What is Mindfulness-Based Cognitive Therapy (MBCT)?

Mindfulness-based cognitive therapy (MBCT)

Mindfulness-based cognitive therapy, also known as MBCT, is a group-based treatment program that was originally developed by Segal, Williams, & Teasdale (2002) 1 to prevent relapse in clinical populations with recurrent major depressive disorder (MDD). The MBCT program helps participants learn to step out of habitual, automatic patterns of the mind and body that arise during depressive episodes. MBCT targets cognitive reactivity by teaching participants to develop different ways of relating to sensations, thoughts, and feelings that contribute to depressive relapse. By becoming more aware of body sensations, feelings, and thoughts through mindfulness techniques, participants learn to recognize, accept, and disengage from habitual patterns that might cause recurring challenges.

Course Format: The MBCT program follows a manualized protocol 1 including The Mindful Way Workbook 2 for course participants (Segal, Williams, & Teasdale, 2002). MBCT provides instructions for integrating meditation, mindfulness movement, and cognitive techniques over an 8-week course. In the first four sessions, participants learn the basics of mindfulness. This includes learning to become aware of how little attention is paid in daily life, noticing how quickly the mind shifts, and restoring focus using body scan, a technique that teaches participants to pay attention to bodily sensations in a gradual sequence from the feet to the head. Participants also learn how mind wandering allows negative thoughts and feelings to escalate. In the last four sessions, participants focus on recognizing and skillfully responding to shifts in mood. As participants develop their mindfulness practices in class and at home using audio recorded instructions, participants learn to approach patterns of negative moods and thoughts by simply allowing and exploring these thoughts while using breathing practices as a focal point for their awareness. MBCT is not recommended for patients who are acutely suicidal, currently abusing drugs or alcohol, experiencing a major crisis, and are active in other mental health treatment.

“By becoming more aware of body sensations, feelings, and thoughts through mindfulness techniques, participants learn to recognize, accept, and disengage from habitual patterns that might cause recurring challenges.”

Instructor Requirements: Similar to other mindfulness-based interventions, the MBCT course has instructor requirements. Importantly, the instructor must maintain an on-going meditation practice to appropriately and skillfully navigate the challenges that participants might encounter. The creators of MBCT emphasize that the instructors’ basic understanding of mindfulness and personal orientation will be one of the most powerful influences affecting this process. Additionally, although the second edition of the MBCT manual (Segal, Williams, & Teasdale, 2012) aims to cultivate mindfulness and self-compassion, the authors advise against explicitly teaching self-compassion to clinically depressed individuals, as this could perpetuate feelings of being unlovable and unworthy. Instead, the instructor should implicitly embody kindness and compassion through their presence, guidance in meditation practice, and responses to participants’ discussion3.

Course Outcomes: MBCT has been developed to improve concentration, mindful awareness of thoughts, emotions, and body sensations, acceptance, decentering, and a non-fixing attitude. According to several empirical studies3, MBCT participants report a range of improvements for depression, anxiety, rumination, insomnia, tension, mindfulness, compassion, self-compassion, concentration, resilience, optimism, and quality of life. 

Clinical Populations: Robust empirical evidence from meta-analyses (an analysis of many independent studies on the same subject) supports its therapeutic effectiveness across a range of disorders. A growing body of empirical studies demonstrates that MBCT significantly reduces the risk of depressive relapse by 35% compared to standard treatment, and by 44% for patients with three or more depressive episodes5. These are similar to the rates found for antidepressant treatment. MBCT has also been used to treat different clinical populations and disorders including children6,  adolescents7, pregnant women at risk for depression8, hypochondriasis9, chronic fatigue syndrome10, tinnitus11, auditory hallucinations12, insomnia13, social phobia14, generalized anxiety disorder15, panic disorder, depression in primary care16, and cancer patients17. As clinicians and researchers continue to test and expand its clinical application, MBCT has become one of the most versatile mindfulness-based interventions.

