Finding out that your doctor may now suggest sitting in silence as a treatment for one of the most crippling mental health issues in the contemporary world is somewhat unsettling. And yet, things are becoming more and more like that. Doctors who used to automatically reach for the prescription pad are starting to think about an alternative treatment that doesn’t involve going to the pharmacy, paying a co-pay for a bottle of medication, or waiting to see if the side effects are manageable.
The method is called mindfulness-based cognitive therapy, or MBCT. It is a structured clinical program that incorporates traditional meditation methods into cognitive behavioral therapy. It has taken years to go from a promising pilot study to something that is on the verge of mainstream medical credibility, but it is not wholly new—researchers at Oxford University were generating early trial results as early as the late 2000s. The frustrating aspect of this story has always been the discrepancy between evidence and adoption.
In actuality, the evidence is rather striking. Mindfulness training reduced relapse rates in individuals with recurrent depression by about half in two different clinical trials. In one study, after taking a mindfulness course, patients who had previously relapsed at a rate of 78% saw that number drop to 36%. These improvements are not insignificant. Nevertheless, only one in five general practitioners in the UK currently has access to a mindfulness course that they can recommend to their patients, even though 72% of GPs say they think it would be helpful. It is difficult to explain that discrepancy without coming to the conclusion that the system just hasn’t kept up with the science.
Not only are the behavioral outcomes of this practice compelling, but researchers have also discovered what is going on inside the brain. When someone is depressed, the medial prefrontal cortex, also known as the “me center,” becomes hyperactive. This area is in charge of self-referential thinking, rumination, and future-focused anxiety.
According to Harvard Medical School research, meditation seems to break the feedback loop between that area and the brain’s fear-processing center, the amygdala. When you break that connection, the feelings of dread, spiraling thoughts, and cortisol spikes start to fade. The hippocampus, a part of the brain linked to memory that tends to shrink in people with recurrent depression, showed an increase in grey matter volume after eight weeks of daily meditation, according to one study. It’s difficult not to find that impressive.
There is a feeling that the opposition to meditation prescriptions has always been more cultural than scientific. According to The Guardian, a general practitioner in south London acknowledged that he had personally sought out a Buddhist center to learn meditation for his own stress. However, he felt uneasy suggesting it to patients because he was worried they would interpret it as a religious recommendation. There is still some tension.
Meditation still carries a certain kind of cultural freight, associations with incense and retreat weekends and Instagram captions about “being present.” The atmospheric quality of the clinical version is significantly lower. It entails taking a seat, paying attention to your breathing, and developing the ability to recognize thoughts without pursuing them. That’s about it. Chanting is not necessary.
In reality, meditation asks a person to observe challenging emotions from a distance rather than repressing them, which is surprisingly straightforward. According to a Harvard-affiliated researcher, “this helps provide some distance from those negative thoughts or stressful feelings, allowing you to recognize that, although they affect you, they are not you.”
It’s really unclear if that reframing is sufficient for everyone; researchers are cautious to note that MBCT is not meant to be used in place of all other treatments and that it works best for people who have had three or more prior episodes of depression. However, the case for it as a relapse prevention tool has been quietly growing for over 20 years.
In just ten years, the number of antidepressant prescriptions in the UK nearly doubled, hitting nearly 36 million in 2008. According to a survey of general practitioners, 75% of them had prescribed medication to patients whom they thought would have benefited more from something else. That is a startling admission; it is not a criticism of any specific physician, but rather an indication that the system is under pressure to choose the best course of action. It turns out that there was always meditation. To look in that direction, medicine simply needed some time.
