Mindfulness-based cognitive therapy (MBCT) is an approach to mental health and well-being that combines components of cognitive therapies and principles of mindfulness to help people develop a new relationship with their troublesome thoughts and emotions. Originally designed to prevent depression relapse, MBCT is now used to treat other mental health challenges. If you’re wondering whether mindfulness-based cognitive therapy could be right for you, this guide can help you decide.
What is Mindfulness-Based Cognitive Therapy?
Mindfulness-based cognitive therapy is a structured program that teaches people about their thoughts (cognitions) and how they can exist peacefully alongside them, rather than struggling against them or trying to change them.1 The “cognitive” part of MBCT addresses the mind and helps people recognize their own thought patterns that drive their emotions and behaviors. The “mindfulness” part guides people toward a new way of being with their thoughts and experiencing their lives fully moment by moment.
With MBCT, people learn awareness. When aware of their own thought patterns, negative thoughts no longer occur automatically, running constantly in the background of their mind and leading to disruptive, out-of-control emotions.2 With mental health challenges like depression and anxiety, people know that they’re not feeling and living their best. A common way to try to improve is to think—and overthink—about their own thoughts in an attempt to stop or change them, but, unfortunately, this just keeps people stuck in them.3
MBCT helps people develop a new relationship with themselves and their thoughts. Rather than overthinking and trying to force changes or ignoring and suppressing thoughts and feelings, with MBCT people learn to become fully aware of them and let them come and go without tangling with them.3 MBCT is ultimately about allowing and accepting negative thoughts while shifting your focus to what is happening in the present moment because when you’re focused on the present, you’re not trapped in negative thoughts about the past or the future.
Rather than psychotherapy that explores personal experiences and meaning, it’s an educational program that teaches about thoughts; the relationship between thoughts, emotions, and behaviors; and tools and techniques people can use on their own.4 Typically, MBCT is delivered in a group setting, and about 10-15 participants meet weekly for eight weeks (exact group size and structure may vary) for training in cognitive and mindfulness techniques and to receive homework assignments to continue learning outside of sessions.2 Some people choose to attend therapy individually while participating in an MBCT group.
Techniques Used in Mindfulness-Based Cognitive Therapy
MBCT teaches both cognitive and mindfulness tools for people to use in their daily lives for optimal mental health.5 Depression and other mental health challenges involve automatic negative thoughts (ANTs) that affect the way people view themselves, others, and their lives. Thoughts lead to problematic moods and emotions. Together, thoughts and emotions influence people’s actions. Actions also influence thoughts and feelings, and people can become stuck in a negative cycle that can be hard to escape. MBCT seeks to help people break out of this cycle.
Cognitive techniques focus on helping people learn about their thoughts and include:2
- Learning the nature of ANTs
- Noticing them and catching them as they occur
- Considering them objectively to see that thoughts aren’t always factual
Mindfulness techniques are designed to help people live fully and freely in each moment of their lives despite challenges and negative thoughts. Once people notice their thoughts, they can then choose to just let them exist rather than struggling against and arguing with them.
There are specific tools people can draw on to help them shift their focus from their thoughts to their tangible life in their present moment, including:6
- Mindful breathing
- Body scan and progressive muscle relaxation
- Seated meditations, both guided and self-led
- Walking meditations
- Mindful stretching (such as yoga poses and sequences or informal stretching done with full mind-body awareness)
- Mindfulness in daily tasks, using your senses to focus completely on whatever you are doing in a given moment
What’s the Goal of Mindfulness Based Cognitive Therapy & Who Determines That Goal?
The goal of MBCT is to help people recognize and deal with negative thoughts and emotions as they occur and then to use mindfulness to become centered and calm in the present moment, free from the trap of negative thoughts and feelings.4 Mindfulness-based cognitive therapy helps people develop a new relationship with themselves, their thoughts and feelings, and their lives. Harsh self-criticisms and judgements about situations are replaced with acceptance and compassion. It’s important to note that acceptance does not mean giving up or resigning yourself to depression or other challenges but instead encompasses an attitude of allowing thoughts to exist as they are without getting stuck in them and living fully in the present moment instead of trapped in thoughts of the past or future.
