How does mindfulness based cognitive therapy work

It could be expected that participants with higher baseline rumination benefit more from MBCT and those with lower rumination from CFT. The study was conducted in a residential rehabilitation and health clinic in Iceland, where clients usually stay for 4 weeks. The clinic offers a holistic approach in treating their clients with a variety of programs, e.

The participants were recruited through convenience sampling; the treatment participants were allocated to the intervention starting at the time they began their rehabilitation. Up to 15 clients are typically included in each treatment group at the clinic and treatment participants were therefore allocated to two MBCT and two CFT groups. Complete pre-post data sets were obtained from 58 participants, 20 from the MBCT group, 18 from the CFT group, and 20 from the control group.

A complete pre-post and follow-up data was obtained from 43 participants, 17 from the MBCT group, 13 from the CFT group, and 13 from the control group. Table 1 shows the distribution of gender and age across the three arms of the study. After removing outliers the complete pre-post data for all four measures was from 54 participants, 19 from the MBCT group, 17 from the CFT group, and 18 from the control group. The complete pre-, post-, and follow-up data for all four measures was from 32 participants, 13 from the MBCT group, 12 from the CFT group, and 7 from the control group.

Treatment participants were asked to complete the pre- and post-treatment questionnaires at the beginning of the first session and at the end of the last session in the MBCT and CFT groups. At the follow-up assessment 1 month after treatment participation, participants completed follow-up questionnaires electronically.

Participants in the control group also completed the questionnaires at the same time points as treatment participants electronically. The treatments were delivered by two experienced therapists, one of them is a clinical psychologist and the other is a psychiatric nurse. The clinical psychologist was also under Paul Gilberts' supervision.

To ensure quality of the treatments they delivered, they had regular supervision sessions and provided each other with feedback in terms of adherence to the treatments.

However, no other formal external examination was put into place to ensure the fidelity of the treatments. MBCT was delivered following the treatment protocol Segal et al. Session content included guided mindfulness practices i. This pilot study followed a pre-post design with a control group and two intervention arms.

The assessments were conducted at the baseline, after the 4-weeks long interventions and at 1 month follow up. Self-Compassion Scale SCS; Neff, b consists of 26 items, rated on a five-point Likert-scale, assessing the positive and negative aspects of the three main factors of self-compassion: Self-Kindness vs. Self-Judgement ; Common Humanity vs. Isolation ; and Mindfulness vs. Over Identification.

Birnie et al. This measure has been criticized because of its factor structure Williams et al. It is worthwhile to note its overlap with measuring mindfulness as it has a mindfulness subscale. Reflection Rumination Questionnaire RRQ: Trapnell and Campbell, consists of 12 items, rated on a five-point Likert-scale, assessing three aspects of rumination: ruminative self-attention, the tendency to rehash, re-evaluate or dwell on past events or experiences. It consists of 21 items in which individuals are required to indicate the presence of a symptom over the past week from 0 did not apply to me at all over the last week to 3 applied to me very much or most of the time over the past week.

To date, normative data has not been created for an Icelandic population for these measures. Therefore, all four questionnaires have been translated into Icelandic and then back-translated to confirm the accuracy of the initial translation. It was expected that Icelandic participants would respond in similar ways to Western participants for which the norms have been established.

Internal consistency was calculated for each measure. Between-group comparisons at the pre-treatment time for all the measures examined possible baseline differences. Significant interactions for all the measures were investigated further for predicted differences using paired-samples t -tests. Correlations among the dependent measures at pre-treatment time are shown in Table 2.

All the relationships were in the expected directions. Table 2. Table 3. The mean scores for pre- and post-treatment scores on the dependent measures for participants in the treatment groups and the control group are shown in Figure 1. Figure 1. Table 4. The mean scores on the dependent measures across time for participants in the treatment groups and the control group are shown in Figure 2. In line with abovementioned results it shows that the effects of both treatments are mostly maintained at 1month follow-up.

Figure 2. In order to investigate whether the tendency to ruminate affected how participants responded to the two interventions, the participants in the MBCT and in the CFT groups were further split into two subgroups based on a median split of their RRQ scores at pre-test. Higher than median scores determined higher rumination tendency and lower than median scores determined lower rumination tendency.

This resulted in an additional factor of rumination which was included in the following analyses. Participants in both treatment groups showed significant increases in mindfulness and self-compassion and decreases in rumination, depression, anxiety, and stress at post-test, whereas there were no changes reported for participants in the control group.

The significant findings for the symptom change and mindfulness scores in the two treatment groups were accompanied by large effect sizes. The significant reductions in rumination were associated with large effect size in the MBCT group and medium effect size in the CFT group.

Furthermore, the exploration of the effects of MBCT and CFT on the participant outcomes depending on their pre-treatment tendency to ruminate revealed that MBCT participants who were high in rumination, but not those low in rumination, showed significantly increased mindfulness scores. Interestingly, for CFT participants mindfulness scores at post-test significantly increased in both rumination groups.

