The thoughts, feelings, and emotions that we experience every day shape the nature of our reality.
“Our life is what our thoughts make it” –Marcus Aurelius
Countless hours have been spent debating and discussing the implications of quotes like this from Roman Emporer and philosopher Marcus Aurelius. The idea holds as much truth now as it did nearly 2,000 years ago, and can open a seemingly bottomless rabbit hole of questions about the nature of the human mind.
Are we what we think, or are we the entity that thinks? Can we change our very nature by focusing on changing our thoughts?
We won’t follow that rabbit hole today, but we will work from a generally accepted assumption that our thoughts define our reality and that we can take control of this reality and make adjustments to it that can enhance our quality of life.
Mindfulness-based cognitive therapy is one tool that can help us learn to recognize and understand our thought and feeling patterns, with the goal of creating new, more effective patterns.
This article contains:
Before you start reading this article, I recommend downloading Week 1 of Mindfulness X for free. This package will help you understand mindfulness on a theoretical level and provide the tools to apply mindfulness to your work with clients or students.
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What is Mindfulness-Based Cognitive Therapy?
Mindfulness-based cognitive therapy (MBCT) is a type of therapy born from the union of cognitive therapy and meditative principles.
- Cognitive therapy aims to help clients grow and find relief from symptoms of mental illness through the modification of dysfunctional thinking (Beck Institute, 2016).
- Mindfulness can be summed up as the practice and state of being aware of our thoughts, feelings, and emotions on a continuous basis (Greater Good Science Center, 2017). Mindfulness also contributes to an acceptance of the self as it is, without attaching value judgments to our thoughts.
The marriage of these ideas is MBCT, a powerful therapeutic tool that can be successfully applied to the treatment of depression, anxiety, bipolar disorder, and more.
For a closer look at MBCT, watch one of its founders describe how MBCT can be applied to depression:
Does it Work?
All signs point to “yes!”
Two experiments testing the efficacy of MBCT on depression demonstrated that relapse rates for the disorder decreased (Kuyken et al., 2008; Teasdale et al., 2000), while more recent studies have shown the applicability of MBCT in treating a variety of ailments, include anxiety, depression, and ADHD in clients from multiple age groups (Haydicky, Carly, Wiener, & Ducharme, 2015; Kishita, Takei, & Stewart, 2016; Schroevers, Tovote, Snippe, & Fleer, 2016).
MBCT has also been approved by the UK National Institute of Clinical Excellence as an effective treatment for depression relapse (MBCT.com).
MBCT For Treating Depression
While research is still being gathered into the efficacy of using MBCT to treat individuals with less chronic depression, MBCT is thought to be particularly effective for the treatment of people who have suffered from multiple episodes of depression (Mental Health Foundation).
How Does it Work?
MBCT uses these mindfulness benefits to improve mental health:
- Mindfulness helps the client discover their own thought and mood patterns.
- Mindfulness helps the client learn how to be present and appreciate the small pleasures of everyday life.
- Mindfulness teaches the client how to stop the downward spiral that can emerge from a bad mood or thinking about painful memories.
- Mindfulness allows the client to “shift gears” from their present state of mind to one that is more aware, more balanced, and less judgmental.
- Mindfulness gives the client access to another approach for dealing with difficult emotions and moods (MBCT.com).
In particular, MBCT is effective in helping clients deal with depression. The MBCT website lays out its three goals:
- To help you understand what depression is.
- To help you discover what makes you vulnerable to downward mood spirals, and why you get stuck at the bottom of the spiral.
- To help you see the connection between negative thinking and downward spirals; including setting unrealistically high standards for yourself, feelings that you are simply “not good enough,” and ways you may lose touch with what makes our life worth living.
To learn how mindfulness and meditation can help us deal with life’s challenges by affecting the way our brains work, watch this interesting and informative TED Talk from Sara Lazar:
For more information on how MBCT can be applied to help treat mental ailments, see the next section on the techniques and exercises that are frequently in its application.
Popular MBCT Exercises and Techniques
There are a lot of mindfulness exercises to cope with mental illness and stress. In addition to exercises like mindful seeing, acceptance, and mountain meditation, there are many techniques specific to MBCT.
