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.
Cycles
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.
Promise
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
Appreciating Beauty
Just Notice
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.
References:
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.
Laura L.C. Johnson, MBA, MA, LMFT, Cognitive Behavior Therapist
Anxiety Counseling Solutions, San Jose, CA
Images
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
18 comments
Laura, beautifully and succinctly described. I just want to emphasize an important line you said that can get lost amidst some of your most intriguing bits of information. Not much evidence exists to support MBSR for people who are currently depressed, the action appears to be in preventing relapse after a successful dose of CBT. The other action is for people that are not suffering from a disorder are are looking to develop a stronger, secure psychological foundation.
Also, do you want to say MBSR has features in common with PP or does it make sense to include MBSR within PP?
cheers,
Todd
Hi Todd,
This is a good question. Now that you’ve brought it up, I could have defined MBCT as a positive psychotherapy treatment within positive psychology. The reason I said MBCT has features in common with positive psychology is because it’s used for relapse prevention for chronic depression. Currently, the field of psychology splits itself into psychotherapy vs. positive psychology. In my opinion, this is an arbitrary distinction as I’ve written about putting the “positive” back into psychotherapy.
Laura Johnson, MBA, MA, LMFT
http://www.lauralcjohnson.com
Laura,
I am currently a student in a positive psychology course and found your article very interesting. The combination of mindfulness with CBT is intriguing. By first applying mindfulness techniques, I would imagine it makes the CBT part more effective. Do you know if there have been any studies on MBCT and anxiety? Also, do you use MBCT in treating your patients with anxiety issues, and if so, have you found it to be effective?
Thank you!
Sharon
Hi Sharon,
Great question! In general, mindfulness-based psychotherapies and mindfulness-based stress reduction (MBSR) are effective for helping folks with anxiety issues. There was a study in 2008 that showed some promise for using mindfulness-based cognitive therapy (MBCT) for generalized anxiety disorder: http://www.ncbi.nlm.nih.gov/pubmed/17765453.
Best,
Laura Johnson, MBA, MA, LMFT
http://www.lauralcjohnson.com
Todd and Laura,
OK, so MBCT isn’t necessarily effective for helping people get out of a major depressive episode.
How about people who have been living with a low level of chronic depression for a very long time? Has it been shown to help them get over it?
Kathryn
Hi Kathryn,
MBCT might be helpful for dysthymia, which is when people have low-levels of chronic depression over a long time. In this study, people with dysthymia were included but it doesn’t appear that they analyzed their results separately: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2808477/. The researchers found promising results for MBCT with people who are currently depressed but recommend further research be completed due to the limitations of their study such as no control group.
Thanks for your question!
Laura Johnson, MBA, MA, LMFT
http://www.lauralcjohnson.com
I am currently in a Positive Psychology class, in fact, you came to our class and spoke! Very interesting might I add. Your article makes me wonder if this technique could be used in patients with bi-polar in the sense that when they are having a manic episode to take a step back and use these various techniques to help calm them down? Any insight?
Thanks!
Brittany Snyder
Hi Brittany,
Another great question! I am so impressed with all the interesting questions my article has generated. Yes, there is some preliminary evidence that MBCT can be helpful for bipolar disorder: http://www.jad-journal.com/article/S0165-0327(07)00306-0/abstract.
Thanks,
Laura Johnson, MBA, MA, LMFT
http://www.lauralcjohnson.com
I’m sorry Laura! I was mistaken on who wrote the article, my apologies!
Laura – you might find ACT even more useful than MCBT.
And there is a trick to breathing – check out some of the articles that I wrote for PPND about parasympathetic nervous system activity, especially:
The Rhythm of Calm
Hi Wayne,
Thanks for bringing up ACT – Acceptance and Commitment Therapy. There is lots of research showing ACT is effective with many different psychological problems. I’ll write about ACT in a future article.
Best,
Laura Johnson, MBA, MA, LMFT
http://www.lauralcjohnson.com
Hi Laura,
You mentioned that the goal of MCBT isn’t to analyze and change one’s negative thoughts, but instead to simply be aware of one’s thoughts and learn to regard them as events of the mind. I think that this is a very interesting approach and I really enjoyed your article. However I just have one question; is the use of MCBT enough to keep those who are chronically depressed from returning to their depressive states? I think that this new technique can be very useful but, in my opinion, other forms of therapy would still be needed for individuals. Thanks!
Kelsey
Hi Kelsey,
Yes, I agree that other forms of therapy would be needed. At the moment, cognitive behavioral therapy (CBT) has the most research supporting it as an effective therapy for depression. MBCT (a form of CBT) is something that can be added for people who suffer from recurring episodes of depression.
Thanks,
Laura Johnson, MBA, MA, LMFT
http://www.lauralcjohnson.com
Laura,
I really found your article interesting. I have a few questions also.
You mention the effectiveness of MBCT among people who experience three or more depressive episodes, but what is considered a depressive episode?
So MBCT in the long run hopes to create change through self-reflection in the deep breathing sessions? If you can identify how you react to situations and think calmly and rationally about your reaction patterns, then maybe you can slowly react less harshly and therefore escape a depressive episode following the event, correct?
You said that people attended for an 8-week class; do you think / have people reported that three minutes in an optimum time for mindful breathing? Is there a specific reason the limit is at three minutes versus four?
Thanks,
Ali
Hi Ali,
A depressive episode is defined in the Diagnostic and Statistical Manual of Mental Disorders (known as the DSM-IV) as follows:
Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
(1) depressed mood most of the day, nearly every day.
(2) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
(3) significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.
(4) insomnia or hypersomnia nearly every day.
(5) psychomotor agitation or retardation nearly every day.
(6) fatigue or loss of energy nearly every day.
(7) feelings of worthlessness or excessive or inappropriate guilt nearly every day.
(8) diminished ability to think or concentrate, or indecisiveness, nearly every day.
(9) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
I think you got it right about how mindfulness can help someone become less reactive to negative thinking and situations. However, mindfulness is much broader than just deep breathing. There are many types of breathing and meditation exercises as well as a worldview of acceptance of reality.
I am not aware of the right amount of time for mindful breathing. The three-minute breathing space is just one of many exercises that can help reduce reactivity.
Thanks for your questions!
Laura Johnson, MBA, MA, LMFT
http://www.lauralcjohnson.com
Hi, Laura, thank you for your article. A couple questions: is MCBT a standardized 8 week course + one full day around the country? Who developed it and what is its history? Also, can MCBT be used with addiction and eating disorders?
Thanks, Ann
Hi Ann,
MBCT is a standardized program for chronic depression developed by Segal, Williams & Teasdale as described in their manual: Mindfulness-Based Cognitive Therapy for Depression: A New Approach to Preventing Relapse. If people are following the manual, then they should be conducting MBCT in the same way no matter where they are. However, keep in mind that mindfulness is being integrated into many treatments and people often come up with new names when they tweak a treatment.
Thanks for your questions.
Laura Johnson, MBA, MA, LMFT
http://www.lauralcjohnson.com
Hi, Laura, thanks for answering re the MCBT course… I am assuming the course is for clients, not therapists. How can you find a course in your area? Also, if depression has a strong genetic basis, do you think MCBT is ever sufficient, or is taking medication almost always needed as well? What about MCBT for addiction? Thanks.