CBT-inspired methods are used in MBCT, such as educating the
participant about depression and the role that cognition plays within
it.
MBCT takes practices from CBT and applies aspects of mindfulness to the
approach. One example would be "decentering", a focus on becoming aware
of all incoming thoughts and feelings and accepting them, but not
attaching or reacting to them.
This process aims to aid an individual in regard to disengaging from
self-criticism, rumination, and dysphoric moods that can arise when
reacting to negative thinking patterns.
Like CBT, MBCT functions on the etiological theory that when individuals who have historically had depression become distressed, they return to automatic cognitive processes that can trigger a depressive episode. The goal of MBCT is to interrupt these automatic processes and teach the participants to focus less on reacting to incoming stimuli, and instead accepting and observing them without judgment. Like MBSR, this mindfulness practice encourages the participant to notice when automatic processes are occurring and to alter their reaction to be more of a reflection. It is theorized that this aspect of MBCT is responsible for the observed clinical outcomes.
Beyond the use of MBCT to reduce depressive symptoms, research additionally supports the effectiveness of mindfulness meditation in reducing cravings for individuals with substance abuse issues. Addiction is known to involve interference with the prefrontal cortex that ordinarily allows for delaying of immediate gratification for longer term benefits by the limbic and paralimbic brain regions. The nucleus accumbens, together with the ventral tegmental area, constitutes the central link in the reward circuit. The nucleus accumbens is also one of the brain structures that is most closely involved in drug dependency. Mindfulness meditation of smokers over a two-week period totaling five hours of meditation decreased smoking by about 60% and reduced their cravings, even for those smokers in the experiment who had no prior intentions to quit. Neuroimaging of those who practice mindfulness meditation reveals increased activity in the prefrontal cortex.
Like CBT, MBCT functions on the etiological theory that when individuals who have historically had depression become distressed, they return to automatic cognitive processes that can trigger a depressive episode. The goal of MBCT is to interrupt these automatic processes and teach the participants to focus less on reacting to incoming stimuli, and instead accepting and observing them without judgment. Like MBSR, this mindfulness practice encourages the participant to notice when automatic processes are occurring and to alter their reaction to be more of a reflection. It is theorized that this aspect of MBCT is responsible for the observed clinical outcomes.
Beyond the use of MBCT to reduce depressive symptoms, research additionally supports the effectiveness of mindfulness meditation in reducing cravings for individuals with substance abuse issues. Addiction is known to involve interference with the prefrontal cortex that ordinarily allows for delaying of immediate gratification for longer term benefits by the limbic and paralimbic brain regions. The nucleus accumbens, together with the ventral tegmental area, constitutes the central link in the reward circuit. The nucleus accumbens is also one of the brain structures that is most closely involved in drug dependency. Mindfulness meditation of smokers over a two-week period totaling five hours of meditation decreased smoking by about 60% and reduced their cravings, even for those smokers in the experiment who had no prior intentions to quit. Neuroimaging of those who practice mindfulness meditation reveals increased activity in the prefrontal cortex.
Background
In 1991 Philip Barnard and John Teasdale created a multilevel concept
of the mind called "Interacting Cognitive Subsystems" (ICS). The ICS
model is based on Barnard and Teasdale's concept that the mind has
multiple modes that are responsible for receiving and processing new
information cognitively and emotionally. Barnard and Teasdale's (1991)
concept associates an individual's vulnerability to depression with the
degree to which he/she relies on only one of the modes of mind,
inadvertently blocking the other modes.
The two main modes of mind include the "doing" mode and "being" mode.
The "doing" mode is also known as the driven mode. This mode is very
goal-oriented and is triggered when the mind develops a discrepancy
between how things are versus how the mind wishes things to be.
The second main mode of mind is the "being" mode. "Being" mode, is not
focused on achieving specific goals, instead the emphasis is on
"accepting and allowing what is," without any immediate pressure to
change it.
The central component of Barnard and Teasdale's ICS is metacognitive
awareness. Metacognitive awareness is the ability to experience negative thoughts and feelings as mental events that pass through the mind, rather than as a part of the self.
Individuals with high metacognitive awareness are able to avoid
depression and negative thought patterns more easily during stressful
life situations, in comparison to individuals with low metacognitive
awareness.
Metacognitive awareness is regularly reflected through an individual's
ability to decenter. Decentering is the ability to perceive thoughts and
feelings as both impermanent and objective occurrences in the mind.
Based on Barnard and Teasdale's (1991) model, mental health is
related to an individual's ability to disengage from one mode or to
easily move among the modes of mind. Therefore, individuals that are
able to flexibly move between the modes of mind based on the conditions
in the environment are in the most favorable state. The ICS model
theorizes that the "being" mode is the most likely mode of mind that
will lead to lasting emotional changes. Therefore, for prevention of
relapse in depression, cognitive therapy must promote this mode. This
led Teasdale to the creation of MBCT, which promotes the "being" mode.
This therapy was also created by Zindel Segal and Mark Williams, and was partially based on the mindfulness-based stress reduction program, developed by Jon Kabat-Zinn.
Theories behind these mindfulness-based approaches to psychological
issues function on the idea that being aware of things in the present,
and not focusing on the past or the future, will allow the client to be
more apt to deal with current stressors and distressing feelings with a
flexible and accepting mindset, rather than avoiding, and, therefore,
prolonging them.
Applications
The
MBCT program is a group intervention that lasts eight weeks. During
these eight weeks, there is a weekly course, which lasts two hours, and
one day-long class after the fifth week. However, much of the practice
is done outside of classes, where the participant uses guided meditations and attempts to cultivate mindfulness in their daily lives.
MBCT prioritizes learning how to pay attention or concentrate
with purpose, in each moment and most importantly, without judgment.
Through mindfulness, clients can recognize that holding onto some of
these feelings is ineffective and mentally destructive. Mindfulness is
also thought by Fulton et al. to be useful for the therapists as well
during therapy sessions.
MBCT is an intervention program developed to specifically target
vulnerability to depressive relapse.Throughout the program, patients
learn mind management skills leading to heightened metacognitive
awareness, acceptance of negative thought patterns and an ability to
respond in skillful ways. During MBCT patients learn to decenter their
negative thoughts and feelings, allowing the mind to move from an
automatic thought pattern to conscious emotional processing. MBCT can be used as an alternative to maintenance antidepressant treatment, though it may be no more effective.
Although the primary purpose of MBCT is to prevent relapse in
depressive symptomology, clinicians have been formulating ways in which
MBCT can be used to treat physical symptoms of other diseases such as
diabetes, cancer, etc. Clinicians are also discovering ways to use MBCT to treat the anxiety and weariness associated with these diseases.
Evaluation of effectiveness
A
meta-analysis by Jacob Piet and Esben Hougaard of the University of
Aarhus, Denmark Research found that MBCT could be a viable option for
individuals with major depressive disorder (MDD) in preventing a relapse.
Various studies have shown that it is most effective with individuals
who have a history of at least three or more past episodes of MDD. Within that population, participants with life-event triggered depressive episodes were least receptive to MBCT.
According to a 2017 meta analysis, mindfulness-based interventions
support the decrease in depressive and anxious symptoms in addition to
overall level of patient stress.
A mindfulness program based on MBCT offered by the Tees, Esk, and
Wear Valleys NHS Foundation Trust, showed that measures of
psychological distress, risk of burnout, self-compassion, anxiety,
worry, mental well-being, and compassion to others all showed
significant improvements after completing the program.
Research supports that MBCT results in increased self-reported
mindfulness which suggests increased present-moment awareness,
decentering, and acceptance, in addition to decreased maladaptive
cognitive processes such as judgment, reactivity, rumination, and
thought suppression.
Results of a 2017 meta-analysis highlight the importance of home
practice and its relation to conducive outcomes for mindfulness-based
interventions.
