Depresssion Treatment - Mindfulness-Based Cognitive Therapy

Mindfulness-Based Cognitive Therapy (MBCT) is an effective psychotherapy for preventing future episodes of depression after someone has recovered from an episode of depression.  Thus, MBCT is not a treatment for someone who is depressed right now.  Instead, MBCT is a treatment for someone who has been depressed in the past and is interested in learning skills to prevent depression in the future.  MBCT is very similar to Cognitive-Behavioral Therapy  (CBT) in that it is based on the belief that depression is caused by the relationship between negative thoughts and low mood.  It is different from CBT because CBT focuses on changing the content of negative thoughts while MBCT focuses on changing the relationship with negative thoughts.  In MBCT, the focus is on mindfulness skills to develop more awareness of negative thinking patterns and ultimately disengage from these negative thinking patterns so that mild sadness does not turn into depression.
 
How does MBCT work? The basic idea in MBCT is that depression is caused and maintained by negative thinking patterns and the difficulties people have in disengaging from them.  Based on principles of Buddhist meditation and Jon Kabt-Zinn’s mindfulness based stress reduction program for chronic pain, MBCT skills involve directly observing thoughts and emotions related to depression with a non-judgmental attitude.  This is a very different way of engaging with thoughts than is common in depression, whereby people often spent a lot of time think excessively about their problems, how problems started, and what problems mean.
 
What does MBCT look like in action?  Although there are now many variations of MBCT, the original format included 8 weekly group therapy sessions and 4 follow-up sessions.  Patients learn a combination of 1) traditional mindfulness skills through formal practices called body scans and mindfulness of the breath, and 2) traditional CBT skills through learning about the CBT model of depression and developing awareness of one’s own experience of depression.  In addition to the group therapy sessions, there is also a strong emphasis on practicing these skills between sessions, usually for 1 hour per day.  
MBCT is divided into two phases.  In the first phase, patients learn the basic mindfulness skills of non-judgmental, present-focused attention.  That means being able to pay attention to some aspect of the present moment without labeling it as good or bad.  In the second phase, patients learn how to apply these skills to stressful situations that could increase the chance for relapse.  That means helping people become able to experience a stressful event, become non-judgmentally aware of their experience, and make a clear choice on how to respond to the situation.  In the final part of the second phase, patients develop individual plans for maintaining a formal mindfulness practice and identify specific ways of coping when life gets stressful.
 
Sources

• Kabat-Zinn J. Mindfulness-based stress reduction (MBSR). Constructivism in the Human Sciences 2003;8: 73–107.
• Teasdale JD, Segal ZV, Williams D, et al. Prevention of relapse/ recurrence in major depression by mindfulness- based cognitive therapy. J Consult Clin Psychol 2000;68: 615–23.