Addiction A-Z

Mindfulness-based cognitive therapy

Many people just go through life on autopilot. Whether it’s their morning routine or how they handle stress, they don’t really stop and consider what they’re doing or why. In other words, they’re not mindful. For example, if you’re prone to binging on sweets when you’re feeling sad or picking a fight with your spouse whenever you’re really mad at your boss, you’re not acting mindfully. You’re reacting rather than responding after careful consideration. To put it another way, you’re not being mindful.

Learning to be mindful is a key element in mindfulness-based cognitive therapy (MBCT). Originally developed to treat those struggling with recurring bouts of depression, MBCT incorporates mindfulness techniques and practices, such as meditation, with cognitive behavioral therapy (CBT). Cognitive behavioral therapy is one of the most widely researched and effective treatments for a variety of disorders, including depression, anxiety, and many other mental health issues. Combining mindfulness strategies with CBT creates a powerful formula for helping those struggling with mood disorders, anxiety disorders, low self-esteem, and many other disorders and problems.

Understanding Mindfulness

Mindfulness involves being aware of what you’re thinking, feeling, and experiencing in the present moment – without judgment. The goal is to fully accept any negative or unwanted thoughts and feelings as a normal part of life, rather than to try to avoid or get rid of them. You recognize them as transitory and allow them to pass. Paying close attention to what’s going on internally enables you to consider an appropriate response (which often includes no response at all), and avoid having a habitual or knee-jerk reaction.

Psychological suffering often stems from trying to resist or control distressing thoughts, feelings and experiences. For example, one of the hallmark symptoms of obsessive-compulsive disorder is engaging in some sort of compulsive behavior in an attempt to alleviate the anxiety triggered by an obsessive thought. Another example is the use of alcohol or drugs to numb or escape painful feelings, or to quiet troubling thoughts. These reactions just lead to more suffering, whereas mindfulness helps ease suffering.

Mindfulness and CBT

In traditional cognitive therapy, you’re taught to identify and challenged irrational thoughts and distorted beliefs. The mindfulness aspect involves takes that a step further and teaches you to challenge how you perceive those thoughts. For many, the natural tendency is to regard them as something to react to rather than to simply accept them. Traditional CBT challenges their veracity (i.e. recognizing cognitive distortions as inaccurate rather than true, meaningful, important, or remotely representative of reality), while mindfulness takes it a step further and recognizes that these unwanted thoughts are also temporary or fleeting internal events. They don’t need to be judged, nor do they need a behavioral response – which often involves over-reacting to them, assuming they’re true, or giving them meaning and power they don’t deserve. They just are – and that’s okay. In fact, so many of the thoughts that cause unnecessary problems are really harmless, uninteresting, or inaccurate.

Now, it’s important to remember that mindfulness takes practice. It isn’t something you can just suddenly switch on. It’s a mental muscle that needs to be developed and strengthened by using it regularly. But the more you practice it, the easier it becomes. And MCBT shows you how to do that.

As mentioned previously, MBCT was initially developed to treat individuals who experience recurrent depression. It combines the cognitive behavioral strategies used to identify and change negative thoughts patterns with a variety of mindfulness techniques, including breathing exercises and meditation. Rather than relying on antidepressants as one of the primary treatments for recurrent depression, MBCT helps reduce and, in many cases, eliminate the need for medication altogether.

History of Mindfulness-Based Cognitive Therapy

People all over the world have been using mindfulness-based practices for centuries. Meditation is perhaps one of the most well-known mindfulness practices, and it has played an important role in many different religions, such as Buddhism.

Mindfulness-based therapies, however, have been around for less than a century. Shoma Morita, a Japanese psychiatrist and long-time student of Zen meditation, is one of the earliest pioneers in this area. It’s been over 90 years since he developed the mindfulness-based therapy known as Morita Therapy.

Mindfulness-based cognitive therapy is a much more recent therapy. It stems from the work of Jon Kabat-Zinn Ph.D., who created Mindfulness-Based Stress Reduction. Dr. Zindel Segal, a Canadian psychiatrist, along with two psychologists – John Teasdale and Mark Williams – took the concepts of MBSR and adapted them to treat individuals who suffered from recurrent depression. Like MBSR, MBCT is structured as an intensive 8-week treatment program.

These four experts have co-authored several books on MBCT, including Mindfulness-Based Cognitive Therapy for Depression (by Segal, Williams, & Teasdale, published in 2002), and The Mindful Way through Depression: Freeing Yourself from Chronic Unhappiness (published in 2007 by Williams, Segal, Teasdale, & Kabat-Zinn).

