Origins of MBCT

Jon Kabat-Zinn developed Mindfulness-Based Stress Reduction (MBSR) as an eight-week program for people with stress-related health issues such as high blood pressure, heart disease, and chronic pain. The success of Kabat-Zinn’s program let Zindel Segal, Mark Williams, and John Teasdale to create Mindfulness-Based Cognitive Therapy (MBCT) as a means of preventing relapse for their patients who had been treated for chronic depression issues.

Segal, Williams and Teasdale released their book, Mindfulness-Based Cognitive Therapy for Depression: A New Approach to Preventing Relapse in 2002.This work is the definitive text on MBCT.

What is MBCT?

Segal, Williams and Teasdale adapted Kabat-Zinn’s MBSR program for specific use with people suffering from chronic depression. MBCT is the result of this modification. MBCT helps practitioners understand the nature of depression. Students of MBCT learn the specific states and conditions that leave them vulnerable to downward spirals of depression. MBCT also uses radical acceptance strategies to help patients overcome feelings of inadequacy that lead to cycles of depression. Research into the effectiveness of MBCT in preventing relapse (a return to depressive symptoms) demonstrates that the techniques of MBCT can reduce rates of depressive relapse by as much as 50% (Ma and Teasdale, 2004; Teasdale et al, 2000).

MBCT and Depression

 The most common treatment for depression is antidepressants. While antidepressants can alleviate the symptoms of depression, they do nothing to treat the root causes of the depressive state, and when the patient stops taking the medication, the symptoms can return. Depression is often described as a “bottomless pit” or a “black hole.” Once a person has entered this state, it is very difficult to climb out of the pit of depression.

As the symptoms of depression worsen, hopelessness increases. Physical ailments often accompany the depression. These physical maladies are generally caused by the depression and not by any physical illness. If allowed to progress far enough, this sense of hopelessness and helplessness can lead to suicidal thoughts.

A person who has experienced one major depressive episode has about a 50% chance of having another. After a second episode, the risk of having a third rises to somewhere between 80% and 90% (Teasdale et al, 2000).

One theory of problem development with depression says that negative thinking leads to negative moods. Research tends to support this theory. The reverse is also true: negative mood leads to negative thinking. When a person starts to consider himself a failure, or when hope seems to have disappeared, both negative thoughts and negative moods reappear.

This pattern of brooding over negative thoughts is called rumination. When rumination begins, a return to depression is almost inevitable. Rumination occurs because the depression sufferer is trying to seek a solution; he is looking for a way out of the depression cycle. Paradoxically, rumination only serves to intensify feelings of hopelessness and helplessness, which in turn reinforce the depression, making things worse instead of better.

MBCT helps to defuse this downward spiral of depression by allowing practitioners to identify these negative cycles of thought and mood, and to slow or stop the process of rumination before it spirals out of control.

How Does MBCT Work?

As noted above, depression sufferers often describe the experience as being at the bottom of a well or a pit. In such a situation, a sort of mental tunnel vision sets in. MBCT draws on mindfulness skills to help practitioners identify the signals of such negative interactional patterns early, before they have a chance to develop into a full-blown depression. Mindfulness allows the patient to see that negative thought and mood cycles are simply processes. They do not have to choose to participate in those cycles if they do not wish to.

As depression sets in, a person tends to withdraw and set up barriers of non-feeling as a protective measure. Retreating behind this wall of non-feeling results in a state of anhedonia: the inability to feel pleasure in things that the patient once found pleasurable. One of the skills of mindfulness is focusing on one thing at a time. By combining this skill with the skills of observing and describing, a depression sufferer is able to lower the barriers of non-feeling and again begin to experience pleasurable thoughts, feelings and activities.

A great deal of rumination involves anxieties about past events or worries about possible future events. MBCT draws on the mindfulness skill of being present in the moment. By focusing only on the “now,” an MBCT practitioner avoids the tendency to make assumptions about future events or to engage in regrets over past events. By living in the present, the patient breaks the rumination cycle that leads to deeper states of depression.

Another goal of the rumination cycle is to view negative moods as problems to be solved. This tendency leads to self-reinforcing cycles of negativity, especially if faced with an insoluble problem. Instead of trying to find a solution to the depression, MBCT teaches the patient to enter into being mode. From this mode, the depression is no longer a problem to be solved. It is simply a transitory state of mind. By learning to be still and wait for the depression to pass, the rumination cycle is broken. If there is no problem to be solved, then there is no need to find a solution, and there is no reason for the rumination.

Mindfulness and MBCT allow a person to become more aware of the patterns of thought and behavior that lead to her depressive states. By identifying these cycles and increasing awareness of them, she learns that such states are not things to be battled. They are simply transitory processes. As she comes to accept them as a part of herself, she comes to realize that fighting the depression only increases the depressive symptoms. But by engaging in being mode, she finds that there is nothing to fight.

MBCT Programs

MBCT programs are based on Kabat-Zinn‟s eight week Mindfulness-Based Stress Reduction (MBSR) program. Consequently, MBCT programs are usually eight weeks in length, and consist of one session per week, usually two hours long. A different skill is covered each week, and homework assignments are usually given in the form of directives. The goal of MBCT is to move patients from reacting to negative circumstances to responding to them. The goal of MBCT is not to find relaxation or happiness, but to learn to accept that negative thought and feeling cycles occur. MBCT teaches patients how to avoid getting drawn into self-reinforcing cycles of rumination and avoidance behavior.

MBCT programs are generally eight weeks long, and usually follow the outline below:

Week 1 consists of an introduction to mindfulness and an explanation of the foundations of the practice.

Week 2 teaches students how to cultivate patience and to become more aware of perceptions by using the skills of observing and describing.

Week 3 usually involves learning to shift from doing mode into being mode by ceasing to strive against emotional states. In this class, practitioners learn to minimize avoidance behavior. Basic mindful meditation skills are also usually taught at this time.

Week 4 helps students learn to differentiate between responding and reacting by introducing the idea of viewing their perceptions non-judgmentally.

Week 5 usually incorporates group reflections on how the practice of mindfulness has brought change to their lives.

Week 6 Incorporates a mindful walking meditation and lessons on communicating mindfully by being present and minimizing the tendency to avoid difficult topics of conversation.

Week 7 focuses on building trust and self-reliance.

Week 8 ends the series by encouraging students to continue learning. There is also a review and time for reflection from students and instructors.

Mindfulness-Based Cognitive Therapy (MBCT) Resources

Mindfulness-Based Cognitive Therapy

Official Site of the founders of MBCT, Zindel Segal, Mark Williams and John Teasdale