Mindfulness Based Cognitive Therapy
If you are looking for mindfulness based cognitive therapy in Grand Rapids, MI– Paul Krauss MA LPC can help.
Give Paul a call at 616-365-5530 for a complimentary 15 minute consultation or email [email protected]
While “mindfulness” is all the rage these days, without help from a clinically informed practitioner, it may not have the therapeutic effect intended. Mindfulness based cognitive therapy have been both clinically proven to help reduce both depression and anxiety in people.
What is MBCT and how was it developed?
Mindfulness Based Cognitive Therapy (MBCT) is a rather recent development in the treatment of mental illness, originally designed to reduce relapse in individuals with persistent major depression (Segal, Teasdale, & Williams, 2004). In its intended form, MBCT is a group skills-training program taught in intervals specified by a manual, preferably by a therapist who has had their own extensive practice with MBCT and/or mindfulness in general (Helen & Teasdale, 2004; Segal, Williams, & Teasdale, 2002). MBCT was specifically intended to address an individual’s vulnerability between major depression episodes, though it has recently been utilized to treat anxiety and bipolar disorder (Williams, Russell, & Russell, 2008; Orsillo, Roemer, Lerner, & Tull, 2004).
As a psychoeducational skills-training group (part group therapy, part mindfulness practice, and part teaching/coaching), MBCT is designed for patients in remission from the acute symptoms of major depression (Helen & Teasdale, 2004). The groups teach patients to increase their awareness of their thoughts, feeling and bodily sensations, while also relating to them differently. The most popular example of patients’ change of perspective in relation to their thoughts and feelings, in the literature, is for patients to treat them as “passing events in the mind” rather than identifying them or treating them as the absolute reality of their life situation (Williams, Russell, and Russell, 2008; Helen & Teasdale, 2004; Segal, Teasdale, & Williams, 2004; Segal, Williams, & Teasdale 2002).
Zindel V. Segal, John D. Teasdale, and J. Mark G. Williams (2002) originally had set out to develop some sort of cognitive therapy maintenance treatment for people who had experienced a major depressive episode and were in remission. After Dr. Marsha Linehan introduced her use of “mindfulness” to the trio, as part of her successful treatment called Dialectical Behavior Therapy, they began to investigate the technique. Segal, Teasdale, and Williams then traveled to the University of Massachusetts, where Dr. John Kabat-Zinn had been treating patients, suffering from chronic illnesses, with a program called Mindfulness Based Stress Reduction (MBSR) since the 1970s (Segal, Williams, & Teasdale, 2002). The methods of mindfulness, as developed by Kabat-Zinn, urges a patient to “decenter” or observe thoughts and feelings from a wider perspective as a method to steer away from “automatic” mental reactions to stress (reactions, that often inhibit logical and effective problem-solving) (Segal, Williams, & Teasdale, 2002). Kabat-Zinn’s Mindfulness techniques themselves were originally derived from Buddhism’s mindfulness meditation (Carey, 2008). Following Segal, Teasdale, and Williams study of and participation in Kabat-Zinn’s MBSR, the trio began to develop MBCT by bringing a cognitive therapy background to a mindfulness structure. And after the results of a randomized clinical test demonstrated that formerly depressed patients who went through a beta version of MBCT were significantly less likely to relapse into major depression again during the year that followed the program, Segal, Teasdale, and Williams secured the funding to make MBCT into a fully-fledged treatment program (a treatment program, which is now soaring in popularity) (Segal, Williams, & Teasdale, 2002).
Mindfulness Based Cognitive Therapy: The Basics
As stated earlier, MBCT is essentially structured as skills-training group. Yet, the program is generally referred to as a class instead of a group, because the founders believe this is a better description of the learning environment. To begin, once a patient has met with the instructor individually for a preparation session, the patient then joins up to eleven other members for 8 weekly 2-hour sessions led by the instructor. Between sessions, members are given daily homework assignments, which generally consist of guided or unguided awareness and mindfulness exercises (Helen & Teasdale, 2004).
During the MBCT program, patients are taught to identify their own ruminative thinking and to free themselves from a “mode of mind” where negative thinking is dominant and instead to utilize mindfulness to achieve a state of “acceptance” and “being” (Coelho, Canter, & Ernst, 2007). Patients are taught to “decenter” themselves from negative thoughts or feelings, but not to avoid them, rather to observe these thoughts from a more objective distance. Of course, before the patients learn specific techniques, they must begin to understand and practice the core skill of MBCT: Mindfulness (Segal, Williams, & Teasdale, 2002). Interestingly enough, an instructor usually leads patients through the practice of guided awareness (or mindfulness) before explaining the technique at length, so patients have a nonbiased experience they can both reflect and build upon.
