Mindfulness-based cognitive therapy (MBCT) combines elements of mindfulness practice and cognitive behavioral therapy to help individuals develop greater awareness and acceptance of their thoughts, emotions, and experiences in order to cultivate resilience and prevent relapse in depression and anxiety.
This psychotherapy was designed to help people who experience repeated episodes of depression and to help prevent depression from returning. Mindfulness interventions have shown promise for improving OCD symptoms (Pseftogianni et al., 2023).
MBCT usually takes the form of 8 weekly sessions, with guided meditations accompanying the program so that participants can practice skills at home throughout the course.
What is Mindfulness?
Mindfulness is a type of meditation that focuses on being aware of any sensations and feelings in the present moment without interpretation or judgment.
It is a compassionate type of awareness with a sense of knowing what is happening in the external and internal world as it is happening.
Mindfulness has grown in popularity over recent years and can involve breathing methods, guided imagery, and other practices to relax the body and mind and help reduce stress and anxiety.
How was mindfulness-based cognitive therapy developed?
In the 1990s, psychologists Jon Teasdale and Phillip Barnard found that the mind had two main modes: the ‘doing’ mode and the ‘being’ mode.
The ‘doing’ mode is goal-orientated, triggered when the mind sees a difference between how things are and how it wants things to do. Whereas the ‘being’ mode isn’t focused on achieving specific goals but rather accepting and allowing what is.
It was found that the ‘being’ mode was the one that led to lasting emotional changes.
Therefore, the psychologists concluded that effective cognitive therapy would have to promote not just cognitive awareness but also the ‘being’ mode of the mind, such as mindfulness offers.
Psychiatrists Zindel Segal and Mark Williams, as well as Jon Kabat-Zinn, became involved and helped combine these new ideas about cognitive therapy with Kabat-Zinn’s 1979 mindfulness-based stress reduction program to create what is known as MBCT.
The program was developed specifically for depression. What is known about depression is that it is a recurrent and episodic condition, with people more likely to continue having depressive episodes for years.
With MBCT, the idea is that the person with depression will learn skills to catch negative thought spirals as they are happening and be able to disengage from them before it develops into a depressive episode.
Goals of mindfulness-based cognitive therapy
The MBCT website outlines three ways in which mindfulness practice can help people:
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To help you understand what depression is.
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To help you discover what makes you vulnerable to downward mood spirals and why you get stuck at the bottom of the spiral.
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To help you see the connection between negative thinking and downward spirals. This includes setting unrealistically high standards for yourself, feelings that you are simply not good enough, and ways you may lose touch with what makes life worth living.
MBCT vs. CBT
MBCT and cognitive behavioral therapy (CBT) help recognize unhelpful thoughts and involve learning that these thoughts aren’t facts but something one can take a wider view of.
They both aim to make the person feel less likely to be drawn into automatic reactions to thoughts, feelings, and events. Also, both CBT and MBCT are short to medium-term therapies, and both tend to work best for those with depression and anxiety.
The main difference between the two therapies is that MBCT uses mindfulness, which involves recognizing what is going on in the present moment, and how an individual is thinking, feeling, and experiencing in the present moment.
CBT, on the other hand, uses cognition to understand negative thought processes – it is very analytical, with clients charting their emotions and reactions as homework.
So, while MBCT encourages noticing what is going on around the person, CBT encourages the person to constantly notice their thoughts.
CBT also encourages the individual to push out unhelpful thoughts, whereas MBCT involves letting negative thoughts drift through the mind without judgment.
Techniques
MBCT utilizes a combination of mindfulness meditation, cognitive restructuring, and psychoeducation to help individuals recognize and modify unhelpful thought patterns, increase self-compassion, and develop a more present-focused and accepting mindset.
Below are some of the techniques specifically used in MBCT:
Meditation
People may learn meditative techniques during MBCT. This can involve practicing guided or self-directed meditation that helps them gain a greater awareness of their body, thoughts, and breathing.
Body scan exercise
This exercise typically involves lying down in a comfortable position and focusing on the breath, noticing the rhythm and sensation of this.
Then, the individual will be asked to bring awareness to different areas of their body, usually beginning at the toes and moving up through the body until they reach the top of the head.
During this awareness, they will be asked to note how each part of their body feels, the texture of clothing against their skin, any temperature or sensations they feel, and whether areas feel sore or heavy/light.
Mindfulness practices
This involves becoming more aware of the present moment. It is something that can be practiced during meditation but can also be incorporated into the everyday activities people complete.
