Mindfulness-Based Cognitive Therapy

Distinctive Features

Rebecca Crane

• Editorial: Routledge
• Año: 2017
• ISBN:
  9781317237389
• Edición: 2
• Categoría: Psicología
• Categoría: Historia y teoría en psicología

This new edition of Mindfulness-Based Cognitive Therapy: Distinctive Features (MBCT) provides a concise, straightforward overview of MBCT, fully updated to include recent developments. The training process underpinning MBCT isbased on mindfulness meditation practice andinvites a new orientation towards internal experience as it arises - one that is characterised by acceptance and compassion. The approach supports a recognition that even though difficulty is an intrinsic part of life, it is possible to work with it in new ways.

The book provides a basis for understanding the key theoretical and practical features of MBCT and retains its accessible and easy-to-use format that made the first edition so popular, with 30 distinctive features that characterise the approach. Mindfulness-Based Cognitive Therapy: Distinctive Features will be essential reading for professionals and trainees in the field. It is an appealing read for both experienced practitioners and newcomers with an interest in MBCT.

Part 1
The Distinctive Theoretical Features of MBCT

1
An integration of mindfulness-based stress reduction and cognitive behavioural therapy

Mindfulness-Based Cognitive Therapy (MBCT) was developed as a targeted approach for people who have a history of depression and are therefore vulnerable to future episodes. Taught while participants are in remission, it aims to enable them to learn how to bring attention to body sensations, thoughts, and emotions, and to respond adaptively to the early warning signs of relapse. The programme has the practice of mindfulness meditation at its core; it draws on the structure and process of the Mindfulness-Based Stress Reduction (MBSR) programme and integrates within these some aspects of Cognitive Behavioural Therapy (CBT) for depression. It is taught in an 8-week class format for up to fifteen participants. This chapter offers a summary of these three areas which are integral to MBCT and have informed its development: mindfulness meditation practice, MBSR, and CBT for depression.

Mindfulness

Mindfulness practices in various forms are found in all contemplative wisdom traditions. Within the tradition of Buddhism it is part of an integrated framework which offers an understanding of the origins of emotional distress, and a means of freeing oneself from the pattern of adding suffering to existing difficulty and pain. Mindfulness enables us to see and work with the universal vulnerabilities and challenges that are an inherent part of being human.

Mindfulness is the awareness that emerges when we pay attention to experience in particular ways: on purpose (the attention is deliberately placed on particular aspects of experience); in the present moment (when the mind slips into the past or the future, we bring it back to the present); and non-judgementally (the process is infused with a compassionate spirit of allowing whatever experience arises; Kabat-Zinn, 2013). It is simply being aware of what is going on, as it is arising, attending deeply and directly with it, and relating to it with acceptance. Although simple in its intention and essence, mindfulness practice often feels hard and difficult work. It is a practice through which we systematically train ourselves to be in the present moment more often and to turn towards experience. This runs counter to hardwired instincts to avoid the difficult and challenging aspects of our experience.

Mindfulness teaching and practice contains three broad elements:

1. The development of awareness through a systematic methodology involving formal mindfulness practices (body scan, sitting meditation, mindful movement) and informal mindfulness practice (cultivating present-moment awareness in daily life).
2. A particular attitudinal framework characterised by kindness, curiosity, and a willingness to be present with the unfolding of experience. These attitudes both are deliberately cultivated within the practice and emerge spontaneously from it.
3. An embodied understanding of human vulnerability. This is developed both through experientially exploring personal experience through formal and informal mindfulness practice; and by integrating this experiential data with an understanding of the philosophical frameworks surrounding mindfulness practice. We learn through this that although suffering is an inherent part of experience, there are ways that we can learn to recognise and step out of the patterns of habitually collaborating to perpetuate and add to it. Within MBCT these understandings are conveyed throughout the teaching process, but are particularly brought to the fore through the process of inquiry (interactive dialogue between teacher and participants; see Chapter 28).

The three broad elements of mindfulness practice outlined above are mirrored in the construction of MBCT. So, the programme contains:

1. The cultivation of awareness through mindfulness practice.
2. A particular attitudinal framework characterised by non-striving, acceptance, and the development of friendly interest in experience. These qualities are largely conveyed implicitly through the teaching process. Much therefore relies on the teacher capacity to ‘embody’ the attitudinal qualities that participants are being invited to experiment with (see Chapter 30).
3. A process of linking the learning to an understanding of working with vulnerability. The personal experiential learning is integrated within a wider framework of understanding, which relates both to the nature of general human vulnerability, and to the particular nature of vulnerability to depressive relapse. Within MBCT this integration is facilitated through dialogue, reflection, group exercises, and didactic teaching.

The three developers of MBCT – Zindel Segal, then of the Center for Addiction and Mental Health in Toronto; Mark Williams, then of Bangor University; and John Teasdale, then of the Applied Psychology Unit of the Medical Research Council in Cambridge – commenced their development process during the 1990s by first reviewing a theoretical understanding of the basis of vulnerability to depressive relapse and recurrence.¹ This led them to the recognition that a key protective mechanism in preventing depressive relapse is the ability to de-centre or step back from thought processes. The understanding emerged that this, and other skills relevant to the prevention of depression, can be developed through mindfulness meditation practice. Segal, Williams, and Teasdale were thus led to the work of Jon Kabat-Zinn.