The most popular course of MBCT treatment was developed by Jon Kabat-Zinn. This treatment is an 8-week group-based therapy program created to help clients cope with both mental and physical symptoms (Good Therapy, 2016). Groups meet once a week for two hours and complete homework outside of class for six days a week. Homework includes meditation practice, audio-guided mindfulness exercises, and techniques like the three-minute breathing space (Good Therapy, 2016).
Three-Minute Breathing Space
The three-minute breathing space is a quick exercise that is undertaken in three steps:
- The first minute is spent on answering the question, “how am I doing right now?” while focusing on the feelings, thoughts, and sensations that arise and trying to assign these words and phrases.
- The second minute is spent on keeping awareness on the breath.
- The last minute is used for an expansion of attention from solely focusing on the breath, to feeling physical sensations and how they affect the rest of the body.
For a guided version of the three-minute breathing space, watch this video.
Other recommended MBCT techniques are discussed below.
The Body Scan exercise begins with the participants lying on their backs with their palms facing up and their feet falling slightly apart, or sitting in a comfortable chair with feet on the floor.
Participants lie very still for the duration of the exercise, and move deliberately and with awareness if they need to adjust their position.
Next, the facilitator begins guiding participants through the Body Scan, beginning with bringing awareness to the breath: noticing the rhythm and the experience of breathing in and out. The facilitator explains that participants should not try to change the way they are breathing, just hold gentle awareness on the breath.
The facilitator brings attention to the body next: how it feels, the texture of clothing against the skin, the contours of the surface on which the body is resting, the temperature of the body and the environment.
Participants are then instructed to bring their awareness to parts of the body that are tingling, sore, or feeling particularly heavy or light. The facilitator asks the participants to note any areas of their body where they don’t feel any sensations at all or, conversely, areas that are hypersensitive.
A typical body scan runs through each part of the body, paying special attention to the way each area feels. The scan typically moves in this order:
- Toes of both feet
- The rest of the feet (top, bottom, ankle)
- Lower legs
- Pelvic region- buttocks, tailbone, pelvic bone, genitals
- The abdomen
- Lower back
- Upper back- back ribs & shoulder blades
- Hands (fingers, palms, backs, wrists)
- Arms (lower, elbows, upper)
- Face and rest of head (jaw, mouth, nose, cheeks, ears, eyes, forehead, scalp, back & top of head)
- Blow hole (Fleming & Kocovski, 2007)
After the Body Scan is complete, participants are instructed to bring awareness back to the room when they are ready. It is recommended that participants open their eyes slowly and move naturally to a comfortable sitting position.
Mindfulness can be practiced in many situations throughout the day, including exercise. However, rushing straight to the exercise can be a missed opportunity to prepare both mind and body for physical exertion.
Stretching before a workout is important for several reasons, including:
- It’s a natural and instinctive movement for humans.
- Regular stretching improves flexibility and range of motion.
- Stretching improves and increases circulation by bringing a rush of oxygen to the muscles.
- It feels good to stretch (Crain).
Mindful stretching adds even more benefits, such as increased awareness and a sense of balance. Several options to practice mindful stretching are listed below.
Pandiculation is a fancy term for a fairly simple stretch. To try this stretch, put your palms on your shoulders (or as close to your shoulders as you can get), raise your elbows up to shoulder height, open your mouth, and let out a big, satisfying yawn (Crain).
Proprioceptive Neuromuscular Facilitation (PNF)
PNF is a set of guidelines rather than a specific technique. This type of stretching is based on four principles:
(1) To avoid pain in your stretches,
(2) To stretch slowly to avoid injury,
(3) To exercise caution when stretching, and make sure to stretch the correct muscle, and
(4) To stretch carefully to avoid affecting other muscles or joints (Berg, 2011).
The six steps of PNF are as follows:
- Assume the correct starting position
- Stretch until you reach the point where you feel a sting or pain in the muscle
- Relax the muscle(s)
- Tighten the muscle without moving it
- Relax again
- Stretch to the new point where you feel a sting or other pain
You can repeat the last three steps up to six times, depending on what is right for you at the time (Berg, 2011).
There are several yoga poses that facilitate mindful stretching, and these four are recommended in particular:
- Gomukhasana: This pose involves opening the chest through the extension of the triceps and shoulders, and is typically performed while kneeling or sitting with crossed legs.