To date, there has been a substantial amount of research on the effectiveness of MBCT for recurrent depression, and an increasing amount of research supporting its effectiveness for many other psychiatric disorders.

Mindfulness Skills

In mindfulness-based cognitive therapy, as well as other mindfulness-based therapies, learning the following skills is a key aspect of therapy:

  • Paying attention – closely observing the things happening around you, as well as your thoughts and feelings about them
  • Withholding judgment – accepting your thoughts and feelings without judging them
  • Focusing on the present moment – consciously staying in the moment rather than acting on auto-pilot, as well as not dwelling on the past or fretting about the future
  • Non-critical participation – participating in activities without being self-conscious or self-critical
  • Doing what works – taking effective action instead of waffling and second-guessing yourself
  • Stepping back – learning to step back from a stressful situation in order to consider the best way to respond instead of just reacting to it

Mindfulness Techniques

There are several different mindfulness techniques used in MBCT. Practicing them will help you learn to quiet your mind and stay in the present moment. Following are several techniques that may be used:

Three-minute breathing space – Negative emotions impact the way you breathe. For example, consider how your breathing changes when you’re angry (often more rapid) or anxious (often more rapid and shallow). Focusing on your breathing is one of the best ways to bring you back to the present moment, while helping you feel relaxed and centered.

The three-minute breathing space is a type of meditation that gives you the opportunity to take a brief step back when you’re feeling stressed. The 3-step process involves 1) acknowledging (without trying to change) your physical sensations first, then your thoughts, and finally your feelings; 2) redirecting your focus to your breathing without altering it; and 3) expanding your awareness from your breathing to your entire body, and then expand your awareness to your entire experience.

Walking meditation – This is a popular mindfulness technique that essentially involves meditating as you walk. The goal is to focus on your breathing, your physical sensations, and the movement of your body.

Yoga – Yoga has long been known as an effective way to reduce stress. In its truest form, yoga is a type of moving meditation. Practicing yoga regularly has a variety of benefits including reduction of anxiety symptoms, improved sleep, and more positive mood.

Body scan – The body scan technique helps you tune into any physical sensations you’re experiencing, such as pain or muscle tension. While lying on your back, close your eyes and, as the name suggests, carefully scan your entire body. Take notice of any problem areas; stop at each one and take several slow, deep breaths until that area relaxes. Some people prefer to imagine a healing beam of light shining on the spot.

Seated meditation – This exercise is one of the most traditional ways to meditation. As you sit quietly in a comfortable position, close your eyes. You can focus on a mantra (e.g. “Ohm”) or on your breathing. Continue to divert your focus back to your breathing or mantra as thoughts drift through your mind.

What to expect in MBCT

Mindfulness-based cognitive therapy is structured as an 8-week group therapy program. Classes occur once a week and last for 2 hours or 2.5 hours, depending on the program facilitator. This provides sufficient time for everyone in the group to participate. There is also a full day retreat (lasting from 7 to 8 hours) mid-way through the course. This typically takes place between weeks 5 and 8.

Prior to starting the 8-week class, you’ll have an individual session with the person conducting the sessions. This will give you an opportunity to talk about what to expect from MBCT and discuss any questions and concerns you may have. Since much of the work in MBCT is done outside of class, you’ll be given materials to use at home, which typically include a CD with guided meditations and a practice manual.

Groups are small in size to ensure that each participant receives sufficient support and individual attention. You should come to sessions dressed in comfortable, loose-fitting clothing (for the various exercises that are part of therapy, such as yoga poses, body scan, etc.). During classes, participants will discuss what they practiced at home, what that was like for them, any obstacles they encountered during the week, and how to deal with those effectively.

Each MBCT class has a specific theme. The class themes in MBCT are as follows:

  • Automatic Pilot
  • Dealing with Barriers
  • Mindfulness of the Breath
  • Staying Present
  • Allowing and Letting Be
  • Thoughts are Not Facts
  • How Can I Best Take Care of Myself
  • Using What’s Been Learned to Deal with Future Moods

Goals of MBCT:

Over the course of the 8 weeks, you will:

  • Have a better understanding of how your mind works
  • Recognize when you’re vulnerable to old thought patterns that trigger a downward mood spiral
  • Learn to accept yourself without criticism and judgment
  • Learn how to stop second-guessing yourself
  • Learn how to treat yourself with kindness and compassion rather than engaging in negative, self-destructive thought patterns
  • Explore ways to let go of hold habits and create new, more positive behaviors
  • Learn to look at yourself and the world from a new perspective
  • Become more aware of all the beauty and wonder around you

