What is A Mindful Approach to Depression and Anxiety (MBCT)?

Mindfulness-Based Cognitive Therapy (MBCT) was developed in 2002 by researchers Zindel Segal, Mark Williams, and John Teasdale. It integrates mindfulness principles, inspired by Jon Kabat-Zinn’s Mindfulness-Based Stress Reduction (MBSR) course, with components of cognitive behavioral therapy (CBT). MBCT is designed to help individuals break free from the patterns of thought and behavior that contribute to recurring episodes of depression and anxiety.

Rather than focusing on directly treating symptoms, MBCT aims to cultivate self-awareness and emotional resilience through both formal meditation practices and informal mindfulness exercises. Participants learn to recognize the modes of mind that often perpetuate mood disorders and develop new ways of relating to these thoughts and feelings. While not a replacement for therapy, MBCT provides valuable tools to help individuals navigate their mental landscape, offering a pathway toward a more balanced and fulfilling life.

Who is MBCT for?

This course is designed for adults 18 and older and for both new and seasoned practitioners. Specifically, this course is for those who are interested in mindfulness techniques to manage depression and anxiety symptoms with a structured and practical approach.

What is the Weekly Overview of A Mindful Approach to Depression and Anxiety (MBCT)?

The MBCT curriculum presented here serves as a general overview and is subject to potential modifications based on the unique needs, insights, and discussions that may arise during class.

The 8-week course could be divided into two halves. The first four weeks involve learning basic mindfulness practices, the nature of thoughts, focused attention and how thoughts are connected to emotions and body sensations. Students begin to see how undetected negative thoughts and emotions can lead us into a reactive downward spiral. The second half of the course, metacognitive awareness is developed, as students learn to be with whatever is arising in thoughts, emotions or body sensations. By developing this awareness, some space is created for them to explore thoughts just as mental events, or get curious about feelings or sensations. Then they learn to make choices around how they want to respond to these sensations, and begin to invite choices that are more helpful. Students are encouraged to extrapolate what they learn in more formal practices and in informal practices to become aware of habitual mind patterns that may lead them into depression or anxiety and to design action steps to prevent themselves from spiraling. All sessions include experiential practices as meditation or cognitive therapy exercises, reflection on the practice in session and at home, a didactic point, poetry related to the theme and an invitation to home practice.

Orientation: Welcome, overview, and introductions
It is important that before committing to the MBCT course, students understand thoroughly what the course will be like and explore their intentions and readiness. It is a chance for both the students to know the course, each other, and for the instructor to know the students and create a safe container by setting some guidelines together, prior to course start. Students are introduced to the MBCT origins, how the course may be helpful, some challenges of the course and are exposed to some practice. Students are also informed of the course expectations insofar as time commitment and weekly practice. Orientation is followed by individual interviews with each student to explore more in-depth their motivations, questions, concerns and see if this is the right time to take the course.

Week 1: Awareness and Automatic Pilot
The theme of Week One is focused on beginning to notice the mind’s “automatic pilot” mode. This session includes experiential mindfulness practices and group reflection and discussion. With the Mindful Eating exercise, students are invited to explore slowing down and stepping out of autopilot. In the Body Scan practice, students are invited to practice intentionally shifting the focus of their attention, opening to thoughts, emotions and body sensations in their moment-to-moment experience. By becoming aware of and choosing where we place our attention, we can explore shifting from our automatic reactivity to a mode in which we open to and observe our experience with kindness. In that space of observation we can open to the choices we have as alternatives to our habitual mind patterns.

Week 2: Living in Our Heads
Week Two explores experiential knowing and how our perceptions color our experience. The Body Scan focuses on opening to intense or challenging sensations in the body, without getting hooked into stories or thoughts. Students are invited to explore recognizing “being” mode versus “doing” mode. With a cognitive exercise we explore the relationship between thoughts, feelings and body sensations and how the way we perceive or interpret an event influences our emotions, body sensations and moods. A brief Sitting Meditation is introduced in this session. Students are invited to a mindful exploration of pleasant events in their home practice.

Week 3: Gathering the Scattered Mind
Week Three explores how the mind’s tendency is to be scattered or lost in thought, and how the body is a place we can return to. The Sitting Practice (or Focused Awareness) offers students a point of focus to cultivate presence, return from the ruminative mind to a more centered mind and shift from doing mode to being mode. Mindful Movement also invites students to be with the body in movement.  This session introduces the 3-step breathing space and Mindful Movement practice. Students are invited to a mindful exploration of unpleasant events as part of their home practice.