- Side to side neck stretch: This stretch is performed by sitting and gently using your hand to pull your head to one side at a time.
- Pigeon Pose: This pose is a fairly complicated pose, with your hips to the floor and one leg in front of you, perpendicular to the mat, and the other leg straight out behind you. For more information on correctly executing this pose, see the detailed explanation here.
- The Scorpion: To practice this pose, lie flat with your arms straight out to the side. Next, lift your right foot as high as you can with the sole straight up to the ceiling. Finally, lift your right hip and reach your right foot over to the outside of your left leg, while keeping your chest and arms on the floor. Switch legs to experience both stretches (Crain).
Whatever technique you use, mindful stretching can be an excellent addition to MBCT.
Sometimes the most simple exercises can be the most helpful. In the case of MBCT, this is especially true. Practicing mindfulness throughout the day is the best way to make sure it is woven into your life.
This exercise is an easy one for beginners. While showering, direct your attention to the temperature of the water as it hits your body, the feel of the spray, the smell of the shampoo, and the sensation of lathered soap against your skin. If your mind begins to wander, a common problem during showers, gently bring it back to the present with thoughts about what you are seeing, hearing, smelling, and feeling.
Mindfully Brushing Your Teeth
Similar to mindful showering, bring your awareness to the sensations evoked by the feel of the brush. Ask yourself how the bristles feel against your teeth, your gums, and your tongue. Focus on the taste of the toothpaste to keep yourself in the present moment.
Mindful eating is turning your full attention to whatever you are eating. One helpful tip that has not yet been mentioned is to turn off any distractions like the computer, TV, radio, and smartphone, to allow all of your senses to focus on the task of eating.
Try this mindfulness exercise when you have only a few dishes to wash.
Watch as you scrape or sponge the dirty dishes. Notice the textures, sights, and sounds of washing dishes. You can even focus your attention on the smell, although the desirability of this move is up for debate.
Mindfully Making Your Bed
Instead of making your bed quickly and carelessly, put effort into making the bed. Move deliberately and with purpose. Pay attention to what you are seeing and doing. Notice the way the sheets slip across the bed and the way the pillows look underneath the cover. Feel the different textures of the bedding, and above all, try to immerse yourself in your current task, as mundane as it may seem.
As covered earlier, mindful exercising is a great way to incorporate mindfulness into a healthy lifestyle. Turn off the TV and music and bid farewell to friends and family for a few moments. Focus your awareness on how your muscles feel, how you are moving, and the changing rate of your breath. Give yourself a full experience of exercising without the distractions from the pain or heavy breathing that we often find ourselves trapped with.
Taking the opportunity to practice mindfulness whenever one is presented will help you to maintain a healthy sense of awareness and balance throughout your day.
For more exercises and techniques to apply to your practice, check out this Preliminary Client Handout for MBCT for tons of useful information and “homework assignments,” as well as two dozen guided meditations and talks from MBCT teachers.
If you’re interested in diving more deeply into MBCT, continue on to the next section where we describe MBCT learning opportunities.
MBCT Courses, Teacher Trainings, Certification Programs
MBCT is still a relatively new treatment, but it has grown quickly in popularity. There are numerous courses, trainings for MBCT teachers, and programs for certification in MBCT available for mental health and social service professionals who want to incorporate MBCT into their work.
There are many classes based on the MBCT program offered in different locations.
- For anyone living near Oxford in the UK who is interested in learning about MBCT, a course is held at the Oxford Mindfulness Centre. In groups of 25 participants, the course lasts 8 weeks and meets for 2 hours per week plus 6 hours on one Saturday. The Oxford Mindfulness Center also offers a course that meets for five to six hours every two weeks. This course also caps participants at 25 per group and is offered to all adults.
- If you are not located near Oxford, there are other courses around the country and the world. The Brighton Buddhist Centre in the UK also hosts a mindfulness course based on MBCT for anyone who experiences depression or anxiety, as well as courses on mindfulness-based stress reduction and mindfulness for living with pain and illness.
- The Atlanta Mindfulness Institute holds an 8-week MBCT class for up to 10 people at a time. This course also includes a 6-hour “retreat” day on a weekend day during the 8-week run.