For instance, mindfully making a cup of tea, mindfully washing up, and mindful cooking.
Mindfulness stretching
This technique involves stretching the body in a mindful way to help bring awareness to the body and the mind.
Rushing straight into exercise can be a missed opportunity to prepare the mind and body for physical exertion.
Mindfulness stretching can also add more benefits to exercise, such as increased awareness and a sense of balance.
Yoga
MBCT may also encourage people to practice yoga poses that can help facilitate mindful stretching of the body.
Some poses can help to open up the chest or other areas of the body, bring awareness to parts of the body, and incorporate working and moving with the breaths.
3-minute breathing space
People in MBCT may be taught what is known as the 3-minute breathing space technique. This focuses on three steps, each one minute in duration:
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Observing the experience (the individual brings awareness to how they are doing at that moment).
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Focusing on the breath.
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Attending to the body and any physical sensations that might be experienced.
These techniques of MBCT allow the individual to move away from automatic and unhelpful responses, towards an understanding that there are other ways to respond to situations.
By developing a mindfulness meditation routine, individuals can use the techniques whenever they start to feel overwhelmed by negative emotions.
The idea is that when sadness occurs and starts to bring up all the usual negative associations that trigger depressed feelings, the individual is equipped with the tools that will help them substitute negative thought patterns with positive ones.
What can mindfulness-based cognitive therapy help with?
MBCT was developed for people with recurring episodes of depression or unhappiness to prevent a relapse.
Though originally developed to address recurrent depression, MBCT can be a beneficial treatment for a wide range of concerns, including:
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Anxiety disorders such as generalized anxiety disorder (GAD)
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Addictions
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Bipolar disorder
- OCD
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Traumatic brain injury
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Depression associated with medical illnesses
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Treatment-resistant depression
- Psychotic disorders
What does the research say?
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Five mental health services from a range of regions in the United Kingdom contributed data to examine the impact of MBCT on depression. Of the group, 96% sustained their recovery across the treatment period.
There was also a significant reduction in residual symptoms consistent with a reduced risk of depressive relapse (Tickell et al., 2019).
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MBCT was shown to be an effective treatment for relieving anxiety and depressive symptoms in patients with panic disorder and GAD (Kim et al., 2009).
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A self-help method of MBCT was tested for effectiveness. It was found that participants showed significant interaction in favor of self-help on measures of depression, anxiety, stress, satisfaction with life, mindfulness, and self-compassion (Taylor et al., 2014).
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MBCT was compared to antidepressant treatment for depression. It was found that while 48% of those taking antidepressants did not relapse, 52% of those who undertook MBCT did not relapse.
There was no big difference between these two types of treatment, suggesting that MBCT can be as effective at preventing relapses as antidepressants (Kuyken et al., 2015).
Benefits of mindfulness-based cognitive therapy
In MBCT, individuals are taught cognitive concepts, such as the association between thoughts and feelings, and they also have the opportunity to develop a deeper understanding of depression.
Rather than trying to avoid or eliminate sadness or other difficult emotions, people learn to change their relationship with these emotions.
The skills learned can be used whenever feelings of intense and persistent sadness occurs, and the person will be prepared to handle uncomfortable emotions.
How does mindfulness help reduce downward mood spirals?
Mindfulness practice is thought to help us see more clearly when we have unhelpful patterns of the mind, such as tunnel vision, and learning how to recognize when our mood is beginning to go down.
This means that we may be more likely to catch it earlier than we would before.
It can teach us how to get back in touch with the experience of being alive – learning to savor the simple pleasures that have been available all along but taken for granted.
Mindfulness may help stop the escalation of hurtful memories and thoughts from the past and teach us to focus on the present moment rather than reliving past experiences or pre-living the future.
Practicing mindfulness can help us enter an alternative mode of mind that includes thinking but is bigger than thinking.
It teaches us to shift from the mode of mind dominated by critical thinking, which is likely to provoke downward mood spirals, to another mode of mind where we experience the world directly, without judgment.
Mindfulness can help to develop our willingness to experience emotions and our capacity to be open to painful emotions. It helps to give us the courage to allow distressing moods, thoughts, and sensations to come and go without having to struggle with them.
We may also discover that difficult and unwanted thoughts and feelings can be held in awareness and seen from a different perspective which brings with it a sense of compassion to the suffering we are experiencing.
Considerations
MBCT has potential limitations to consider. It may not be suitable for severe mental health conditions, and consistent commitment to mindfulness practice is necessary for its effectiveness.