Mindfulness is defined as “paying attention in a particular way: on purpose, in the present moment, and nonjudgementally” (Segal, Teasdale, & Williams, 2002, p 77). When a person is practicing mindfulness they have means to identify when a switch in their thinking is needed (for example, negative thoughts about themselves arise), and also the tools to just be in the moment and not let depressing thoughts take over: acknowledge the thought as a thought and let it go (Segal, Williams, & Teasdale, 2002). Yet, MBCT is not in the practice of replacing or restructuring thoughts about the self (to become positive or happy) like many other traditional forms of cognitive and psychotherapy; instead, MBCT aims to provide the patient with freedom from ruminative thinking patterns and mental anguish. For as Segal, Teasdale, Williams noted, attempting to alter, fight, displace, or avoid negative thoughts often causes more mental turmoil and can lead to a relapse of depression. And when they achieve freedom through MBCT, the patient can more easily achieve their goals, such as becoming happier (Segal, Williams, & Teasdale, 2002).
The actual 8-week program that is MBCT is highly structured, and consists of a combination of teaching skills, brief group therapy, mindfulness exercises, group discussion and reflection, and assigning homework. Patients are given both homework and handouts to educate them further regarding the mindfulness skills they are learning during the sessions as well as their purposes. Because of the nature of the exercises, many of which come with suggested scripts, and the concepts being so heavily based on “being in the moment” rather than topics to be debated or discussed, the developers recommend that the instructor be a therapist who has been through a MBCT program or has an active and regular mindfulness practice or their own (Segal, Williams, & Teasdale, 2002).
Throughout the program MBCT teaches participants many exercises through which they can begin to practice mindfulness and eventually apply it to their personal lives. Starting with an awareness exercised dubbed “the raisin exercise” participants learn to bring their mind to the present moment and examine in detail the raisin by sight, touch, smell, taste, and how it feels inside the body (Segal, Williams, & Teasdale, 2002). Shortly after this exercise, participants learn the body-scan meditation. The instructor leads this exercise with the participants lying comfortably on the floor. The instructor speaks to the participants and instructs them to bring awareness to the different physical sensations of all parts and sections of the body, one by one. Moving from section to section slowly with an in-breath ushering in consciousness and focus on a section or part and the out breath moving the participant onward. The body scan meditation is a mindfulness exercise and part of the overall mindfulness program, which works by bringing participants awareness to different parts of the body (Segal, Williams, & Teasdale, 2002).
One of the other main practices of the MBCT program is mindfulness meditation, where participants sit in a comfortable position and focus on their breathing. When thoughts other than breathing-in and breathing-out come, one should acknowledge them and let them go. The goal is to sit for about 15 minutes and attain a more mindful perspective to bring back to daily activities. Other exercises and practices of MBCT include a 3-minute breathing space, some cognitive exercises (using mindfulness to reframe and “decenter” thoughts and utilize deliberate thinking), homework, and some light yoga where participants focus their awareness on subtle movements. Eventually participants will use mindfulness to be more deliberate and aware during everyday activities. Participants will also learn to identify negative thoughts, symptoms, and relapse signs– and cope with them (Segal, Williams, & Teasdale, 2002).
Just as the act of mindfulness meditation is related to Buddhist meditation, but has a different non-religious and clinical focus, the body scan meditation shares traits of progressive muscle relaxation. The body scan meditation is about the awareness of feelings and sensations in different parts and sections of the body, while progressive muscle relaxation is focused on physical relaxation. In progressive muscle relaxation, one tenses or flexes a different part or muscle of the body for 8 seconds on the inhaled breath and then exhales and releases the hold for 15 seconds, before moving on to the next part or muscle. While body scan meditation and progressive muscle relaxation follow similar sequences of focus on body parts, breathing, and both take place on the floor, progressive muscle relaxation emphasizes the physical relaxation of each muscle throughout the exercise and not the mindful awareness (Segal, Williams, & Teasdale, 2002; Richmond, 2008)
As a program, MBCT is extremely comprehensive in scope and should offer a patient, who actually devotes themselves to the homework and practice, a great opportunity to learn and really change some fundamental ways in which they interact with their thoughts, feelings, and bodily sensations. Most of all, MBCT provides an alternative or supplement to traditional therapy and pharmaceutical treatments, which could help prevent a patient from relapsing.
