being engaged in the world around us are really critical. And I love that you're doing the drumming with your son because that will always be a resource for him. Like he will have that knowing, not just as a kind of mental thing.

Like I used to play the drums with my dad and it was super fun and we laughed and, you know, but like that will live in his body, that experience of enjoyment and connection. And so these kinds of activities of like ways in which we can stay engaged with the world, that we have those in our histories we can draw from, or we have people in our lives right now who can help support us in developing them. Because when people are experiencing depression,

that's that every fiber of your being is pulling away from that. The gravitational force towards withdrawing and isolating and avoiding is so powerful. When we talk about lists and these activities, the awareness we can develop, I always wanna balance that with just really clearly saying like we can't take a kind of like Nike, like just do it, just get out there and play the drums when you're feeling down,

because although that can sound like a simple thing to do in the moment when someone's experiencing depression, that can be a herculean effort. So both are true, like it's simple and it's powerful and it's essential and it can be really hard. Much more of my conversation with Sonia Demidjinn right after this. Some of the hardest moments of my life are when I've been deep in depression and forcing myself to exercise when that flu-like ache that often comes with depression and it feels so wrong to exercise, but I know it'll make me feel

better. That's just a tough moment for me. What's your take on anti-depressants? She's smiling, like she's going to say something. Yeah. So it's interesting because I was just emailing with a colleague, Jay Farnier, who's a great depression researcher who was the senior author on a paper that we and a group of researchers published in 2010.

I emailed him and said, when you share these data, you know, it's over a decade later, like, are you qualifying this in any sort of way? Because I think these points are still as relevant today as they were over a decade ago. And he said, not really, I agree. These findings are still important and relevant. So the essence of that study, which was what's called an individual

participant level meta-analysis, which pulled the data from multiple studies that looked at differences between antidepressant medication and placebo. And for adults with depression, and what was really interesting about that was that if we took all the people pulled from all the studies, if you ordered people in terms of the severity of their depression at the beginning of the study, it was only among the most severe category that there was a significant difference that has been determined by other guidelines is a meaningful difference between the antidepressant medication and placebo. So that doesn't mean that the medication wasn't effective for all the rest of the people. It just wasn't significantly more effective than taking a placebo.

So more effective than taking a placebo. So that suggests that the specific efficacy of antidepressant medication is limited to that group of people. What that suggests is like there is those data would indicate that there is specific value and benefit to antidepressant medication and that the vast majority of people in those studies got the same benefit from a placebo, which are findings that have been available now for over a decade, and that as

least as far as I can see, haven't dramatically influenced the kind of mental health care that's available or treatment guidelines. What's going on there? I think it's an example of the way in which we as scientists and you know, We, as scientists and, you know, our world generally, we haven't developed effective ways, communicating important scientific findings in a way that has broad access. And so I think there's more work to do there. I think the decision about whether or not to take in and out of present is what that means for any given individual is a decision

that the individual and their healthcare provider need to make and it's important to know about these kinds of research findings that are available. I think the other really important point about what we know about how antidepressant medications work and how they don't is that and this is very relevant to the kinds of training and skills that we've been talking about in terms of staying well over the long term and preventing relapse of depression is the evidence is very clear and we've've done studies, many people have done studies that speak to this, is that regardless of how the benefit is provided, whether or not it's actually something specific to the pharmacological agent,

or it's the placebo effect of expectancies and doing something every day, taking medication, that that benefit persists only as long as people are continuing to take the medication. And so we don't see enduring benefits once people have stopped taking an antidepressant. This is in contrast to programs like Mindful Mid-Bell and Sur MBCT, or other Mindfulness-based programs where we see benefit even after the program window has ended and people are no longer attending

those classes, that there's some kind of learning that happens that stays with you in a way that whatever benefits anti-depressant medication offers doesn't stay with you in the same kind of way once you have stopped taking that medication. How do MBCT at all stack up against pharmacological interventions in terms of benefit in the moment. Well, people are taking them. Yes, while people are either taking the medicine or doing the course, is your stuff better than a placebo? Yeah, so my colleagues, Endal Siegel's probably done the most direct tests of the question that you're asking

