MBCT

What is Mindfulness Based Cognitive Therapy (MBCT)?

by David J. Miklowitz, PhD
(unpublished content)

The MBCT is an 8-session treatment. Patients meet on a weekly basis in groups of 8-12 people with a facilitator. MBCT integrates cognitive-behavioral therapy with mindfulness meditation practice.

The MBCT represents an important recent development in the effort to prevent recurrences of depression and bipolar disorder. The MBCT is based on an understanding of bipolar or unipolar depression as highly recurrent disorders. Medication is the first-line treatment for these disorders, but there are high rates of nonadherence with medications (particularly in bipolar disorder), and patients often relapse when medication is discontinued. There is a need to develop psychosocial interventions as adjuncts to medications to reduce relapse rates, enhance functioning, and improve medication adherence.

Mindfulness has been defined as “paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally.” MBCT teaches mindfulness in the context of a brief, group intervention, incorporating yoga, psychoeducation, and cognitive-behavioral strategies to prevent future episodes of depression.

Explicitly designed to modify underlying vulnerability factors among recovered individuals with prior histories of depression or bipolar disorder, MBCT teaches participants meditation practices with the explicit aim of developing skills in interrupting cognitive and behavioral patterns associated with relapse/recurrence. The development of MBCT is grounded in basic research on cognitive, attentional, and affective factors associated with depressive symptom emergence. Its central theory is that individuals with histories of depression are vulnerable to recurrence during episodes of sadness, during which cognitive patterns, which were present during previous episodes, are reactivated and can trigger the onset of new episodes. Such patterns are assumed to be automatic, based on repeated associations of dysphoric mood and negative thinking during previous episodes.

The skill of mindfulness can be taught to individuals with prior depressive or bipolar histories during times of normal mood, such that when sad mood occurs, individuals would be well equipped to prevent the exacerbation of such moods into clinical depression. In this way, mindfulness strategies target vulnerability factors associated with depressive relapse and recurrence. Specifically, mindfulness is intended to reduce the tendency to respond with strong emotion to particular thoughts or bodily sensations that occur with sad mood. Mindfulness practice trains individuals to notice and step out of habitual and automatic modes of responding with more intentional, non-judgmental, and present-focused awareness.

Mindfulness is also intended to reduce the automatic patterns by which at-risk individuals fail to notice or actively avoid early warning signs of depressive or manic relapse. It aims to increase awareness and acknowledgment of such experiences, thereby facilitating early effective action. Overall, the aim of mindfulness is to teach individuals skills that will help them to interrupt habitual patterns of thinking or behaving so that sad, irritable, or euphoric moods remain only mild or transient, rather than escalating into clinically significant depressive, manic, anxious, or suicidal states.

Results from studies in England and the U.S. indicate that MBCT is an effective treatment for relapse prevention in mood disorders, and may have special applicability to suicidal states (Williams and colleagues, 2006, 2007).