However, all these significant findings need to be interpreted with caution given the non-randomized design of this study and a relatively small sample size. However, only the MBCT group showed significant reductions in anxiety scores whereas the CFT group did not manifest a significant change. Overall, findings of the current study are consistent with a number of studies that have shown that MBCT and CFT are effective at enhancing mindfulness and self-compassion and at reducing depression, anxiety, stress, and rumination Teasdale et al.

This is the first study that has directly compared the effects of MBCT and CFT and according to our findings there were no significant differences in their effects, except for follow up reductions in anxiety with significant change in the MBCT group only.

Interestingly, both MBCT and CFT resulted in significant improvements for self-compassion with a medium effect size for the MBCT group and small effect size in the CFT group which is contrary to the prediction that explicit cultivation of self-compassion leads to larger enhancements Gilbert, a. Our findings partly support the notion that people differ in their response to the treatments based on their tendency to ruminate as participants who were high in rumination at pre-test in the MBCT group showed a significant increase in mindfulness at post-test and those with low rumination did not show improvements.

Such selective increase in mindfulness for the high rumination participants lends further support to previous results with recurrently depressed participants in remission where only those with high rumination positively responded to a brief mindfulness induction Barnhofer et al.

This interesting finding is more broadly in line with the pervious evidence that MBCT is particularly effective for people with depression Teasdale et al. However, findings from the current study also surprisingly revealed that both high and low rumination participants in the CFT group showed significant increases in mindfulness at post-test which is contrary to Barnhofer's study where only participants with low rumination benefited from brief loving kindness instructions.

Importantly, we haven't found differences between the high and low rumination groups for either MBCT or CFT in symptom change and self-compassion scores which somewhat limits the findings of differences in mindfulness gains and requires further investigation. Overall, interpretation of the findings of the current study needs to take into account several limitations.

First, the study did not employ a randomized controlled design. While this raises some concerns with regard to comparability of the groups, there were no significant differences found in any of the measures between the groups at pre-treatment. Second, the treatment groups were in a residential rehabilitation and health clinic during the treatment period, in which they were offered variety of other beneficial programs along with MBCT and CFT.

This could have confounded the findings to some extent. Shorter time-frame for delivery of MBCT and CFT half in comparison to the usual 8-week format, yet equal number of sessions was covered may have also impacted the results since it may take time to develop mindfulness and self-compassion skills. In addition, no external examination was put into place in order to ensure the fidelity of the treatments.

Finally, the follow-up time in the current study was limited to one month which does not allow for informed conclusions about possible longer-term effects of MBCT and CFT and their comparison. Future studies should employ a randomized controlled design with a larger sample, in both clinical and non-clinical settings and with longer and repeated follow-ups.

If conducted in a residential rehabilitation clinic, it would be recommended to compare the treatment groups to a control group that is also in the clinic at the same time but not receiving MBCT or CFT. It would be interesting to compare MBCT to a standardized manualized self-compassion program. Future studies could also include assessments such as behavioral or psychophysiological markers to bypass some of the limitations of self-reports.

Impact of individual differences at the baseline, such as levels of rumination, on treatment outcomes needs further investigation. In conclusion, the findings from the current study suggest that both MBCT and CFT are effective at enhancing mindfulness and self-compassion and at reducing depression, anxiety, stress, and rumination in clients with anxiety, depression, and stress difficulties. MBCT encourages clarity of thought and provides you the tools needed to more easily let go of negative thoughts instead of letting them feed your depression.

Much like cognitive therapy, MBCT operates on the theory that if you have a history of depression and become distressed, you are likely to return to those automatic cognitive processes that triggered a depressive episode in the past.

The combination of mindfulness and cognitive therapy is what makes MBCT so effective. Mindfulness helps you observe and identify your feelings while cognitive therapy teaches you to interrupt automatic thought processes and work through feelings in a healthy way.

The primary goal of MBCT is to help patients with chronic depression learn how to avoid relapses by not engaging in those automatic thought patterns that perpetuate and worsen depression. A study published in The Lancet found that MBCT helped prevent depression recurrence as effectively as maintenance antidepressant medication did. Research also has shown that MBCT can reduce the severity of depressive symptoms as well as help reduce cravings for addictive substances.

Research also suggests that MBCT can be safe and effective for treating people who are currently experiencing active depression. Research on the efficacy of MCBT for active or severe depression is still ongoing. It's important to talk to your doctor about your symptoms to determine if this approach is right for you. It is important to note that while the class or group aspect of MBCT is important, much of the work is done outside of class.

Participants are asked to do homework, which includes listening to recorded guided meditations and trying to cultivate mindfulness in their daily lives. This may mean bringing mindfulness to day-to-day activities , like brushing your teeth, showering, washing the dishes, exercising, or making your bed, by applying MBCT skills such as:. Though a lot of the hard work of MBCT is self-directed, advocates stress that the classes themselves are important to the efficacy of the program.

Finding classes might be challenging, however, depending on the availability of trained MBCT therapists in your area. The MBCT program is a group intervention that lasts eight weeks.

