Mindfulness based cognitive therapy (MBCT) is a non-pharmacological intervention to reduce current symptoms and to prevent recurrence of major depressive disorder. It is a group-based, 8-week training, consisting of meditation exercises combined with cognitive behavioural techniques. The focus of MBCT is to teach individuals to become more aware of thoughts and feelings and to relate to them in a wider, decentered perspective as “mental events“ rather than as aspects of the self or as necessarily accurate reflections of reality.

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Mindfulness Based Cognitive Therapy is an innovative, empirically validated treatment program designed to prevent relapse in people who have recovered from unipolar depression and has shown promise in the treatment of mood disorders more generally. Self-knowledge grounded in sustained meditative awareness is its central tenet. The heart of MBCT lies in acquainting patients with the modes of mind that often characterize mood disorders while simultaneously inviting them to develop a new relationship to these modes. Patients learn to view thoughts as events in the mind, independent of their content and emotional charge. They need not be disputed but are held in a more spacious awareness, large enough to contain aspects of the self deemed both broken and whole.

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MBCT prioritizes learning how to pay attention on purpose, in each moment and nonjudgmentally. Learning the basics of mindfulness is the focus of Sessions 1–4. First, participants become aware of how little attention is usually paid to daily life. They are taught to become aware of how quickly the mind shifts from one topic to another. Second, having noticed that the mind is wandering, they learn how to bring it back to a single focus. This is taught, first, with reference to parts of the body and to breathing. Third, the participants learn to become aware of how this mind wandering can allow negative thoughts and feelings to escalate, without their being aware that this is happening.

Only when a person has become aware of these aspects is he or she likely to use MBCT to be vigilant for mood shifts, then move on to handle them. Handling mood shifts involves the second phase of MBCT and is dealt with in Sessions 5–8. Whenever a negative thought or feeling arises, the instructions emphasize allowing it simply to be here, exploring it as it is, before taking steps to respond skillfully by using specific strategies. How is this done? Participants learn how to become fully aware of the thought or feeling, then, having acknowledged it, to move their attention to their breathing for a minute or two before expanding attention to the body as a whole. We call this the breathing space. It becomes the common thread through the rest of the program, gradually allowing participants to weave what is being learned from the formal practices into everyday life. The use of the breathing space develops in Sessions 3 to 7 as participants deepen their practice. At first, participants learn to take a 3-minute breathing space three timeseach day. From Session 4, they add to this by seeing how the breathing space may be used at times of difficulty, when it may turn out to be sufficient to handle difficulties in the moment, to free participants from the unpleasant thoughts or feelings. Gradually we invite participants to see the breathing space more explicitly as the essential first step in dealing with difficulties, after which they may choose how best to respond. First, they may choose simply to “reenter”—to return to the flow of their lives with a more grounded and spacious presence, in better shape to relate to whatever life has to offer. Or following Session 5, they may choose to deal with the difficulty by noting the part of the body it affects, and bringing awareness to that part of the body, using the breath to open and soften to the sensation rather than tighten and brace around it. Or (following Session 6) they may deal with difficulties by seeing more clearly how negative thoughts arise with mood and are then taken to be true; how adhesive these thoughts are, and how they may be seen and held in awareness as “mental events.” Or (following Session 7) they may choose to deal with a difficulty by taking action specifically chosen for its ability in the past to bring some pleasure or sense of mastery. Because of the large variety of contexts in which the breathing space is used, it is important to emphasize its flexibility. It will not always be possible for participants to close their eyes and take exactly 3 minutes, but pausing (1) to acknowledge what is going on, (2) to gather themselves by going to the breath, before (3) expanding the focus of attention to sense the wider perspective of the here and now comprises a three-step “mini-meditation” that is an important first step. Finally, participants are encouraged to become more aware of their own unique warning signs of impending depression, and to develop specific action plans for when this might occur (p. 84-85).

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A manualized 8-week group intervention based largely on Kabat-Zinn’s (1990) MBSR program. It incorporates elements of cognitive therapy that facilitate a detached or de-centered view of one’s thoughts. Designed to prevent depressive relapse by teaching formerly depressed individuals to observe their thoughts and feelings nonjudgmentally based on an information processing theory of depressive relapse. This attitude toward depression-related cognitions is believed to prevent the escalation of negative thoughts into ruminative patterns.

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MBCT places little emphasis on changing or altering thought content; rather, by focusing on participants’ awareness of their relationship to their thoughts and feelings, it aims to enhance metacognitive awareness.