- Finally, the University of California, San Diego (UCSD) Center for Mindfulness offers public programs for those wishing to learn how to apply MBCT to their own lives, including a course for youth, a course on self-compassion, a five-day program designed to help participants learn to cope with life’s challenges, and a resilience training course for first responders.
MBCT Teacher Training and Certification Programs
Many courses are offered around the country and the world for teachers who wish to learn more about practicing MBCT with their clients. The website www.mbpti.org lists many classes, including:
- Little Flower Children’s Yoga & Mindfulness Teacher Training
- MBCP: Mindfulness-Based Childbirth and Parenting
- MBCT: Mindfulness-Based Cognitive Therapy
- MBEB: Mindfulness-Based Emotional Balance Teacher Training Intensive
- MBRP: Mindfulness-Based Relapse Prevention
- MFY: Making Friends with Yourself: A Mindful Self-Compassion Program for Teens & Young Adults Teacher Training
- MBSR TTI: Mindfulness-Based Stress Reduction Teacher Training Intensive Mindful Practice in Medicine: An Introductory Workshop
- MSC: Mindful Self-Compassion Teacher Training
The UCSD Center for Mindfulness provides an outline of the teacher qualification and certification program that these courses can be applied towards. There are three phases to this pathway:
(1) teacher qualification, (2) teacher certification, and (3) post-certification recommendations.
Phase 1: Teacher Qualification
This phase begins with individuals who wish to become MBCT teachers completing the prerequisites for the 5-day MBCT teacher training course, then attending the course itself. Next, teachers complete the MindfulNoggin online course and apply for “Teacher in Training” status. Finally, future teachers must complete a minimum of 20 hours of mentorship while teaching two 8-week MBCT courses, then apply for teacher qualification status.
The flowchart shows the basic outline of this phase.
Phase 2: Teacher Certification
Phase 2 begins when teacher qualifications have been granted (step 6 in phase 1).
Future MBCT teachers must teach at least 3 additional MBCT courses after qualification to advance to the next step: attending the Advanced Teacher Training Intensive (ATTI).
Finally, teachers can provide evidence of completion of at least 10 hours of mentorship while teaching one of the 8-week courses. When teachers have finished all of these steps, they can apply for teacher certification.
This phase is outlined in the flow chart to the right.
Phase 3: Post-Certification Recommendations
Like most worthwhile learning opportunities in life, the learning does not stop at the end of the course or program. Teachers are encouraged to continue attending mindfulness meditation retreats, engaging with peers, soliciting feedback from experienced MBCT teachers, and engaging in further training to develop their skills.
It is imperative that teachers continue their professional development so they can keep up with the new ideas and techniques in MBCT and ensure they are offering their clients the best treatment that is available.
- In addition to the UCSD Center for Mindfulness pathway, similar training can be found at the Oxford Mindfulness Centre, the Mindful Academy in Spain, and several universities and other institutions in the UK.
- The website MBCT.com also hosts plenty of information on training and courses for those wishing to practice MBCT as clients or with clients. For example, the Mindful Mood Balance for Mental Health Professionals introduces participants to the basics of MBCT in an online format. This course is also the first step towards the MBCT Teacher Certification.
- Another MBCT training course is offered at the Centre for Mindfulness Studies in Toronto, Canada. This course is part of the Applied Mindfulness-Based Cognitive Therapy (MBCT) certificate program, which is offered in addition to an Applied Mindfulness-Based Stress Reduction (MBSR) program. These programs hold the distinction of providing instruction from one of the founders of MBCT, Zindel Segal.
- The Centre for Mindfulness Studies also offers courses designed specifically for healthcare professionals and educators, and hosts courses designed for professional development rather than obtaining a certificate.
There is no shortage of teacher training in MBCT. The only difficult part is choosing which training program to attend!
The Mindfulness-Based Cognitive Therapy Manual (+PDF)
If you’d rather read about MBCT yourself or start out with a good introduction to MBCT, check out the MBCT Implementation Resource List, a great resource for learning about and setting up your own MBCT practice.
After a description of MBCT and how it is applied in the UK, this document outlines the guiding principles for implementing MBCT:
- Research needs to be translated and accessible to clients.
- Ownership of the research or implementation process is critical.
- People who are enthusiastic about the practice are vital for promoting it.
- Conduct an analysis of context to ensure you can be fully prepared to meet the challenges that will arise.
