Mindfulness-Based Cognitive Therapy Explained

By Team TherapyRoute

Mindfulness-based cognitive therapy, or MBCT, brings cognitive therapy together with meditation.² Cognitive therapy looks at how thoughts affect mood and behaviour. Mindfulness means noticing thoughts and feelings as they happen, without judging them.

It was developed mainly to lower the risk of depression returning after someone recovers.² MBCT is aimed at people who are already feeling better, which is different from treatment for a current low period.

Where MBCT comes from

MBCT belongs to what clinicians call the third wave of cognitive and behavioural therapy.¹ Two waves came before it. The first came from learning theory, and used conditioning to change behaviour. The second arrived in the 1970s, with more attention on thinking, and it led to modern cognitive behavioural therapy, or CBT.

The third wave includes MBCT alongside acceptance and commitment therapy and dialectical behaviour therapy.¹ Behaviour therapy has a South African history too, which includes the work of Joseph Wolpe.

What MBCT is for

Depression often returns, and many people have more than one episode over time. Remission means a person is close to being free of symptoms.

A relapse is the return of symptoms from the episode being treated.¹ A recurrence is a fresh episode that starts after a person has recovered. MBCT is usually added once someone has reached remission.

Medication can bring quick relief during a low period. Once it is stopped, medication does little to prevent later episodes.² Talking therapies such as MBCT can produce longer-lasting change.

Research has found that adding it after recovery reduced the risk of relapse and recurrence.² Many people use MBCT alongside medication rather than instead of it, and combined care aims to keep the benefits of both.

How MBCT works

Earlier approaches use direct, teaching-style methods to change thoughts. Third-wave therapies work on how a person experiences those thoughts, with the aim of a wider and more flexible set of responses.

For MBCT, that means learning to notice thoughts without being ruled by them. A hard thought can be seen as a passing event, not a fact.¹ The thought still comes; what changes is how a person responds to low moods.

What a course looks like

MBCT is taught as a course rather than as private one-to-one therapy. The standard programme runs as eight weekly sessions of about two hours, with a meeting beforehand in which the teacher and the person considering the course work out together whether this is a sensible time in their life to take it.³ The group works through a set curriculum from beginning to end, so people usually start together.

Sessions follow a recognisable shape. Most open with a guided practice, after which the group talks through what came up in it and in the past week at home, and the teacher draws that into the theme of the week. Attention in the first half of the course goes to noticing what is happening internally, and in the second half it turns to applying that to real difficulties, including spotting the early signs that a low period is building.³

Practice between sessions is part of the design rather than an extra. The usual schedule is roughly 45 minutes a day of formal practice, together with short informal practices during ordinary activities and some brief written notes on what was noticed.³

The practices the course teaches

Mindfulness meditation is the spine of it. The practices taught include a body scan, sitting meditation, mindful movement drawn mainly from hatha yoga, and a short three-minute breathing space used to reconnect with the present in the middle of an ordinary day.³

The cognitive element carries over from CBT, and is sometimes called cognitive restructuring: the same attention to habitual, unhelpful patterns of thinking, with handouts and exercises for recognising them. What MBCT does not do is argue with the content of a thought or try to swap it for a more accurate one, and there is no emphasis on changing how strongly a person believes it.³

De-centring is the name for the skill both parts are working towards. It means observing your own thoughts and feelings as temporary events in the mind rather than as valid reflections of reality or as central parts of who you are.⁴

What the course asks of you

Daily practice for eight weeks is the main demand, and most people carry some version of it on afterwards. Participants are told before they start that they will not necessarily enjoy this, that there will be times it feels difficult or boring, and that continuing through those stretches matters.³

It is also slow. Noticing your own patterns of thought, and then relating to them differently, takes time and steady repetition, and nobody should expect the course to settle a long-standing difficulty on its own.

The group format does not suit everybody. Some people would rather work privately with one therapist, and it is worth raising that when you enquire, since some MBCT-trained clinicians offer an individual version or can help you settle in to a group.

The course itself is demanding and tends to raise the intensity of what a person is feeling, which is why teachers generally advise against beginning during acute distress or a period of upheaval.³ For complex or long-standing difficulties, MBCT usually sits inside wider care rather than standing in for it.

Is MBCT right for you?

MBCT may suit you if you have recovered from depression and want to stay well. It is usually not the first step during a severe current episode. A mental health professional can help you work that out.

The original design, and most of the evidence, concern recurrent depression. Adapted versions of the course have since been developed and studied for anxiety disorders, health anxiety, chronic pain and living with long-term physical illness, and that body of work is younger and smaller than the relapse-prevention research.⁴

If you are struggling right now, please ask for support first, before any decision about starting a course of therapy. If you are in danger, these helplines and suicide hotlines worldwide list numbers by country. There is no shame in asking for help early.

If MBCT sounds right for you, speak with a therapist. Our guide on how to find the right therapist is a good place to start.

How to find a course

Look for a clinician or teacher with specific training in MBCT rather than in mindfulness alone, since the two are not the same qualification. Courses run through hospital departments, community mental health services, university clinics and private practices, and availability varies a great deal by country and city.

Worth asking before you commit: whether the course follows the full eight-week curriculum, when the next intake starts, how large the group will be, what the daily home practice will require of you, and whether there is a meeting beforehand to talk it through. If your own therapist or doctor is already involved in your care, tell them you are considering a course, so that the two pieces of care sit together rather than separately.

Common questions

Is MBCT the same as mindfulness meditation?

No, they are not the same. MBCT uses mindfulness inside a structured therapy based on cognitive therapy.

Can I do MBCT while taking medication?

Yes, this is common. MBCT is often added after someone reaches remission on medication.

References

Show references

1. [1] Sadock BJ, Sadock VA, Ruiz P, eds. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. 10th ed. Philadelphia: Wolters Kluwer; 2017.
2. [2] Gabbard GO, ed. Gabbard's Treatments of Psychiatric Disorders. Washington, DC: American Psychiatric Publishing.
3. [3] Crane R. Mindfulness-Based Cognitive Therapy: Distinctive Features. Hove: Routledge; 2008.
4. [4] Eisendrath SJ, ed. Mindfulness-Based Cognitive Therapy: Innovative Applications. Cham: Springer International Publishing; 2016.