Because MBCT is delivered in a structured group program, the goals are inherent to the program. People who simultaneously engage in individual therapy may set other, unique goals with their therapist.
What Can Mindfulness-Based Cognitive Therapy Help With?
Mindfulness-based cognitive therapy was specifically designed to help prevent depression relapse in people prone to recurrent depression.1 While this remains its primary use, MBCT has been used to help people living with other mood disorders such as bipolar disorder, anxiety, addictions, personality disorders like borderline personality disorder, and chronic medical conditions.2,4
MBCT has been used to help people experiencing chronic medical conditions such as cancer, fibromyalgia, diabetes, epilepsy, and chronic pain.2 In these instances, MBCT does not provide or substitute for medical care and treatment. Instead, it is a type of palliative care designed to help people cope with the symptoms of their illness and improve their quality of life.
In all cases, participants in an MBCT group learn to become aware of their problematic thoughts and to accept them rather than struggling against them. Additionally, regardless of the reason for attending MBCT, participants learn mindfulness tools and techniques to help them experience a sense of wellbeing despite whatever challenges they may be facing. Mindfulness is not just a tool for developing a new relationship with thoughts, feelings, and problems but is a way of experiencing and participating in life. As such, everyone can benefit from learning mindfulness skills whether or not they have ever experienced depression or any other mental health challenge.7
Mindfulness-Based Cognitive Therapy Settings
Mindfulness-based cognitive therapy is primarily delivered in a group setting, with participants gathering together with an MBCT-certified therapist or instructor to learn cognitive and mindfulness techniques. What those groups are like can vary. If you are interested in MBCT, your options include participating in a group class or attending a retreat.
MBCT Group Classes
These programs are held in settings such as community centers, therapy offices, clinics, and hospitals or may be conducted online. Participants come together in person or online, usually once per week, for a two-hour session dedicated to a topic involving thoughts or mindfulness.8 While each class provides information and techniques, most of the work is done outside of class at home with specific assignments designed to help people apply the information to their lives.
MBCT Retreats
Retreats are immersive experiences in which participants leave home to stay in a location to attend a program. Several meditation centers worldwide hold MBCT retreats, including Spirit Rock Meditation Center in Woodacre, CA, Insight Meditation Society in Barre, MA, and Gaia House in Devon, U.K.6 Goals and objectives are the same as in an MBCT group class, but people complete the homework and exercise while at the retreat rather than returning home and doing the activities between meetings. The advantage of a retreat is the full-time presence of the instructor and other participants for support. The expense and time commitment may be substantial, however.
Cost of Mindfulness-Based Cognitive Therapy
Because MBCT is delivered in a group format, the cost is often lower than that of attending individual therapy sessions.9 An individual session with a therapist can range from $50-$250, and sessions can be limited to one or just a few to weekly sessions for years.10 At the time of this writing, an eight-week program at the University of Massachusetts is $650 paid in full by the participant or $555 under limited insurance plans . Insurance doesn’t always cover the cost of MBCT.11 To find out if yours does and for classes they include, call the number or visit the website listed on the back of your insurance card.
Also, a study comparing the cost of MBCT to the cost of antidepressant medication found that over a 15-month period, the cost of the two types of treatment was about the same.9 The initial cost of MBCT is higher when you pay for it upfront, but there are no ongoing charges as with prescription medication.
How to Find a Mindfulness-Based Cognitive Therapist or Program
To find an MBCT therapist or program, visit Access MBCT, a service offered by MBCT.com, the online home of mindfulness-based cognitive therapy. Access MBCT provides a directory to help people interested in MBCT find a therapist who conducts programs in their area. Other directories can point you to MBCT therapists or programs as well.
