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Under a Creative Commons license Open access Highlights• Mindfulness-based cognitive therapy for recurrent major depression •A systematic review of 23 clinical trials investigating mechanisms of change •MBCT may work according to the theoretically proposed mechanisms. •Better designs that can assess greater causal specificity are needed. •We provide recommendations for future research. AbstractBackgroundThe investigation of treatment mechanisms in randomized controlled trials has considerable clinical and theoretical relevance. Despite the empirical support for the effect of mindfulness-based cognitive therapy (MBCT) in the treatment of recurrent major depressive disorder (MDD), the specific mechanisms by which MBCT leads to therapeutic change remain unclear. ObjectiveBy means of a systematic review we evaluate how the field is progressing in its empirical investigation of mechanisms of change in MBCT for recurrent MDD. MethodTo identify relevant studies, a systematic search was conducted. Studies were coded and ranked for quality. ResultsThe search produced 476 articles, of which 23 were included. In line with the theoretical premise, 12 studies found that alterations in mindfulness, rumination, worry, compassion, or meta-awareness were associated with, predicted or mediated MBCT's effect on treatment outcome. In addition, preliminary studies indicated that alterations in attention, memory specificity, self-discrepancy, emotional reactivity and momentary positive and negative affect might play a role in how MBCT exerts its clinical effects. ConclusionThe results suggest that MBCT could work through some of the MBCT model's theoretically predicted mechanisms. However, there is a need for more rigorous designs that can assess greater levels of causal specificity. KeywordsMindfulness MBCT Depression Mediation Treatment mechanisms Review Cited by (0)Copyright © 2015 The Authors. Published by Elsevier Ltd.
Marcus Aurelius Countless hours have been spent debating and discussing the implications of quotes like this from Roman Emporer and philosopher Marcus Aurelius. The idea holds as much truth now as it did nearly 2,000 years ago, and can open a seemingly bottomless rabbit hole of questions about the nature of the human mind. Are we what we think, or are we the entity that thinks? Can we change our very nature by focusing on changing our thoughts? We won’t follow that rabbit hole today, but we will work from a generally accepted assumption that our thoughts define our reality and that we can take control of this reality and make adjustments to it that can enhance our quality of life. Mindfulness-based cognitive therapy is one tool that can help us learn to recognize and understand our thought and feeling patterns, with the goal of creating new, more effective patterns. Before you read on, we thought you might like to download our three Mindfulness Exercises for free. These science-based, comprehensive exercises will not only help you cultivate a sense of inner peace throughout your daily life but will also give you the tools to enhance the mindfulness of your clients, students, or employees. This Article Contains:
What is Mindfulness-Based Cognitive Therapy?Mindfulness-based cognitive therapy (MBCT) is a type of therapy born from the union of cognitive therapy and meditative principles.
The marriage of these ideas is MBCT, a powerful therapeutic tool that can be successfully applied to the treatment of depression, anxiety, bipolar disorder, and more. For a closer look at MBCT, watch one of its founders describe how MBCT can be applied to depression: Does it work?All signs point to “yes!” Two experiments testing the efficacy of MBCT on depression demonstrated that relapse rates for the disorder decreased (Kuyken et al., 2008; Teasdale et al., 2000), while more recent studies have shown the applicability of MBCT in treating a variety of ailments, including anxiety, depression, and ADHD in clients from multiple age groups (Haydicky, Carly, Wiener, & Ducharme, 2015; Kishita, Takei, & Stewart, 2016; Schroevers, Tovote, Snippe, & Fleer, 2016). MBCT has also been approved by the UK National Institute of Clinical Excellence as an effective treatment for depression relapse (MBCT.com). MBCT for treating depressionWhile research is still being gathered into the efficacy of using MBCT to treat individuals with less chronic depression, MBCT is thought to be particularly effective for the treatment of people who have suffered from multiple episodes of depression (Mental Health Foundation). How does it work?MBCT uses these mindfulness benefits to improve mental health:
In particular, MBCT is effective in helping clients deal with depression. The MBCT website lays out its three goals:
To learn how mindfulness and meditation can help us deal with life’s challenges by affecting the way our brains work, watch this interesting and informative TED Talk from Sara Lazar: For more information on how MBCT can be applied to help treat mental ailments, see the next section on the techniques and exercises that are frequently in its application. Popular MBCT Exercises and TechniquesIn addition to exercises like mindful seeing, acceptance, and mountain meditation, there are many techniques specific to MBCT. The most popular course of MBCT treatment was developed by Jon Kabat-Zinn. This treatment is an 8-week group-based therapy program created to help clients cope with both mental and physical symptoms (Good Therapy, 2016). Groups meet once a week for two hours and complete homework outside of class for six days a week. Homework includes meditation practice, audio-guided mindfulness exercises, and techniques like the three-minute breathing space (Good Therapy, 2016). Three-minute breathing spaceThe three-minute breathing space is a quick exercise that is undertaken in three steps:
For a guided version of the three-minute breathing space, watch this video. Other recommended MBCT techniques are discussed below. Body scanParticipants lie very still for the duration of the exercise, and move deliberately and with awareness if they need to adjust their position. Next, the facilitator begins guiding participants through the Body Scan, beginning with bringing awareness to the breath: noticing the rhythm and the experience of breathing in and out. The facilitator explains that participants should not try to change the way they are breathing, just hold gentle awareness on the breath. The facilitator brings attention to the body next: how it feels, the texture of clothing against the skin, the contours of the surface on which the body is resting, the temperature of the body and the environment. Participants are then instructed to bring their awareness to parts of the body that are tingling, sore, or feeling particularly heavy or light. The facilitator asks the participants to note any areas of their body where they don’t feel any sensations at all or, conversely, areas that are hypersensitive. A typical body scan runs through each part of the body, paying special attention to the way each area feels. The scan typically moves in this order:
After the Body Scan is complete, participants are instructed to bring awareness back to the room when they are ready. It is recommended that participants open their eyes slowly and move naturally to a comfortable sitting position. Mindfulness stretchingHowever, rushing straight to the exercise can be a missed opportunity to prepare both mind and body for physical exertion. Stretching before a workout is important for several reasons, including:
Mindful stretching adds even more benefits, such as increased awareness and a sense of balance. Several options to practice mindful stretching are listed below. – PandiculationPandiculation is a fancy term for a fairly simple stretch. To try this stretch, put your palms on your shoulders (or as close to your shoulders as you can get), raise your elbows up to shoulder height, open your mouth, and let out a big, satisfying yawn (Crain). – Proprioceptive Neuromuscular Facilitation (PNF)PNF is a set of guidelines rather than a specific technique. This type of stretching is based on four principles: (1) To avoid pain in your stretches, The six steps of PNF are as follows:
You can repeat the last three steps up to six times, depending on what is right for you at the time (Berg, 2011). – Yoga PosesThere are several yoga poses that facilitate mindful stretching, and these four are recommended in particular:
Whatever technique you use, mindful stretching can be an excellent addition to MBCT. Daily mindfulnessSometimes the most simple exercises can be the most helpful. In the case of MBCT, this is especially true. Practicing mindfulness throughout the day is the best way to make sure it is woven into your life. – Mindful ShoweringThis exercise is an easy one for beginners. While showering, direct your attention to the temperature of the water as it hits your body, the feel of the spray, the smell of the shampoo, and the sensation of lathered soap against your skin. If your mind begins to wander, a common problem during showers, gently bring it back to the present with thoughts about what you are seeing, hearing, smelling, and feeling. – Mindfully Brushing Your TeethSimilar to mindful showering, bring your awareness to the sensations evoked by the feel of the brush. Ask yourself how the bristles feel against your teeth, your gums, and your tongue. Focus on the taste of the toothpaste to keep yourself in the present moment. – Mindful EatingMindful eating is turning your full attention to whatever you are eating. One helpful tip that has not yet been mentioned is to turn off any distractions like the computer, TV, radio, and smartphone, to allow all of your senses to focus on the task of eating. – Mindful DishwashingTry this mindfulness exercise when you have only a few dishes to wash. Watch as you scrape or sponge the dirty dishes. Notice the textures, sights, and sounds of washing dishes. You can even focus your attention on the smell, although the desirability of this move is up for debate. – Mindfully Making Your BedInstead of making your bed quickly and carelessly, put effort into making the bed. Move deliberately and with purpose. Pay attention to what you are seeing and doing. Notice the way the sheets slip across the bed and the way the pillows look underneath the cover. Feel the different textures of the bedding, and above all, try to immerse yourself in your current task, as mundane as it may seem. – Mindful ExercisingAs covered earlier, mindful exercising is a great way to incorporate mindfulness into a healthy lifestyle. Turn off the TV and music and bid farewell to friends and family for a few moments. Focus your awareness on how your muscles feel, how you are moving, and the changing rate of your breath. Give yourself a full experience of exercising without the distractions from the pain or heavy breathing that we often find ourselves trapped with. Taking the opportunity to practice mindfulness whenever one is presented will help you to maintain a healthy sense of awareness and balance throughout your day. For more exercises and techniques to apply to your practice, check out this Preliminary Client Handout for MBCT for tons of useful information and “homework assignments,” as well as two dozen guided meditations and talks from MBCT teachers. If you’re interested in diving more deeply into MBCT, continue on to the next section where we describe MBCT learning opportunities. MBCT Courses, Teacher Trainings, Certification ProgramsMBCT is still a relatively new treatment, but it has grown quickly in popularity. There are numerous courses, trainings for MBCT teachers, and programs for certification in MBCT available for mental health and social service professionals who want to incorporate MBCT into their work. MBCT coursesThere are many classes based on the MBCT program offered in different locations.
