Profile: Professor Sona Dimidjian talks cultivating mindfulness and mental wellness for women, children, and families
Professor Sona Dimidjian is a clinical psychologist, researcher and author. She is also a professor in the Department of Psychology and Neuroscience, and the director of the Renée Crown Wellness Institute, both at the University of Colorado. Her research includes preventing depression and supporting wellness in new and expectant mothers, as well as enhancing mindfulness and compassion among youth and families. She has a keen interest in navigating key developmental transitions, and in using technology to expand the access and the power of community-based partnerships.
We talked to Sona about her guiding principles, how she merges life experiences with conceptual theory, and the search for enduring impact.
The path to mindfulness
Can you share some of the values that have shaped your professional journey and areas of focus?
I’ve always been guided by a desire to help people through psychology. For as long as I can remember, I’ve had both an acute sense of the suffering that exists in the world, and dedication to bring whatever resources, attention, and energy I had to reducing it. I felt a resonance and fascination with psychology, and realized that the discipline of psychology, and the tools of science could be engaged for social benefit, elevating justice and reducing suffering. I’ve always seen the practice of science itself as an ethical one. There were some important events overlaid on top of that – collaborators and partners appeared at critical junctures who presented opportunities or influenced my direction – but they’ve all been rooted in an abiding commitment to listening deeply to the experiences of clients and people who are struggling.
The search for tangible, enduring ways to make a difference
After my initial psychology degree, I was really interested in clinical research and clinical practice, so I got my master’s in social work. I then worked in clinical and community settings with adolescents who were depressed, or experiencing suicidal thoughts or behaviors, and one of the clients we were working with died by suicide. It was a pivotal experience for me. I saw first-hand the gap between those who had access to the latest science and empirically based interventions, and those who didn’t. Seeing the kinds of barriers that exist for people based on geography, income, race, immigration status and language – and the potential impact that could have – made me question everything, and I thought that I didn’t want to be in the field anymore.
I left and worked in a catering company for a while. I still wanted to be grounded in direct ways of nourishing people, and doing things that were creative and uplifting, but I could see that while I had this in a daily or ‘moment to moment’ way, I didn’t have any enduring sense that I was tangibly making a difference. That was what I was looking for. When I realized this, I started thinking about going back to graduate school to work with Neil Jacobson, who was my graduate mentor at the University of Washington. He had a perspective on how to treat depression that was critical and simple, yet powerful, with a focus on behavioral activation. He also had a deep understanding of the relationship between science and practice, and the ethical responsibilities of psychological science and clinical research, which were important to me. I was in Seattle for nine years, and that transition was key in grounding my commitment to the importance of evidence and evidence-based practice. I appreciated the importance of using science to identify and understand what types of clinical interventions and programmes can be most effective for people, in a way that separates fact from assumption.
The merging of real-life experience and conceptual theory
I had my own mindfulness practice since high school, and it had weaved in and out of my life over the years. While I was in Seattle, Zindel Segal, Mark Williams and John Teasdale were starting to publish about Mindfulness Based Cognitive Therapy. As I was becoming aware of the benefits of those practices in my own life, their work helped me understand the conceptual theory about why those practices were relevant and important in terms of helping people recover and stay well from depression. For a long time, though, I kept my understanding of the conceptual theory separate from my personal experiences of mindfulness.
Neil Jacobson died abruptly of a heart attack when he was 50, at the end of my second year of graduate school. It was a shock and a great loss to our entire research community. He was very much a larger-than-life person, and I think we thought he’d live forever, so it was a lot to absorb and reckon with. As a way of navigating that, I turned to my own practice of mindfulness with a much greater focus.
After Neil died, Marsha Linehan became an important mentor for me. Marsha and dialectical behavior theory (DBT) have a strong grounding in mindfulness as a core skill, so that was a big focus of our conversations and connection. She was also great at encouraging people to bring their own life experiences into their work, or suggesting how they could do it, in ways that had profound and rippling benefits for many people. Once she had recognized how much mindfulness mattered to me, she kept asking why I was keeping it over in the corner of my life instead of bringing it into the centre of my work? That’s exactly what I did! I first tracked down Zindel Segal in a hotel lobby at a conference and explained what I wanted – or needed – to learn from him. I must have effectively communicated my sense of urgency because he very surprisingly agreed to supervise me. That might not seem like a big deal today, but at that time he was based in Toronto and I was in America, and people weren’t working remotely as they do now, so it was a new way of working.
A sense of responsibility
We started offering MBCT groups in the community with supervision and consultation from Zindel. There was a woman in the class who talked about doing the body scan at home with her toddler and listening to the audio practices with her little child. It was powerful to hear about how transformative it had been for her and her family: both as a mother, and in her relationship with her child. Crucially, she said it would have been even more beneficial if she could have learned the techniques when she was pregnant, because it would have spared all of them a lot of adversity and hardship in those early months.