If you don’t live near an MBCT program, you have the option of attending a live program remotely through an online program. The University of Massachusetts’ Center for Mindfulness offers online MBCT courses. Participants at long distances can join classes held in person at UMASS.
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Who Is Able to Offer Mindfulness-Based Cognitive Therapy?
Mindfulness-based cognitive therapy programs must be led by qualified therapists who are licensed mental health professionals with additional training in MBCT.4
To be able to lead MBCT classes, professionals must complete these steps:2
- Receive an advanced degree and licensure to become a mental health professional such as a therapist, counselor, or psychologist
- Attend a dedicated MBCT training program (such programs are offered worldwide)
- Complete an additional MBCT course such as the Mindful Noggin online MBCT course or the Participant Observer live MBCT course
- Apply for the teacher-in-training status
- Teach a minimum of 20 hours of MBCT courses under supervision/mentorship of an established MBCT practitioner
Once a professional has completed these steps, they can apply for full teacher qualification. At this point, they can lead programs on their own. Many therapists choose to continue their MBCT education by taking more courses, continuing to teach, and undergoing further mentorship in order to become certified.
Only qualified and certified professionals can lead MBCT courses. When investigating any MBCT program, be sure to check the credentials of the instructor to ensure they are a licensed mental health professional with specific training and certification in mindfulness-based cognitive therapy.
Key Questions to Ask a Mindfulness-Based Cognitive Therapist When Considering MBCT
For best success with any therapy, including MBCT, it’s important to make sure it’s a good fit for you personally. Before beginning a program, it’s okay and encouraged for you to either call the instructor or meet with them in-person one-on-one to determine if MBCT is right for you. One of the most important factors in any type of therapy is the relationship you have with the therapist, so when you visit with a potential MBCT therapist, notice how your personalities fit and whether you feel a positive sense of connection, or rapport.12
Key questions to ask a therapist when considering MBCT include:
- Do you have a screening process to select group participants?
- Do you try to select people who will fit well together during the group?
- How do I know if I’m ready for group therapy or if I should stick with individual therapy?
- Do you also provide individual therapy for people who want more personal work?
- How much work is done outside of class, and what is the typical time commitment?
- What happens if I decide that I’m not happy with the group after a few sessions?
- What can I do to ensure that I get the most out of this MBCT group?
What to Expect at Your First Session
The first session of any group therapy or course is a formative one, with participants and leaders becoming accustomed to each other and the environment.13 The therapist will help everyone interact smoothly and feel comfortable, accepted, and safe. You’ll learn what to expect throughout the course and begin to develop a rhythm with the other participants as you discover the rules and procedures.
The first MBCT session involves far more than getting to know each other and figuring out the rules, however. Your therapist will dive right into the heart of the course, and you’ll begin learning and growing immediately. In every session, including the first, you’ll gain information about thoughts and/or mindfulness, and you’ll learn and practice tools and techniques to use in your life. Often in the first class, you’ll become more aware of your thoughts, feelings, and negative patterns so you can stop living on autopilot and start living with intention.8
Is Mindfulness-Based Cognitive Therapy Effective?
Research has found MBCT to be effective in preventing depression relapse; indeed, two separate studies have found that in people with recurrent depression, MBCT reduces rates of relapse by up to 50 percent.14 This is significant, as without treatment, as many as 80 percent of people who have experienced an episode of major depression have a relapse.9
A 2008 study compared people taking maintenance medication (antidepressants taken after depression symptoms have lifted, perhaps at a lower dosage than during the episode) to prevent a depression relapse with people taking an MBCT group therapy program and tapering off medication in the process. After the study and over a 60-week follow-up period, two-thirds of the people taking maintenance medication had experienced a depression relapse while only one-third of those in the MBCT group had a relapse.9
Another group of three complementary studies conducted by Teasdale and colleagues together found that MBCT reduces the risk of depression relapse better than medication because it increases people’s awareness of their thoughts and helps them stop struggling against those negative thoughts and instead focus their attention on what is happening in the present moment.15
As these studies concluded, people with recurring tend to have low awareness of their own negative thought patterns and how these contribute to problematic emotions and behaviors. Mindfulness-based cognitive therapy teaches people the skills they need to recognize their thoughts and change the way they relate to them.
