Mindfulness-Based Cognitive Therapy (MBCT)

Question

Mindfulness-Based Cognitive Therapy (MBCT)

Summary

MBCT has gained popularity in the last decade, both in psychotherapy literature and popular press. Besides, its advocates, both qualitative and quantitative data from empirical studies, affirm its efficacy. Self-control and improved mental clarity are amongst its benefits. The literature and findings presented in the current paper suggest that Mindfulness-Based Cognitive Therapy is an effective approach to treating or managing psychiatric disorders. Mindfulness is a psychological state of awareness. To be consistent with most of the research presented in the paper, mindfulness is defined as timely awareness of personal experience or thought without judgment.

The paper gives an overview of MBCT and how it is applied. Further, it substantiates the assertion that MBCT is effective in the treatment of psychiatric disorders by exploring various empirical studies. The explored studies and their respective findings suggest that MBCT is an intervention with numerous benefits in the treatment of various psychiatric disorders, including panic disorder, alcohol/substance abuse, Posttraumatic Stress Disorder (PSTD), Depression, Borderline Personality Disorder (BPD), Eating Disorders, Obsessive-Compulsive Disorder (OCD), anxiety disorders, Bipolar Disorder (BD) and Insomnia among others. Further studies are needed to identify factors affecting efficacy and acceptability.

The Effectiveness of Treatment on People with Psychiatric Disorders

Introduction

Mindfulness-Based Cognitive Therapy has also demonstrated efficacy or effectiveness in preventing relapses in recurrent depression in various treatment trials. In its simplest form, mindfulness is the process of learning how to be conscious and stay in the present moment instead of living out of reality. That is to say, it is largely a mental process that enables people to cultivate acceptance and face each scenario as it appears. In the recent past, Mindfulness-Based Cognitive Therapy (MBCT) as an approach to psychological treatment has become popular and an extensively researched area in medicine. Besides Mindfulness-Based Stress Reduction (MBSR), MBCT is one of the widely used and evaluated Mindfulness-Based Therapies used in the contemporary field of medicine.

More recently, Mindfulness-Based Cognitive Therapy has been designed to reduce the risk of relapses in recurrent depression. There is substantial empirical evidence supporting the practical application of MBCT subject to the fact that it has a significant potential of preventing or reducing psychological illness for patients. The current research paper will provide an overview of MBCT and identify the evidence of its efficacy or effectiveness in the treatment of patients with psychiatric disorders.

Literature Review

Psychiatric disorders are mental illnesses that cause abnormal perceptions or thinking. Such conditions also disrupt a person’s mood, feelings, and ability to relate with others. People with such disorders often lose connection with reality. Some of the major causes of mental disorders include brain tumors, stroke, brain infection, alcohol, and some drugs. Treatment depends on the cause of the disorder and it might involve talk therapy or drugs to control symptoms. Fortunately, most psychiatric disorders are manageable. Most patients diagnosed with severe psychiatric disorders can gain relief from their symptoms through active participation in an individual treatment plan. Besides medication treatment, cognitive behavioral therapy, peer support groups, and interpersonal therapy can assist in recovery.

Mindfulness-Based Cognitive Therapy (MBCT)

In the last decade, interventions and practices related to mindfulness have become accepted progressively more as complimentary Mindfulness-Based Interventions (MBIs) for various physical or mental illnesses (Chiesa & Malinowski, 2011; Stew, 2010). Particularly, Mindfulness-Based Cognitive Therapy (MBCT) and Mindfulness-Based Stress Reduction (MBSR) have been studied and theorized as clinical interventions presenting a strong pool of evidence indicating their effectiveness. MBCT developed from the combination of aspects of MBSR with approaches and knowledge from cognitive therapy and cognitive psychology (Carmody & Baer, 2008; Chiesa & Malinowski, 2011; Sipe & Eisendrath, 2012; Segal, Williams, & Teasdale, 2002; Stew, 2010).