Official Link: MBCT Protocol

References

  1. Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. Guilford Press.
  2. Teasdale, J. D., Williams, J. M. G., & Segal, Z. V. (2014). The mindful way workbook: An 8-week program to free yourself from depression and emotional distress. Guilford Publications.
  3. Segal, Z. V., Williams, M., & Teasdale, J. (2018). Mindfulness-based cognitive therapy for depression. Guilford Publications.
  4. Piet, J., & Hougaard, E. (2011). The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: a systematic review and meta-analysis. Clinical psychology review, 31(6), 1032-1040.
  5. Semple, R. J., & Lee, J. (2014). Mindfulness-based cognitive therapy for children. In Mindfulness-based treatment approaches (pp. 161-188). Academic Press.
  6. Bögels, S., Hoogstad, B., van Dun, L., de Schutter, S., & Restifo, K. (2008). Mindfulness training for adolescents with externalizing disorders and their parents. Behavioural and cognitive psychotherapy, 36(2), 193-209.
  7. Dimidjian, S., & Goodman, S. (2009). Nonpharmacological intervention and prevention strategies for depression during pregnancy and the postpartum. Clinical obstetrics and gynecology, 52(3), 498.
  8. McManus, F., Surawy, C., Muse, K., Vazquez-Montes, M., & Williams, J. M. G. (2012). A randomized clinical trial of mindfulness-based cognitive therapy versus unrestricted services for health anxiety (hypochondriasis). Journal of consulting and clinical psychology, 80(5), 817.
  9. Rimes, K. A., & Wingrove, J. (2013). Mindfulness‐based cognitive therapy for people with chronic fatigue syndrome still experiencing excessive fatigue after cognitive behaviour therapy: a pilot randomized study. Clinical psychology & psychotherapy, 20(2), 107-117.
  10. Philippot P, Nef F, Clauw L, de Romrée M, Segal Z. A randomized controlled trial of mindfulness-based cognitive therapy for treating tinnitus. Clin Psychol Psychother. 2012 Sep;19(5):411-9. doi: 10.1002/cpp.756. Epub 2011 May 12. PMID: 21567655.
  11. Chadwick, P., Hughes, S., Russell, D., Russell, I., & Dagnan, D. (2009). Mindfulness groups for distressing voices and paranoia: a replication and randomized feasibility trial. Behavioural and Cognitive Psychotherapy, 37(4), 403.
  12. Britton, W. B., Haynes, P. L., Fridel, K. W., & Bootzin, R. R. (2012). Mindfulness-based cognitive therapy improves polysomnographic and subjective sleep profiles in antidepressant users with sleep complaints. Psychotherapy and psychosomatics, 81(5), 296-304.
  13. Piet, J., Hougaard, E., Hecksher, M. S., & Rosenberg, N. K. (2010). A randomized pilot study of mindfulness‐based cognitive therapy and group cognitive‐behavioral therapy for young adults with social phobia. Scandinavian Journal of Psychology, 51(5), 403-410.
  14. Craigie, M. A., Rees, C. S., Marsh, A., & Nathan, P. (2008). Mindfulness-based cognitive therapy for generalized anxiety disorder: A preliminary evaluation. Behavioural and Cognitive Psychotherapy, 36(5), 553.
  15. Kim, B., Lee, S. H., Kim, Y. W., Choi, T. K., Yook, K., Suh, S. Y., … & Yook, K. H. (2010). Effectiveness of a mindfulness-based cognitive therapy program as an adjunct to pharmacotherapy in patients with panic disorder. Journal of Anxiety Disorders, 24(6), 590-595.
  16. Shawyer, F., Meadows, G. N., Judd, F., Martin, P. R., Segal, Z., & Piterman, L. (2012). The DARE study of relapse prevention in depression: design for a phase 1/2 translational randomised controlled trial involving mindfulness-based cognitive therapy and supported self monitoring. BMC psychiatry, 12(1), 1-11.
  17. Foley, E., Baillie, A., Huxter, M., Price, M., & Sinclair, E. (2010). Mindfulness-based cognitive therapy for individuals whose lives have been affected by cancer: a randomized controlled trial. Journal of consulting and clinical psychology, 78(1), 72.

 

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Michael Juberg

Michael is pursuing his Ph.D. in Clinical Psychology at the University of Hawai’i, Mānoa.

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