![A still room with a cushion by an open window and hills beyond](https://viacara.com/img/content/approaches-mindfulness-based-therapy-feature-light.webp) # Mindfulness-Based Cognitive Therapy Learn how mindfulness-based cognitive therapy (MBCT) works, why NICE recommends it to stop depression returning and how it differs from MBSR. ## 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](https://viacara.com/approaches/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](https://viacara.com/approaches/mindfulness-based-therapy/#ref-1), [Segal et al. 2013](https://viacara.com/approaches/mindfulness-based-therapy/#ref-4) ## 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. Practising *awareness* - **Pay attention** You practise noticing present experience, such as your breath or sensations. - **Notice the mind** You notice thoughts and feelings as they arise. - **Return attention** When your mind wanders, you gently return attention to the practice. This is an example of practice, not the whole course. MBCT combines mindfulness with cognitive therapy. Sources: [Segal et al. 2013](https://viacara.com/approaches/mindfulness-based-therapy/#ref-4), [Oxford Mindfulness: overview](https://viacara.com/approaches/mindfulness-based-therapy/#ref-7) ## 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](https://viacara.com/approaches/mindfulness-based-therapy/#ref-1) ![The view from the window, clouds passing over the hills](https://viacara.com/img/content/approaches-mindfulness-based-therapy-mid-light.webp) MBCT teaches you to notice a low mood arriving, before it takes hold ## 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](https://viacara.com/approaches/mindfulness-based-therapy/#ref-1), [NHS England: talking therapies manual](https://viacara.com/approaches/mindfulness-based-therapy/#ref-3) ## 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. Shared practice, different *focus* - **MBCT** Sessions combine mindfulness with cognitive therapy exercises. You explore patterns of thinking linked with depression. - **MBSR** Sessions include body awareness, mindful movement and meditation. You explore how you respond to stress in daily life. Both are taught courses with practice between sessions. NICE's advice on preventing depression returning names MBCT, rather than mindfulness in general. 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](https://viacara.com/approaches/mindfulness-based-therapy/#ref-6), [Segal et al. 2013](https://viacara.com/approaches/mindfulness-based-therapy/#ref-4), [Oxford Mindfulness: MBCT course](https://viacara.com/approaches/mindfulness-based-therapy/#ref-9), [UMass Memorial Health: MBSR](https://viacara.com/approaches/mindfulness-based-therapy/#ref-8), [NICE NG222](https://viacara.com/approaches/mindfulness-based-therapy/#ref-1), [NHS: mindfulness](https://viacara.com/approaches/mindfulness-based-therapy/#ref-2) ## 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. 9 randomised trials pooled 2016 analysis [Kuyken et al. 2016](https://viacara.com/approaches/mindfulness-based-therapy/#ref-5) almost 1.3k people followed across the trials [Kuyken et al. 2016](https://viacara.com/approaches/mindfulness-based-therapy/#ref-5) about a third less likely to relapse with MBCT over 60 weeks [Kuyken et al. 2016](https://viacara.com/approaches/mindfulness-based-therapy/#ref-5) 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](https://viacara.com/guides/understanding-approaches/) starts from what you want, not from the name of a therapy. Source: [Kuyken et al. 2016](https://viacara.com/approaches/mindfulness-based-therapy/#ref-5) On this page [What is mindfulness-based cognitive therapy?](https://viacara.com/approaches/mindfulness-based-therapy/#what-is-mindfulness-based-cognitive-therapy) [How it works](https://viacara.com/approaches/mindfulness-based-therapy/#how-it-works) [What sessions look like](https://viacara.com/approaches/mindfulness-based-therapy/#what-sessions-look-like) [Who is it best suited to?](https://viacara.com/approaches/mindfulness-based-therapy/#who-is-it-best-suited-to) [MBCT or MBSR?](https://viacara.com/approaches/mindfulness-based-therapy/#mbct-or-mbsr) [The