Mindfulness Based Cognitive Therapy (MBCT) in clinical depression treatment

Clinical Research
The research, just published in the Journal of Consulting and Clinical Psychology, found that the group-based psychological treatment called Mindfulness Based Cognitive Therapy (MBCT) was as good or better as treatment with anti-depressants like Prozac in preventing a relapse of serious depression -- and the non-drug therapy was more effective in enhancing quality of life. What's more, the study concluded MBCT is cost-effective in helping people with a history of depression stay well for the long term.

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The research team, which included British investigators from the Mood Disorders Center at the University of Exeter and the Center for Economics of Mental Health (CEMH) at the Institute of Psychiatry at King's College in London, looked at 123 people who had suffered repeated episodes of clinical depression. In a randomized control trial, the research subjects were assigned to one of two groups. Half continued their on-going drug treatment with anti-depressants and the rest participated in an MBCT course and were also given the option of stopping their anti-depressant medications.

MBCT focuses on targeting negative thinking and helps people who are at risk for recurring depression to stop their depressed moods from spiraling out of control into a full episode of depression. During the eight-week trial, groups of between eight and fifteen people attended meetings with a therapist who taught them a range of meditation exercises that they could continue to practice on their own once the course ended. The MBCT exercises were primarily based on Buddhist meditation techniques and helped the study participants learn to focus on the present, rather than dwelling on the past or worrying about future tasks.

Although the meditation exercises worked in a different way for each person, many reported more control over their negative thoughts and depressed feelings. Over the 15 months after the trial ended, about 47% of the group following the MBCT course experienced a relapse -- but those who continued normal treatment with anti-depressant drugs experienced a much higher, 60 percent relapse rate. In addition, the group practicing the mindfulness meditation techniques learned in the MBCT program reported a far better quality of life, more overall enjoyment and better physical well-being.

In a statement to the media, Professor Willem Kuyken of the University of Exeter, who headed the research, explained that people treated with anti-depressants are highly vulnerable to relapse when they stop their prescription drug therapy. "MBCT takes a different approach – it teaches people skills for life. What we have shown is that when people work at it, these skills for life help keep people well. Our results suggest MBCT may be a viable alternative for some of the 3.5 million people in the UK known to be suffering from this debilitating condition. People who suffer depression have long asked for psychological approaches to help them recover in the long-term and MBCT is a very promising approach. I think we have the basis for offering patients and GPs an alternative to long-term anti-depressant medication. We are planning to conduct a larger trial to put these results to the test and to examine how MBCT works," Kuvken said.

About MBCT
Mindfulness-Based Cognitive Therapy (MBCT) is designed to help people who suffer repeated bouts of depression and chronic unhappiness. It combines the ideas of cognitive therapy with meditative practices and attitudes based on the cultivation of mindfulness. The heart of this work lies in becoming acquainted with the modes of mind that often characterize mood disorders while simultaneously learning to develop a new relationship to them. MBCT was developed by Zindel Segal, Mark Williams and John Teasdale, based on Jon Kabat-Zinn's Mindfulness-Based Stress Reduction program at the University of Massachusetts. Kabat - Zinn's work shows that for these people who have had little success with conventional pain management, the internal work of mindfulness practice substantially helped in dealing with pain.

So the authors of MBCT worked with Kabat - Zinn in specifying the MBSR for training chronic sufferers of depression in skills that prevent relapse. Their own research shows in people with 3 or more episodes, MBCT cut the relapse rate in half (over the 60 week follow-up period).

MBCT consists of a mix of mindfulness practice, of practicing a mere noticing of sensation (vipassana practice), as well as certain thought-tracking techniques from cognitive therapy. It is taught as an 8 week class that focuses on skill acquisition, rather than on psychotherapy per se. Groups are from 8-12 people, a size that tends to pull away from the tendency for it to become group therapy. It's really about learning and practicing skills.

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MBCT addresses unwanted beliefs, feelings and body sensations. People are then taught to change the way their mind normally responds to negative events and thoughts. This helps to create a more positive outlook. The goal is to provide skills for life to help prevent chronic depression.