Looking back, that was a critical moment for me, and it had real influence in my direction. I felt a profound, deep understanding of how true her point was, and a sense of responsibility to make sure this was not a missed learning opportunity for other parents during pregnancy and the post-partum period. The idea of learning these techniques beforehand, so they are with you during that potentially vulnerable phase, seemed so important, yet the research literature around non-pharmacological intervention options for women during pregnancy was so limited. I could see there was an opportunity to do more.
Another critical moment was when I was invited to do a year-long fellowship with the Beck Institute. People were introducing themselves, and Sherryl Goodman, a professor at Emory University who had studied the impact of depression among moms and kids for about 20 years, explained that she had been doing research on this. She had already demonstrated there were adverse impacts but was now starting to look at what could be done about it. I practically leapt across the table at her and said ‘I know what we can do about it! Do you want to work on this together?’ Throughout that year we established a collaboration, and have been working together since then, in a way that really brings intervention science and developmental science together in a beautiful way.
Cultivating mental wellness among mothers
This area has been a big research focus for you. Can you give a brief summary of your work with Sherryl Goodman?
The mindfulness based cognitive therapy work that Sherryl and I have done with women during pregnancy and postpartum was specific to people who had some prior experience with depression. They already know what depression is, how it feels, and how it impacts their lives. Those experiences are an important part of the learning process. They are aware of how challenging it is, and they ask questions about what they can do and learn now, that will help protect them from the recurrence of depression during pregnancy and early parenting.
We started working with the standard MBCT protocol that I’d used previously, but with a stance of curiosity, openness, and collaboration with groups of pregnant women. Throughout the eight sessions we asked questions, observed, listened, collected data, discussed and made modifications through a fairly lengthy adaptation process. Then we tested the modified protocol in a pilot clinical trial across two settings. We also did some initial survey and interview work with women to understand what they thought of this approach, what the benefits were, to what extent it matched what they were looking for, and the perception of needs that they had.
The power of accessibility
At the same time, Zindel and I continued to work together, and this collaboration was rooted in that early awareness of differences in accessibility. There’s a lot of knowledge and practices available to those who can access research centres and academic medical centres, or if they have access to psychology journals, but for most people in the world, that’s not the case. We focused on the question of how to increase access to these programmes, and how to ensure they still work outside of the rarefied, optimal conditions they have been delivered in so far. Zindel and I therefore started creating a programme called Mindful Mood Balance, which is a digital delivery of MBCT.
What excites you about the work you are doing now?
Over the last few years we’ve merged the work I’ve been doing with Sherryl Goodman and Zindel Segal to create a Mindful Mood Balance for Moms programme, and we’ve been actively studying it across multiple settings. We just finished a study in the US with women, who have histories of recurrent depression, and who were treated with antidepressants prior to pregnancy. We assigned them randomly to either the Mindful Mood Balance for Moms programme or their usual care, and then studied what they did with their medication, without manipulating or controlling it in any way. In this way, we will know how many decided to stay on medication, and how many came off. We will be able to examine whether this very brief skills-based, non-pharmacological approach provided protection to women who are at elevated risk of depression during pregnancy and postpartum.
We’re looking at this data now. I’m excited to share what we learn in the next few months because I think they are very relevant for the kinds of very personal mental health decisions that women are required to make currently without a lot of data to guide their choices.
What were the key clinical implications from the Mindful Mood Balance for Moms programme? What is important for clinicians to know?
We found that participating in this programme significantly reduced depression relapse for women, compared to usual care during pregnancy and postpartum, but I think it’s important that it’s a relatively brief programme. It’s two hours a week for eight weeks, and women reported practicing a few times a week, but even from that short time we saw enduring benefits through six months postpartum. That shows it’s possible for people to learn new skills in the context of their everyday lives, even during a vulnerable, transitionary, chaotic time like postpartum. We have evidence-based programmes which allow people to have confidence that the skills they’re learning can be practiced in manageable ways, even while they’re working, parenting or growing a whole human being, and that even short periods of practice can make a difference.
Sometimes the prospect of preventing or alleviating depression can feel like a Herculean endeavor, and when people feel overwhelmed or lacking in energy, it can be hard for them to imagine that it could be possible. This data shows that, with support, relief in the immediate and in the long term is within reach. This is how the power of science helps us to focus. In a world of possibility, there’s now something that we know has benefitted other people who share some aspects of your client’s history. It can help to give confidence, optimism and hope in that moment, and it can help to chart a path forward. That’s an optimistic and encouraging message for clinicians to give their clients.
The Crown Institute at Colorado University, Boulder
Can you share what is special about the Crown Institute?
The Crown Institute is inspiring for various reasons. It promotes the wellness of young people and the systems that support them using interdisciplinary research-practice partnerships, as well as co-creating and studying programs to help young people and families thrive. There’s a focus on enabling access to help, which goes back to some of my early commitments around creating equitable access to learning. It also uses the tools of science and technology to ensure that people have resources and opportunities for learning that work. Most excitingly, this is brought to life with an emphasis on working in partnership, whether that’s with young people, families, communities or schools to help ensure that all young people have an opportunity to start life learning skills and knowledge to be well for the long term. The Crown Institute addresses what it means to be well in a broader context, not just for the individual, but also the other people and systems in their lives that matter to them.