Mindfulness Based Cognitive Therapy and Depression
To understand more specifically how MBCT works and why several studies have deemed the psychoeducational therapeutic program an efficacious treatment, it is important to take a closer look at the workings of chronic major depression, the condition for which it was developed in the first place. While there has been success in treating major depressive disorder through therapy, pharmaceuticals, and electroconvulsive treatments, many of those treatments were focused on the acute symptoms and not the long-term reoccurring episodes. Until the early 1980s there were not many studies conducted on the rate of relapse for individuals suffering from major depression (Segal, Teasdale, & Williams, 2002). Since the initial studies suggested an enormous need for a maintenance therapy or other means to prevent relapse, other studies have emerged: “at least 50% of patients who recover from an initial episode of depression will have at least one subsequent depressive episode, and those patients with a history of two or more past episodes will have a 70-80% likelihood of recurrence in their lives” (Segal, Teasdale, & Williams, 2002, p 14).
According to the vulnerability model of depression studies, relapse and recurrence are more likely to occur after the initial depressive episode because “negative, self-critical, and hopeless thinking, during episode of major depression, lead[s] to changes at both cognitive and neuronal levels” (Segal, Teasdale, & Williams, 2004, p 48). So individuals who have recovered from one or several major depressive episodes are essentially changed from their experience with the disorder. As a result, low-lying dysphoric thoughts are likely to lead recovered individuals to worse states of mind (in both content and process) and eventually to another episode of major depression (Segal, Teasdale, & Williams, 2004; Williams, Russell, & Russell, 2008). These dysphoric thoughts are not necessarily the catalyst for sending a recovered individual to relapse, but they are just part of a larger picture, which involves how individuals deal with such thoughts.
Since mindfulness can be considered an “alternative cognitive mode” in which an individual learns to process thoughts and feelings differently than they have learned in the past, MBCT techniques have proven vital to preventing relapse in formerly depressed individuals by enabling them to identify dysphoric feelings/thoughts early-on and respond in a manner that effectively “nips [negative thinking patterns] in the bud” (Segal, Teasdale, & Williams, 2004). MBCT techniques differ from traditional cognitive therapy in many ways, but one major way is that in general cognitive therapy emphasizes therapeutic problem solving and fixing of issues through identifying, talking about, and processing negative thoughts or feelings, while MBCT empowers individuals to actually turn toward the negative feeling or thought and relate to that experience in the moment (Segal, Williams, & Teasdale, 2002).
There is mounting empirical evidence that MBCT is more effective in preventing an individual from relapsing into a depressive episode than treatment as usual. In two 2003 studies, MBCT was shown to halve recurrence rates of depression over treatment as usual (Segal, Teasdale, & Williams, 2004). More specifically, it was demonstrated that patients who had experienced three or more episodes of depression benefited the most, while patients with two or fewer episodes of depression in the MBCT did not differ from those receiving treatment as usual (Segal, Teasdale, & Williams, 2004). There are several theories that seem to account for this difference in the statistical effectiveness of MBCT in preventing recovered individuals from depressive relapse: First, automatic and habitual patterns of negative thinking become more intense and are more easily reactivated in an individual who has had more past depressive episodes (usually those with three or more episodes). Second, individuals who have two or less episodes of major depression, in general, come from a slightly different population (they were more likely to have later onset of depression, and the depression was more likely to be caused by negative life events) than those with three or more episodes, who may have developed more fixed maladaptive thinking traits (Coehlo, Canter, & Ernst, 2007).
MBCT has also been shown to reduce “overgeneral autobiographical memory”, which is a pattern of thought common in some depressive patients. Being a rather new method of treatment, MBCT will still require many years of study, including comparing its use versus pharmaceutical drugs and so on, before it will be widely accepted as a preferred treatment for depression (Coehlo, Canter, & Ernst, 2007). In general, MBCT is known to reduce study participants relapse into a depressive episode “within 12 months from 70% to 39%, increases the average time to relapse by at least 18 weeks, and decreases the Beck Depression Inventory score after treatment by nearly 5 points” (Williams, Russell, & Russell, 2008, p 529).
Mindfulness Based Cognitive Therapy and Anxiety
While there has yet to be extensive research published evaluating the effects the MBCT program on individuals who suffer from anxiety disorders, it is important to note that the basic skills and methods of mindfulness appear to work well with combating the underlying symptoms of clinical anxiety (Orsillo, Roemer, Lerner, & Tull, 2004). For instance, individuals who suffer from anxiety disorders often go to great lengths to avoid “objects or situations” that increase their symptoms, causing them superfluous difficulties. MBCT might be an effective treatment for individuals who exhibit the aforementioned behaviors, as it empowers individuals to turn toward their feelings (regarding objects or situations) and observe them from a “decentered” perspective, which could potentially cause symptom reduction (Orsillo, Roemer, Lerner, and Tull, 2004).