Week 4: Recognizing Aversion
In this session, the main theme is around how the mind habitually reacts to unpleasant events with “aversion”, which tends to cause more suffering. Students are invited to recognize aversion by noticing their habitual mind patterns when they are faced with the unpleasant. Taking a wider perspective allows students to relate differently to their experience. Students are also invited to do a full sitting meditation, a cognitive therapy exercise on automatic thoughts, mindful walking and a 3-step breathing space. Students are introduced to the “responsive” 3-step breathing space whenever they notice unpleasant experiences.

Week 5: Allowing / Letting be
Week 5 delves deeper into relating differently to unpleasant feelings by learning to counteract aversion by adopting an attitude of inviting or allowing whatever is, to be, without reactive judging or pushing away. We practice a sitting meditation and read a poem as well as do a 3-step breathing space. Students are invited to turn their awareness onto thoughts, emotions and body sensations as they explore a difficulty, learning to be open to the discomfort and experiment with different choices they have to work with difficulty.

All-Day: A Day of Mindful Practice
This day is an opportunity for students to experience a mini-retreat style day, practicing for a longer period of time. The main practices from the course are carried out throughout the day in silence. There is some time at the start for introductions and towards the last part of the day to reflect, discuss and ask questions. This gives students an opportunity to strengthen their practice. The main practices include Sitting Meditation, Body Scan, Mindful Movement/Stretching, Walking Meditation, Mindful Eating, and Mountain Meditation.

Week 6: Thoughts Are Not Facts
Week 6 explores ways we can relate differently to our thoughts. We can begin to recognize that while our thoughts can have an impact on our emotions and actions, they are merely mental events and not necessarily facts. Students are invited to practice a sitting meditation with a focus on thoughts, their origin (putting them into context), and how we relate to them. There is a cognitive therapy exercise on moods, thoughts and alternative viewpoints. Students are invited to explore the 3-step breathing space more deeply. Students are encouraged to explore habitual warning signs and triggers of depression in their home practice.

Week 7: How Can I Best Take Care of Myself
Week 7 focuses on ways we can prepare to take care of ourselves when we notice signs of depression or low mood. Students are invited to do a Sitting Meditation with a focus on noticing how they relate to thoughts, feelings and body sensations, particularly the difficult. Also, they explore how daily activities can nourish or drain them, and design a plan for how to schedule their activities to best support wellbeing. Students will also identify signs of relapse and design an action plan to best respond to these signs. A 3-step breathing space and/or Mindful Walking are guided in this session. An invitation to do a breathing space followed by choosing a pleasant/nourishing activity is introduced as a way to take care of ourselves.

Week 8: Maintaining and Extending New Learning
In Week 8, students are encouraged to visit their intentions for continuing a regular mindfulness practice and design plans to take care of themselves. In this session the whole course is reviewed. We return to the beginning with a Body Scan practice and students are invited to reflect on their experience, discuss their plans to keep up their momentum and explore positive motivations for continuing their practice.

What are the Learning Objectives and Outcomes of A Mindful Approach to Depression and Anxiety (MBCT)?

• Discuss what mindfulness is and is not from a theory- and evidence-based perspective
• Discuss the history and foundation of Mindfulness-Based Cognitive Therapy (MBCT)
• Discuss the purpose of the stress response, including its usefulness
• Describe how thoughts and core beliefs can influence depressive symptoms and stress reactivity
• Explain how reactivity to stressors can impair emotional and physical wellbeing that may lead to depression and anxiety 
• Discuss how cognitive distortions or conditioned ways of thinking may foster cycles of depression and anxiety
• Discuss the difference between an active acceptance of distress and an emotional resignation
• Employ and practice the body scan meditation in ways that bring attention to depression and/or anxiety 
• Employ and practice the focused attention meditation in ways that bring attention to depression and anxiety with curiosity and non-judgment
• Employ and practice the mindful movement (yoga) meditation in ways that bring attention to how and where the body holds tension, sadness, and worry
• Employ and practice informal mindfulness practices in ways that support bringing awareness and attention to depression and anxiety symptoms
• Apply mindfulness to cultivate a greater sense of present-moment awareness 
• Apply mindfulness to cultivate a deeper connection with the body
• Apply mindfulness to cultivate a deeper connection with emotions
• Apply mindfulness techniques to identify negative thought patterns that contribute to depression and anxiety 
• Utilize mindfulness to recognize habitual behavior patterns that characterize depression and anxiety
• Utilize mindfulness to identify typical bodily sensations that arise when depression or anxiety arise
• Utilize mindfulness to increase the ability to identify, feel, and tolerate unpleasant, unwanted, and contradictory emotions
• Describe how mindfulness can alter maladaptive feedback loops to facilitate the self-management of depression and anxiety
• Explain how mindfulness promotes emotional regulation in the context of depression and anxiety
• Apply mindfulness techniques to challenge negative thought patterns that contribute to depression and anxiety
• Utilize mindfulness practices to promote greater mental flexibility 
• Explain how formal meditations and informal mindfulness practices can support wellbeing
• Identify when formal meditations and informal mindfulness practices may be used to support symptoms of depression and anxiety
• Utilize mindfulness to cultivate skillful responses to depression and anxiety symptoms
• Utilize mindfulness to manage the ongoing physical, mental, and emotional symptoms of depression and anxiety symptoms over time

What is the Science and Research on A Mindful Approach to Depression and Anxiety (MBCT)?

