Mindfulness-Based Cognitive Therapy with People at Risk of Suicide

Mark Williams, DPhil, is Professor of Clinical Psychology Emeritus at the University of Oxford Department of Psychiatry, where he was Founding Director of the Oxford Mindfulness Centre. He collaborated with John Teasdale and Zindel Segal in developing mindfulness-based cognitive therapy (MBCT) to prevent relapse and recurrence in major depression; together, they coauthored Mindfulness-Based Cognitive Therapy for Depression, Second Edition (for mental health professionals), as well as the self-help guides The Mindful Way Workbook and (with Jon Kabat-Zinn) The Mindful Way through Depression, Second Edition. Dr. Williams continues to train mindfulness teachers internationally.Melanie Fennell, PhD, is a Founding Fellow of the Oxford Cognitive Therapy Centre, where she is now an Associate Trainer. She is also an Associate Trainer at the Oxford Mindfulness Centre. As a research clinician in the University of Oxford Department of Psychiatry, she contributed to the development of evidence-based treatments for depression and anxiety disorders, including MBCT. She developed and led the Oxford Diploma in Cognitive Therapy, the Oxford Diploma/MSc in Advanced Cognitive Therapy Studies, and (with Mark Williams) the Oxford Master of Studies program in Mindfulness-Based Cognitive Therapy. Dr. Fennell is an Honorary Fellow of the British Association of Behavioural and Cognitive Psychotherapies (BABCP) and was voted “Most Influential Female UK Cognitive Therapist” by the BABCP's membership in 2002.Thorsten Barnhofer, PhD, is Professor of Clinical Psychology at the University of Surrey, United Kingdom, where he conducts research into the use of mindfulness-based interventions for the prevention and treatment of mental disorders. He has a particular interest in the mechanisms by which mindfulness meditation benefits psychological and neural functioning. Previously, he worked in Mark Williams’s group at the Oxford Department of Psychiatry, where he was involved in research on MBCT for suicidal and chronic depression. A cognitive-behavioral therapist and yoga teacher, Dr. Barnhofer regularly teaches MBCT training workshops and retreats for mental health professionals.Rebecca Crane, PhD, MA, DipCot, is Director of the Centre for Mindfulness Research and Practice at Bangor University in Wales, and has led the development of its training programs since 2001. She previously worked in the mental health field as an occupational therapist and an integrative counselor. Dr. Crane teaches and trains internationally in both MBCT and mindfulness-based stress reduction (MBSR), and is a certified MBSR teacher with the Center for Mindfulness at the University of Massachusetts Medical School. She is the author of Mindfulness-Based Cognitive Therapy: Distinctive Features.Sarah Silverton, DipCot, MEd, teaches at the Centre for Mindfulness Research and Practice at Bangor University, Wales. She has extensive experience as an occupational therapist, counselor, and mindfulness teacher and trainer. She is the author of The Mindfulness Breakthrough.

• 1. IntroductionI. Theoretical and Research Background2. The Origins of Despair: An Evolutionary Perspective3. Why the Idea of Suicide Won't Let Go4. How Could Mindfulness Help?: Doing and BeingII. MBCT for Those at Risk of Suicide5. Assessing Vulnerability to Depression and Suicidality6. Developing the Preclass Interview: Encouraging Vulnerable Participants to Engage in and Persist with Mindfulness Meditation7. Session 1: Awareness and Automatic Pilot8. Session 2: Living in Our Heads9. Session 3: Gathering the Scattered Mind10. Session 4: Recognizing Aversion11. Session 5: Allowing/Letting Be12. Session 6: Thoughts Are Not Facts13. Session 7: How Can I Best Take Care of Myself?14. Session 8: Maintaining and Extending New Learning15. How Does MBCT Enable Transformation?: Jane's StoryIII. Training Teachers and Defining Competence16. MBCT Teaching Integrity: Assessing Mindfulness-Based Teaching Skills17. The Experience of Being an MBCT TeacherIV. MBCT--The Results18. Mindfulness on Trial: Does MBCT Help People at Risk of Suicide?Further Reading and ResourcesReferences

