Mindfulness-Based Cognitive Therapy (MBCT) is one of the so-called third-wave of behavioral psychological treatments. Each of these approaches uses mindfulness principles in conjunction with cognitive and behavioral techniques to treat a variety of mental illnesses. Bringing together two seemingly disparate theoretical models, MBCT aims to get the best of both worlds. While mindfulness is at the core of the therapy, it is the cognitive-behavioral techniques that make it practical for treating mental health.
Mindfulness-based cognitive therapy is essentially a combination of mindfulness and cognitive-behavioral therapy (CBT) practices. The two approaches offer separate but interconnected benefits. The CBT techniques are mostly useful for counteracting distorted or unhelpful thoughts. The mindfulness techniques, on the other hand, are useful for learning to be at peace with the world, even when unwanted emotions threaten to overwhelm. Combined, they provide a framework for managing emotions so that they do not spiral into distorted thinking and mental illness.
MBCT is relatively new, as are similar mindfulness-based treatments. The first studies date back to 2000, but proponents of these approaches intend them to have a strong scientific basis. They aim to incorporate what were once considered only spiritual practices into the gamut of evidence-based mental health treatments.
Mindfulness-based cognitive therapy is founded on the theory that there are two separate states of existence: being and doing. Most of the time, people are doing, focused on activity that produces results. When we are doing, what we consider to be negative emotions are undesirable. They get in the way of success and cause significant pain. When people are being on the other hand, they are focused only on the present moment. In this state, no emotions are positive or negative. They simply are, and we can appreciate how they actually feel, as opposed to what our thoughts turn them into. We can also appreciate that all emotions are temporary.
MBCT is based on Bernard and Teasdale’s ICS (interactive cognitive subsystems) model. ICS suggests that the possesses different modes for receiving and processing data: being and doing. An individual is able to detach from one mode and move to the other mode. Generally, it is the being mode that promotes positive mental health, while the doing mode is necessary for living a productive life.
Thoughts and emotions, as well as physical processes, all have an impact on each other. In people who suffer from depression, all three build on each other, triggering a spiral into a depressive episode.
MBCT teaches the individual to interrupt those processes which generally proceed automatically and trigger depression. Rather than allowing the thoughts, emotions, and physical sensations to amplify each other and send the person spiraling, s/he learns to recognize the process in the early stages. Once they have recognized it, they can interrupt it by detaching from the doing mode and moving into the being mode. In the being mode, there is no need to try and stop the thoughts, emotions, and feelings, and one can allow them to play out naturally. When a person is not trying to influence his emotions, they last only around 15 to 20 seconds. Instead, they can detach and watch the emotions, thoughts, and feelings coming and going.
MBCT is not used for eliminating certain feelings. It provides tools for the person to manage those feelings. The CBT techniques are useful for learning to recognize trigger moments, as well as to change some of the thoughts that contribute to the spiral, preventing the individual from being able to change modes.
CBT techniques for effectively maintaining relationships, following through with plans and goals, and finding distraction when all else fails, all ensure that the individual is best-placed to succeed at recovering from and preventing further bouts of depression.
Mindfulness-based cognitive therapy is delivered in a group setting, once or twice a week. Individual sessions with a therapist are often useful to supplement the training. Homework is an important feature of MBCT and other “third-wave” therapies. Since the sessions themselves are training rather than psychodynamic therapy, group members need to practice the techniques on their own in order for them to be successful. In order for MBCT training to be useful in moments of crisis, patients need to be proficient at using the techniques beforehand. Ideally, MBCT techniques help the individual prevent them reaching particularly low points.
A range of practical mindfulness techniques are used in MBCT sessions. These include body scans, which are meant to ground the individual and help them recognize the emotions they are experiencing. By focusing on the physical, the individual is able to detach from the emotion rather than over-identifying with it. Other mindfulness techniques include breathing, sitting meditations, walking meditations, as well as mindful eating. These techniques give the individual skills for being, aware of themselves without judgment.
CBT techniques are also utilized. In particular, practitioners teach individuals to challenge thoughts using reality testing. This involves listing thoughts and learning to look at them more objectively, comparing them with what can be concluded from the actual facts. The fundamental teaching is that thoughts are not equivalent to facts, and neither are emotions.
Other CBT techniques include such simple things as setting aside a time to worry about things that will otherwise concern the person the whole day, as well as learning to set SMART goals. Skills for approaching important or sensitive conversations are also a necessary part of training.
