Person stretches at sunset in field of flowersMindfulness-based cognitive therapy (MBCT) combines cognitive behavioral techniques with mindfulness strategies in order to help individuals better understand and manage their thoughts and emotions in order to achieve relief from feelings of distress.

Though originally developed to address recurrent depression, MBCT may be beneficial to people seeking treatment for a wide range of mental health concerns. 

Development of MBCT

MBCT, which was developed by Zindel Segal, Mark Williams, and John Teasdale, is primarily derived from the earlier work of Teasdale, Jon Kabat-Zinn, and Phillip Barnard.

The approach, which is still relatively new—the first clinical trial was published in 2000—incorporates principles from Kabat-Zinn's mindfulness-based stress reduction modality, an 8-week program designed to help people cope with the mental and physical effects of health concerns, and Bernard and Teasdale's ICS (interactive cognitive subsystems) model. ICS is based on the premise that the human mind possesses different modes for receiving and processing data, the two primary modes of which are the “being” mode and the “doing” mode. The model also suggests mental health may be dependent on a person's ability to detach from one mode and move between other modes, based on what is present in the environment. The MBCT program emphasizes the “being” mode, as this mode is believed to promote lasting emotional change, specifically for individuals experiencing recurrent depressive episodes. 

How Does MBCT Work?

In this therapy approach, people can learn how to use cognitive methods and mindfulness meditation to interrupt the automatic processes often triggering depression. Low mood, negative thoughts, and certain body sensations such as weariness and sluggishness often occur together during an episode of depression. Even after the episode passes, connections may still exist between the different symptoms, and it is possible for a small negative stimulus to trigger a large downward spiral: Researchers have found when people with a history of depression experience a low mood, they may also experience negative memories and thoughts from the past, which may, in turn, lead to worry about the future and physical sensations such as fatigue.

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MBCT helps participants learn how to recognize their sense of being and see themselves as separate from their thoughts and moods. This disconnect can allow people to become liberated from thought patterns in which the same negative messages may be replayed over and over. After developing an awareness of the separation between thoughts, emotions, and the self, people in treatment may find that while the self and the emotions may exist simultaneously, they do not have to exist within the same dimension. This insight can contribute to healing by helping individuals learn to interject positive thoughts into negative moods in order to disarm those negative moods. 

In general, MBCT attempts to give participants the necessary tools to combat depressive symptoms as they arise. People who learn these skills may then be able to revert to these methods in times of distress or when faced with potentially overwhelming situations.

Techniques Used in MBCT

This therapy is delivered as a weekly group treatment program over the course of eight weeks. Each weekly session lasts for two hours, but completing a 45-minute homework assignment six days a week is also required. For homework, participants listen to audio recordings and practice mindfulness meditation. People in treatment are also introduced to a technique called the three-minute breathing space. This technique encourages participants to incorporate formal practice into their day-to-day life. 

Though there is currently no consensus as to how mindfulness should be defined, the basic concept refers to the practice of developing, in a non-judgmental manner, a deeper awareness of what is happening within one’s mind and body from moment to moment. Certain meditation techniques—breathing meditations, sitting meditations, body scan meditations, walking meditations, and yoga—may help to improve a person’s mindfulness. In MBCT, individuals in treatment are also taught cognitive concepts such as the association between thoughts and feelings, and they also often have the opportunity to develop a deeper understanding of depression.

Issues Treated with MBCT

Mindfulness is believed to promote good health, and many studies have associated mindfulness with decreases in depression and anxiety. Thus, many mental health professionals have incorporated mindfulness-promoting activities into therapy sessions, and these activities have been shown to help reduce symptoms of depression, decrease stress, and improve emotional control, regardless of the specific issues being addressed.  

MBCT in particular may be used as a primary treatment modality or in conjunction with other forms of therapy. Individuals experiencing certain medical concerns may also obtain benefit from MBCT: In a 2013 study of 33 women with fibromyalgia, researchers found that those who were treated with MBCT demonstrated a significantly reduced impact of fibromyalgia, a significant decrease in depressive symptoms, and a slight decrease in the intensity of bodily pain when compared to those who did not receive MBCT. Researchers have also shown individuals with cancer, diabetes, chronic pain, and epilepsy who incorporate MBCT into treatment plans may see improvement in well-being.