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The core skill that the MBCT program aims to teach is the ability, at times of potential relapse, to recognize and disengage from mind states characterized by self-perpetuating patterns of ruminative, negative thought. In MBCT, participants learn how to disengage from one mode of mind and enter another, incompatible, mode of mind that will allow them to process depression-related information in ways that are less likely to provoke relapse (p.74).

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Mindfulness-based cognitive therapy (MBCT) is a type of therapy born from the union of cognitive therapy and meditative principles. Cognitive therapy aims to help clients grow and find relief from symptoms of mental illness through the modification of dysfunctional thinking (Beck Institute, 2016). Mindfulness can be summed up as the practice and state of being aware of our thoughts, feelings, and emotions on a continuous basis (Greater Good Science Center, 2017). Mindfulness also contributes to an acceptance of the self as it is, without attaching value judgments to our thoughts. MBCT is thought to be effective for many clients, but it has been found to be especially effective for one group in particular: people who have suffered from multiple episodes of depression (Mental Health Foundation).

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Overview of MBCT Program
1. Initial assessment interview - This initial assessment interview, which lasts around 1 hour, conducted with each prospective participant, is based on the initial material sent to participants before they attend. This material explains some aspects of depression and the program, and can be used as a starting point for dialogue between instructor and participant.
2. MBCT classes — since MBCT is used for people who are highly vulnerable to serious mood problems, it requires relatively small classes (a. Raisin Exercise and Body Scan, b. 10-Minute Sitting Meditation-Mindfulness of the Breath, c. Stretch and Breath Meditation, Mindful Movement-Formal Practice, 3-Minute Breathing Space-Regular Version, d. Sitting Meditation, Mindful Walking, 3-Minute Breathing Space-Responsive Version, e. Working with Difficulty Meditation, f. 10-Minute Sitting Meditation, 20-Minute Sitting Meditation, Bells at 5, 10, 15, 20, and 30 min).

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Mindfulness-based cognitive therapy (MBCT) was developed as a psychosocial intervention for teaching people with recurrent depression the skills to stay well in the long term.

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MBCT may exert its psychological mechanisms of action by increasing acceptance, self-compassion, present-moment awareness, and ability to selectively deploy one’s attention, while enhancing cortical regulation of limbic circuits involved in affective disorders

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Both MBSR and MBCT incorporate a range of formal mindfulness practices as a key method for training attentional control as well as the non-judgemental attitudinal dimensions of mindfulness. MBSR has been found to have positive effects on pain, anxiety and stress in people with chronic disorders, such as fibromyalgia, coronary artery disease, back pain and arthritis. Preliminary evidence suggests that MBCT can decrease depression, anxiety and fatigue in some physical conditions, such as coronary heart disease, diabetes and cancer.

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The 8-week MBCT program is a group intervention that allows participants to become aware of how conditioned patterns of mind and mood can trigger depression relapse and sustain current symptoms of depression. Through the practice of mindful awareness, they develop the capacity to mindfully disengage from distressing moods and negative thoughts. For those who have suffered from recurrent depression, being able to recognize the early signs of relapse allows for skillful intervention before mood symptoms and negative thought patterns become severe.

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MBCT can effectively treat mental health obstacles by applying mindfulness in all steps:

Mindfulness helps the client discover their own thought and mood patterns.
Mindfulness helps the client learn how to be present and appreciate the small pleasures of everyday life.
Mindfulness teaches the client how to stop the downward spiral that can emerge from a bad mood or thinking about painful memories.
Mindfulness allows the client to “shift gears” from their present state of mind to one which is more aware, more balanced, and less judgmental.
Mindfulness gives the client access to another approach to dealing with difficult emotions and moods (MBCT.com).

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MBCT.com lays out the three steps through which MBCT can help:

It will help you understand what depression is.
It will help you discover what makes you vulnerable to downward mood spirals, and why you get stuck at the bottom of the spiral.
It will help you see the connection between downward spirals: High standards that oppress us or feelings that we are simply “not good enough”, ways we put pressure on ourselves or make ourselves miserable with overwork and ways we lose touch with what makes life worth living.

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Developed by Zindel Segal, Mark Williams, and John Teasdale. MBCT is based on MBSR and combines the principles of cognitive therapy with those of mindfulness to prevent relapse of depression. MBCT, like MBSR, utilizes secular mindfulness techniques including seated meditation. The program specifically teaches recognition of deteriorating mood with the aim of disengaging from self‐perpetuating patterns of ruminative, negative thoughts that contribute to relapse.

