Laura L.C. Johnson, MA, MBA, LMFT, LPCC is a Cognitive Behavior Therapist and the founder and executive director of the Cognitive Behavior Therapy Center of Silicon Valley and Sacramento Valley. She integrates positive psychology with cognitive behavior therapy and schema therapy, which have been shown to be effective for a wide variety of problems in hundreds of studies. Her clients learn skills to build positive emotions, optimism, and resilience while decreasing unhelpful thinking, behaviors, and emotions. Full bio. Laura's articles are here.
Chronic Unhappiness is Hard to Change
It’s challenging to try to help people change who have had a lifetime of mental suffering and hold deeply-entrenched negative beliefs about themselves and the world. The other day I was working with a client who yelled out in pain, “There’s nothing positive about my situation!” I sat there feeling helpless because I could see his strengths, but my words fell on deaf ears.
One type of therapy I am exploring for clients with chronic depression is Mindfulness-Based Cognitive Therapy (MBCT), which was developed by Segal, Williams, and Teasdale. They found that people who hold depressive thinking styles are more easily triggered into depressive episodes. The more times this happens, the stronger the neurological connections become and the more likely they are to experience another depressive cycle.
What is MBCT?
MBCT combines mindfulness and cognitive therapy. It is generally taught in an eight-week class of two hours each plus one full-day session. Participants learn mindfulness techniques like the three-minute breathing space, which helps them to call upon mindfulness in stressful moments.
The cognitive therapy component includes learning about negative thinking styles and your own automatic thought patterns, reframing negative thoughts as part of the landscape of depression, recognizing that thoughts aren’t facts and asking yourself questions to help you see reality more clearly. Homework includes using CDs with guided meditations at home.
MBCT in Action
Let’s say you have just gotten chewed out by your boss for turning in a report with several mistakes. Your normal mode of responding might be to defend yourself and argue, “You didn’t give me enough time.” Or maybe it’s to passively listen and then sulk at your desk with thoughts like “I’m no good at this job” and “He’s always such a jerk.” For someone with a strong negative thinking style, this could be enough to trigger depression.
Instead, you can use the three-minute mindful breathing meditation to become aware of the thoughts, feelings, and bodily sensations that arise in the moment of a challenging situation. The goal of the three-minute breathing space isn’t to take away negative feelings. It’s to help you access a clearer frame of mind so you can respond to stressful situations more skillfully and use different approaches to relate to your thoughts.
Promising Research for MBCT
The National Institute for Health and Clinical Excellence in the United Kingdom recommends MBCT for people who are currently well but have experienced three or more depressive episodes. In 2000, a research study found that 66% of participants in MBCT remained relapse-free vs. 34% in the control group. Another study in 2004 replicated the results and found the rate of relapse to be 36% in MBCT group vs. 78% in the control group. MBCT was not found to be effective in people with one or two depressive episodes.
MBCT and Positive Psychology
MBCT has some strategies in common with positive psychology. MBCT helps participants to:
- Observe their negative thoughts with curiosity and kindness
- To accept themselves and stop wishing things were different
- To let go of old habits and choose a different way of being
- To be present in the moment and notice small beauties and pleasures in the world
MBCT is intriguing because the goal isn’t to analyze and change your negative thoughts, but instead to simply be aware of your thoughts and learn to regard them as events of the mind. MBCT teaches people to notice their thought patterns and to change their relationship to their thoughts. Instead of believing the things your mind tells you like, “I am loser because I’ll never get a date,” you might instead just notice, “There’s that thought again that I’m a loser,” without having to react to it.
By noticing when you are at risk of getting caught in the negative habits of your mind, you will be more able to prevent sadness from spiraling into full-blown depression.
Ma, S.H., & Teasdale, J.D. (2004). Mindfulness-based cognitive therapy for depression: Replication and exploration of differential relapse prevention effects. Journal of Consulting and Clinical Psychology, 72, 31-40.
Mindfulness Based Cognitive Therapy sites:
National Institute for Health and Clinical Excellence, United Kingdom. Depression: The treatment and management of depression in adults (see page 10)
Segal, Williams & Teasdale. (2001). Mindfulness-Based Cognitive Therapy for Depression: A New Approach to Preventing Relapse. Guilford Press.
Teasdale, J. D., Segal, Z. V., Williams, J. M. G., Ridgeway, V., Soulsby, J., & Lau, M. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy.. Journal of Consulting and Clinical Psychology, 68, 615-623.
Williams, M., Teasdale, J., Segal, Z. & Kabat-Zinn, J. (2007). The Mindful Way through Depression: Freeing Yourself from Chronic Unhappiness. Guilford Press.
Cycles courtesy of Mike Cattell
Crouching Tiger (butterfly) courtesy of Ajith U
Colorful World of Things Natural (flower) courtesy of sling@flickr
Batur Volcano and Lake (Appreciating Beauty) courtesy of tropicalLiving