and has found specific benefits relative to placebo most direct tests of the question that you're asking and has found specific benefits relative to placebo, particularly among people who have what his group described as like unstable periods of remission. So people for whom their depression had improved, but it was kind of up and down that for that group in particular, there were benefits to MBCT, which, you know, again gives us some important evidence that it's more than just the ingredients that go with placebo, which most people emphasize the power of expectancy, doing something that you think will have an impact. So we've seen that

in the study that Zendol and his colleagues did, we also, this was a compassion-based intervention that was just for the general population, not specifically tied to mental health, but my colleague, Tor Wager and her graduate student, Yoni Ishar, who's no longer a graduate student, is a researcher in his own right in the world now. And then another colleague, Jess Andrews-Hannad, did this really interesting study speaking in placebo with a compassion meditation that was four different compassion meditation practices

that people were asked to do over a four-week period that Rochie-John Halifax created and recorded. And this was in a study where we asked adults to participate to do something that would increase compassion for others in the world. And so we were interested in the extent to which this compassion meditation training would have those effects. But we also wanted to answer the question you're asking, which is, like, does it work in any specific ways that are over and above just asking people to do something that would make them more compassionate?

So, Tor has had decades of experience studying placebo effects in pain, he had the idea to create this compassion placebo, which was we gave people nasal spray that we told them was oxytocin, and that if they sprayed it in their nose every day for four weeks, it would change their brain in a way that would make them more compassionate. And it was a saline solution, so it had no thing active in it. And in that study, what was interesting was that we did find specific

effects of the compassion intervention over and above the nasal spray oxytocin placebo. And we included a condition where people basically just listened to stories and looked at images of people who were suffering over time without giving them anything to do in response to those. And we actually found one of the largest differences was between the compassionate intervention in that group with respect to the amount that people were willing to donate

money that we gave to people in this study, and that people in that group actually were less generous by the end of the study than they were at the beginning, which we wondered if was in part a function of asking people to be in the presence of suffering others over and over again, without giving them any tools or training for how to respond to that and how to take action in response to that, which is also a place that I think people are in and are routine and daily basis in our lives right now with the kind of events in our world and exposure through different forms of media. So I think it raises some really interesting questions about also the importance of compassion meditation as a protective practice

for our connection as human beings in our world today. You've raised innumerable, fascinating questions over the course of this conversation. I see that our time here is kind of drawing to a close, but let me just ask you quickly, can you just plug your books and where you are on the internet and any programs you're offering just for people who want to learn more? So I think for people who are interested in learning more about some of the programs that I've described, my colleagues Zindall Seagull and I actually founded a company last year called

Mindful Noggin that's sole intent is to make more widely available. Some of the skills and practices that we've talked about today, so the Mindful Moon Balance Program, another related program called the Three-Minute Breathing Space, which is a kind of core practice that is intended to be brief and transportable in everyday life, are available there. My colleague Cheryl Goodman and I wrote a book expecting mindfully that is brings these practices specifically in work that we've done

with women during pregnancy and early parenting and that really focuses on how learning the skills of mindfulness and self-compassion can be critical for one's own mental health as a new and expected mom and can help to establish a foundation for the transition to parenthood and family life in really important ways. So those are a couple of places to learn more and then you know as the director of the Crown Institute at the University of Colorado Boulder, we are continuing to study and to co-create with young people and families and teachers ways in which practices,

like mindfulness and self-compassion and compassion can bring benefit in people's everyday lives. And so I would also say, stay connected with the research that we're doing and the findings. Because there are a lot of exciting studies that are just getting started that are underway and that will be yielding some important discoveries soon. So,ona, thank you very much. Thank you, Dan. Thanks again to Zona. And thanks, of course, to everybody who makes this show, Samuel Johns, Gabrielle Zuckerman,

DJ Cashmere, Justin Davy, Kim Baikama, Maria Wartell, and Jen Plant. And we get our audio engineering from the good folks over at Ultraviolet Audio. We'll see you on Friday for a bonus. from the good folks over at Ultraviolet Audio. We'll see you on Friday for a bonus. [♪ OUTRO MUSIC PLAYING [♪ Hey, hey, prime members. You can listen to 10% happier early and ad-free on Amazon Music.

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