Mindfulness-based cognitive therapy (MBCT) is a type of cognitive therapy which integrates mindfulness techniques such as meditation and breathing exercises into its protocol¹. Originally developed as a manualized group-skills training program to mitigate depressive relapse, MBCT synthesizes aspects of cognitive behavioral therapy (CBT) with the mindfulness-based stress reduction (MBSR) program developed by Dr. Jon Kabat-Zinn in 1979.^2,3 A review of MBCT thus requires a closer look at each of these components.

CBT is the most researched form of psychotherapy and regarded by some as the "gold standard" in psychotherapeutic treatment due to its extensive clinical support, systematic comparability/favorability to other treatment modalities, and recommended use as a first-line treatment for a variety of psychosocial disorders.⁴ It posits that psychological problems are based, in part, on irrational ways of thinking as well as learned patterns of maladaptive behavior,⁵ and derives treatment techniques from cognitive therapy and behavior therapy to help clients identify and modify maladaptive thought and behavior patterns to elicit change⁶. CBT is both problem-⁷ and goal-oriented, and generally requires fewer sessions than other types of therapy.⁸ Clients receiving CBT treatment are engaged in a collaborative effort to explore and challenge the validity of maladaptive thoughts, emotions, and beliefs regarding troubling life situations, reshape their thinking, and develop effective strategies for modifying problematic behaviors.^8,9 CBT may also involve teaching coping skills for stress/anxiety reduction, as well as other techniques.^7,8

CBT's effectiveness as a treatment method for a variety of health disorders is well-established. Mental health disorders including depression, anxiety disorders, phobias, posttraumatic stress disorder, sleep and eating disorders, obsessive-compulsive disorder, substance use disorders, bipolar disorders, schizophrenia, and sexual disorders may improve in response to CBT.⁸ A 2012 review of meta-analyses extends this group to also include somataform disorders, anger control problems, and general stress, and describes CBT as having "high cost-effectiveness" and an "enormous," "very strong" evidence-base.⁹ A 2006 review of meta-analyses indicated large CBT treatment effect sizes for unipolar depression, generalized anxiety disorder, panic disorder with or without agoraphobia, social phobia, posttraumatic stress disorder, and childhood depressive and anxiety disorders. Moderate effect sizes were indicated for marital distress, anger, childhood somatic disorders, and chronic pain.¹⁰

MBSR is a structured, 8-week intervention combining weekly group classes witih daily mindfulness excercises to practice at home.¹¹ It was initially developed to address stress management, but has since been expanded for use in treatment of various health disorders including anxiety, depression, skin diseases, pain, immune disorders, hypertension, and diabetes.³ Clients receiving MBSR treatment are trained and engaged in secular, mindfulness-based techniques including meditation, yoga, bodily awareness, and exploring patterns of behavior, thinking, feeling, and action.^12,13 MBSR studies have reported its effectiveness in treating symptoms of anxiety and depression,¹⁴ and improving symptom variables in patients with breast cancer,¹⁵ chronic headaches,¹⁶ somatic symptom disorder,¹⁷ HIV,¹⁸ gastrointestinal cancers,¹⁹ and chronic pain.²⁰ A meta-analysis of MBSR found significant, moderate effect sizes on both mental and also physical health outcome variables for all controlled studies reviewed, and overall findings "suggest the usefulness of MBSR as an intervention for a broad range of chronic disorders and problems."²¹

Shifting to mindfulness-based cognitive therapy, MBCT, like MBSR, is traditionally administered in a group format,²² but has also been adapted for individual treatment. Clients receiving MBCT treatment learn meditative techniques and other mindfulness exercises in order to change the ways they relate to negative emotions, rather than trying to avoid or eliminate them.¹ Conventional CBT and MBCT share considerable overlap, for example in their inclusion of condition-specific psychoeducation²³, cognitive restructuring, the development of pleasant activities,²⁴ and a broad focus on increasing attention to thoughts, emotions, and their appraisals.²⁵ However, they differ in their view regarding how clients ought to relate to these appraisals, i.e. judgments about these experiences. CBT focuses on changing the content of clients' negative thoughts in order to break the link between negative thoughts, emotions, and behaviors, whereas MBCT focuses on guiding clients to obtain greater cognitive flexibility through an emphasis on awareness and acceptance of negative experiences. This can help them to "let go" of negative appraisals and reorient toward positive reinterpretations.²⁵

Research supports the efficacy of MBCT in the treatment of depression and other mental health-related symptoms. MBCT has been shown effective in clients with major depressive disorder who have experienced at least three episodes of depression, and in reducing depressive symptoms in people with physical health conditions including vascular disease and traumatic brain injury.¹ A comparison pilot study of individual and group MBCT in depressed people with a comorbid somatic disease showed improvements in depressive and anxious symptoms, as well as positive well-being, mindfulness, and self-compassion, with no significant differences between condition groups.²² A meta-analysis reveiwing MBCT's effectiveness in treating current depressive symptoms (as opposed to depressive relapse prevention) found significant post-treatment improvements in depressive symptoms; these improvements were consistent with moderate effect sizes for depressive symptoms found in other reviews of mindfulness-based therapies not exclusive to MBCT, as well as meta-analyses of cognitive behavioral therapy for the treatment of current depression.²⁶ Further studies support MBCT's effectiveness in reducing depressive symptoms and promoting positive effects on anxiety, well-being, and diabetes-related distress in persons with diabetes,²⁷ reducing risk of depressive relapse,^28,29 and short-term anxiolytic effects comparable to classical CBT.²⁴ While additional studies further support comparable effectivness between MBCT and CBT for current depression,^23,30 MBCT has also been shown to result in greater cognitive reappraisal ability (CRA, the degree to which one can successfully change their emotions when using reappraisal during a laboratory challenge) in comparison with CBT.²⁵

MindVault Health believes the mindfulness-based aspects of MBCT treatment are adaptable and useful for clients who may struggle with attempts to actively control their thoughts and emotions, but who respond positively to acceptance-based approaches. We also believe MBCT treatment is benefical for clients interested in more structured methods of mindfulness-based training.