Mindfulness-Based Cognitive-Behavioral Therapy: A Review
Mindfulness-based cognitive therapy (MBCT) is a form of behavior therapy aimed at treating various different disorders, most commonly major depressive disorder. It developed from an interaction between cognitive therapy and behavior therapy, which is known as cognitive behavioral therapy (CBT). It adds the component of mindfulness, which is more than simply changing what a person perceives, but how those perceptions are made. The goal of MBCT is to increase awareness of thoughts and feelings, so that a person can accurately label his thoughts and separate them from self-image or self-perception. This paper will examine MBCT including: major tenets and historical developments; conceptual and philosophical foundations; therapeutic technique; human development; personality; psychopathology; presumed mode of therapeutic action; goals for treatment; strengths and limitations of the orientation; application in diverse and multi-cultural contexts; and review and critique of the scientific evidence.
Mindfulness-based cognitive therapy (MBCT) is a form of behavior therapy aimed at treating various different disorders. It is most commonly used to help prevent relapses of depression, though it has other applications as well, particularly in relapse prevention in substance abuse. "The focus of MBCT is to teach individuals to become more aware of thoughts and feelings and to relate to them in a wider, decentered perspective as 'mental events' rather than as aspects of the self or as necessarily accurate reflections of reality" (Teasdale et al., 2000, p.616 para. 7). MBCT derives from cognitive behavior therapy (CBT) methods, but combines newer techniques with traditional CBT methods. As the name suggests, the largest difference between MBCT and CBT is the concept of mindfulness and how developing mindfulness can increase the efficacy of therapeutic CBT interventions. This paper will examine the development of MBCT, how it is used in treating individuals, possible future applications, and the strengths and weaknesses of the therapy.
Major Tenets and Historical Developments
In many ways, the history of MBCT is the history of behavior therapy and cognitive therapy, and the history of those two forms of treatment is in many ways the history of psychology. However, it would be inappropriate to suggest that MBCT has only been developing since the introduction of psychology as a science; many ancient philosophies focused on the notion of what is now referred to as mindfulness. While several different therapeutic approaches have developed in the relatively short history of psychology, two have become more widely accepted than other approaches: psychoanalysis and behavior therapy. Both have been used for decades, and behavior therapy became the preferred method for treating problem behaviors. Cognitive therapy is relatively new in comparison with the other two, having developed in the 1960s. Cognitive behavior therapy examines the role that thoughts play in behavior and disorders, and is premised on the notion that by changing thoughts, one can change behavior.
Cognitive therapy was developed primarily to treat depression, with the idea that cognitive therapy was more than a traditional talk therapy. Largely developed by Aaron Beck, cognitive therapy developed because the underlying thought patterns in those with depression did not match psychoanalytic theories, but instead revealed self-defeating thought processes. Therefore, rather than focus on a psychoanalytic approach, Beck hoped to change underlying thought patterns and undermine the negative thought bias that characterized those with depression. While Beck focused on the treatment of depression, "in the early 1960s, the systemic application of learning theory and principles to the modification of emotional disorders suggested enough in the way of positive outcomes and reliable clinical procedures to enable its codification as a distinct therapy" (Segal et al., 2004, p.45, para.1). Combinations of cognitive and behavioral approaches have been developing over the last half-century, and the addition of the mindfulness component is a relatively recent innovation.
Combining cognitive therapy with behavior therapy was a logical combination because disorders generally have two components: behavior and cognition. A therapeutic approach aimed at changing both behavior and cognition would focus on fixing both elements of a disorder. Therefore, "CBT is a commonsense approach that is based on two central tenets: 1) our cognitions have a controlling influence on our emotions and behavior; and 2) how we act or behave can strongly affect our thought patterns and emotions" (Wright et al., 2006, p.1, para. 2).