I met Dr. Patricia Crown in 2016, and we worked closely (alongside others) to establish the Crown Institute. At that first meeting, Dr. Crown said, “I want all kids to grow up knowing they’re okay, they’re not alone, and they can access the help they need.” That really resonated with my interest in the power of behavioral activation and contemplative practices. The strength of contemplative practices is grounded in a belief that we all have the capacities for learning and wellness inside us, and it’s worth thinking about how to start building those skills early enough in people’s lives for them to provide enduring benefits. At the same time, knowing that that requires an awareness that we don’t exist as individuals, we exist in a very interdependent way with other people and with our planet. Thinking about the wellness of one of us requires thinking about the wellness of all of us. That’s why we need to think carefully about inequality and injustice, and the importance of addressing that individually and at a community level.
Working at the Crown Institute has built on my core guiding principles and it’s been an amazing opportunity to deepen and expand the impact of the work I had been doing as an individual researcher and faculty member.
Can you explain a little more about the partnership and co-creation approach, and what that means practically?
After decades and centuries of the same old methods, people are suffering at ever more alarming rates today. People at younger and younger ages are struggling and suffering with greater and greater severity. We cannot afford to keep doing business as usual when it comes to people’s mental health and wellness: we need a deep commitment to a new approach. That’s what we’re aiming for with the participatory approach at the Crown Institute.
Accordingly, a core commitment for all the research and programmes within the institute is that we do research with people, not on people or for people. We should approach our research this way so that we can understand the right questions to ask, but this requires a willingness to work with humility. You have to tolerate starts and stops, twists, turns and messiness a way in which you don’t if you’re the only one who’s deciding the questions and the methods, where you can chart a course and follow it. You have to accept ambiguity and the unknown, learning as you go with curiosity and openness. I think that’s a critical skill for realizing the visions and goals that we have.
You’ve been working with mindfulness for a long time from both an academic, professional level, as well as your own personal practice and experience. Has your perspective changed over time and why?
My daughter is 20 now, but before I became a parent, I did a lot more residential retreats and practices of mindfulness where I would go and sit in silence for 10 days. When my daughter was a baby, I remember looking at these retreat centres and realizing how inhospitable and unwelcoming they were to families for the most part. An important part of developing my interest in mindfulness for new and expectant moms was the realization that we needed to make the experience more accessible, especially when seeing the barriers that working parents encounter. I was fortunate to have amazing mentors and support when I was a graduate student and their attitude was ‘you can totally do this; we’ll figure out how to make it work’. They supported me as an early career scientist and as a mother. I do want to ‘pay it forward’ from those amazing people who were supportive of me.
Both in professional settings and my own personal experience, I became much more curious around how mindfulness can be made accessible to someone who’s pregnant and working, who has a husband, or an infant. How can we bring this practice into their daily life without requiring them to separate themselves from the relationships in their lives. Fundamentally, these practices are about a person’s relationship with themselves and others; the notion that you must somehow learn to sever your ties or extract yourself from relationships is counterintuitive.
I still think there is a role for the quiet moments of formal practice. They allow you to focus in a particular kind of way, and can be important for nourishing yourself, particularly in a life that has a lot of commitments, or where you are spread thin or feel overwhelmed. Ultimately, though, it’s not about being quiet by yourself in a separate room, but about how you can bring that quiet, peace and centeredness to the chaos of your everyday life.
Have you found the ways to create tangible, enduring nourishment that you were searching for earlier in your career?
Absolutely! It comes from all the facets of the work I do now, intertwined with one another. I get to work with students and can appreciate the longevity of these bold and ambitious goals for the benefit of everyone. I can be sure that we are engaging the tools of science itself as an ethical practice.
The kinds of changes that we’ve been talking about, when considered at the level of our state of Colorado, the US, or the entire world, will take many generations to accomplish. One of the gifts of working with students is knowing that they are the next generation who will carry forward these values, this vision, and this work. It’s both essential and inspiring to know that we are laying the foundation for more generational change.
Studying the practices and programmes that we are developing in partnership with young people, families, communities, and teachers has shown how enduring this type of support can be. Through these processes of co-creation, we can see the benefits both in that moment and in the longer term.
Being part of an amazing emerging community of researchers, practitioners and community members – through the Crown Institute – has also been incredibly rewarding. We have a very strong commitment to aligning what we do with how we do it, which allows everyone to see and feel those tangible benefits, and to be nourished by this work in their everyday life. It’s pretty awesome!
|Dimidjian, S., & Goodman, S. H. (2019). Expecting mindfully: Nourish your emotional well-being and prevent depression during pregnancy and postpartum. Guilford Publications. Chicago.|
|Dimidjian, S., & Segal, Z. V. (2015). Prospects for a clinical science of mindfulness-based intervention. American Psychologist, 70(7), 593.|
|Dimidjian, S., Barrera Jr, M., Martell, C., Muñoz, R. F., & Lewinsohn, P. M. (2011). The origins and current status of behavioral activation treatments for depression. Annual review of clinical psychology, 7, 1-38.|