During those eight weeks, there is a weekly course, which lasts two hours, and one day-long class after the fifth week. There is not necessarily an established network of teachers around the globe or a single directory in which you can find a program close to home.

Talk to your doctor or consider searching an online therapist directory if you are interested in finding an MBCT therapist in your area.

Mindfulness has become increasingly popular for its ability to promote mental health, so even mental health professionals who are not specifically trained in MBCT may incorporate some aspects of mindfulness practices in their therapy sessions. Everything feels more challenging when you're dealing with depression. Get our free guide when you sign up for our newsletter. Mindfulness-based cognitive therapy for depression: Trends and developments. Psychol Res Behav Manag.

Mindfulness-based cognitive therapy: Theory and practice. Can J Psychiatry. Crane R. This additional treatment was equally frequent in the MBCT group as in the control group and therefore does not confound our mediation results see table 1. The only possibility we cannot exclude is that the observed mediation effects represent in part the synergistic effects of MBCT in combination with additional treatment.

Furthermore, adherence to the MBCT protocol was not assessed formally, hence it cannot be ruled out that trainings may have differed slightly with regard to adherence. However, if this would be the case, then the currently observed mediation effects are likely conservative estimations of the true effects.

Also, patients meeting criteria for depressive disorder were excluded in this study. Therefore, the current results may not generalize to patients with current depression. This manuscript partially uses data which has been used in a previous publication [ 17 ].

Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Abstract Mindfulness based cognitive therapy MBCT is a non-pharmacological intervention to reduce current symptoms and to prevent recurrence of major depressive disorder.

Introduction Major depressive disorder MDD is an invalidating condition, with high rates of residual symptoms and high probability of recurrence [ 1 ]. Methods Participants Figure 1 shows the flow of participants through the study. Download: PPT. Intervention MBCT In accordance with the protocol of Segal, Williams and Teasdale [ 2 ], trainings took place in groups of people and consisted of eight weekly meetings lasting 2,5 hours. Statistical analyses All analyses were carried out according to intention-to-treat.

Figure 2. Mediation analysis pathway, for the effect of MBCT on residual symptoms of depression. Note 1 : Post-intervention measures were taken 8 weeks after the pre-intervention measures. Figure 3. Independence of effects A multiple regression analysis was performed to examine the independence of the mediators above. Discussion This study yields information about the pathway of change mediating the reduction of residual depressive symptoms during a course of MBCT. Comparison with previous studies In line with previous reports, changes in mindfulness skills and cognitive processes appeared important mediators in the effect of MBCT [ 9 , 15 , 16 ].

Affective and cognitive factors in the mechanism of MBCT The current study examined the role of both affective and cognitive variables in the mechanism of change of MBCT.

Strengths and limitations This study provides new insights in the cognitive and affective factors that mediate the reduction of depressive symptoms associated with MBCT. Supporting Information. Checklist S1. Protocol S1. Trial protocol. References 1. Am J Psychiatry PubMed: View Article Google Scholar 2.

New York: The Guilford Press. Teasdale JD Psychological treatments for depression: How do they work? In SJ Rachman. Best of behavior research and therapy. Behav Res Ther View Article Google Scholar 5. Br J Psychiatry View Article Google Scholar 6. Green SM, Bieling PJ Expanding the scope of mindfulness-based cognitive therapy: Evidence for effectiveness in a heterogeneous psychiatric sample. Cogn Behav Practice View Article Google Scholar 7.

Psychol Psychother Theory Res Practice View Article Google Scholar 8. Manicavasgar V, Parker G, Perich T Mindfulness-based cognitive therapy vs cognitive behaviour therapy as a treatment for non-melancholic depression. J Affect Disord View Article Google Scholar 9. Psychol Med View Article Google Scholar J Consult Clin Psychol Clin Psychol Rev Kazdin AE Mediators and mechanisms of change in psychotherapy research.

Annu Rev Clin Psychol 3: Int J Cognitive Therapy 3: Geschwind N, Peeters F, Drukker M, van Os J, Wichers M Mindfulness training increases momentary positive emotions and reward experience in adults vulnerable to depression: A randomized controlled trial.

Teasdale JD Mindfulness-based cognitive therapy. Cognition, emotion and psychopathology: Theoretical, empirical and clinical directions. New York: Cambridge University Press.

Psychiatry Res Hamilton M A rating scale for depression. J Neurol Neurosurg, Psychiatry Assessment Pers Individ Dif Clin Psychol Psychother 6: Gedragstherapie J Pers Assess Arch Gen Psychiatry Child Abus Negl Paykel ES The interview for recent life events.

Paeg Delespaul Assessing schizophrenia in daily life. The experience sampling method. Maastricht: Maastricht University Press. Goodman LA On the exact variance of products. J Am Stat Assoc Annu Rev Psychol Sobel ME Asymptotic confidence intervals for indirect effects in structural equation models. Sociological Methodology. Ender PB Sgmediation. Program to compute Sobel-Goodman mediation tests.

Accessed August 2.