Mindfulness-Based Cognitive Therapy
Alex Risberg LICSW Candidate • December 17, 2024
Treating depression by creating structural changes within the brain
Mindfulness-Based Cognitive Therapy (MBCT) is a form of therapy that was created to treat depression, specifically treatment-resistant depression. Developed by Zindel Segal, John Teasdale, and Mark Williams, MBCT combines elements of cognitive therapy with mindfulness meditation. Research has shown that MBCT creates structural changes within brain areas that are associated with depression (Brewer et al., 2011). This means that MBCT reforms the brain, something that antidepressant medications have not been shown to do. This blog post will introduce the main ideas behind MBCT and briefly review the research backing this effective treatment option.
Major depressive disorder (MDD), characterized by persistent low mood and a lack of interest in normally pleasurable activities, is highly prevalent and adversely affects the lives of those who suffer from MDD and their loved ones. Depressive episodes are rarely a one-time occurrence. Half of individuals who have experienced one depressive episode are likely to experience another episode in life, and 80% of those who have experienced two episodes are likely to experience a third (American Psychiatric Association, 2013). Living with MDD is like living underwater. Everyday tasks take more energy than normal. You feel sad and down and have little motivation to do anything. MDD can bring a happy, thriving person to a halt. If left untreated, MDD can lead to thoughts of suicide and attempts to end one’s life.
Luckily, MBCT provides an effective way to treat MDD and keep depressive episodes at bay. To understand MBCT, it is important to understand what mindfulness is and how mindfulness concepts are combined with cognitive therapy in MBCT. In a nutshell, mindfulness is the practice of attending to the present moment free from judgment. It is often said that fixation on the past is depression and fixation on the future is anxiety. Mindfulness helps us to practice focusing on what is happening here and now, and to approach our experiences without labels of good or bad. We allow ourselves to experience life as it comes.
Meditation is the most common way of practicing mindfulness (though there are many ways to practice!) When we meditate we focus our attention on our breath. We feel the sensations of our breath flowing in and out of our bodies. If our mind wanders we notice this and bring the attention back to the breath. Think of each of these cycles of attention as repetitions of the practice. Each time we bring the attention back we become stronger and more mindful.
Mindfulness practice encourages us to treat thoughts as passing events rather than permanent indicators of truth. This reevaluation of negative thinking helps to break the cycles of rumination that often lead to relapses into depressive episodes. According to a review of the research by MacKenzie and Kocovski (2016), “there is consistent empirical evidence in support of using MBCT to decrease the risk of depressive relapse”. The review found that MBCT was effective for both patients currently experiencing a major depressive episode as well as those in remission.
Mindfulness practice begins with observation of the mind. By observing thoughts rather than identifying with them meditators gain space and freedom from the emotions that can be disruptive in life. The difference between “I am sad” and “I am experiencing sadness” is subtle, but mindfulness helps individuals make this distinction. We can begin to see sadness or anxiety as a passing experience, rather than a permanent characteristic of life.
MBCT allows depressed individuals to take control of their minds and emotions by making structural, long-lasting changes to their brains. The importance of this work cannot be overstated. From its beginnings in Buddhism, the purpose of mindfulness has been to eliminate suffering. Luckily, Western psychology is beginning to embrace the teachings of the Buddhist tradition. What is clear and most important is that these techniques work.
More research may uncover the details of how MBCT works, but this research is secondary to the importance of saving lives and giving patients hope. Hope is the greatest gift in times of suffering. MBCT provides that gift in the darkest of spaces.
Depression is an enormous burden. It is emotional inertia. Like a still boulder, getting one’s mood moving in the right direction from a standstill is nearly impossible. However, MBCT provides a lever to get the boulder moving. Once started, the process builds on itself, and inertia begins to work in the patient’s favor, instead of against them. The world needs more levers and more people heading in positive directions. Once this motion gets started, it will be impossible to stop.
References
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental
Disorders (DSM-5). American Psychiatric Pub.
Brewer, J., Worhunsky, P., Gray, J., Tang, Y., Weber, J., & Kober, H. (2011). Meditation experience is associated with differences in default mode network activity and connectivity. Proceedings of the National Academy of Sciences of the United States of America, 108(50), 20254-20259.
MacKenzie, M. B., Kocovski, N .L. (2016). Mindfulness-based cognitive therapy for depression: Trends and developments. Psychological Research and Behavior Management, 9, 125–32.
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