While all psychological interventions require some understanding of biology, cognitive therapy, and, therefore, by extension, CBT and MBCT require an understanding of cognitive neuroscience. While scientists do not yet fully understand brain function, they do understand that the brain functions by sending signals that are processed by neurotransmitters in the brain. Therefore, one's thoughts not only change behavior and emotions, but can actually change the shape and function of the brain. Therefore, by changing what someone thinks in a short-term scenario, one can change the pathways in the brain. Moreover, the brain's function in attention is critical "Scientific study of attention shows us that it is not a single mental function but a complex system with several distinct branches or networks" (Zylowska & Siegel, 2012, p.56, para.3). Therefore, changing neural pathways impacts how a person can pay attention, and when how a person can pay attention is changed, it is inevitable that the person will interpret internal and external stimuli differently.
Mindfulness contributes to this concept of attention. Moreover, while mindfulness is a seemingly simple concept, it is actually far more intricate than one would presume. Mindfulness is more than simply paying attention; it is tightly focused attention, and it can help change the impact of an experience. "This type of awareness, known as mindfulness, is much more than paying attention more thoroughly. It is paying attention differently -- changing how we pay attention" (Williams et al., 2007, p.54, para. 1). By changing how a person pays attention, one can change how that person perceives the world, how that person's brain is structured, and not only change the behavior of the person, but the impetus behind that behavior. Moreover, it is important to understand that MBCT proponents believe that mindfulness can be taught and that "paying attention is a trainable skill, capable of ongoing refinement" (Kabat-Zinn, 2012, p.33, para.2).
As its own individual form of therapy, MBCT developed throughout the 1990s. Those credited with developing MBCT include Zindel Segal, Mark Williams, and John Teasdale. They were inspired by Jon Zabat-Kinn, who had developed a mindfulness-based stress reduction program. The underlying idea is that the individual operates in several different modes, and those individuals who are the healthiest and most successful are those who can easily transition between modes. Moreover, people need to have a standard, default mode, and the mode selected for MBCT is the being mode, because it places the individual in the right position for easy transitions between modes.
Conceptual and Philosophical Foundations
One of the interesting things about MBCT is that, while it is a psychological intervention, it has actually been used far longer than the formal profession of psychology. In many ways, cognitive therapy, particularly mindfulness, has a foundation in ancient philosophy. This is based upon the notion that emotions are neither solely internal nor solely external, but the result of the individual interacting with the world. "In recent decades there has been an unfortunate trend away from a philosophical understanding of behavior therapy to a more technique- understanding," but the background philosophy is a huge part MBCT (O'Donohue & Fisher, 2008, p.1, para.3). In fact, while this is not a new concept, MBCT brings together elements from psychology, sociology, and philosophy in a way that makes it clear that behavior and cognition are inexplicably intertwined and that the individual does not exercise sole control over the development of those processes. On the contrary, "Subjective thoughts, images, and feelings are rooted in the enduring attitudes and assumptions, or schemas that the individual develops from prior experience. Human experience is automatically filtered through these cognitive structures existing in the brain, by which input is categorized and evaluated (Laird, & Metalsky, 2008, p.35, para.1).
One of the major concepts in MBCT is the idea of kindness. While kindness may seem like an amorphous concept, and may seem like an implicit part of a therapeutic process, it is not always part of the process in other forms of therapy. Therefore, one of the defining characteristics of MBCT is that it is not a critical and negative approach. On the contrary, the "cultivation of self-compassion (as a contrast to judgments and criticism that often arise in response to clients' own thoughts and feelings) [is] an important aspect of these treatments" (Roemer, & Orsillo, 2009, p.4, para. 2).
Ideas Related to Therapeutic Technique
One of the things to keep in mind when looking at therapeutic technique is what types of disorders the therapy is most likely to be used to treat. MBCT is most likely to be used to treat depression and addiction. Moreover, it is not generally a first-line treatment. In other words, MBCT is not generally used to help someone get through a major depressive disorder or find sobriety. Instead, MBCT is frequently used as…