On October 20, 2007, leading researchers in the fields of mood disorders and meditation discussed the promise—and limitations—of meditation for the prevention and treatment of major depression. Participating in a day-long symposium titled "Mindfulness, Compassion, and the Treatment of Depression" was His Holiness the Dalai Lama. The event, which drew an audience of more than 3000, was cosponsored by Emory University in Atlanta and the Mind & Life Institute and was the 15th time that the Dalai Lama has met with Western scientists under the aegis of the Mind & Life Institute to engage in dialogue about points of intersection and divergence between Buddhist and scientific worldviews.
The conference focused on the role that meditation might play in promoting cognitive, emotional, and physiological states that are protective against depression. This issue was examined within the broader context of whether developing mindfulness and greater compassion through meditation training in adulthood might help individuals compensate for the depressogenic effects of adversity, trauma, and lack of nurturance early in life, all of which are primary environmental contributors to major depression.
During the conference, researchers presented data that suggested that mindfulness practices may help prevent the recurrence of major depression and that meditation practices specifically designed to promote compassionate cognitions and emotions toward others may have effects on the brain and body that are directly relevant to depression.
The Dalai Lama opened the conference by acknowledging the unique relationship that exists between Emory University and several leading institutions of higher education within the Tibetan exile community, a relationship that has culminated in the Dalai Lama joining the Emory faculty as a Distinguished Presidential Professor. He expressed his conviction that Western physical sciences and Buddhist traditions of studying the mind have much to offer each other in better understanding mind-body interactions relevant to health.
To set the stage for a discussion of the therapeutic potential of meditation, Charles B. Nemeroff, MD, PhD, Reunette W. Harris Professor and chairman of the Emory department of psychiatry and behavioral sciences, and Helen S. Mayberg, MD, professor of psychiatry at Emory, provided the Dalai Lama with an overview of current scientific understandings of the risk factors for, and neurobiology of, major depression.
Dr Nemeroff recounted the tremendous cost in human suffering inflicted by depression and noted that people with major depression are more than twice as likely to die, not just of suicide, but of medical conditions such as cardiovascular disease. He reviewed data that showed that most of the risk for depression comes from environmental factors and highlighted the importance of a history of trauma, adversity, and/or lack of parental nurturance early in life, especially in individuals with vulnerability genes for depression. He showed evidence that individuals who were exposed to early adversity have lifelong biological changes relevant to depression, including hyperactivity of stress-response pathways and reductions in CNS oxytocin, a hormone known to contribute to social bonding.
Dr Mayberg reviewed recent findings regarding the neurobiology of depression, focusing on her team's work with deep brain stimulation (DBS) in the white matter surrounding the subgenual anterior cingulate cortex as a treatment for severe, treatment-resistant major depression.1 In addition to showing remarkable video footage of rapid and sustained mood improvements brought on by DBS, Dr Mayberg made the stronger point—with which the Dalai Lama very much agreed—that when depression reaches a certain degree of severity it may require biological interventions to normalize the brain to a degree sufficient to engage in behavioral strategies such as meditation.
Meditation and cognitive therapies
John Dunne, PhD, associate professor in the department of religion at Emory, served to bridge the more established scientific knowledge of depression with the still-nascent field of meditation research by highlighting intriguing similarities between cognitive-behavioral theories of depression and Buddhist understandings of the origin of emotional suffering. Dr Dunne noted that both disciplines recognize the important role played by negative cognitive schemas in the development of emotional suffering. These schemas are characterized by an excessive self-focus, an exaggerated and negative self-representation, and a tendency to hold to rigid interpretations of experience that confuse one's negative perceptions and emotions with actual external reality.
A central goal of Buddhist practice—which is relevant to depression—is to recognize that cognitive schemas are necessarily subjective and limited and are not the same thing as the larger reality they represent. Mirroring Dr Mayberg's earlier comment that the pain of severe depression makes it difficult for people to identify or empathize with others, Dr Dunne stressed that a Buddhist perspective would also acknowledge the importance of recognizing the depressive tendency to falsely place the self at the center of all events. It is in this context, he asserted, that meditation makes sense as an intervention for depression.
By cultivating mindfulness, he noted, meditation helps people recognize thoughts as thoughts. By enhancing compassion for others, meditation may offer an avenue for counteracting the negative self-focus that is common in depression.
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