Mindfulness-Based Cognitive Therapy: How It Works, Cost, & What to Expect

What Is Mindfulness-Based Cognitive Therapy?

Mindfulness-based cognitive therapy is a structured program that teaches people about their thoughts and how they can exist peacefully alongside them, rather than struggling against them or trying to change them.² The “cognitive” part of MBCT addresses the mind and helps people recognize the 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.

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.

MBCT Vs. Traditional CBT

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.

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 the goals of MBCT and CBT as well.¹ 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.

What Can MBCT Therapy Help With?

Mindfulness-based cognitive therapy was specifically designed to help prevent depression relapse in people prone to recurrent depression.² 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.¹

MBCT has been used to help people experiencing chronic medical conditions such as cancer, fibromyalgia, diabetes, epilepsy, and chronic pain.¹ 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.

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.² 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.

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.² 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.

MBCT techniques include:

Meditation

There are many ways of practicing meditation, but in general meditation involves training your attention to reach a mental state of calm concentration. Bringing your attention to the present moment, then allowing thoughts and feelings to come and go without judgment, builds important self-regulation skills that can be beneficial to clients in therapy.

Body Scan Exercises

Many people begin their meditation practice with a body scan. A body scan simply involves closing your eyes and turning your attention inward, to your body, the physical self. Check in with your body, head to toe, and notice without judgment any sensations. People often describe this exercise as being relaxing and grounding.

Mindfulness Practices

Mindfulness is all about bringing your attention to the present moment. By being fully present, aware of where you are, what you’re doing and how you’re experiencing it internally, you can reduce overwhelming thoughts and feelings related to the past or future and find peace in the moment at hand. The goal of mindfulness is to observe thoughts, feelings and sensations objectively, rather than slipping into reactivity.

Mindful Stretching

Mindful stretching is a practice that is beneficial for both mind and body, with stress-reducing effects. What sets mindful stretching apart from everyday exercise is that it emphasizes deep breathing patterns, a slow, methodical flow of movement, and mindful awareness of the sensations experienced during the routine.

Yoga

Yoga is an ancient practice that brings together movement, mindfulness, breathing techniques, and meditation, benefitting both mind and body. Practicing yoga for mental health has been shown to significantly reduce stress, increase mindfulness, interoceptive awareness and spiritual well-being.⁴

3-Minute Breathing Space

This is a short meditation that can be implemented anytime with minimal time investment in order to re-center and ground yourself in the midst of life’s challenges. The 3-minute breathing space meditation involves three distinct steps, each one-minute long. First, you become aware of your thoughts, feelings and sensations. Second, you focus your attention on your breath. Finally, you expand your attention to the sensations going on throughout the body. This method has been shown to reduce stress and feelings of exhaustion.⁵

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.⁶ 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 stay together to complete the training. Goals and objectives are the same as in an MBCT group class, but people complete the homework and exercises 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.

Benefits of Mindfulness-Based Cognitive Therapy

Research has demonstrated the many benefits and applications of MBCT, including:

• Provides chronic pain relief⁷
• Reduces stress
• Improves insomnia⁸
• Prevents depression relapse⁹
• Increases emotion regulation skills¹⁰
• Reduces anxiety and depression¹¹
• Mitigates age and racial biases¹²
• Helps to manage difficult thoughts and feelings

What to Consider Before Starting Mindfulness-Based Cognitive Therapy

MBCT has a strong evidence base with many proven benefits. That being said, it requires a firm commitment to attending weekly sessions, practicing new skills at home, completing homework, and being open to building new habits. In addition to daily homework assignments, many therapists ask that clients keep a gratitude journal. MBCT is also a physically active therapy, involving yoga and stretching. If you have any injuries or other physical health concerns that might impede your ability to participate in these activities it is recommended that you consult with your doctor before beginning MBCT.

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.

Who Is Able to Offer Mindfulness-Based Cognitive Therapy?

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.

To be able to lead MBCT classes, professionals must complete these steps:¹

• 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.

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.¹³

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?

Cost of Mindfulness-Based Cognitive Therapy

Because MBCT is delivered in a group format, the cost for this therapy is often lower than that of attending individual therapy sessions.¹⁴ 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.¹⁵ 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. Mental health insurance doesn’t always cover the cost of MBCT.¹⁶ 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.

What to Expect at Your First Session

At a first session, 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.⁶

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.¹⁷ This is significant, as without treatment, as many as 80 percent of people who have experienced an episode of major depression have a relapse.¹⁴

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.¹⁴

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.¹⁸

As these studies concluded, people with recurring symptoms 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 Institute of Clinical Excellence in the United Kingdom.¹⁷

Criticisms of MBCT

No approach to mental health is perfect, and MBCT is no exception.

Major criticisms of MBCT include:¹

• 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.

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.¹⁹ Mindfulness is much older, dating back thousands of years and rooted in traditions both secular and religious.²⁰

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.²¹ To do so, they drew on Teasdale’s work in interactive cognitive subsystems (ICS) model of psychology as well as on existing mindfulness concepts.¹

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.