MBCT was developed from the MBSR, a psychiatric program developed by Jon Kabat-Zinn. Such a form of psychiatric intervention has been proved to be very effective at improving the well-being of patients with various medical illnesses, including cancer chronic pain, and hypertension. Additionally, such therapy works equally well in relieving the symptoms of various psychological issues, including alcohol/substance abuse, panic disorder, anxiety disorders, Bipolar Disorder (BD), Depression, Borderline Personality Disorder (BPD), Eating Disorders, Posttraumatic Stress Disorder (PSTD), obsessive-compulsive disorder (OCD) and Insomnia among others. The foundational framework was developed to address the need of patients suffering from multiple episodes of depression. Other developers include John D. Teasdale, J. Mark G. Williams, and Zindel V. Segal (Segal, Williams, & Teasdale, 2002).

Method and Process of MBCT

MBCT program is employed through an 8-week course of therapy, as well as home-based mindfulness meditation exercises (Finucane & Mercer, 2006; Howells, Ives-Deliperi, Horn, & Stein, 2012). Patients learn skills and gain the ability to avoid negative feelings and thoughts. Instead, they focus on the positive changes in the mind and body through meditation, controlled breathing, and yoga. While undergoing therapy, participants learn to recognize their significance in life and detach themselves from their moods and thoughts. Such detachment enables an individual to be liberated from obsessive thought patterns, which frequently repeat the same negative messages.

Such insight enables an individual to heal by interpolating positive responses and thoughts to moods to neutralize themselves. In understanding how a Mindfulness-Based Therapy like MBCT can reduce the distress associated with some medical or psychological conditions, it is critical to compare and combine studies, as well as theoretical information regarding MBCT so that to develop a standardized treatment approach to psychiatric disorders. To that end, the section that follows explores various studies and theoretical reviews substantiating the assertion that MCBT is effective in the treatment of psychiatric disorders.

The Efficacy and Effectiveness of MBCT in Treating Psychiatric Disorders

In a study conducted by Carmody & Baer (2008) results indicated improvement in well-being and mindfulness. It was conducted to investigate the relationship between the home practice of mindfulness meditation exercises and the levels of perceived stress, mindfulness, psychological and medical symptoms, as well as the psychological well-being within a data set of 174 adults in a clinical MBSR program at the University of Massachusetts Medical School. The study also concluded that there was a reduction in stress and related symptoms. The study was designed as an eight-session group program for people with stress-related conditions and anxiety (Carmody & Baer, 2008).

All participants finished metrics of symptoms, mindfulness, perceived stress, and well-being before and after MBSR. Their home practice was monitored all through the study. The formal meditation exercises practiced at home included sitting mediations, yoga, and body scan. Carmody & Baer (2008) established that progress in mindfulness mediated the connection between recognized mindfulness practices and amplification in psychological functioning. It follows that the practice of mindfulness mediation results in the enrichment of mindfulness, as well as in enhanced well-being and reduction in symptoms. Such findings are relevant to the current paper because they support the basis of several mindfulness-based interventions.

Consequently, regular meditation practice should cultivate mindfulness skills in daily activities, which, in turn, leads to symptom reduction and improved psychological functioning. One of the limitations of the study that should be considered is that most of the subjects were well-educated and had the financial capability to either pay for the treatment or participate in meditation-based programs. To this end, the findings cannot be assumed to generalize other populations. The study was also limited by the lack of a control group. Despite this, the efficacy of MBSR has been proven by previous controlled studies (Sipe & Eisendrath, 2012).

Future controlled research should compare MBSR to various stress reduction programs to ascertain whether the presented approaches resulting in improvement are distinct to MBSR and also evaluate the possible confusing impact of other behaviors that may change in subjects encouraged to participate in such programs.

Courbasson, Nishikawa & Shapira (2011) suggested that incorporating mindfulness into conventional cognitive-behavioral intervention has the potential of treating co-existing Binge Eating Disorder and Substance Use Disorders (BED-SUD). Individuals with BED often demonstrate comorbid SUD (Courbasson, Nishikawa, & Shapira, 2011). In a study to examine treatment results for such a coexisting disordered demographic, Courbasson, Nishikawa & Shapira (2011) used 38 outpatient participants diagnosed with BED-SUD in a 16-week group Mindfulness-Action Based Cognitive Behavioral Therapy (MACBT).