Research has show that anxiety disorders are characterized by set patterns of anxious or over generalized response to stimuli by individuals. MBCT may be an effective treatment for such disordered responses as it emphasizes taking a new and more nuanced perspective of stimuli for a more adaptable and, hopefully, asymptomatic response (Orsillo, Roemer, Lerner, & Tull, 2004). In fact, MBCT shares many similarities with Acceptance and Commitment Therapy (ACT), which has been utilized to successfully treat anxiety. ACT as well as Dialectical Behavior Therapy (DBT), used to treat individuals with a high risk of self-harm, both share traits with MBCT, as they primarily utilize “non-language based strategies” that seek to assist a patient with viewing and comprehending their problems in a fundamentally different way which allows the patient to cope with symptoms in a new and, hopefully, advantageous manner (Orsillo, Roemer, Lerner, & Tull, 2004).
While labeled “probably efficacious” by the American Psychological Association, MBCT has received high praise from both therapists and patients (Helen & Teasdale, 2004). For instance, one reviewer suggested that “mindfulness may promote exposure to previously avoided internal experiences, lead to cognitive change or a change in attitude about one’s thoughts, increase self-observation and management, produce a state of relaxation, or increase acceptance” (Orsillo, Roemer, Lerner, & Tull, 2004, p 77). Another benefit of MBCT is that the program can provide a needed alternative or supplement to both therapy and pharmaceutical treatment for a patient. And unlike some traditional talk-therapies, MBCT’s class-like program empowers patients by teaching them skills and methods of dealing with thoughts and feelings that they can practice on their own without relying on treatment providers. In fact, because of its group format (using one instructor) and limited number of sessions, MBCT is rather cost effective and may be an excellent alternative treatment for economically disadvantaged individuals, who may not have comprehensive insurance or cannot afford traditional therapy or even medications (Coehlo, Canter, & Ernst, 2007). Another aspect of diversity other than the economic class system, is that MBCT is known to be associated with Buddhist meditation, which for a person of any culture (religious or not) could be cause for some skepticism; however with proper promotion and culturally-sensitive education, hesitant individuals from any culture will hopefully come to understand that MBCT is a non-sectarian, non-religious psychological treatment developed exclusively for dealing with mental disorders.
MBCT is a relatively new treatment, developed specifically for treating patients who are in recovery from depression, yet its usefulness is still in the beginning stages of being empirically documented. Part of a so-called “third-phase” of treatments which, along with ACT and DBT, build upon the traditional understandings and structures of behavioral and cognitive therapies with new techniques such as “mindfulness, acceptance, relationship, and spirituality” as well as MBSR to advance the field of therapy (Segal, Teasdale, & Williams, 2004, p 45). Already, MBCT has proven to significantly reduce relapse in individuals recovering from depression by fifty percent over those who are engaged in treatment as usual (Segal, Teasdale, & Williams, 2004). Future studies will inevitably study MBCT as an alternative to pharmaceuticals as well as a treatment for other types of mental illness besides depression, which could lead to even greater acceptance and use of the program in the years to come (Williams, Russell, & Russell, 2008).
Carey, B. (2008, May 27). Lotus therapy. The New York Times.
Coelho, H. F., Canter, P. H., & Ernst, E. (2007). Mindfulness-based cognitive therapy: Evaluating current evidence and informing future research. Journal of Consulting Psychology, 75, 1000-1005.
Helen, M. S., & Teasdale, J. D. (2004). Mindfulness-based cognitive therapy for depression: Replication and exploration of differential relapse prevention effects. Journal of Consulting and Clinical Psychology, 72, 31-40.
Orsillo, S. M., Roemer, L., Lerner, J. B., & Tull, M. T. (2004). Acceptance, mindfulness, and cognitive-behavioral therapy: Comparisons, contrasts, and application to anxiety. In S. C. Hayes, V. M. Follette, & M. M. Linehan (Eds.), Mindfulness and acceptance: Expanding the cognitive-behavioral tradition (pp. 67-91). New York: The Guilford Press.
Richmond, R. L. (2008) A Guide to psychology and its practice: Progressive muscle relaxation. Retrieved July 7, 2008, from http://www.guidetopsychology.com/pmr.htm
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). New York: The Guilford Press.
Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. New York: The Guilford Press.
Williams, J. M. G., Russell, I., & Russell, D. (2008). Mindfulness-based cognitive therapy: Futher issues in current evidence and research. Journal of Consulting Psychology, 76, 524-529.
This article was written by Paul Krauss MA LPC