Mindfulness-Based Cognitive Therapy (MBCT)

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Mindfulness-Based Cognitive Therapy (MBCT)

THC Editorial Team January 20, 2021
Thanatopsis 1850 Landscape Art
Landscape—Scene from "Thanatopsis," 1850, Asher Brown Durand, The Metropolitan Museum of Art

Contents

What Is Mindfulness-Based Cognitive Therapy?

Mindfulness-based cognitive therapy (MBCT) is a form of therapy that alleviates anxiety by encouraging people to pay attention to their present experiences and physical sensations with a nonjudgmental sense of openness and curiosity. Rumination, or the replaying of intense worries, is a major component of both anxiety and depression.1 Recurrent thoughts, which can be past- or future-oriented, often demand people’s full attention and may negatively affect their quality of life. MBCT uses the techniques and tools of mindfulness to disrupt people’s negative, habitual, and irrational thought processes by decreasing their cognitive reactivity to such thoughts. It also combines cognitive therapy with meditative and mindfulness practices to cultivate aware, calm states. Crucially, MBCT promotes acknowledging negative thoughts and/or circumstances while simultaneously addressing internal mental and emotional distress with kindness and empathy.2

MBCT is rooted in mindfulness practices, which differ starkly from typical approaches to life in technology-saturated contemporary societies. People often struggle to focus on a given thought or task, and their minds wander restlessly. Even if people are able to focus on the present moment, they often critique, judge, or even reject certain emotions or thoughts that arise. One study analyzed over 2,000 adults who were randomly assigned to either a certain question about happiness or a question about whether they were thinking about the activity they were currently doing. They found that mind wandering was a frequent occurrence and that individuals who experience increased mind wandering and decreased attention to their present experiences are more likely to be unhappy.3 Mindfulness exercises seek to help people cultivate a noncritical present awareness of their current states and to promote happiness, greater well-being, and reduced negativity.4

What Is the History of Mindfulness-Based Cognitive Therapy?

The idea of mindfulness and the techniques involved originated in Eastern meditative practices and religious traditions. Those techniques are now incorporated into contemporary research due to their mental health treatment abilities.5

In the late 1970s, pioneering academic Jon Kabat-Zinn created a mindfulness-based stress reduction (MBSR) program. A group of clinicians, Segal, Williams, and Teasdale subsequently adapted MBSR and created mindfulness-based cognitive therapy (MBCT). Although MBSR and MBCT both utilize an 8-week structure in which trained instructors teach clients meditative practices to cultivate mindfulness, their goals are different. MBSR can help with physical and emotional pain, fear, panic, and various types of stress, whereas MBCT was initially developed to prevent relapse in individuals with recurrent depression. MBCT has since expanded to treat a variety of psychological conditions, but it explicitly focuses on alleviating low moods and negative thoughts.6

How Does Mindfulness-Based Cognitive Therapy Work?

People who undergo MBCT generally meet with a clinician, often in a group setting, for a 2-hour session once per week for 8 weeks. MBCT participants are typically assigned 45 minutes of additional at-home practice.7

Several exercises and techniques are associated with MBCT:8,9,10,11

  • The three-minute breathing exercise involves sitting in a comfortable position with your feet on the floor. After you close your eyes, focus on any feelings, thoughts, and bodily sensations you experience at that moment. To the best of your ability, observe those elements without rejecting or changing them in any way. Then, focus only on the sensation of your breath as it rises and falls. Next, expand your attention to the rest of your body and even to the space around you. After 3 minutes, open your eyes gently.
  • The body scan begins by either lying on your back or sitting comfortably in a chair with your feet flat on the floor. Initially, pay attention to the rise and fall of your breath, without changing its natural rhythm. Then, direct your awareness to your body—how it feels in the present moment, if you have any aches or pains, how your clothing feels against your skin, what parts of your body touch the floor or chair, and whether you have any hypersensitive areas. Next, begin a systematic scan from head to toe, and refocus any wandering thoughts back to your body, breath, and physical sensations. After you scan and explore your entire body, gently reopen your eyes.
  • Mindful stretching includes three major forms of physical movement: (a) yoga poses, such as hero’s pose, child’s pose, forward fold, mountain pose, tree pose, and low lunge; (b) static stretches, which include hamstring or quad stretches that are each held for about 30 seconds; and (c) progressive muscle relaxation, which involves tensing a muscle group for 5 to 7 seconds followed by relaxing it for 15 to 30 seconds.
  • The daily mindful practice exercise promotes mindful awareness of everyday activities such as showering, brushing teeth, eating, and cooking food. In this exercise, focus on your bodily sensations as you complete each activity.