According to Courbasson, Nishikawa & Shapira (2011), MACBT is an integrated intervention based on both mindfulness and cognitive-behavioral therapies. The sample was mainly female (30 female) with alcohol (75%) as the primary problematic substance. Cannabis followed with 36.4%. The Eating Disorder Examination Questionnaire (EDE-Q) and a Structured Clinical Interview for DSM-IV disorders were used to confirm the diagnoses of BED and SUD (Courbasson, Nishikawa, & Shapira, 2011). An Addiction Severity Index (ASI) was used to assess the severity, extent, and duration of substance and alcohol use. Cognitive and behavioral symptoms associated with depression were measured using the Beck Depression Inventory (BDI-II).

Central to study were the skills needed to regulate emotions, such as sadness, anxiety, happiness, anger without the use of substances or alcohol. To this end, the subjects managed to tolerate difficult emotions and uncontrollable urges until their severity decreased without engaging in multi-adaptive behaviors. During the program, analyses showed that binge eating episodes could be reduced by controlling depression scores. A wealthy body of literature and studies proves the effectiveness of mindfulness-based approaches, which support Courbasson, Nishikawa & Shapira’s suggestion of accepting and employing MBCT in various psychiatric conditions, including BED-SUD (Courbasson, Nishikawa, & Shapira, 2011).

Cognitive interventions have been included in approaches designed to change and challenge the content of dysfunctional beliefs and thoughts theorized to contribute to the development and relapse of BED-SUD (Courbasson, Nishikawa, & Shapira, 2011). BED-SUD psychiatric disorder is associated with increased distress and disability in both clinical and community samples. The findings of the current study supported the hypothesis MABCT that has a positive impact on the behavioral and affective dimension of BED-SUD.

Further, the study indicated that MABCT has the potential to lessen the attitudinal aspects of disordered eating. Such findings are not surprisingly consistent with voluminous literature demonstrating the benefits of mindfulness interventions for depressive symptoms (Bhanji, 2011; Chiesa & Malinowski, 2011; Stew, 2010; Davis & Kurzban, 2012). Depression has been proven to affect the treatment of substance use and eating disorders lending further potential to the preliminary effectiveness of MACBT.

Depression is one of the most consulted conditions in the United Kingdom's primary care due to its ubiquitous nature and vulnerability to recurrence and relapse (Bhanji, 2011). In a 2011 theoretical review, regarding the treatment of depression using ‘third wave’ therapies in primary care, Bhanji (2011) challenged the guidelines predefined by the National Institute for Health and Clinical Excellence (NICE), which focuses on the use of cognitive-behavioral therapy to treat depression in the primary care. In the same context, Bhanji (2011) argued that the existing paradigm should shift to other viable treatments for depression particularly mindfulness-based therapies. The other treatment methods are Metacognitive Therapy and Acceptance and Commitment Therapy (Bhanji, 2011; King, et al., 2013; van der Valk, van de Waerdt, Meijer, van den Hout, & de Haan, 2013).

The basis of Bhanji’s critique was in recognition that mindfulness-based therapies were effective in treating depression, therefore, the predefined guidelines by NICE should incorporate the ‘new wave’ therapies. Cautiously, the review outlined that further empirical evidence is required. A large-scale mixed approach study comparing and contrasting the third wave therapies to CBT would give more formidable results. Such observation is light of numerous studies that have stressed the need to make detailed comparisons among therapies with control groups (Carmody & Baer, 2008; Chiesa & Malinowski, 2011; Kaviani, Hatami, & Javaheri, 2012).

According to van der Valk, van de Waerdt, Meijer, van den Hout & de Haan (2013), CBT is an evidence-based treatment for patients with psychotic disorders. In scenarios where CBT was used almost exclusively to treat psychotic symptoms, such as delusions and hallucinations, it was later complemented by Person-Based Cognitive Therapy to alleviate distress related to psychotic symptoms. In a pilot study to establish the feasibility, possible favorable effects, and adverse effects of Mindfulness-Based Therapy in patients recuperating from a first psychotic episode, van der Valk, van de Waerdt, Meijer, van den Hout & de Haan (2013) found out that Mindfulness-Based Therapy had no significant unfavorable effects on psychotic symptoms within the sample population.