There is a considerable number of studies that indicate mindfulness-based mental health interventions, as well as MBCT in particular, are effective. These studies indicate that these interventions can be used to treat anxiety, depression, and other mood disorders, in addition to personality disorders such as BPD.
However, recent criticism has contended that the evidence supporting mindfulness treatments is deficient. They claim that mindfulness is overhyped, to an extent which is not supported by the evidence. Studies have methodological concerns. One of the biggest concerns is that the definition of mindfulness is often left vague. Results are also difficult to measure, considering that people respond very differently to mindfulness.
Critics do not contend that mindfulness does not work. However, they point out that the strongest evidence only points to moderate gains. This is not reflected by the billion dollar industry built around it.
Nonetheless, in many countries, mindfulness-based interventions are used as official treatments in government-funded treatment centers. Another mindfulness-based intervention, dialectical behavioral therapy (DBT), has had more success in treating borderline personality disorder (BPD) than most other treatments.
Mindfulness has long been used by practitioners for dealing with stress, anxiety, and difficult emotions. It has been used to increase contentment and happiness in general. The practice goes back millennia and is considered by many to be a way of life, rather than a useful practice.
MBCT in particular is most widely indicated for treatment of anxiety and depression. Controlled trials have demonstrated that MBCT can prevent relapse for individuals with recurrent depression by 50%. Evidence also indicates that it is successful in treating anxiety and other concerns related to mood. A 2014 review found that MBCT may be effective for addressing bipolar disorder, food and eating issues, and psychosis.
In addition, individuals with certain medical concerns have also reported benefits for well-being from MBCT. These include individuals with fibromyalgia, cancer, diabetes, chronic pain, and epilepsy. MBCT cannot be used in treatment of these ailments themselves, but helps sufferers deal with the symptoms and prevent despair.
A range of institutions around the world provide mindfulness-based cognitive therapy certification. These include the UCSD Mindfulness-Based Professional Training Institute in the US, the Oxford Mindfulness Centre in the UK, the University of Geneva, Switzerland, the Centre for Mindfulness Studies in Canada, and Bangor University in Wales. In addition, training in mindfulness-based interventions is provided by government institutions to all psychology interns in order for them to get the necessary experience to gain certification as a mental health professional. This is the case in South Africa, where mental health institutions use DBT as an official treatment for mood disorders.
MBCT teacher training consists of six steps:
Once they have achieved teacher qualification, they may pursue certification by teaching courses and further mentorship.
While there is a considerable corpus of evidence supporting the efficacy of MBCT, methodological deficiencies undermine many studies. Furthermore, since mindfulness-based mental health interventions are relatively new, there is little evidence proving long-term benefits. Such evidence may come to light in the next few years.
The strongest evidence supports the use of MBCT for treating depression and anxiety. However, there are relatively few rigorous studies proving its efficacy in treating other conditions, such as eating disorders, bipolar disorder, and psychosis.
Finally, MBCT requires a commitment from the individual, which naturally skeptical people may find difficult.
Mindfulness-based cognitive therapy was developed by John Teasdale, Zindel Segal, and J. Mark G. Williams. They remain the most important MBCT practitioners, and still work in research departments at various universities.
Jon Kabat-Zinn, who developed mindfulness-based stress reduction (MBSR), is one of the most significant influences on the developers and practitioners of MBCT. He is the most notable figure in Western mindfulness in general and is considered the person who brought secular mindfulness to the greater public. He has written numerous books. While some of his books focus specifically on MBSR, others focus on mindfulness as a general practice and way of life.
When seeking MBCT treatment, groups run by mindfulness or mental health institutions are likely your first port of call. One of the benefits of seeking MBCT treatment for depression or anxiety is that there’s less chance of clashing with a therapist, based on their particular style or personality. Since treatment is more about training, the best therapists are excellent facilitators, and success is not dependent on their interpretations or even a particularly strong personal connection. While connecting on a personal level with the therapist is always positive, it is not as crucial with MBCT as with other therapies.
Any MBCT therapist you find should be a licensed mental health professional (LMHP). In many places, a qualification in psychology or a related field is a prerequisite for training as an MBCT teacher. The therapist should have certification from one of the major MBCT groups.
Discuss your particular concerns with a potential therapist, so that they can advise you as to whether mindfulness-based cognitive therapy is the right treatment for you. Ask about their experience and whether their group operates under the umbrella of the major MBCT organizations.
Mindfulness-based cognitive therapy has been effective for many people in treating depression and anxiety. While some have criticized the rigor of the evidence behind MBCT, many reliable studies indicate its efficacy. It is becoming more and more popular, due to its accessibility and practical nature.
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