evidence](https://viacara.com/approaches/mindfulness-based-therapy/#the-evidence) Related [Cognitive Behavioural Therapy (CBT)](https://viacara.com/approaches/cbt/) [Dialectical Behaviour Therapy (DBT)](https://viacara.com/approaches/dbt/) [Person-Centred Therapy](https://viacara.com/approaches/person-centred/) [Understanding Different Approaches](https://viacara.com/guides/understanding-approaches/) [Finding the Right Support](https://viacara.com/guides/finding-a-practitioner/) Thanks for your interest. We're not taking on new clients at the moment. ## Interested in *mindfulness-based* therapy? We ask what matters to you, then find professionals who fit. Leave your email and we'll let you know as soon as we're ready for you. This conversation helps us find you the right support. What you share helps us understand what you're looking for and find someone who fits. Your email keeps you updated on what's happening next and isn't shared with anyone we introduce you to. [Privacy policy](https://viacara.com/privacy/) [Terms of service](https://viacara.com/terms/) ## References 1. National Institute for Health and Care Excellence (2022). *Depression in adults: treatment and management (NG222)*. [nice.org.uk](https://www.nice.org.uk/guidance/ng222) 2. National Health Service (2022). *Mindfulness*. [nhs.uk](https://www.nhs.uk/mental-health/self-help/tips-and-support/mindfulness/) 3. NHS England (2024). *NHS Talking Therapies for anxiety and depression manual, version 7*. [england.nhs.uk (PDF)](https://www.england.nhs.uk/wp-content/uploads/2018/06/nhs-talking-therapies-manual-v7.1-updated.pdf) 4. Segal, Z. V., Williams, J. M. G. & Teasdale, J. D. (2013). *Mindfulness-Based Cognitive Therapy for Depression, second edition*. Guilford Press. [guilford.com](https://www.guilford.com/books/Mindfulness-Based-Cognitive-Therapy-for-Depression/Segal-Williams-Teasdale/9781462537037) 5. Kuyken, W., Warren, F. C., Taylor, R. S., Whalley, B., Crane, C., Bondolfi, G., Hayes, R., Huijbers, M., Ma, H., Schweizer, S., Segal, Z., Speckens, A., Teasdale, J. D., Van Heeringen, K., Williams, M., Byford, S., Byng, R. & Dalgleish, T. (2016). *Efficacy of mindfulness-based cognitive therapy in prevention of depressive relapse: an individual patient data meta-analysis from randomized trials*. JAMA Psychiatry. [doi:10.1001/jamapsychiatry.2016.0076](https://doi.org/10.1001/jamapsychiatry.2016.0076) 6. Kabat-Zinn, J. (2013). *Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness, revised edition*. Bantam. [penguinrandomhouse.com](https://www.penguinrandomhouse.com/books/89149/full-catastrophe-living-revised-edition-by-jon-kabat-zinn-preface-by-thich-nhat-hanh-foreword-by-joan-borysenko/) 7. Oxford Mindfulness (n.d.). *What is mindfulness?*. [oxfordmindfulness.org](https://oxfordmindfulness.org/what-is-mindfulness) 8. UMass Memorial Health (n.d.). *Mindfulness-based stress reduction*. [ummhealth.org](https://www.ummhealth.org/services-treatments/center-mindfulness/mindfulness-programs/mbsr) 9. Oxford Mindfulness (n.d.). *Mindfulness-based cognitive therapy for depression*. [courses.oxfordmindfulness.org](https://courses.oxfordmindfulness.org/courses/mbct-for-depression) ## Related ### [Cognitive Behavioural Therapy (CBT)](https://viacara.com/approaches/cbt/) Learn how CBT works, what happens in sessions and what NICE says about it, and read about its forms for sleep, pain and self-help. ### [Dialectical Behaviour Therapy (DBT)](https://viacara.com/approaches/dbt/) Learn how DBT works, what its four skill modules teach and what NICE says about it for people with borderline personality disorder. ### [Person-Centred Therapy](https://viacara.com/approaches/person-centred/) Learn how person-centred therapy works, what sessions look like and why the relationship with your therapist matters most. ### [Understanding Different Approaches](https://viacara.com/guides/understanding-approaches/) A plain-English guide to the main therapeutic approaches including CBT, person-centred therapy, psychodynamic and integrative methods. ### [Finding the Right Support](https://viacara.com/guides/finding-a-practitioner/) A practical guide to finding a mental health practitioner who fits your needs, preferences and budget.