Because of positive results in scientific studies, MBCT has been accepted as a legitimate approach to depression relapse prevention. An indication of MBCT’s acceptance is its endorsement as a credible treatment by the National Insitutute of Clinical Excellence in the United Kingdom.14
Criticisms of MBCT
No approach to mental health is perfect, and MBCT is no exception.
Major criticisms of MBCT include:2
- Because MBCT is so new, to date not enough studies have been conducted to determine the long-term effectiveness of MBCT
- Many of the studies done into MBCT have had flaws such as a small size or problems with methodology
- Many of the studies have been conducted by MBCT’s founders rather than outside, objective groups
- Most studies focus on MBCT’s effectiveness for prevention of recurrent depression, so there is a lack of empirical evidence for its effectiveness for other conditions
- Because MBCT relies heavily on homework done outside of the class setting, there’s a chance that people won’t comply with the treatment and will therefore have less success
These issues do not mean that MBCT is ineffective or an unreliable treatment. As noted above, the studies that have been conducted yield positive results and indicate that mindfulness-based cognitive therapy significantly reduces the risk of a depression relapse. These criticisms merely point to the need for expanded research into the approach to determine its long-term effectiveness and its applicability to other mental health conditions.
How is Mindfulness-Based Cognitive Therapy Different Than Other Cognitive Therapies?
Mindfulness-based cognitive therapy has been compared to another popular and research-based approach to mental health known as cognitive behavioral therapy (CBT). While both approaches help people recognize and address automatic negative thoughts, they do so in different ways.16
While MBCT is a structured group educational program, CBT is often delivered individually, in one-on-one talk therapy sessions. MBCT is time-limited and lasts exactly eight weeks. Individual CBT sessions with a therapist can be short- or medium-term, frequently lasting between six week and six months.
There is a fundamental difference between MBCT and CBT as well.2,4,15,16 Cognitive behavioral therapy seeks to help people change their thoughts and beliefs by:
- looking for evidence to prove those thoughts incorrect
- and then rewording the thoughts to become more realistic and positive
In MBCT, people learn to accept their thoughts. They learn about thoughts and become aware of them and their effect on their lives, but the emphasis is not on challenging or changing those thoughts.
Instead, the mindfulness component of MBCT helps people:
- develop a new way of relating and responding to their thoughts through nonjudgmental acceptance
- focus on the present moment rather than on those negative thoughts (the negative thoughts are allowed to come and go, and people are no longer distracted by them)
History of Mindfulness-Based Cognitive Therapy
Mindfulness-based cognitive therapy is a unique blend of mental health approaches that had, until MBCT, existed independently of each other. Cognitive therapies began in the 1950s when Albert Ellis and Aaron Beck each pioneered their rational emotive behavior therapy (REBT) and cognitive behavior therapy (CBT), respectively.17 Mindfulness is much older, dating back thousands of years and rooted in traditions both secular and religious.18
According to the University of San Diego Center for Mindfulness, MBCT was developed in 2002 when psychologists and researchers Zindel Segal, Mark Williams, and John Teasdale used their knowledge and experience in cognitive therapies and mindfulness to develop mindfulness-based cognitive therapy.19 To do so, they drew on Teasdale’s work in interactive cognitive subsystems (ICS) model of psychology as well as on existing mindfulness concepts.2
Less than two decades old, the field is a newcomer in psychology and is in its infancy. However, it has already proven successful in helping people prevent depression relapse and has begun to be used to treat other mental health conditions as well.
For Further Reading
Visit these organizations to learn more about MBCT:
