Mindfulness-Based Cognitive Therapy (MBCT)

Scientific Rating:
1
Well-Supported by Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
Medium
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Mindfulness-Based Cognitive Therapy (MBCT) has been rated by the CEBC in the area of: Depression Treatment (Adult).

Target Population: Adults (between 18-70 years old) who have suffered three or more prior episodes of major depression

Brief Description

MBCT is based on Jon Kabat Zinn’s Stress Reduction program at the University of Massachusetts Medical Center, which was developed to help people suffering with chronic physical pain and disease. It includes simple meditation techniques to help participants become more aware of their experience in the present moment, by tuning in to moment-to-moment changes in the mind and the body. Participants learn the practice of mindfulness meditation through a course of eight weekly classes (the atmosphere is that of a class, rather than a therapy group) and through daily practice of meditation skills while listening to tapes at home. MBCT also includes basic education about depression and suicidality, and a number of exercises derived from cognitive therapy. These exercises demonstrate the links between thinking and feeling and demonstrate ways that participants can care for themselves when they notice their mood changing or a crisis threatens to overwhelm them.

Program Goals:

The overall goals of Mindfulness-Based Cognitive Therapy (MBCT) are:

  • Target the critical risk mechanism in recurrent depression: patients' tendency to react to small changes in mood with large amounts of negative self-focused rumination
  • Teach patients (in groups and through home-based practice) to notice the tendency to ruminate earlier in its sequence so that more skillful means can be deployed in responding (rather than reacting) to whatever is causing it
  • Teach participants to recognize the mode of mind they are in, so they can, if they choose, change from analytic (over-thinking) mode to a mindful, experiential mode

Essential Components

The essential components of Mindfulness-Based Cognitive Therapy (MBCT) include:

  • Makes no attempt to change the content of negative thinking, unlike Cognitive Therapy
  • Encourages participants to change their relationship to their own thoughts, feelings, and body sensations, so that they have an opportunity to discover that these are fleeting events in the mind and the body which they can choose to engage with – or not
  • Helps participants to realize that their thoughts, emotions, and sensations are just thoughts, emotions, and sensations, rather than ‘truth’ or ‘me’ by having the therapist repeatedly notice and observe with interest and compassion
  • Helps participant learn to see more clearly the patterns of the mind, and to recognize when his/her mood is beginning to dip without adding to the problem by falling into analysis and rumination
  • Helps break the old association between negative mood and the negative thinking
  • Helps participants develop the capacity to allow distressing emotions, thoughts, and sensations to come and go, without feeling that they have to suppress them, run away from them, or do battle with them
  • Strives to have participants learn to stay in touch with the present moment, without being driven to dwell on the past or worry about the future
  • Taught in classes withthe recommended size being 12 participants

Adult Services

Mindfulness-Based Cognitive Therapy (MBCT) directly provides services to adults (regardless of whether they are parents or caregivers) and addresses the following:

  • Depression

Delivery Settings

This program is typically conducted in a(n):

  • Community Agency
  • Hospital
  • Outpatient Clinic

Homework

Mindfulness-Based Cognitive Therapy (MBCT) includes a homework component:

CDs of meditation practices, to be practiced daily six days per week

Languages

Mindfulness-Based Cognitive Therapy (MBCT) has materials available in languages other than English:

Dutch, French, Italian, Japanese, Korean, Polish, Spanish

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

Room that is large enough for 12-14 chairs, preferably able to have 12-14 yoga mats for mindful movement practices

Minimum Provider Qualifications

Registered practitioners in their own field with some experience in that field before undertaking this work, a personal mindfulness practice, and training in experiencing and teaching the intervention

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contacts:
Training is obtained:

Varies by site, please contact training contact closer to your location for information

Number of days/hours:

Varies by site, please contact training contact closer to your location for information

Implementation Information

Since Mindfulness-Based Cognitive Therapy (MBCT) is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

Show implementation information...

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Mindfulness-Based Cognitive Therapy (MBCT) as listed below:

The implementation guide contains a tool for conducting a local analysis of readiness for MBCT. It is available at http://mindfulnessteachersuk.org.uk/.

Formal Support for Implementation

There is formal support available for implementation of Mindfulness-Based Cognitive Therapy (MBCT) as listed below:

Courses and Masterclasses are offered at the Oxford Mindfulness Centre, Oxford, UK. See http://www.oxfordmindfulness.org.

Fidelity Measures

There are fidelity measures for Mindfulness-Based Cognitive Therapy (MBCT) as listed below:

The Mindfulness-based Intervention – Teacher Assessment of Competence (MBI-TAC) assesses the application of skills in the six domains relevant to mindfulness teaching. Each of six domains (e.g. coverage and pacing of curriculum and guiding mindfulness practices) is rated on a six- point scale, anchored with behavioral descriptors for assessors to use as criteria (1 = Incompetent, 2 = Beginner, 3 = Advanced Beginner, 4 = Competent, 5 = Proficient, 6 = Advanced). The MBI-TAC is available at http://mindfulnessteachersuk.org.uk/; follow links to Teaching Assessment Criteria where there is a PDF of the Assessment Scale.

Implementation Guides or Manuals

There are implementation guides or manuals for Mindfulness-Based Cognitive Therapy (MBCT) as listed below:

A detailed implementation guide is available at http://mindfulnessteachersuk.org.uk/pdf/MBCTImplementationResources.pdf.

Research on How to Implement the Program

Research has not been conducted on how to implement Mindfulness-Based Cognitive Therapy (MBCT).

Relevant Published, Peer-Reviewed Research

This program is rated a "1 - Well-Supported by Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The program must have at least two rigorous randomized controlled trials with one showing a sustained effect of at least 1 year. The article(s) below that reports outcomes from an RCT showing a sustained effect of at least 1 year has an asterisk (*) at the beginning of its entry. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Show relevant research...

A meta-analysis has been conducted on Mindfulness-Based Cognitive Therapy (MBCT) though this article is not used for rating and therefore is not summarized:

  • Piet, J., & Hougaard, E. (2011). The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: A systematic review and meta-analysis. Clinical Psychology Review, 31(6), 1032-1040.

*Teasdale, J. D., Segal, Z .V., Williams, J. M. G., Ridgeway, V. A., Soulsby, J. M., & Lau, M. A. (2000). Prevention of relapse/recurrence in major depression by Mindfulness-Based Cognitive Therapy. Journal of Consulting and Clinical Psychology, 68(4), 615-623.

Type of Study: Randomized controlled trial
Number of Participants: 145

Population:

  • Age — 18-65
  • Race/Ethnicity — Not specified
  • Gender — Not specified
  • Status — Participants were patients recruited from community health care facilities and media announcements.

Location/Institution: U.K.

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Volunteers were included if they met Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) criteria for recurrent depression and had a history of treatment with antidepression medication (ADM), but were in remission and not taking ADM at the time the study began. They were randomly assigned to continue treatment as usual (TAU) or to receive Mindfulness-Based Cognitive Therapy (MBCT) training in addition to TAU. Measures included the Hamilton Rating Scale for Depression (HRSD) and the Beck Depression Inventory (BDI). Participants were also assessed bimonthly during the follow-up period for recurrence of a major depressive episode. Results showed that participants in the MBCT condition had half the rate of relapse and recurrence of depression as those in the TAU condition. The authors note that MBCT was designed to prevent relapse and would not be likely to be effective as a primary treatment for depression.

Length of postintervention follow-up: 1 year.

*Ma, S. H., & Teasdale, J. D. (2004). Mindfulness-Based Cognitive Therapy for depression: Replication and exploration of differential relapse prevention rates. Journal of Consulting and Clinical Psychology, 72(1), 31-40.

Type of Study: Randomized controlled trial
Number of Participants: 130

Population:

  • Age — Mean=44.5 years
  • Race/Ethnicity — Not specified
  • Gender — Not specified
  • Status — Participants were patients recruited through general practitioners and the media.

Location/Institution: U.K.

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Patients in remission or recovery from major depression were randomly assigned to receive treatment as usual (TAU) or TAU plus MBCT. They were assessed at baseline using the Hamilton Rating Scale for Depression (HAM-D) and the Beck Depression Inventory. Participants also completed the Measure of Parenting Style describing their mother’s and father’s behaviors toward them up to age 16. In addition, participants were assessed for relapse or recurrence of depression at 3-month intervals and were asked whether the episodes were brought on by specific life events. Results showed a relapse rate of 36% in patients with 3 or more previous episodes of depression who received MBCT, compared to 78% in the TAU group. The treatment was most effective in preventing relapses that were not associated with significant life events and was less effective for those patients with only 2 recent relapse episodes.

Length of postintervention follow-up: 1 year.

Kuyken, W., Byford, S., Taylor, R. S., Watkins, E., Holden, E., White, K., … Teasdale, J. D. (2008). Mindfulness-Based Cognitive Therapy to prevent relapse in recurrent depression. Journal of Consulting and Clinical Psychology, 76(6), 966-978.

Type of Study: Randomized controlled trial
Number of Participants: 123

Population:

  • Age — Not specified
  • Race/Ethnicity — Not specified
  • Gender — Not specified
  • Status — Participants were patients recruited through their primary care physicians.

Location/Institution: Devon, England

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Participants were included if they had three or more episodes of depression and had been treated with antidepressant medication (ADM) over the past 6 months. They were randomly assigned to receive either a maintenance dose of the ADM or an 8-week MBCT course which included support in tapering off their medication. Depression was assessed with theStructured Clinical Interview for DSM-IV at 3-month intervals, the Hamilton Rating Scale for Depression (HRSD) and the Beck Depression Inventory (BDI). Participants also reported on their quality of life using the World Health Organization Quality of Life (WHOQOL-BREF) instrument . Results showed that MBCT was more effective in reducing depressive symptoms and improving quality of life than maintenance ADM. Patients in the MBCT condition were also more likely to significantly reduce or to discontinue their ADMs.

Length of postintervention follow-up: Approximately 7 months.

Barnhofer, T., Crane, C., Hargus, E., Amarasinghe, M., Winder, R., & Williams, J. M. G. (2009). Mindfulness-based Cognitive Therapy as a treatment for chronic depression: A preliminary study. Behavior Research and Therapy, 47, 366-373.

Type of Study: Randomized controlled trial
Number of Participants: 28

Population:

  • Age — Mean=42 years
  • Race/Ethnicity — Not specified
  • Gender — Not specified
  • Status — Participants were recruited through local mental health practitioners and the media.

Location/Institution: U.K.

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Individuals with a history of at least 3 episodes of major depression, a current diagnosis of major depression, a history of suicidal ideation, and absence of co-occurring disorders were eligible for the study. Participants were randomly assigned to receive either MBCT or treatment as usual (TAU). Depression was assessed before and after treatment using the Structured Clinical Interview forDSM-IV, the Beck Depression Inventory (BDI), and the Beck Scale for Suicide Ideation (BSS). Results showed that symptoms were reduced from severe to mild for those in the MBCT group, but remained unchanged for the control group. There were not group differences in suicidal ideation.

Length of postintervention follow-up: 1 month or less.

*Segal, Z. V., Bieling, P., Young T., MacQueen, G., Cooke, R., Martin, L., Bloch, R., & Levitan, R. D. (2010). Antidepressant monotherapy vs sequential pharmacotherapy and mindfulness-based cognitive therapy, or placebo, for relapse pophylaxis in recurrent depression. Archives of General Psychiatry, 67(12),1256-1264.

Type of Study: Randomized controlled trial
Number of Participants: 160

Population:

  • Age — 18-65 years
  • Race/Ethnicity — Not specified
  • Gender — Not specified
  • Status — Participants were users of outpatient services recruited from treatment centers.

Location/Institution: Outpatient clinics at the Centre for Addiction and Mental Health, Toronto, Ontario, Canada, and St Joseph’s Healthcare, Hamilton, Ontario

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study compared rates of relapse in depressed patients in remission receiving Mindfulness-Based Cognitive Therapy (MBCT) against maintenance antidepressant pharmacotherapy or a placebo. Measures utilized were the Structured Clinical Interview for DSM-IV, the Hamilton Rating Scale for Depression (HRSD), and the Quick Inventory of Depressive Symptomatology. Results showed that MBCT and antidepressants had similar outcomes. Limitations include concerns regarding sufficient power to detect small effects and possible bias. 

Length of postintervention follow-up: 18 months.

*Bondolfi, G., Jermann, F., der Linden, M. V., Gex-Fabry, M., Bizzini, L., Rouget, B. W., Myers-Arrazola, L., ... Bertschy, G. (2010). Depression relapse prophylaxis with Mindfulness-Based Cognitive Therapy: Replication and extension in the Swiss health care system. Journal of Affective Disorders, 122(3), 224-231. 

Type of Study: Randomized controlled trial
Number of Participants: 60

Population:

  • Age — Not specified
  • Race/Ethnicity — Not specified
  • Gender — Not specified
  • Status — Participants were individuals with history of recurrent major depression.

Location/Institution: Geneva and Lausanne University Hospitals, Switzerland

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study presents information on unmedicated patients in remission from recurrent depression that were assigned to Mindfulness-Based Cognitive Therapy (MBCT) and Treatment as Usual (TAU) or Treatment as Usual alone. Measures utilized were the Structured Clinical Interview for DSM-IV, the Hamilton Rating Scale for Depression (HRSD), the Montgomery–Asberg Depression Rating Scale, and the Beck Depression Inventory II. Relapse rate and time to relapse were measured over a 60-week observation period. The frequency of mindfulness practices during the study was also evaluated. Over a 14-month prospective follow-up period, time to relapse was significantly longer with MBCT+TAU than TAU alone, although both groups relapsed at similar rates. Analyses of homework adherence revealed that following treatment termination, the frequency of brief and informal mindfulness practice remained unchanged over 14 months, whereas the use of longer formal meditation decreased over time. Limitations include small sample size.

Length of postintervention follow-up: 14 months.

*Godfrin, K. A., & van Heeringen, C. (2010). The effects of Mindfulness-Based Cognitive Therapy on recurrence of depressive episodes, mental health and quality of life: A randomized controlled study.  Behaviour Research and Therapy, 48(8), 738-746.

Type of Study: Randomized controlled trial
Number of Participants: 106

Population:

  • Age — 18 years or older
  • Race/Ethnicity — Not specified
  • Gender — Not specified
  • Status — Participants were depressed patients with a history of at least 3 depressive episodes.

Location/Institution: University Department of Psychiatry of the University Hospital Ghent

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study investigated the effects of Mindfulness-Based Cognitive Therapy (MBCT) on the relapse in depression and the time to first relapse since study participation, as well as on several mood states and the quality of life of the patients. Patients were assigned to MBCT and Treatment as Usual (TAU) or Treatment as Usual alone. Measures utilized were the Structured Clinical Interview for DSM-IV, the Hamilton Rating Scale for Depression (HRSD), the Profile of Moods Scale, and the Beck Depression Inventory II. Relapse rate and time to relapse were measured over a 60 week observation period. At the end of the study period relapse/recurrence was significantly reduced and the time until first relapse increased in the MBCT plus TAU condition in comparison with TAU alone. The MBCT plus TAU group also showed a significant reduction in both short and longer-term depressive mood and better mood states and quality of the life. Limitations include possible selection bias.

Length of postintervention follow-up: 14 months.

Manicavasgar , V., Parker G., & Perich, T. (2011). Mindfulness-Based Cognitive Therapy vs. cognitive behaviour therapy as a treatment for non-melancholic depression.  Journal of Affective Disorders, 130(1-2), 138-144.

Type of Study: Partially randomized controlled trial (3 of 11 groups were randomized)
Number of Participants: 69

Population:

  • Age — 18 years or older
  • Race/Ethnicity — Not specified
  • Gender — Not specified
  • Status — Participants were adults who met criteria for a current episode of major depressive disorder.

Location/Institution: Black Dog Institute, Prince of Wales Hospital Campus, NSW, Australia

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study examined the comparative effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) and Cognitive Behaviour Therapy (CBT) as treatments for non-melancholic depression. Measures utilized were the Composite International Diagnostic Interview, the Beck Depression Inventory II, Beck Anxiety Inventory, and the Social and Occupational Functioning Scale. Participants were assigned to either an 8-week MBCT or CBT group therapy condition. They were assessed at pretreatment, 8-week post-group, and 6- and 12-month follow-ups. There were significant improvements in pregroup to postgroup depression and anxiety scores in both treatment conditions and no significant differences between the two treatment conditions. However, significant differences were found when participants in the two treatment conditions were dichotomized into those with a history of four or more episodes of depression vs. those with less than four. In the CBT condition, participants with four or more previous episodes of depression demonstrated greater improvements in depression than those with less than four previous episodes. No such differences were found in the MBCT treatment condition. No significant differences in depression or anxiety were found between the two treatment conditions at 6- and 12-month follow-ups. Limitations include small sample size and the lack of randomization of all subjects (only 3 of the 11 groups were randomized).

Length of postintervention follow-up: 6 and 12 months.

*Williams, J. M. G., Crane, C., Barnhofer, T., Brennan, K., Duggan, D. S., Fennell, M. J., ... & Russell, I. T. (2014). Mindfulness-Based Cognitive Therapy for preventing relapse in recurrent depression: A randomized dismantling trial. Journal of Consulting and Clinical Psychology, 82(2), 275.

Type of Study: Randomized controlled trial
Number of Participants: 274

Population:

  • Age — 18-68 years (Mean=43 years)
  • Race/Ethnicity — 95% Caucasian
  • Gender — 72% Female
  • Status — Participants were users of outpatient services recruited through referrals from primary care and mental health clinics.

Location/Institution: Oxford, England, and Bangor, North Wales

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study compared Mindfulness-Based Cognitive Therapy (MBCT) with both cognitive psychological education (CPE; a modification of MBCT without training in meditation) and treatment as usual (TAU) in preventing relapse to major depressive disorder (MDD) in people currently in remission following at least 3 previous episodes. Subjects were randomly assigned to MBCT plus TAU, CPE plus TAU, and TAU alone. Measures utilized were the Structured Clinical Interview for DSM-IV, the Beck Scale for Suicidal Ideation, the Suicide Attempt and Self-Injury Interview, the Hamilton Rating Scale for Depression (HRSD), the Beck Depression Inventory–II (BDI-II), and the Childhood Trauma Questionnaire (CTQ). Analyses showed no significant difference between the groups for the likelihood of relapse. However, analyses did show that for those with history of childhood trauma, MBCT made a significant difference. Limitations include generalizablity to other ethnic populations and small sample size issues that limited some analyses.

Length of postintervention follow-up: 12 months.

Eisendrath, S. J., Gillung, E., Delucchi, K., Mathalon, D. H., Yang, T. T., Satre, D. D., & ... Wolkowitz, O. M. (2014). A preliminary study: Efficacy of Mindfulness-Based Cognitive Therapy versus sertraline as first-line treatments for major depressive disorder. Mindfulness. [Advance online publication]

Type of Study: Nonequivalent control groups design using matching at the group level
Number of Participants: 43

Population:

  • Age — 18-70 years
  • Race/Ethnicity — 24 White, 6 Asian, 4 African American, 4 Hispanic, and 5 Other
  • Gender — 31 Female
  • Status — Participants were individuals with major depressive disorders recruited via flyers, Craigslist, and clinical referrals.

Location/Institution: University of California, San Francisco Medical Center

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study investigated the efficacy of Mindfulness-Based Cognitive Therapy (MBCT), compared to sertraline (antidepressant medication), for patients with acute major depression. MCBT participants were recruited to match the gender, age, and depressive severity of a depressed control group that completed 8 weeks of sertraline therapy two years prior to the current study. Measures utilized were the Hamilton Rating Scale for Depression (HRSD), Quick Inventory of Depressive Symptamotology-Self Report (QIDS-SR16), the Five Facet Mindfulness Scale (FFMQ), the Self Compassion Scale (SCS), the Experience Questionnaire, Ruminative Response Scale, and the Structured Clinical Interview for DSM-IV. Results indicate that both MBCT and sertraline were effective in reducing depressive symptom ratings. Limitations include the nonrandomization of participants, the time disparity between the two studies, and small sample size.

Length of postintervention follow-up: None.

References

Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2013). Mindfulness-Based Cognitive Therapy for depression (2nd ed). New York: Guilford Press.

Teasdale, J. D. Williams, J. M. G., & Segal, Z. V. (2014). The mindful way workbook: An eight-week program to free yourself from depression and emotional distress. New York: Guilford Press.

Williams, J. M. G., Teasdale, J. D., Segal, Z. V., & Kabat-Zinn, J. (2007). The mindful way through depression: Freeing yourself from chronic unhappiness. New York: Guilford Press.

Contact Information

Name: Mark Williams, MA, MSc, PhD, DSc
Agency/Affiliation: University of Oxford
Department: Department of Psychiatry
Website: www.mbct.co.uk
Email:
Phone: +44 1865 876288

Date Research Evidence Last Reviewed by CEBC: March 2016

Date Program Content Last Reviewed by Program Staff: April 2016

Date Program Originally Loaded onto CEBC: March 2010