A non-controlled, non-randomized probable report-based study was carried out. 16 patients were offered a Mindfulness-Based Therapy that lasted for 4 weeks. Southampton Mindfulness Questionnaire, Symptoms Checklist 90, as well as the Positive and Negative Syndrome Scale, were analyzed before and after the therapy. 81.5% (13) of the 16 participants completed the therapy with no major development in psychotic symptoms (van der Valk, van de Waerdt, Meijer, van den Hout, & de Haan, 2013).

However, there was a single incidence of increased distress in one patient who had misunderstood therapy instructions. A drop in psychological symptoms was documented. The study demonstrated the effectiveness of MBCT with emphasis on caution about the practice and therapy instructions. In other words, therapists should be cautious with the MBT instructions to avoid scenarios in which the patient’s condition is worsened due to misunderstanding.

Mindfulness-based interventions demonstrate the potential for stress management in general medical conditions. Preliminary evidence from a pilot study of MBCT to manage veterans with PTSD showed that mindfulness-based interventions are accepted in trauma-exposed individuals (King, et al., 2013). MBCT shows considerable efficacy for the prevention of severe depression relapse. However, there is limited information relating to its efficacy in anxiety disorders. To expound on the efficacy of MBCT in the treatment of anxiety disorders, King, et al. (2013) investigated the acceptability, clinical effects, and feasibility of the MBCT course for PSTD. Participants were recruited from the patients seeking treatment for severe PSTD at the Outpatient Clinic of the Ann Arbor VA Health Care System (King, et al., 2013).

Subjects were assigned to 8-week MBCT groups customized for PSTD (four MBCT groups, n=20) alongside with TAU comparison group (three TAU groups, n=17). Significant improvement in PSTD was indicated by ITT analyses in the context of MBCT groups and not the TAU context. The result of the study suggests that MBCT intervention is an acceptable adjunctive therapy for managing PTSD (King, et al., 2013). Additionally, MBCT has the potential to reduce PSTD cognitions and avoidance of symptom clusters. It is in line with a recent evaluation of a community-based MBCT program for adults with mild depressive symptomatology in a large randomized controlled trial (Pots, Meulenbeek, Veehof, Klungers, & Bohlmeijer, 2014).

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Similarly, Pots, Meulenbeek, Veehof, Klungers & Bohlmeijer (2014), found that there was a significant reduction in experimental avoidance, depression, and anxiety. In the same context, there was considerable development in mindfulness and the psychological and emotional health of the participants. Based on the presented study results and limitations, further researches are needed to explore efficacy in a randomized controlled environment.

MBCT is also effective in the suppression of suicidal thoughts (Hepburn, et al., 2009). Thought suppression is a mental control approach linked to depression. In environments with adequate resources, suppression of harmful thoughts is short-lived but increases negative intrusions in the long run. Individuals who suppress instances of depressing thoughts are more likely than their counterparts to develop depressive symptoms in the future. The study by Hepburn et al, (2009) investigates how MBCT affects thought suppression (TS) in individuals with previous suicidal attempts making them vulnerable to developing future depression.

The study entailed 68 participants in a randomized-controlled assessment model. The participants were allocated to TAU and MBCT groups for comparisons. Measures of depression and thought suppression were taken before and after treatment. Result from a preliminary study by Hepburn et al., (2009) on the effects of MBCT on depression and thought suppression in persons with suicidality and depression indicated that MBCT minimized self-reported attempts of suicide significantly.

Such results conform to the idea that mindfulness training reduces suicidal behavior in BPD (Sachse, Keville, & Feigenbaum, 2011). Additionally, the results are in line with the observation that mindfulness training reduces depressive relapse, the environment in which suicidal thoughts emerge (Segal, Williams, & Teasdale, 2002). Therefore, based on previous studies, theoretical reviews, and the present study, it is argued that MCBT is effective for suicidality.

Besides treating recurrent depression, MBCT has been found to significantly reduce Borderline Personality Disorder (BPD). As cited by Sachse, Keville & Feigenbaum (2011), BPD is a persistent pattern on unsteadiness of effects, self-image, and interpersonal relationships. Emotional dysregulation fortifies the major patterns of behavioral and cognitive dysregulation. Since BPD involves frequent rates of Axis-I comorbidity, the approaches which address comorbid conditions can prove to be valuable in the treatment plans of people suffering from BPD (Sachse, Keville, & Feigenbaum, 2011).

