Mindfulness Based Cognitive Therapy

Question 1

Underlying Theory

Answer 1

• Although mindfulness has been incorporated into a number of broad third-wave CBT treatments (e.g. ACT, DBT, meta-cognitive therapy3),
• two specific manualised mindfulness- based psychological interventions have been studied extensively: mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT).
• MBSR is an 8 week group-based program focused on teaching mindfulness skills and bringing mindfulness into daily living especially in areas of physical or emotional distress.
• MBCT combines the structure and skills of MBSR with cognitive behavioural techniques. It is designed for the prevention of relapse in recurrent depression.

Question 2

Practice Context

Answer 2

• The focus of mindfulness is to teach the individual to become more aware of their thoughts and feelings and to relate to them as mental events rather than something that is true or not true.
• In this sense, it fosters a decentred relationship to thoughts and emotions. The development of MBCT was informed by studies which showed that depressive relapse was associated with negative automatic thinking such as rumination, catastrophising and self- criticism and that being able to decentre from this thinking was likely to be beneficial in reducing depression

Question 3

Techniques and Strategies

Answer 3

• Mindfulness-based cognitive therapy (MBCT) is a psychological therapy designed to aid in preventing the relapse of depression, specifically in individuals with Major depressive disorder (MDD).
• It uses traditional Cognitive behavioral therapy (CBT) methods and adds in newer psychological strategies such as mindfulness and mindfulness meditation. Cognitive methods can include educating the participant about depression.
• Mindfulness and mindfulness meditation, focus on becoming aware of all incoming thoughts and feelings and accepting them, but not attaching or reacting to them. Like CBT, MBCT functions on the theory that when individuals who have historically had depression become distressed, they return to automatic cognitive processes that can trigger a depressive episode.
• The goal of MBCT is to interrupt these automatic processes and teach the participants to focus less on reacting to incoming stimuli, and instead accepting and observing them without judgment.
• This mindfulness practice allows the participant to notice when automatic processes are occurring and to alter their reaction to be more of a reflection.
• Beyond its use in reducing depressive acuity, research additionally supports the effectiveness of mindfulness meditation upon reducing cravings for substances that people are addicted to.
• Addiction is known to involve the weakening of the prefrontal cortex that ordinarily allows for delaying of immediate gratification for longer term benefits by the limbic and paralimbic brain regions.
• Mindfulness meditation of smokers over a two-week period totaling 5 hours of meditation decreased smoking by about 60% and reduced their cravings, even for those smokers in the experiment who had no prior intentions to quit. Neuroimaging of those who practice mindfulness meditation has been shown to increase activity in the prefrontal cortex, a sign of greater self-control

Question 4

Applications

Answer 4

Mindfulness-Based Cognitive Therapy is recommended by the National Institute for Health and Care Excellence (NICE) for the prevention of relapse in recurrent depression.

Question 5

Evidence Base

Answer 5

• Evidence shows that Mindfulness-Based Cognitive Therapy can, on average, reduce the risk of relapse for people who experience recurrent depression by 43%. (J Mark et al, 2014).
• Research also suggests that it’s particularly effective for groups who are more likely to relapse (Teasdale et al, 2000).
• As a psycho-social approach to staying well, it’s a cost-effective and accessible treatment for individuals and providers (M Williams and W Kuyken, 2012),
• Right now, very few people are referred onto Mindfulness-Based Cognitive Therapy. 2010 survey found that 69% of GPs said they rarely or never refer their patients with recurrent depression for Mindfulness-Based Cognitive
• Therapy. Similarly, 75% of GPs have prescribed anti-depressant medication to patients with recurrent depression, believing that this alternative might be more appropriate.
• Availability of the therapy around the country as an NHS treatment is still limited, and there is ongoing work to explore how widely available this was in 2014 (J Rycroft-Malone et al, 2014).

Question 6

MBCT for depression

Answer 6

Kavani et al (2011)

The results indicated that MBCT was effective at helping participants to deal with their anxiety and depressive feelings before, during and after stressful circumstances.

• In addition, the reductions in negative automatic thoughts and dysfunctional attitudes in those who received
  MBCT were significant.
• The findings provide further evidence that MBCT might be a useful intervention for enhancing well-being in non-clinical pop

                              Teaside et al (2000)

• For patients with 3 or more previous episodes of depression (77% of the sample), MBCT significantly reduced risk of relapse/recurrence.
• For patients with only 2 previous
  episodes, MBCT did not reduce relapse/recurrence. MBCT offers a promising cost-efficient psychological approach to preventing relapse/recurrence in recovered recurrently depressed patients.

                            Kingston et al (2007)

• In comparison to TAU and across time participants experienced a significant reduction in depressive symptoms following MBCT

                               Eisendrath (2008)

-Participants who completed MBCT experienced a significant decrease in levels of depression, anxiety and rumination

Question 7

MBCT for Bi-polar

Answer 7

Williams et al (2007)

• Participants who received MBCT had significantly lower anxiety scores post treatment. The effect of MBCT in reducing depression was observed among all participants.

Question 8

MBCT for Anxiety

Answer 8

Craigie et al (2008)

• Significant improvement in pathological worry and GAD related symptoms at post treatment.
• Treatment gains were maintained at follow up

                           Evans et al (2008)

• At post treatment participants experienced a significant reduction in anxiety, tension, worry and depressive symptoms.