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The ultimate aim of the MBCT program is to help individuals make a radical shift in their relationship to the thoughts, feelings, and body sensations that contribute to depressive relapse (p. ). The central task of MBCT is to give patients the understanding and skills that will enable them to recognize and free themselves from these states of mind—to empower them to step out of the habitual, automatic patterns of mind and body that are reactivated by depressed mood and make them vulnerable to further episodes of depression (p. 65).

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Mindfulness-based Cognitive Therapy (MBCT) combines aspects of cognitive therapy with training in meditation. MBCT teaches people skills that enable them to become more aware of their thoughts without judgment, viewing negative (positive and neutral) thoughts as passing mental events rather than as facts.

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Mindfulness-Based Cognitive Therapy (MBCT) is an eight-week program designed to help people who suffer repeated bouts of depression and chronic unhappiness. It combines the ideas of cognitive therapy with meditative practices and attitudes based on the cultivation of mindfulness. The heart of this work lies in becoming acquainted with the modes of mind that often characterize mood disorders while simultaneously learning to develop a new relationship to them.

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The process of learning through Mindfulness Based Cognitive Therapy follows this flow: Concentration, Awareness/mindfulness of thoughts, emotions/feelings, impulses to act, body sensations, Being in the moment, De-centering, Acceptance/nonaversion, nonattachment, kindly awareness, Letting go, “Being” rather than “doing,” non-goal attainment, no special state (of relaxation, happiness, peace, etc.) to be achieved. Bringing awareness to the manifestation of a problem in the body.

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MBCT consists of 8 consecutive weekly sessions of about 2 hours’ length. Instruction consists of various formal and informal meditation practices, including guided body scans, sitting and walking meditations, mindful movement (based on Hatha yoga), 3-minute breathing spaces, and focused awareness on routine daily activities. Early sessions involve more guided meditations bringing attention to breathing or bodily sensations. Later, there is more emphasis on developing an independent practice and expanding mindful awareness to mental events, including thoughts and emotions that may previously have been avoided. Homework is an essential element of treatment, and patients are encouraged to spend 45 minutes daily practicing mindfulness activities, often using guided meditation recordings.

MBCT also includes elements of cognitive therapy and psychoeducation about depression. People learn that attempting to resist or avoid unwanted thoughts or feelings may actually intensify distress and perpetuate depression, rather than help resolve it. Additional behavioural elements also include supporting participants to mindfully complete activities that enhance well-being, such as taking a bath, listening to pleasant music, or going for a walk. Patients develop action plans that identify early warning thoughts or feelings that signal worsening symptoms, along with steps to take when they occur.

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Mindfulness-Based Cognitive Therapy (MBCT) integrates MBSR with cognitive science and Cognitive Behavioural Therapy. It was initially developed as a relapse prevention treatment in those with a high risk of depression recurring, but has since been adapted to a range of different populations and contexts.

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MBCT is based on MBSR and combines the principles of cognitive therapy with those of mindfulness to prevent relapse of depression. MBCT, like MBSR, utilizes secular mindfulness techniques including seated meditation. The program specifically teaches recognition of deteriorating mood with the aim of disengaging from self‐perpetuating patterns of ruminative, negative thoughts that contribute to relapse

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MBCT is an eight-week, manualized group intervention program adapted from the MBSR model. Developed as an approach to prevent relapse in remitted depression, MBCT combines mindfulness training and elements of cognitive therapy (CT) with the goal of targeting vulnerability processes that have been implicated in the maintenance of depressive episodes.

Like CT, MBCT aims to help participants view thoughts as mental events rather than as facts, recognize the role of negative automatic thoughts in maintaining depressive symptoms, and disengage the occurrence of negative thoughts from their negative psychological effects.

However, unlike the traditional CT approach that places considerable emphasis on evaluating and changing the validity of the content of thoughts and developing alternative thoughts, MBCT aims primarily to change one’s awareness of and relationship to thoughts and emotions (Teasdale et al., 2000). The theoretical rationale on which MBCT is based (Teasdale, Segal, & Williams, 1995) is that the negative thoughts that accompany depression become associated with the depressed state, and that, as the number of depressive episodes increases, negative automatic thoughts become more easily reactivated by feelings of dysphoria, even when these do not occur in the context of a full-blown depressive episode. The negative thoughts, in turn, increase depressed mood and other symptoms of depression, leading to an increased risk for relapse to a major depressive episode. MBCT specifically targets loosening the association between negative automatic thinking and dysphoria. Because these associations are theorized to be stronger among those with a greater number of previous episodes, they may be expected to show the greatest benefit of the intervention

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