The emotional deregulation traits of BPD involve heightened emotional arousal and reactivity or mood. The proven track record of MBCT on psychiatric in-patients and individuals open to suicide suggests that MBCT can be effective to patients meeting BPD criteria. The most detailed treatment for BPD is DBT, which is based on the conventional cognitive behavioral therapy model. DBT incorporates skill-based treatment strategies, including distress moderation, interpersonal value, and emotional regulation (Sachse, Keville, & Feigenbaum, 2011). The basis of such strategies is mindfulness skills. To that end, Sachse, Keville & Feigenbaum (2011) conducted a feasibility study of MBCT for clients with BPD.

The study entailed repeated measures of comparison within-subject and between subjects of the participants with BPD. Measures of impulsivity, attention, dissociation, experimental avoidance, depression, anxiety, and mindfulness were documented based on theoretical models and previous studies. A total of 22 participants diagnosed with BPD attended an 8-week traditional MBCT group program. Out of the participant, 16 completed the sessions. As hypothesized, the study found that MBCT is valuable to individuals with MBCT. By applying intention-to-treat (ITT) analyses, improvements in attention were noted. Further, post analyses of the study identified changes in somatoform dissociation and mindfulness. A weak improvement in state anxiety, experimental avoidance, and mindfulness was depicted by a dose-effect analysis. The study results recommend that further research of MBCT for application with individuals diagnosed with BPD is merited.

As an effort to expand the knowledge and literature about the effectiveness of MBCT in treating bipolar disorder, Howells, Ives-Deliperi, Horn & Stein (2012) carried out a pilot Electroencephalographic (EEG) study to find out whether MBCT enhances frontal control in Bipolar Disorder (BD). It was motivated by the fact that significant advances had been recorded regarding the psychobiology of BD but specific deficits about its symptoms were unclear. Characteristically, cognitive processing in BD involves several attention abnormalities (Perich, Manicavasagar, Mitchell, Ball, & Hadzi-Pavlovic, 2013).

MBCT merges mindfulness meditation with features of cognitive therapy. Mindfulness mediation is a variant of attention training with the potential of improving attention impairment in BD patients. In the study, 12 Bipolar Disorder clients and nine control participants were engaged in a detailed band frequency analysis (Howells, Ives-Deliperi, Horn, & Stein, 2012). The participants completed the conventional 8-week (2 months) MBCT course with a repetition of EEG. For brain activity tests, participants with BD demonstrated a considerable decline in theta band power, decreased theta/beta ratios, and amplification in beta band power during the resting state. As beta band power lessened, subjects with BD under the MBCT course illustrated progress over their frontal cortex. In conclusion, participants with bipolar disorder registered decreased attention readiness.

In addition, there was a decrease in the processing of non-irrelevant information during attentional processes. It implies that MBCT improved attentional readiness in BD. Further, MBCT improved the attenuated processing of non-relevant information. Despite the tangible findings that emerged in the study, the small sample size limited the ability to determine whether some of the undesired results are false. Notably, patterns towards statistical significance can reach significant figures with a large sample (Howells, Ives-Deliperi, Horn, & Stein, 2012).

The other limitation of the study is that impact of prescription on brain activities was not incorporated in the analysis. Thirdly, the control group (9 participants) was not subjected to MBCT intervention. Further, no control BD group was integrated into the presented data. Such data would be valuable for future studies. Lastly, the study participants were mainly females thus, limiting the generalizability of the study results.

In the endeavor to lessen the gap in the medical literature regarding mindfulness as a mediating factor in the favorable outcomes of Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT) programs, Collard, Avny & Boniwell (2008), conducted a study to examine the connection between mindfulness and individual well-being. In the study, the guiding question was to find out whether MBCT had the potential to increase the participants’ degree of Negative effect. The results indicated that the level of participants’ mindfulness increases significantly. Consequently, the negative effect decreased significantly and the positive effect remained constant.

