Mindfulness-Based Cognitive Therapy
Depressive relapse is triggered when mild dysphoria reactivates the ruminative, self-critical processing style laid down in previous episodes, and it is prevented by training a different mode of mind — decentred, present, and non-elaborative — before the slide begins.
Not feeling better, but getting better at being with what is — and noticing the slide before it becomes a fall.
Who built it
Jon Kabat-Zinn
Molecular biologist, UMass Medical School
Developed Mindfulness-Based Stress Reduction in 1979, adapting Buddhist meditation practice into a secular eight-week group programme for chronic pain — the template every subsequent mindfulness-based intervention follows.
MBSRZindel Segal, Mark Williams & John Teasdale
Clinical researchers
Set out to build a maintenance cognitive therapy for recurrent depression, found that the mechanism was metacognitive rather than content-based, and built MBCT on that finding.
MBCT
Theory of personality
MBCT rests on the differential activation hypothesis: in people who have been depressed, even mild sadness reactivates the whole pattern of negative thinking that accompanied previous episodes. Each episode strengthens the association, so less and less is required to trigger it — which is why relapse risk climbs with each episode and why after three episodes the risk exceeds 70%.
Two modes of mind
Doing mode
- Detects discrepancy between how things are and how they should be
- Generates action to close the gap
- Superb for external problems
- Applied to mood, produces rumination: why am I like this, what is wrong with me
- Conceptual, evaluative, time-travelling
Being mode
- Allows experience to be as it is, without a discrepancy to close
- Direct sensory contact rather than conceptual commentary
- Present-moment, non-evaluative
- No agenda of fixing
- Available to be trained
Theory of psychopathology
MBCT is a relapse-prevention treatment and is explicit about that scope. Its target is not the current episode but the pattern of recurrence, and the mechanism it targets is rumination and the automatic reactivation of depressogenic processing by ordinary low mood.
Theory of change
Change comes through decentring: relating to thoughts as passing mental events rather than as facts or as the self. This is the same target as ACT’s defusion, arrived at from a different direction, and it is measurable — decentring mediates outcome in several trials.
- 1Regular formal practice builds the capacity to notice where attention is.
- 2Noticing allows early detection of the slide into rumination, before it gathers momentum.
- 3Decentring changes the relationship to the thought rather than its content.
- 4Deliberate response replaces automatic reaction — the "three-minute breathing space" is the mechanism in miniature.
- 5A relapse-prevention plan links warning signs to specific practices.
Key concepts
The vocabulary you need to read the literature and to be understood in supervision.
Where it sits in the transtheoretical grid
Which change processes the system leans on, and at what level of content it aims.
- Consciousness raising
Increasing information about oneself and the problem - feedback, interpretation, education, observation.
- Counterconditioning
Substituting an incompatible response for the problem response - relaxation, assertion, exposure, defusion, opposite action.
- Self-reevaluation
Appraising how one thinks and feels about oneself with respect to the problem; values clarification.
- Stimulus control
Restructuring the environment so that problem cues are less likely and healthy cues more likely.
- Maladaptive cognitions
- Symptom & situational problems