Mindfulness-Based Stress Reduction

Kabat-Zinn (2013) pioneered the adaptation of meditation practices from their original Buddhist context into an accessible psycho-educational eight-session programme. Kabat-Zinn’s intention and vision in developing MBSR was to render the learning from the practice of mindfulness into a programme suitable for delivery in mainstream institutions such as hospitals, which could inform the lives of patients who suffer from chronic pain and a variety of other conditions. Mindfulness was thus embedded within a group-based educational programme, and integrated with models of stress from mind-body medicine, and explorations on working with the challenges of modern living. The programme involves intensive training in mindfulness meditation, and teaching which enables participants to apply the learning from the practices into the practicalities of the management of challenge within daily life.

MBSR was originally taught to groups of participants with a range of physical and psychological challenges, and has now also been adapted to a variety of specific diagnoses and conditions. These include patients with diagnoses such as cancer, rheumatic conditions and eating disorders, and contexts such as prisons, low-income inner-city areas, medical education and corporate settings. MBSR has become a part of a newly recognised field of integrative and participatory medicine (Dyson, 2009).

The overall way the programmes are structured into eight weekly psycho-educational style sessions with a day of guided meditation practice in week 6, and the sequencing of the introduction of the different mindfulness practices, is the same in MBCT and in MBSR. The core difference is the way the programme learning is tailored towards the participants that it is designed for.

Cognitive Behavioural Therapy

The CBT contribution within the MBCT integration takes two broad forms:

1. It provides an underpinning psychological framework and understanding drawn from CBT for depression (Beck et al., 1979). This informed the development of the approach (see Chapter 2), and informs the teaching process through offering an understanding that enables the teacher and the participants to link the learning to depression (see Chapter 14).
2. It informs the inclusion of curriculum elements drawn from CBT (see Chapter 27).

Summary

Mindfulness meditation is the foundation of the MBCT programme; MBSR informs its structure, content and teaching style; CBT offers an underpinning theoretical framework, and informs some content and elements of the teaching process

Note

1 Although relapse and recurrence have slightly different meanings, for simplicity the term relapse will be used hereon. The term relapse refers to the continuation of a single episode of depression, which has been masked by the person taking antidepressants, while the term recurrence refers to the commencement of a completely new episode of depression (Frank et al., 1991).

References

Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford Press.

Dyson, E. (2009). Why participatory medicine? Journal of Participatory Medicine, 1(1), 1–5.

Frank, E., Prien, R. F., Jarrett, R. B., Keller, M. B., Kupfer, D. J., Lavori, P. W.,… Weissman, M. M. (1991). Conceptualization and rationale for consensus definitions of terms in major depressive disorder: Remission, recovery, relapse, and recurrence. Archives of General Psychiatry, 48(9), 851–855. doi:http://dx.doi.org/10.1001/archpsyc.1991.01810330075011

Kabat-Zinn, J. (2013). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain and illness. New York: Delacorte.

2
Underpinned by the cognitive theory of vulnerability to depression

Depression is a major public health problem that, like other chronic conditions, typically runs a relapsing and recurring course, damaging health and causing considerable human suffering (Collins et al., 2011; Derek, 2011). In terms of disability-adjusted life years, the World Health Organization consistently lists depression in the top five disabling conditions, and in terms of years lost to disability in the top two. It forecasts that this will worsen over time (World Health Organization, 2016). A key feature of major depression is the likelihood that sufferers will experience repeated episodes. It follows, therefore, that the heightened vulnerability to relapse for people with a history of depression is the aspect of the problem that needs particular attention, if the personal and global impact of it are to be lessened.

Developing a cost-effective relapse-prevention approach

A number of interventions – including Interpersonal Psychotherapy, Behavioural Activation, Cognitive Behavioural Therapy (CBT), and antidepressant medication – are effective treatments for depression. Most depression is treated in primary care, and maintenance antidepressants are the most widely used strategy for preventing depressive relapse (Paykel, 2001). However, people tend to be poor at adhering to medication, it only protects while it is being taken, and many people would prefer alternative approaches which equip them with skills to stay well in the longer term (Hunot, Horne, Leese, & Churchill, 2007). Of the psychotherapies offered during depressive episodes only CBT has an enduring depression prevention effect after it is discontinued (Shelton & Hollon, 2012). CBT however relies on the person engaging one-to-one with a skilled, scarce, and expensive therapist. The aim of the three MBCT developers, therefore, was to develop a relapse-prevention approach which could be delivered:

1. In a group format (approaches dealing with depression need to be cost effective if they are to become more widely available).
2. While the participants are in remission (having generally recovered through treatment with antidepressant medication and/or psychotherapy).

In setting out to develop a new approach to preventing depressive relapse, Segal, Teasdale, and Williams first spent time coming to understand more fully the ways in which this particular vulnerability is created and maintained, and the particular processes of mind that may reverse it. Essentially, they were asking two questions: first, ‘What is the basis for the increased vulnerability to depressive relapse in people who have previously experience depression?’ and second, ‘What are the skills developed through CBT during an episode of depression which reduce the longer term vulnerability to relapse?’ (Segal, Williams, & Teasdale, 2013; Teasdale, 2006).

Cognitive model of vulnerability to depressive relapse

As a person experiences more episodes of depression, less environmental stress is required to provoke another episode (Post, 1992). This is because his or her internal style of thinking and experiencing has developed into habitual, learnt patter...