Despite a strong indication of an increase in participants’ satisfaction with life, the trend in the data failed before reaching a statistically significant level. Additionally, there was a correlation between the level of mindfulness and the duration of the therapy. The data was analyzed and interested in a Positive Psychology framework. Such a result is consistent with the findings of Carmody & Baer (2008) regarding the contribution of mindfulness in improving well-being. The emanating observation in the current study is that mindfulness can be incorporated as a concept and as a therapy in the field of positive psychology.

Finucane & Mercer (2006) conducted an investigative mixed process study to determine the effectiveness and suitability of MCBT for patients with anxiety and active depression in primary care. In this study, it was established that non-depressed individuals with a history of relapsing depression are relived from relapse by being part of MCBT interventions. 13 participants with persistent depression and/or anxiety were interviewed twelve weeks after taking part in the adapted MBCT program. Beck Anxiety Inventories (BAI) and Beck Depression Inventories (BDI-II) collected quantitative data (Finucane & Mercer, 2006). Such inventories were administered before and three months after the MCBT intervention.

Qualitative data verified the hypothesis that the MCBT program was beneficial and acceptable to most patients. For the majority of the participant, being in the MCBT group normalized and validated their experience. Over 50% of the participants continued to practice the skills developed three months after the adopted MCBT course had ended. Only a minority of the participants experienced considerable levels of distress, particularly anxiety. The other relevant outcome of the study is that a statistically substantial drop in the mean of anxiety and depression was observed. After the study, the mean value had plunged to a low of 17.8, up from 35.7. On the other hand, the mean reduction for anxiety decreased to a low of 20.5 up from 32.0.

Overall 72% (8 out of 11) participants indicated progress in BDI-II and 63% (7 out of 11) participants showed progress in BAI. Generally, the results of the qualitative investigation were in congruence with quantitative adjustments in levels of anxiety and depression. The findings of the exploratory study affirm that MCBT plays a critical role in the treatment of anxiety and depression in primary or psychiatric care.

According to Perich, Manicavasagar, Mitchell, Ball & Hadzi-Pavlovic (2013), mindfulness-based interventions are a modern addition to an array of psychological therapies designed to treat psychiatric conditions. It entails being attentive in a particular way and non-judgemental. The underlying techniques include meditation and instructions on how to relate to positive thoughts, bodily sensations, and emotions. Perich, Manicavasagar, Mitchell, Ball & Hadzi-Pavlovic (2013) cited MBCT as an 8-week group-based therapy program designed to prevent relapse of depression in individuals suffering from Major Depressive Disorder. MBCT is built on the framework of the MBSR program in combination with cognitive therapy approaches, including relapse prevention strategies and physio-education on depression.

Perich, Manicavasagar, Mitchell, Ball & Hadzi-Pavlovic (2013) conducted a randomized controlled trial of MBCT for therapy bipolar disorder to compare the efficacy of MBCT alongside Treatment as Usual (TAU) and TAU alone over 12 months. Using a DSM-IV diagnosis, participants with bipolar disorder were allocated to either TAU plus MBCT or TAU alone. Out of the recruited participants, 48 were assigned to MBCT and 47 to TAU. No significant differences were found between the groups using the Intention-to-Treat analysis within the 12-month timeframe. State anxiety scores (STAI) showed significant differences.

In conclusion, MBCT did not result in a significant reduction in time to hypo/manic or depressive relapse, mood symptoms severity, and a total number of episodes, but there was a significant effect on anxiety symptoms. The results suggest a potential contribution of MBCT in relieving patients from anxiety concurrent with bipolar disorder. Improvements were also found in easing dysfunctional attitudes related to ideas of achievement. Central to the limitations of the study was a small sample size and a shorter follow-up timeframe. Further, the drop-out rate was high over the follow-up period.

Discussion

The present-day studies have sought to evaluate the effectiveness of MBCT and the majority concur that MBCT is essential in managing mental illnesses or psychiatric disorders. MBCT is essential because the risk of recurrence or relapse among the depressed is very high and triggers for the subsequent episodes are lowered by instances of depression. Research by Segal, Williams & Teasdale (2002) has demonstrated how meditation can assist individuals to live well after recovering from depression and other anxiety disorders. Mindfulness-Based Therapies built on the rationale that once an individual has recovered from an episode of anxiety, depression or suicidal attempt, a relatively small element of depressing thought or mood can trigger a large negative feeling, body sensation, or emotion.