Effectiveness of Mindfulness-Based Cognitive Therapy

Researchers have studied the effects of MBCT among many clinical populations—including people with fibromyalgia, chronic pain, cancer, diabetes, and epilepsy. Results have been promising, but further research must be conducted to confirm the efficacy of MBCT.

MBCT has been proven effective in the following ways:12,13,14,15

  • It prevents relapse of major depression among people at the greatest risk of relapse.
  • It reduces depressive symptoms posttreatment and improves remission rates and quality of life among people with treatment-resistant depression.
  • It significantly decreases worry and anxiety among individuals who experience anxiety.
  • It decreases anxiety and residual depression and improves mood regulation in people diagnosed with bipolar disorder.
  • It significantly decreases depressive scores among individuals who have suicidal thoughts.
  • It improves sleep quality and decreases levels of anxiety, rumination, and worry among people who have persistent symptoms of generalized anxiety disorder.

MBCT may help improve the following mental health conditions:7,16,17

  • anxiety disorder
  • obsessive-compulsive disorder (OCD)
  • major depressive disorder (MDD)
  • bipolar disorder
  • psychosis
  • eating disorders
  • emotional control
  • posttraumatic stress disorder (PTSD)

A group of researchers in the Netherlands investigated MBCT’s effect on chronic and treatment-resistant depression, a population that poses greater challenges with regard to treatment. They assigned participants randomly to either a treatment-as-usual group or a treatment-as-usual plus MBCT group. Their results indicated that those who partook in MBCT displayed greater reductions in their depressive symptoms and also improved in their rumination, remission rates, quality of life, and self-compassion.12

Lovas and Schumann-Olivier conducted a literature review in which they analyzed scientific journal articles regarding MBCT for the treatment of bipolar disorder. The 13 articles they reviewed indicated that MBCT shows promise for helping that specific population. One study displayed a decreasing risk of relapse into mania/hypomania episodes after MBCT treatment. Two studies found that MBCT had a significant positive impact on depressive symptoms. Finally, three studies suggested that MBCT may have protected individuals from a worsening of their anxiety.14

A group of researchers in Spain conducted a literature review exploring the impact of MBCT and other mindfulness-based approaches on eating disorders. They found that there were positive outcomes for bulimia nervosa, anorexia nervosa, and binge-eating disorder. Although the sample sizes were small, the studies displayed statistically significant positive results.18

A study at the University of Michigan investigated the impact MBCT had on combat veterans with PTSD. The researchers found that the intervention helped reduce the veterans’ avoidance symptoms and PTSD cognitions. The researchers suggested that MBCT is an acceptable and effective novel approach for PTSD symptoms and trauma-related cognitions.7