MBCT teacher training and certification programsThe UCSD Center for Mindfulness provides an outline of the teacher qualification and certification program that these courses can be applied towards. There are three phases to this pathway: (1) teacher qualification, (2) teacher certification, and (3) post-certification recommendations. Phase 1: Teacher QualificationThis phase begins with individuals who wish to become MBCT teachers completing the prerequisites for the 5-day MBCT teacher training course, then attending the course itself. Next, teachers complete the MindfulNoggin online course and apply for “Teacher in Training” status. Finally, future teachers must complete a minimum of 20 hours of mentorship while teaching two 8-week MBCT courses, then apply for teacher qualification status. The flowchart shows the basic outline of this phase. Phase 2: Teacher CertificationPhase 2 begins when teacher qualifications have been granted (step 6 in phase 1). Future MBCT teachers must teach at least 3 additional MBCT courses after qualification to advance to the next step: attending the Advanced Teacher Training Intensive (ATTI). Finally, teachers can provide evidence of completion of at least 10 hours of mentorship while teaching one of the 8-week courses. When teachers have finished all of these steps, they can apply for teacher certification. This phase is outlined in the flow chart to the right. Phase 3: Post-Certification RecommendationsLike most worthwhile learning opportunities in life, the learning does not stop at the end of the course or program. Teachers are encouraged to continue attending mindfulness meditation retreats, engaging with peers, soliciting feedback from experienced MBCT teachers, and engaging in further training to develop their skills. It is imperative that teachers continue their professional development so they can keep up with the new ideas and techniques in MBCT and ensure they are offering their clients the best treatment that is available.
There is no shortage of teacher training in MBCT. The only difficult part is choosing which training program to attend! MBCT RetreatsThere are many retreats offered that both clients and practitioners of MBCT can take advantage of in order to further their personal or professional practice. Retreats for clients allow them to continue practicing the techniques learned in MBCT, while retreats for teachers provide an opportunity for personal development, professional development, or both. Retreats for clientsThe website MBCT.com provides information on three meditation retreats for anyone interested in the insight meditation tradition:
Retreats for teachers
Other Online MBCT ResourcesThis article is full to the brim with links to follow and information about MBCT techniques and training. If you would like to learn more about MBCT, try the following web pages:
For more information on MBCT teacher training, check out these links:
A Take-Home MessageMindfulness-Based Cognitive Therapy has shown promise as a viable treatment for depression, anxiety, and other mental disorders, and comes with very few and very minor side effects or risks. If you are interested in participating or adding MBCT to your clinical practice, please take a few minutes to browse through these links. Teachers and trainers may particularly benefit from going through the Mindfulness-Based Cognitive Therapy Implementation Resources PDF. What do you think of Mindfulness-Based Cognitive Therapy? Is it the wave of the future or a passing trend in clinical psychology? Would you use it yourself to help cope with life’s challenges, and/or try it out with your clients? Let us know in the comments section. We hope you enjoyed reading this article. Don’t forget to download our three Mindfulness Exercises for free.
What is mindfulnessMindfulness-Based Cognitive Therapy (MBCT) is designed to help people who suffer repeated bouts of depression and chronic unhappiness. It combines the ideas of cognitive therapy with meditative practices and attitudes based on the cultivation of mindfulness.
Which of the following is true about cognitive rehabilitation?Which of the following is true about cognitive rehabilitation? It is a surgical therapy Cognitive impairment doesn't usually affect social, occupational or communicative functioning. It's a pharmaceutical therapy. It can help with restoring and retraining cognitive functioning.
What is mindfulnessMindfulness-based cognitive therapy (MBCT) is a group treatment derived from mindfulness-based stress reduction (MBSR) developed by Jon Kabat-Zinn and colleagues. MBSR uses training in mindfulness meditation as the core of the program.
Is mindfulnessMindfulness-based cognitive therapy, known as MBCT, is a newer form of CBT that also incorporates meditation, breathing exercises, and other elements of mindfulness into therapy.
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