During the depression, negative emotions stir depressing thoughts and body sensations of fatigue. When the episode is suppressed and the mood returns to normal, sluggish body sensations and depressing thoughts tend to disappear. However, there is an association with other symptoms making people vulnerable even after an episode. It implies that when any pessimistic thought or mood emanates, there is a possibility that all other symptoms will appear, as well, depending on the strength of the negative mood. Based on MBSR, MBCT entails simple mindfulness exercises, including yoga stretches, education about depression, and simple breathing meditations. The atmosphere of MBCT is that of a class covering eight weekly sessions.

An MBCT class equips participants with the knowledge and skills to monitor their minds, as well as to identify when their mood is deviating. In other words, it helps individuals identify the link between positive and depressing thoughts. Generally, MBCT classes are effective in treating various psychiatric disorders, including Major Depression Disorder (MDD), anxiety, suicidal attempts, Bipolar Disorder (BD), Posttraumatic Stress Disorder (PSTD), Binge Eating Disorder, Substance Use Disorders, and Borderline Personality Disorder (BPD).

MBCT was initially designed to prevent setbacks in recurrent depression. With time, it has been applied to individuals open to high risk of suicide. Additionally, it has proved to be valuable among people suffering from anxiety and severe depression. Even though MBCT is largely intended to prevent depressive relapse, the results from various studies indicate that it is a treatment approach with a broader application (Bhanji, 2011; Finucane & Mercer, 2006; Segal, Williams, & Teasdale, 2002; van der Valk, van de Waerdt, Meijer, van den Hout, & de Haan, 2013). Carmody& Baer (2008) indicated progress in well-being and mindfulness with the incorporation of home-based meditation exercises, including body scan, yoga, and sitting meditations.

In the same stud, the authors proved that the application of MBCT intervention led to a reduction in stress and related symptoms. The effectiveness of using MBCT on treating people with psychiatric disorders is evidenced by Courbasson, Nishikawa & Shapira’s (2011) study, which suggested that integrating mindfulness into conventional cognitive-behavioral interventions has the potential of treating co-existing Binge Eating Disorder and Substance Use Disorders (BED-SUD). The current study has a few notable limitations.

The absence of a control group creates the possibility that the findings depict only the positive expectancies thus, future studies should expound on the subject under randomized controlled trials. Additionally, the small sample size and failure to follow-up limit the conclusion concerning the sustainability of the intervention gains. Most importantly, greater sensitivity towards the clinical needs of individuals suffering from concurrent BED-SUD within clinical practice is needed. Being mindful of such needs would cement clinical research and practice.

Future research could explore ways in which mindfulness mediation and mindfulness practices would be incorporated into clinical supervision and trainee’s prospectus. Given that MBSR has been successful with the therapist’s trainees, MBCT may be a simple intervention to be incorporated into the trainee’s curriculum. Furthermore, future research holds the potential to learn about the long-term benefits of meditation to the brain. In summary, MCBT has the potential to enhance patient, therapist, and trainee development, as well as induce transformations that can contribute to effective psychotherapy. The realm of psychology, particularly counseling, could benefit from future studies investigating the cause and effect relationships above and beyond meditational models to understand the efficacy of MBCT better.

Conclusion

Based on the highlighted studies and theoretical reviews in the current paper, it is evident that Mindfulness-Based Cognitive Therapy (MBCT) is effective in the treatment of individuals with psychiatric disorders. MBCT is based on the framework of Mindfulness-Based Stress Reduction and modern Cognitive-Based Therapies (CBT). MBCT is challenging thus, participation requires a continuous individual commitment. The overarching objectives of MBCT are to improve the regulation of emotions by training clients on how to control their attention.

Clients develop a positive relationship with their feelings, body sensations, and thoughts to dissociate themselves from vicious cycles of depressing thoughts or moods and adopt more adaptive strategies of coping. In summary, MBCT has been demonstrated to be effective in preventing and reducing various psychiatric disorders, therefore, further research is needed to determine the factors that might accept its efficacy or acceptability.