Mindfulness-Based CBT

Mindfulness-Based Cognitive Therapy for Depression
Mindfulness-Based Cognitive Therapy for Depression

In 1989, psychologists Mark Williams, John Teasdale, and Zindel Segal met on the way to the World Congress of Cognitive Therapy. Williams and Tasdale were based at the Medical Research Council’s Applied Psychology Unit at Cambridge. All three psychologists were interested in why people relapse and experience recurrent depression.

In April 1992, the psychologists met again to advance a maintenance version of Cognitive Behavioural Therapy (CBT). The MacArthur Foundation had awarded Segal a research grant to understand the cognitive vulnerability of people to depression. The psychologists found that depressive states created negative biases in memory. Teasedale found that depressive thinking could re-emerge. Patients with dysfunctional beliefs could relapse over the next 30 months.

How could the psychologists develop a maintenance version of CBT to prevent depression relapse? Teasdale was familiar with the Buddhist monk Ajahn Sumedho, who emphasised our ability to Understand thoughts as mental activity. The psychologists had also begun to study Jon Kabat-Zinn‘s work on Buddhist mindfulness meditation. Kabat-Zinn had developed a Stress Reduction Clinic at the University of Massachusetts, and later a Center for Mindfulness.

From this work, the psychologists developed an influential program: Mindfulness-based CBT. This informed their clinical book Mindfulness-Based Cognitive Therapy for Depression (2nd ed.). (New York: Guilford Press, 2013).

Kabat-Zinn has described Mindfulness as: “paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally.” After attending Kabat-Zinn’s mindfulness classes, Segal, Williams, and Teasdale developed a version of CBT called “attentional control training.” But in 1995 when they arrived at Kabat-Zinn’s clinic for a second time, the psychologists had reached a conclusion. They had to embrace their own personal mindfulness practice. They also had to transition from being a therapist to Becoming an instructor.

One of the psychologists’ distinctions was between “driven-doing” and “being” modes. The first is goal-driven and focuses on discrepancies and continuous monitoring, which can then lead to ruminations in the subjective universe. In contrast the “being” mode focuses on “accepting” and “allowing”. The core skill of mindfulness-based CBT then is to Recognize ruminative, negative thoughts and to shift more to a process-oriented “being” mode of perception.

The Mindfulness-based CBT program that Segal, Williams and Teasdale developed relates to psyche-enhancing activities and the pursuit of self-mastery. Kabat-Zinn and the psychologists used a form of Buddhist mindfulness meditation similar to the Chan style. Segal, Williams and Teasdale urged people facing potential relapse to spend time doing a task that gave them pleasure, and a sense of self-mastery.

Segal, Williams and Teasdale also adapted and developed several other practices. A body scan meditation helped to identify physical sensations. A Pleasant Experiences Calendar embedded Indulgence as a way to strengthen the psyche. Mindfulness of a routine activity — eating, doing dishes, brushing teeth, attention to a pet — expanded the scope and range of Being to everyday circumstances. Guided, sitting and walking meditations provided further practices to cultivate awareness.

Mindfulness-based CBT is useful for positive, mindful self-growth.