Mindfulness is the foundation of MBCT, enabling individuals to become aware of their thought patterns and behaviors, so that they can better recognize when they are at risk of triggering depression and anxiety. MBCT is not aimed at directly treating or eradicating these ailments, but rather focuses on helping individuals develop a new relationship with their symptoms, fostering the ability to work with them in a more skillful and compassionate manner (Segal et al., 2012).

Additionally, MBCT has a solid foundation of empirical validation, with research highlighting its significant psychological benefits, including:

• Reduction in Symptoms: Decreased levels of depression and anxiety symptoms (Segal et al., 2012; Ghahari et al., 2020).
• Relapse Prevention: Lower risk of relapse in recurrent depression and anxiety (van der Velden et al., 2015; Segal et al., 2012; Ghahari et al., 2020).
• Enhanced Emotional Regulation: Improved ability to manage and respond to emotional or challenging experiences (Cairns & Murray, 2015; van der Velden et al., 2015).
• Increased Self-Awareness: Greater awareness of thought patterns and behaviors (Segal et al., 2012).
• Cognitive Flexibility: Enhanced ability to adapt thinking and reduce cognitive distortions (Dimidjian et al., 2014; Troy et al., 2012).
• Metacognitive Awareness: Ability to observe thoughts non-judgmentally and reduce their impact (van der Velden et al., 2015).
• Improved Well-being: Better overall mental health and resilience (Segal et al., 2012; Bartley, 2011; King et al., 2013).

• Adaptability Across Populations: MBCT has been adapted for various populations, including individuals with cancer (Bartley, 2011) and those dealing with PTSD, demonstrating its effectiveness in supporting significant healthcare concerns (King et al., 2013).

Engaging in MBCT provides individuals with valuable tools to cultivate a healthier, more balanced approach to their thoughts and emotions, promoting long-term mental well-being. While individual experiences may differ, engaging in mindfulness practices offers individuals a valuable opportunity to tap into its wide-ranging benefits.

Sources Cited

1. Bartley, T. (2011). Mindfulness-based cognitive therapy for cancer: Gently turning towards. John Wiley & Sons.
2. Cairns, V. & Murray, C. (2015). How Do the Features of Mindfulness-Based Cognitive Therapy Contribute to Positive Therapeutic Change? A Meta-Synthesis of Qualitative Studies. Behavioural and Cognitive Psychotherapy, 43(3): 342-359. https://doi.org/10.1017/S1352465813000945
   
3. Dimidjian, S., Beck, A., Felder, J. N., Boggs, J. M., Gallop, R., & Segal, Z. V. (2014). Web-based Mindfulness-Based Cognitive Therapy for reducing residual depressive symptoms: An open trial and quasi-experimental comparison to propensity score matched controls. Behav Res Ther, 63: 83–89. https://doi.org/10.1016%2Fj.brat.2014.09.004
4. Ghahari, S., Mohammadi-Hasel, K., Malakouti, S. K., & Roshanpajouh, M. (2020). Mindfulness-based Cognitive Therapy for Generalised Anxiety Disorder: a Systematic Review and Meta-analysis. East Asian Arch Psychiatry, 30(2):52-56. https://doi.org/10.12809/eaap1885
   
5. King, A. P., Erickson, T. M., Giardino, N. D., Favorite, T., Rauch, S. A., et al. (2013). A pilot study of group mindfulness‐based cognitive therapy (MBCT) for combat veterans with posttraumatic stress disorder (PTSD). Depression and anxiety, 30(7), 638-645. https://doi.org/10.1002/da.22104
6. Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2012). Mindfulness-Based Cognitive Therapy for Depression (2nd Edition). New York: The Guilford Press.
7. Troy, A. S., Shallcross, A. J., Davis, T. S., & Mauss, I. B. (2012). History of Mindfulness-Based Cognitive Therapy Is Associated with Increased Cognitive Reappraisal Ability. Mindfulness 4, 213–222. https://doi.org/10.1007/s12671-012-0114-5
   
8. van der Velden, A. M., Kuyken, W., Wattar, U., Crane, C., Pallesen, K. J., et al. (2015). A systematic review of mechanisms of change in mindfulness-based cognitive therapy in the treatment of recurrent major depressive disorder. Clinical Psychology Review, 37, 26-39. https://doi.org/10.1016/j.cpr.2015.02.001