Mindfulness-Based Cognitive Therapy

What is mindfulness-based cognitive therapy?

Mindfulness-based cognitive therapy (MBCT) is a course for people who have had depression before. It is designed to stop it coming back. NICE recommends it for people who are well now but at higher risk of it returning.

It was developed in the 1990s by Zindel Segal, Mark Williams and John Teasdale. They joined mindfulness practice to ideas from CBT about how depression takes hold.

The course is usually taught to a small group over eight weeks. Some therapists also teach it one to one.

Sources: NICE NG222, Segal et al. 2013

How it works

Depression that has come back before tends to come back again. A passing low mood wakes the old thinking, the thinking feeds the mood and the spiral starts. Most people do not notice this happening until they are well inside it.

MBCT trains you to notice sooner. Through short practices, you learn to see thoughts and feelings as events passing through, rather than facts to act on. A dark thought can arrive without being obeyed.

This is the cognitive part. You are not asked to argue with the thought, as you might in CBT. You are asked to recognise it, name it and let it pass.

Sources: Segal et al. 2013, Oxford Mindfulness: overview

What sessions look like

A standard course is eight weekly sessions of about two hours, taught to a small group. Between sessions you practise at home most days, usually with recordings. The home practice is where most of the change happens.

A typical course covers:

• Paying attention. Simple practices such as the body scan and watching the breath
• Noticing the mind wander. Learning that this is normal and returning without blame
• Thoughts are not facts. Seeing a low mood as weather, not as the truth about you
• Early warning signs. Mapping how a relapse starts for you, in your body and your thinking
• A plan for hard days. What to do, and whom to tell, when the signs appear

Source: NICE NG222

Who is it best suited to?

MBCT is built for people who have recovered from depression and want to stay well. NICE names the higher risks of relapse: repeated past episodes, lingering symptoms and a habit of avoiding or dwelling.

For them it recommends group CBT or MBCT. Either can run alone or alongside antidepressants.

It can be a good fit if you:

• Have had depression before, perhaps several times
• Are well enough now to do a daily practice
• Want to reduce or come off antidepressants, with your GP, and want something in their place
• Have found CBT helpful but notice the same thoughts creeping back
• Prefer a skill you keep to a course of treatment that ends

It is not a treatment for severe depression happening now. NHS Talking Therapies says the same: mindfulness is not a primary treatment for an acute episode. A talking therapy or medicine comes first, and MBCT can follow once you are steadier.

Sources: NICE NG222, NHS England: talking therapies manual

MBCT or MBSR?

MBCT grew out of mindfulness-based stress reduction (MBSR). Jon Kabat-Zinn built that eight-week course in 1979 for people with pain and long-term illness. The two courses share most of their practices and the same shape.

The difference is what they are for.

MBSR is for stress. MBCT is for depression that has come back before. It adds sessions on how low mood and thinking feed each other.

NICE's recommendation is specific. It backs MBCT, taught as a course, to stop the next episode in people whose depression has come back before. It is not a general claim that mindfulness treats depression.

It does not cover MBSR, a mindfulness app or a meditation habit on its own.

Those things can be good for you. The NHS says mindfulness can help you notice your thoughts and feel calmer. But if depression has come back more than once, ask a trained therapist for the course with evidence behind it.

Sources: Kabat-Zinn 2013, Segal et al. 2013, Oxford Mindfulness: MBCT course, UMass Memorial Health: MBSR, NICE NG222, NHS: mindfulness

The evidence

The strongest evidence comes from a 2016 analysis that pooled nine randomised trials. Together they followed 1,258 people.

Over 60 weeks, people who took MBCT were about a third less likely to relapse than people who did not. It helped most for people who still had some symptoms when they started.

It is not a cure. Some people relapse after MBCT, and the course asks for daily practice that not everyone can keep up. What the research supports is a real reduction in risk for people who have been through depression more than once.

Not sure whether MBCT fits where you are? Our guide to the different approaches starts from what you want, not from the name of a therapy.

Source: Kuyken et al. 2016