Over the past 15 years, the results of numerous randomized controlled trials have demonstrated that MBCT can be a powerful intervention for people who have experienced clinical depression three or more times. Evidence indicates MBCT may reduce the rate of relapse for individuals with recurrent depression by 50%. MBCT has also been applied to mood and anxiety concerns other than depression, with reported success. A 2014 review of the usefulness of MBCT as a treatment modality for several health conditions found the approach may be effective when addressing issues such as depressive relapse, current depression, residual depression, bipolar, anxiety, food and eating issues, and psychosis, among others. 

Training and Certification

Certification in MBCT is provided by a number of approved institutions around the world, including the UCSD Mindfulness-Based Professional Training Institute (United States), the Oxford Mindfulness Centre (England), the University of Geneva (Switzerland), The Centre for Mindfulness Studies (Canada), and Bangor University (Wales). Therapists who are interested in gaining certification as a teacher of MBCT are required to fulfill two training phases: teacher qualification and teacher certification. 

The teacher qualification phase provides applicants with the necessary foundation for teaching MBCT. It consists of six steps:

  • Satisfy the prerequisites for a five-day MBCT teacher training retreat
  • Attend and participate in the retreat or acquire equivalent training
  • Successfully complete either the MindfulNoggin Online MBCT course or the Participant Observer in Live MBCT course
  • Apply for teacher-in-training status after successful completion of the program
  • Receive a minimum of 20 hours of mentorship while teaching at least two MBCT courses, where each course lasts for eight weeks 
  • Submit application for teacher qualification

Once teacher qualification status has been achieved, applicants may present themselves as a “qualified teacher of MBCT” and begin phase two of the training process if they wish to pursue certification. Teacher certification involves the following five steps:

  • Obtain teacher qualification
  • Teach at least three additional eight-week MBCT courses after receiving teacher qualification
  • Attend and complete the Advanced Teacher Training Intensive (ATTI)
  • Receive a minimum of 10 hours of mentorship while teaching an MBCT course
  • Submit application for teacher certification

Limitations and Concerns

The effectiveness of mindfulness based cognitive therapy is supported by considerable empirical evidence and has. according to research, generally produced positive results for people in treatment. However, because it is a relatively new treatment modality, the long-term benefits of this approach may not yet be fully determinable. A growing body of empirical evidence supports the approach, but further research may provide greater support for its effectiveness when treating bipolar, eating issues, psychosis, and other conditions.

Several critics have highlighted methodological shortcomings in some MBCT studies such as small sample size, a lack of control groups, and a lack of randomization, all of which have potential to affect the results obtained. More rigorous studies are needed to evaluate whether MBCT is more effective than other, more widely practiced forms of therapy, such as cognitive behavioral therapy.

References: 

  1. Mindfulness-based cognitive therapy. (n.d.). Retrieved from http://bemindful.co.uk/understanding-mindfulness/mindfulness-based-cognitive-therapy
  2. Metcalf, C.A., & Dimidjian, S. (2014). Extensions and mechanisms of mindfulness-based cognitive therapy: A review of the evidence. Australian Psychologist, 49(5), 271-279. DOI: 10.1111/ap.12074
  3. Depression in adults: Recognition and management. (2009). Retrieved from http://www.nice.org.uk/guidance/cg90/chapter/key-priorities-for-implementation#psychological-interventions-for-relapse-prevention
  4. 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. DOI: 10.1007/s10608-013-9538-z
  5. Sipe, W.E., & Eisendrath, S.J. (2012). Mindfulness-based cognitive therapy: Theory and practice [Abstract]. Canadian Journal of Psychiatry, 57(2), 63-69. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22340145
  6. MBCT teacher qualification and certification. (n.d.). Retrieved from http://mbpti.org/mbct-teacher-qualification-and-certification