How does MBCT help?
MBCT works by keeping the mind from being caught in old habits that can create a downward spiral of negative thinking. The therapy is based on concepts that teach you to:
  • Get to know the workings of your mind
  • Notice small beauties and pleasures around you instead of living in your head
  • Not drive yourself to meet impossible goals
  • Accept yourself as you are, without judgment
  • Recognize unhelpful thoughts and how they affect your mood
  • Break the link between negative mood and the negative thinking that could lead to a relapse
  • Learn to stay in touch with the present moment, and not obsess about the past or future
MBCT helps you to see more clearly the patterns of your mind; and to learn how to recognize when your mood is beginning to go down. It helps break the link between negative mood and the negative thinking that might normally have escalated into a relapse. You develop the capacity to mindfully disengage from distressing mood, and negative thoughts. You find that you can learn to stay in touch with the present moment, without having to ruminate about the past, or agonize about the future.

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MBCT can be used on its own. It may also be combined with antidepressants or other types of therapy. Studies are looking into whether MBCT can reduce or eliminate the need for antidepressant medication in some people.

What to expect
MBCT is used by health care professionals who have had specific training in this approach. It is usually taught in a group with eight weekly classes. Each person is also asked to do "homework," using CDs with guided meditations that support what they learn in class.

The exercises work in a different way for each person. But many report greater acceptance of - and more control over - negative thoughts and feelings.
Most sessions involve:
  • Simple breathing techniques, meditations and yoga stretches to increase awareness of the present moment. This includes getting in touch with moment-to-moment changes in the mind and the body.
  • Education about depression and anxiety.
  • Group discussion about using these practices at home.
  • Advice on how to deal with any problems that came up.
MBCT can be cost-efficient, as group sessions cost less than individual therapy. Also, some people may be able to reduce their medication in lieu of therapy.

Case studies
Case study 1: Di
Di Cowan of Sampford Peverell, East Devon, has suffered from depression since he was in his late teens, though it was not diagnosed until much later. Now 53, he has been taking anti-depressant drugs for more than 15 years and has had no previous psychological treatment.

It is now two years since he completed the eight-week MBCT trial and Di practices the meditation techniques learned during the trial four or five times a week, for up to an hour each time. He plans to continue doing this for the rest of his life.

Di explains how the techniques learned on the trial have helped him in his daily life: "It's helped me immensely. It's given me the ability to come up against something that would have previously thrown me, think it through, come up with a solution and then move on. It's helped me deal with recurrent thoughts."

Shortly after completing the trial, Di was diagnosed with bone cancer and had to undergo treatment, including a major spinal operation, which has left him less mobile than he was before. Despite this set-back, he feels he is managing his depression using the techniques learned on the MBCT trial.

He says: "My view of the world has changed and I look at life in a new light. I'm much more cheerful and positive. Other people noticed a change. My friends and family were very quick to comment that I was showing an improvement."

Di concludes: "It was very worthwhile and I would highly recommend it to anyone who has similar problems. It's a very sound way of combating mental illness and promoting mental health."

Originally from Manchester, Di has lived in Devon for 28 years. He is a retired Math teacher and is married with two boys, aged 19 and 11.

Case study 2: Stephen
Stephen hopes that MBCT will be "the final piece in the jig-saw" in learning to cope with a tendency towards severe depression that he has suffered since his teens. Now 56, he experienced severe episodes between 2000 and 2002, involving hospitalization. Having already tried a number of alternative therapies, and talking cures, as well as anti-depressant drugs, he finally agreed to try the mood-stabilizer, Lithium.

Soon afterwards, he embarked on a course of cognitive behavioral therapy, and it was via this route that he heard of MBCT. "It was the right thing at the right time", he says. Sufficiently "stabilized" by Lithium, he was able to benefit fully from the techniques taught, which he now practices on a daily basis, some six years later.

The group context of MBCT was important for him. Not only did participants share their individual experiences of depression, and find common ground in symptoms suffered and warning signs to heed, they also helped keep each other "on track" with the practical homework involved. Stephen believes that, in addition to the group's support, self-discipline helped him complete the eight week course and has been essential for him to continue regular practice at home. He says: "Persistence and determination are necessary during the course and become even more vital when you're on your own."

Stephen, who lives in Exeter, is realistic enough to suspect that, without Lithium he could not have reaped the benefits of MBCT. However, he says: "Mindfulness gave me added insight into the way I function and respond to people, and helped me become more accepting. Along the way I have gained an understanding that, much of the time, life may not be as I would like it, but an awareness – particularly a body awareness – of such situations can lead to easier acceptance of them, and sometimes to beneficial change. Maybe, one day, I'll have gained sufficient insight not to need the Lithium any more".

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