Mindfulness-based cognitive therapy (MBCT) was developed as a psychological approach for people at risk for depressive relapse who wish to learn how to stay well in the long-term. Although substantial progress has been made in the treatment of many chronic conditions in psychiatry, recurrent depression continues to cause significant disability and human suffering. Therefore MBCT was developed with the aim of helping people vulnerable to repeated episodes of depression.
The intention was to use a psychological understanding of depressive relapse to develop a targeted approach to relapse prevention for people with recurrent depression. During an episode of depression, low mood coexists with negative thinking, other painful emotions and unpleasant body sensations. Once the episode is past, and mood has returned to normal, the constellation of negative thinking, emotions and body sensations tends to go into abeyance. However, there is evidence that, even after recovery from an episode of depression, people remain vulnerable in that a relatively small change in mood can result in a large escalation of negative thoughts, including self-judgement (such as ‘I am worthless’), negative views of experience (such as ‘Everything is just too difficult’) and hopelessness (such as ‘There is nothing I can do to escape my situation’).
Negative thoughts are accompanied by other powerful emotions in addition to low mood (e.g. anxiety, guilt, anger, frustration, shame), and by physical symptoms and body sensations such as weakness, fatigue, tension and pain.
MBCT is based on Jon Kabat-Zinn’s stress reduction program at the University of Massachusetts Medical Center, which was developed to help people with chronic physical pain and disease. It includes meditation techniques to help participants become more aware of their experience in the present moment, by tuning into moment-to-moment changes in the mind and the body. Participants learn the practice of mindfulness meditation through a course of sessions held weekly for an 8-week period, and through daily mindfulness practice.
MBCT also includes basic education about depression and a number of exercises derived from cognitive therapy that demonstrate the links between thinking and feeling and how participants can care for themselves, especially when they notice a downturn in their mood. Unlike cognitive therapy, the mindfulness approach does not try to change the content of negative thinking. Rather, it encourages participants to change their relationship to thoughts, feelings and body sensations, so that they have an opportunity to discover that these are fleeting events in the mind and the body that they can choose to engage with – or not.
Mark G. Williams and Willem Kuyken, Mindfulness-based cognitive therapy: a promising new approach to preventing depressive relapse, BJP 2012, 200:359-360.