Therapist training and competence are crucial for delivering MBCT successfully. Inadequate training or experience in mindfulness-based approaches can impact the quality of therapy and outcomes for individuals.
While MBCT has been effective in reducing relapse rates for depression and anxiety, it may not provide foolproof protection against future relapses. Some individuals may still experience relapses despite engaging in MBCT.
Further research is needed to explore its long-term effects, compare it to other treatments, and determine its efficacy for specific populations and conditions.
These limitations highlight the importance of considering individual suitability and seeking professional guidance when using MBCT.
How to get the most out of mindfulness based cognitive therapy
How can I seek MBCT?
It’s important to talk to your doctor about your symptoms to determine if this is the right approach for you. Talk to your doctor or consider searching an online therapist directory to find an MBCT therapist.
Depending on the availability of trained MBCT therapists in your area, finding classes may be challenging. An MBCT therapist is a mental health professional who has additional training in mindfulness-based practices and techniques and is skilled in teaching these techniques to others.
Mindfulness has become increasingly popular for promoting mental health, so even mental health professionals who are not specifically trained in MBCT may incorporate some aspects of mindfulness practices in their therapy sessions.
It may be worth contacting therapists and asking if this is something they offer in their treatment.
What can I expect from MBCT sessions?
MBCT is a group intervention that lasts for eight weeks. Each session lasts for about 2 hours, and there is usually a one-day-long class, typically after the 5th week.
Much of the work done in MBCT is completed outside of the sessions. Participants are asked to do homework, which includes listening to recorded guided meditations and trying to cultivate mindfulness in their daily lives.
These homework assignments are usually 45 minutes long, six days a week.
Things to consider before starting MBCT
Much of the research on MBCT is still ongoing as it is a relatively new practice; therefore, the long-term effects are not as well known yet.
MBCT involves a lot of commitment, so you need to be prepared to attend the weekly sessions and complete the homework assignments to ensure you get the most out of the therapy.
In addition to checking credentials, it’s important to find an MBCT therapist who you feel comfortable with.
Further Information
References
Bank, S., Burgess, M., Sng, A., Summers, M., Campbell, B., & McEvoy, P. (2020). Stepping Out of Social Anxiety. Perth, Western Australia: Centre for Clinical Interventions.
Kim, Y. W., Lee, S. H., Choi, T. K., Suh, S. Y., Kim, B., Kim, C. M., Cho, S. J., Kim, J. M., Yook, K., Ryu, M., Song, S. K. & Yook, K. H. (2009). Effectiveness of mindfulness‐based cognitive therapy as an adjuvant to pharmacotherapy in patients with panic disorder or generalized anxiety disorder. Depression and anxiety, 26(7), 601-606.
Kuyken, W., Hayes, R., Barrett, B., Byng, R., Dalgleish, T., Kessler, D., Lewis, G., Watkins, E., Brejcha, C., Cardy, J., Causley, A., Cowderoy, S., Evans, A., Gradinger, F., Kaur, S., Lanham, P., Morant, N., Richards, J., Shah, P., Sutton, H., Vicary, R., Weaver, A., Wilks, J., Williams, M., Taylor, R. S. & Byford, S. (2015). Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): a randomised controlled trial. The Lancet, 386(9988), 63-73.
Mindfulness Based Cognitive Therapy. (n.d.). Retrieved 2022, February 17, from: https://mbct.co.uk/about-mbct/
Parra-Delgado, M., & Latorre-Postigo, J. M. (2013). Effectiveness of mindfulness-based cognitive therapy in the treatment of fibromyalgia: A randomised trial. Cognitive therapy and research, 37(5), 1015-1026.
Pseftogianni, F., Panagioti, M., Birtwell, K., & Angelakis, I. (2023). Mindfulness interventions for obsessive–compulsive and related disorders: A systematic review and meta-analysis of randomized controlled trials. Clinical Psychology Review, 233-243. https://doi.org/10.1037/cps0000132
Taylor, B. L., Strauss, C., Cavanagh, K., & Jones, F. (2014). The effectiveness of self-help mindfulness-based cognitive therapy in a student sample: a randomised controlled trial. Behaviour Research and Therapy, 63, 63-69.
Tickell, A., Ball, S., Bernard, P., Kuyken, W., Marx, R., Pack, S., Strauss, C., Sweeney, T. & Crane, C. (2020). The effectiveness of mindfulness-based cognitive therapy (MBCT) in real-world healthcare services. Mindfulness, 11(2), 279-290.