References

  1. Kingston, T., Dooley, B., Bates, A., Lawlor, E., & Malone, K. (2007), Mindfulness‐based cognitive therapy for residual depressive symptoms. Psychology and Psychotherapy, 80, 193–203.
    https://doi.org/10.1348/147608306X116016
  2. Sipe, W. E., & Eisendrath, S. J. (2012). Mindfulness-based cognitive therapy: Theory and practice. Canadian Journal of Psychiatry, 57(2), 63–69.
    https://doi.org/10.1177/070674371205700202
  3. Killingsworth, M. A., & Gilbert, D. T. (2010). A wandering mind is an unhappy mind. Science, 330(6006), 932.
    https://doi.org/10.1126/science.1192439
  4. Gu, J., Strauss, C., Bond, R., & Cavanagh, K. (2015). How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies. Clinical Psychology Review, 37, 1–12.
    https://doi.org/10.1016/j.cpr.2015.01.006
  5. Segal, Z. V., Teasdale, J. D., & Williams, J. M. G. (2004). Mindfulness-based cognitive therapy: Theoretical rationale and empirical status. In S. C. Hayes, V. M. Follette, & M. M. Linehan (Eds.), Mindfulness and acceptance: Expanding the cognitive-behavioral tradition (pp. 45–65). Guilford Press.
  6. UMass Memorial Medical Center, Center for Mindfulness. (n.d.). MBCT and MBSR: The differences. Retrieved August 3, 2020,from
    https://www.umassmemorialhealthcare.org/umass-memorial-medical-center/services-treatments/center-for-mindfulness/mindfulness-programs/mbct-and-mbsr-the-differences-0
  7. King, A.P., Erickson, T.M., Giardino, N.D., Favorite, T., Rauch, S.A., Robinson, E., Kulkarni, M., &Liberzon, I. (2013).A pilot study of group mindfulness‐based cognitive therapy (MBCT) for combat veterans with posttraumatic stress disorder (PTSD). Depression and Anxiety, 30, 638–645.
    https://onlinelibrary.wiley.com/doi/abs/10.1002/da.22104
  8. Segal, Z. (2018).The three-minute breathing space practice.
    https://www.mindful.org/the-three-minute-breathing-space-practice/
  9. Dreeben, S.J., Mamberg, M.H.,& Salmon, P. (2013).The MBSR body scan in clinical practice. Mindfulness, 4, 394–401.
    https://doi.org/10.1007/s12671-013-0212-z
  10. Mind and Me. (n.d.). [MBCT techniques, exercises, and its impacts.] Retrieved August 3, 2020, from
    http://www.mindandme.com/mbct.html
  11. Parsons, C. E., Crane, C., Parsons, L. J., Fjorback, L. O., &Kuyken, W. (2017). Home practice in mindfulness-based cognitive therapy and mindfulness-based stress reduction: A systematic review and meta-analysis of participants’ mindfulness practice and its association with outcomes. Behaviour Research and Therapy, 95, 29–41.
    https://doi.org/10.1016/j.brat.2017.05.004
  12. Cladder-Micus, M. B., Speckens, A., Vrijsen, J. N., Donders, A. R., Becker, E. S., &Spijker, J. (2018). Mindfulness-based cognitive therapy for patients with chronic, treatment-resistant depression: A pragmatic randomized controlled trial. Depression and Anxiety, 35(10), 914–924.
    https://onlinelibrary.wiley.com/doi/full/10.1002/da.22788
  13. Hofmann, S. G., & Gómez, A. F. (2017). Mindfulness-based interventions for anxiety and depression. Psychiatric Clinics of North America, 40(4), 739–749.
    https://doi.org/10.1016/j.psc.2017.08.008
  14. Lovas, D. A., & Schuman-Olivier, Z. (2018). Mindfulness-based cognitive therapy for bipolar disorder: A systematic review. Journal of Affective Disorders, 240, 247–261.
    https://doi.org/10.1016/j.jad.2018.06.017
  15. Weber, B., Sala, L., Gex-Fabry, M., Docteur, A., Gorwood, P., Cordera, P., Bondolfi, G., Jermann, F., Aubry, J. M., & Mirabel-Sarron, C. (2017). Self-reported long-term benefits of mindfulness-based cognitive therapy in patients with bipolar disorder. Journal of Alternative and Complementary Medicine, 23(7), 534–540.
    https://doi.org/10.1089/acm.2016.0427
  16. 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.
    https://doi.org/10.1111/ap.12074
  17. Key, B. L., Rowa, K., Bieling, P., McCabe, R., &Pawluk, E. J. (2017). Mindfulness-based cognitive therapy as an augmentation treatment for obsessive-compulsive disorder. Clinical Psychology &Psychotherapy, 24(5), 1109–1120.
    https://doi.org/10.1002/cpp.2076
  18. Wanden-Berghe, R. G., Sanz-Valero, J.,&Wanden-Berghe, C. (2010). The application of mindfulness to eating disorders treatment: A systematic review.Eating Disorders, 19(1), 34–48,
    https://doi.org/10.1080/10640266.2011.533604

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