Chronic depression (CD) is a prevalent disease that has serious effects for individuals and society. In general terms, success rates and treatment effects in chronic depression patients are significantly lower compared to the non-chronic depression forms. Current treatment approaches have initially focused on diminishing the adverse effects of chronic depression and paid very little attention on encouraging the positive effect.
Previous studies have shown that the metta meditation increases the positive effect in chronic depression patients. In Buddhism, metta means “helpfulness”, “loving-kindness” and “sincerity”. It stands for an “unselfish” and “unconditionally compassionate” mental attitude that one develops through meditation, toward all entities in one’s relationships with others. Differently from attention-based meditation, the metta meditation (or the loving-kindness meditation) aims to develop a positive attitude toward oneself and others through clearly positive emotional situations. The individual is encouraged for positive activities, helpful behaviors and to develop relationships with others by focusing on individually-created and recurrent methods.
Depression is characterized as the case of high negative effect and low positive effect. This stands for the fact that the negative effect must be reduced while encouraging the positive effect in the treatment of depression. In chronic depression, experiential avoidance and rumination are particularly associated with negative effects and have a strong impact over the permanence of the depression. The awareness meditation could be an approach toward diminishing these mechanisms, because it develops a descriptive attitude toward a negative, yet at the same time, a positive evaluation. Fredrickson formulated a theory that is empirically supported in terms of why an increase in positive effect will be beneficial for individuals in the long run and how it can be encouraged. According to her theory, people having positive feelings expand their attention, they are able to think more flexibly unlike the negative feelings, in which the center of focus is usually narrowed by threats.
Chronic depression is frequently associated with high self-criticism. A bigger motivation to treat oneself better could help make up for this deficit. Furthermore, an increase in the positive effect can also contribute to the increase of the resistance. A recently published study has shown that the metta meditation not only diminishes depression but also improves the psychological well-being and interpersonal relations. Patients reported that there were significant changes in their emotional regulation strategies: The acceptance increased whereas the suppression of negative feelings and rumination decreased. In another study conducted with the patients suffering from CD, specific evidences were found that support the feasibility and reliability of a group therapy, in which awareness and metta meditation were merged through cognitive behavioral techniques.
Avoidance and suppression are not functional strategies in regulating negative emotions, and they prevent one from healing from depressive attacks. Nevertheless, developing an acceptable attitude toward negative emotions is only an important predictor of a successful treatment. Surprisingly, there are increasing number of evidences, setting forth that people with depression suppress not only negative and compelling emotions but also positive emotions. Therefore, avoidance of behavioral level and experiential avoidance can explain the depression being continuous and chronic.
Traditional methods of treatment for depression mainly focus on diminishing the negative effects and teaching interpersonal skills. The metta-based group meditation and individual cognitive behavioral therapy (MeCBT) expand the focus of the treatment up to the positive effect and helpfulness toward other people. Previous studies showed that an independent group meditation, including attention and metta, is a proper technique to increase the positive effect in chronic depression patients and to diminish the depressive indications. Therefore, an independent group meditation is an affordable intervention to stimulate the commencement of the therapeutic process. An additional CBT (Cognitive Behavioral Therapy) enables specific problems to be treated effectively and helps meditation practices be implemented on daily life in a more permanent manner, which in turn reduces the risk of recurrence.