Disorders, conditions, and issues that can benefit from MBCT

Although mindfulness-based cognitive therapy was originally designed to treat individuals who struggled with recurrent episodes of major depression, it is being used to treat many other psychiatric disorders, conditions, and issues as well. Following is a list of disorders, conditions, and issues that can benefit from MCBT:

  • Depression, including:
    • Chronic depression
    • Recurrent depression
    • Treatment resistant depression
  • Recurrent suicidal behavior
  • Generalized anxiety disorder
  • Panic disorder
  • Specific phobias
  • Bipolar disorder
  • Borderline personality disorder
  • Obsessive-compulsive disorder
  • Posttraumatic stress disorder
  • Substance abuse and addiction / relapse prevention
  • Binge eating disorder
  • Body dysmorphic disorder
  • Social anxiety disorder (social phobia)
  • Compulsive disorders
  • Insomnia
  • Chronic pain
  • Chronic fatigue syndrome
  • Schizophrenia
  • Psychosis
  • Hypochondriasis
  • Olfactory reference syndrome
  • Anger issues
  • Aggressive behavior
  • Coping with medical issues, such as chronic pain, hypertension, and cancer
  • Low self-esteemRelationship problems
  • Unresolved grief
  • Difficulties with managing stress

Benefits of MBCT

There are many potential benefits to be gained from mindfulness-based cognitive therapy. They include:

  • Decrease in need for antidepressants and anti-anxiety medication
  • Decreased dependence on mood-altering substances such as alcohol, recreational drugs, and caffeine
  • Decrease in self-critical and self-judgmental thinking
  • Greater self-acceptance
  • Increased self-awareness and insight
  • Increase in intuitive skills
  • Decrease in emotional reactivity
  • Stress reduction / greater ability to effectively handle stress
  • Greater ability to focus and pay attention
  • Stronger sense of balance in life
  • Decrease in self-consciousness
  • Decrease in neurotic thoughts and behaviors
  • Improved mood
  • Decrease in negative thoughts
  • Decreased tendency to ruminate or obsess
  • Increased ability to regulate emotions
  • Greater sense of purpose
  • Stronger immune functioning
  • Improvements in academic performance
  • Improved creativity
  • Greater ability to focus on others due to decrease in self-consciousness
  • More positive relationships with others
  • Improved self-esteem
  • Better sleep
  • Increased sense of satisfaction with life
  • Improvements in working memory
  • Less anxiety
  • Increased sense of empowerment in dealing with serious medical issues

In addition to the long list of potential benefits above, mindfulness-based cognitive therapy gives you effective strategies that you can use long after therapy is over. Stressful situations, unwanted thoughts, and negative emotions are part of living. Using the techniques you learn in therapy, you’ll be able to handle them more effectively. Learning to be mindful is an invaluable skill that will continue to have a very positive impact on your life.

Where to Find an MBCT Class

If you’re interested in participating in an MBCT program, you may be able to find a certified MBCT practitioner in your area. Classes are usually taught by mental health professionals, including psychologists, psychiatrists, marriage and family therapists, professional counselors, and clinical social workers. Classes may be offered in a variety of settings, including private practitioners’ offices, community mental health clinics, residential treatment programs, hospitals, and other clinical settings.

In some cases, you may be referred to an MBCT program by your therapist, medical doctor, drug and alcohol counselor, or other professional. The person who refers you should have information regarding a specific MBCT program to attend. If you’re interested in a program but don’t have a referral, you can search online for a program in your area (e.g. MBCT [your city] or mindfulness-based cognitive therapy [your city]). Once you find a facility or private therapist who offers MBCT classes, you should be able to get more information via their website or by calling.

If you want your treatment to be covered by your health insurance, a referral from a mental health or medical professional is usually required.

There is much to be gained from mindfulness-based training, which is why it’s becoming increasingly popular in the U.S. as well as many other countries. Learning mindfulness techniques combined with cognitive strategies can be beneficial even if you don’t have a diagnosable mental health condition. As mentioned above, MBCT can be very beneficial for individuals struggling with things like grief, low self-esteem, and relationship problems. If you’re not sure if MBCT is right for you, you can always contact a program instructor to discuss your questions and concerns.

Although MBCT is only an 8-week program, it’s an intensive form of treatment. You’ll learn a lot about yourself and gain powerful skills that will benefit you for the rest of your life.

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