"The book is the culmination of an ambitious decade-long effort to develop and refine an effective treatment for the subgroup of depressed patients who are most susceptible to suicidal behavior--those with histories of early maltreatment, an early onset, recurrent episodes, and incomplete recovery. The authors comprehensively present their adaptation of MBCT, provide guidelines for training and supervision, and summarize the results of a recent clinical trial. This is useful and fascinating material for clinicians treating this highly challenging group of patients."--Daniel N. Klein, PhD, Department of Psychology, Stony Brook University"MBCT has established an admirable track record for preventing relapse into depression. But can a program based on mindfulness meditation be safely applied to people suffering from vulnerability to suicide? The authors take us on a scholarly and compassionate journey that lasted over a decade, pointing out the specific adaptations they made to the MBCT program and why. This book represents an important advance for mindfulness-based psychotherapy, an impressive model for how to develop an evidence-based treatment, and a rich resource for anyone who wishes to understand and treat the dilemma of suicide."--Christopher Germer, PhD, private practice, Arlington, Massachusetts"This book examines despair and suicidality with a keen eye. It is a beautiful illustration of how to bring astute observation to an important clinical problem and develop and test a theory-based intervention. The authors present an innovative adaptation of MBCT that helps individuals uncouple suicidality from depressed mood, decrease cognitive reactivity and suicidal thinking, and increase awareness and self-compassion. Importantly, their research demonstrates the particular effectiveness of this approach for the most vulnerable, those who experienced childhood trauma."--Stuart J. Eisendrath, MD, Director, UCSF Depression Center, University of California, San Francisco"Taking up a sensitive and painful topic, this book lays out a comprehensive course for helping suicidal patients using MBCT. Williams et al. explain suicidality through evolutionary logic and grapple directly with the most treacherous aspects of working with this population. The authors argue that MBCT helps to make autobiographical memories more specific, thus addressing a crucial vulnerability factor in suicidality. The volume covers a lot of ground. It provides multiple mindfulness and movement exercises aimed to reduce suicidal thoughts and restore patients on a path of well-being."--Elliot Jurist, Professor of Psychology and Philosophy, The Graduate Center and the City College of New York, City University of New York“Extremely accessible, informative, and engaging, this outstanding book is a 'must read' for anyone with an interest in understanding suicidal despair and its treatment. It is unusual in a single volume to find such a comprehensive description of the science of suicide risk as well as a detailed overview of how to adapt and implement MBCT. The inclusion of the case studies, such as 'Jane's story,' is really helpful."--Rory C. O’Connor, PhD, Director, Suicidal Behaviour Research Laboratory, University of Glasgow, United Kingdom "The authors describe their work with clients who need the best help possible, but who are often excluded from research trials and treatment programs. They discuss how they sensitively adapted the MBCT program to address such problems as the originally high dropout rate of people at the highest risk of suicide. The reward is clear: those who are most vulnerable do best with this adapted version of MBCT, compared to treatment as usual and psychoeducation. I truly hope this program becomes available to all who need it."--Susan Bögels, PhD, Department of Medical, Clinical, and Experimental Psychology, University of Amsterdam, The Netherlands-This book is a very helpful addition to the literature on treatment of patients experiencing suicidal ideation and depression. The authors present a wealth of clinical, teaching, and research information to appeal to clinicians and train them to incorporate mindfulness and cognitive restructuring--within a positive, compassionate stance--to assist clients with significant depression. The informative and easygoing writing style makes the material easy to digest. The rich description of what to do, with examples, makes this book easy to read and absorb so that clinicians can incorporate the techniques in their work with clients.--Mindfulness, 6/26/2017ƒƒThroughout the book there are helpful summary boxes of key points and examples of dialogue to illustrate examples--this helped immensely to make this book very reader friendly….This book would be helpful for any clinician working with clients who present with these difficulties and offers a new, innovative way to effectively work with people who experience acute distress and suffering.--The Psychologist, 6/1/2016ƒƒTeachers of mindfulness-based interventions, both those who are interested in using MBCT with individuals at risk for suicidal thinking and behavior and those who are less inclined to work with such individuals, will benefit from reading this engaging, informative, and accessible book. For the general teacher, the book offers practical, clearly articulated material to increase competency….For the teacher interested in using this adapted version of MBCT to treat individuals at risk of suicidal depression, the book provides a clear and comprehensive review of the protocol changes that were made to tailor the treatment for this population. Moreover, the detailed description of the authors' theoretically and empirically based conceptualization of suicidal behavior clarifies the purposes of and rationale for the various techniques of adapted MBCT.--PsycCRITIQUES, 12/21/2015