- Ensure credibility by providing credible evidence and figures.
- Provide leadership at each level to give strategic support and authority.
- Provide adequate support/resources (including financial, human, and equipment).
- Develop opportunities for integration into clients’ daily lives.
In addition to these general guidelines, there is a chapter on setting up an MBCT service with information ranging from criteria for inclusion and exclusion to an assessment of participants to post-class follow-up tasks for teachers. The last section in this chapter covers the risks that both participants and teachers face when meeting for MBCT (including emotional intensity, a possibility of trauma, conflict in the group, and challenges from participants), and provides some great advice for working around these risks.
Another chapter covers how to conduct MBCT reunions for course “graduates,” with information on different formats, an example invitation, and a sample session plan.
Next, the manual covers the important topic of training and supervision for MBCT teachers. This chapter provides guidelines on best practices, reading materials for teachers and trainers, and required qualities and qualifications for teachers and trainers of MBCT.
Another great chapter focuses on why evaluating the outcomes of MBCT courses is important and how to engage in a proper evaluation. Taking a good look at what went right, what went wrong, and how to incorporate more of the good and less of the bad can drastically improve outcomes for both participants and teachers.
Finally, this manual provides a list of further resources that anyone who wants to teach MBCT should read. If you are interested in learning more about setting up your own MBCT practice, click the link above to open the PDF and find the additional resources listed at the end.
Retreats are great opportunities to mingle with colleagues, learn new skills, and keep up to date on any changes in your field. There are many retreats offered that both clients and practitioners of MBCT can take advantage of in order to further their personal or professional practice. Retreats for clients allow them to continue practicing the techniques learned in MBCT, while retreats for teachers provide an opportunity for personal development, professional development, or both.
Retreats for Clients
The website MBCT.com provides information on three meditation retreats for anyone interested in the insight meditation tradition:
- Spirit Rock Meditation Center in Woodacre, California
- Insight Meditation Society in Barre, Massachusetts
- Gaia House in Devon, United Kingdom
Retreats for Teachers
There are several more opportunities to attend MBCT retreats for teachers and trainers of MBCT.
- Silent retreats are very common locales for mindfulness-based gatherings. In fact, some consider them essential for learning the skills required to successfully teach MBCT. Silence facilitates successful meditation practice by removing distractions from the environment, giving attendees the opportunity to glean the maximum amount of practice and knowledge possible.
- The Center for Mindfulness at the University of Massachusetts provides a list of silent mindfulness retreats for anyone who wants to move on in their certification program. These include:
- The Way of Silence and of Listening Retreat at Fraterna Domus, Rome, Italy
- The Krame Center Retreat at Ramapo College in Mahwah, New Jersey, US
- The Mindful Way Retreat at Delray Beach, Florida, US
- Deepening Mindfulness: An MBSR Retreat at the Won Dharma Center in Claverack, New York, US
- Mindfulness Meditation Retreat in Soutelo, Wila Verde in Braga, Portugal
- Mindfulness Meditation Retreat at Shambhala Mountain Center in northern Colorado
- Insight Meditation Community of Washington in Cabin John, Maryland, US
- Vipassana Meditation Centers throughout the US and Canada Zen Community of Oregon in Clatskanie, Oregon, US
- Karme Choling in Barnet, Vermont, US
For a more detailed list of silent retreat locations, follow this link.
- The Centre for Mindfulness Studies in Toronto also offers an intensive training and retreat for students in their Core MBCT Facilitation Certificate Program. This retreat runs for five days, eight hours a day, and is open to all healthcare professionals and social service workers with a clinical background and a mindfulness and/or meditation practice; however, they must have completed the eight-week MBCT program and formal training in mindfulness.
This retreat combines the peace and calm of a silent meditation retreat with the interaction and learning of a clinical training workshop. Participants of this retreat should expect some stretches of silent meditation and other periods of active discussion with retreat leaders and fellow attendees. For more information on MBCT and mindfulness retreats in the Toronto, CA area, check out this link.
- The Insight Meditation Society also offered an Insight Meditation Retreat for MBSR and MBCT professionals, although it is unclear whether this offering has continued over the past few years. This retreat was conducted over eight days and intended to extend and deepen practitioners’ mindfulness and meditation experiences.
It is conducted mostly in silence, but the schedule includes time for sustained mindfulness practice, daily talks, meditation instructions, and interviews with the leaders. Lying down meditation, yoga, and group discussions are also offered during the retreat to help teachers integrate their practice into their own lives.
Other Online MBCT Resources
This article is full to the brim with links to follow and information about MBCT techniques and trainings. If you would like to learn more about MBCT, try the following web pages:
- Harley Therapy website
- Breathing Space London
- Mindfulness Scotland
- Comparing MBCT and ACT
- MBCT Diary Blog
For more information on MBCT teacher training, check out these links:
- Centre for Mindfulness Research in the UK
- Openground Mindfulness Training
- Breathworks Pathways for MBSR/MBCT Teachers
- UMASS Medical School Mindfulness Professional Education
- UK Network for Mindfulness-Based Teacher Training Organisations
A Take Home Message
Mindfulness-Based Cognitive Therapy has shown promise as a viable treatment for depression, anxiety, and other mental disorders, and comes with very few and very minor side effects or risks.
If you are interested in participating or adding MBCT to your clinical practice, please take a few minutes to browse through these links. Teachers and trainers may particularly benefit from going through the Mindfulness-Based Cognitive Therapy Implementation Resources PDF.
What do you think of Mindfulness-Based Cognitive Therapy? Is it the wave of the future or a passing trend in clinical psychology? Would you use it yourself to help cope with life’s challenges, and/or try it out with your clients? Let us know in the comments section.
- Beck Institute. (2016). What is cognitive behavior therapy (CBT)? Retrieved from www.beckinstitute.org/get-informed
- Berg, K. (2011). Prescriptive Stretching. Champaign, IL, US: Human Kinetics.
- Crain, T. Ready, set, stretch: Mindful stretching as the main event. Retrieved from www.msfitmag.com
- Fleming, J. E., & Kocovski, N. L. (2007). Mindfulness and acceptance-based group therapy for social anxiety disorder: A treatment manual. Retrieved from https://contextualscience.org
- Good Therapy. (2016). Mindfulness-Based Cognitive Therapy. Retrieved from www.goodtherapy.org
- Greater Good Science Center. (2017). Mindfulness. Retrieved from www.greatergood.berkeley.edu
- Haydicky, J., Carly, S., Wiener, J., & Ducharme, J. M. (2015). Evaluation of MBCT for adolescents with ADHD and their parents: Impact on individual and family functioning. Journal of Child and Family Studies 24, 76-94. doi:10.1007/s10826-013-9815-1
- Kishita, N., Takei, Y, & Stewart, I. (2016). A meta-analysis of third wave mindfulness-based cognitive behavioral therapies for older people. International Journal of Geriatric Psychiatry. doi:10.1002/gps.4621
- Kuyken, W., Byford, S., Taylor, R. S., Watkins, E., Holden, E., White, K., Barrett, B., … & Teasdale, J. D. (2008). Mindfulness-Based Cognitive Therapy to prevent relapse in recurrent depression. Journal of Consulting and Clinical Psychology, 76, 966-978. doi:10.1037/a0013786
- Lazar, S. (2011, November). Sara Lazar: How Meditation Can Reshape Our Brains [Video file]. Retrieved from http://www.tedxcambridge.com/speaker/sara-lazar/
- Mental Health Foundation. Understanding Mindfulness: MBSR & MBCT. Retrieved from www.bemindful.co.uk
- Schroevers, M. J., Tovote, K. A., Snippe, E., & Fleer, J. (2016). Group and individual mindfulness-based cognitive therapy (MBCT) are both effective: A pilot randomized controlled trial in depressed people with a somatic disease. Mindfulness, 7, 1339-1346. doi:10.1007/s12671-016-0575-z
- Segal, Z. (2014, February). Zindel Segal: The mindful way through depression [Video file]. Retrieved from http://www.tedxutsc.com/portfolio_page/the-mindful-way-through-depression/
- Teasdale, J. D., Segal, Z. V., Williams, J. M. G., Ridgeway, V. A., Soulsby, J. M., & Lau, M. A. (2000). Prevention of relapse/recurrence in major depression by Mindfulness-Based Cognitive Therapy. Journal of Consulting and Clinical Psychology, 68, 615-623. doi:10.1037//0022-006X.68.4.615