The Diverse Array of Mental Health Modalities
People with limited experience with mental health often talk about “therapy” as a very broad concept, failing to differentiate between the many different modes of treatment that mental health professionals rely on to treat mental health conditions. In actuality, there are myriad different types of therapy, and it’s not a one-size-fits-all type deal. What’s helpful for people suffering from mood disorders may not be helpful at all for people with other health concerns or mental disorders, and knowing which type of therapy is best for you can require a little bit of homework.
This article will introduce one of the most rapidly growing types of clinical practice, cognitive therapy, and explore how mindfulness practices have become an essential part of cognitive therapy sessions for many practitioners and patients. This method has become known as mindfulness based cognitive therapy (MBCT). Read on to learn how mindfulness meditation and other mindfulness practices can enhance evidence-based cognitive therapy to make it more effective.
An Introduction to Cognitive Therapy
Evidence based cognitive therapy has been around in one form or another for over a century. Behavioral psychologists began identifying automatic cognitive processes in the early 1900s. Theorists including Skinner, Watson, and Pavlov contributed to the field, focusing on how everyday life was shaped by our thoughts, rather than the other way around.
Albert Ellis and Rational Emotive Behavioral Therapy
Albert Ellis was one of the first mental health professionals to zero in on negative thoughts and behaviors as a source of distress in patients, whereas previous theorists like Freud had attributed everything to unconscious processes beyond the person’s control. Cognitive therapy developed out of the observation that negative thoughts and negative emotions were directly responsible for people’s challenges, and that these parts of the mind were more accessible than the unconscious.
Albert Ellis developed an early form of cognitive therapy that he called rational emotive behavior therapy. This was an important precursor to cognitive therapy and proceeded from the premise that a person’s negative thoughts about a distressing event were more influential on their mental health than the event itself. Ellis observed multiple interacting cognitive subsystems and outlined how a person’s thoughts shape their behavior.
Aaron Beck, Depression, and Evidence-Based Cognitive Therapy
American psychiatrist Aaron Beck built on Ellis’ work. Beck specialized in treating depressive symptoms in his clients and noticed that the psychoanalytic approach he had learned in school was not doing much to help his patients. No matter how many times they explored the patient’s childhood, their negative thinking persisted.
Beck wondered if these negative thinking patterns were the reason for people’s persistent depression. He gathered empirical evidence of the ways that negative thought patterns shaped his patient’s day to day lives, which formed the basis for the first evidence-based cognitive therapy, and eventually for mindfulness based cognitive practices.
Beck recognized that people don’t choose their thoughts, and that the automatic cognitive processes that they went through were contributing to their recurrent depression.
Today we recognize that recurrent major depressive disorder is caused in large part by these automatic negative thoughts. People are often unaware of the unconscious thoughts that shape their reality. Mindfulness practices can help them recognize and change these thoughts.
Cognitive Therapy and Behavioral Therapy: The Synthesis
Initially, cognitive therapy and behavioral therapy were two separate schools of thought about mental health. Cognitive therapy adherents were focused on the mind, and behavioral therapy adherents were focused on the visible, observable actions of their patients. Aaron Beck had broken ground on the practice of cognitive therapy, and Aaron Ellis had outlined rational emotive therapy. The two schools were often pitted against one another.
The 1980s and 1990s saw a synthesis occur, as mental health professionals including David Clark developed new treatments that combined the approaches. The behavioral side of things brought an understanding of how physical sensations in the present moment can affect our mental health, as positive stimuli encourage some behaviors and discourage others. The cognitive side recognized how downward mood spirals stem from repetitive and automatic thoughts. This combination of theoretical and practical aspects caught on, in a big way.
The Many Flavors of CBT
Today, cognitive behavior therapy encompasses many different modalities of therapy. CBT is now a catch-all term for any therapeutic method that incorporates the evidence based cognitive therapy methods developed in the 80’s and 90’s by followers of Beck and Ellis.
Dialectical behavior therapy is one of the most prominent, and focuses on treatment of people with borderline personality disorder. It incorporates the teachings of CBT to address the recurrent depression and relationship issues that affect sufferers of BPD, and many BPD sufferers incorporate elements of mindfulness based cognitive practice into their treatment.
Acceptance and commitment therapy is another form of evidence based cognitive therapy that focuses on learning to live with one’s experiences and move on from a state of denial and avoidance. But one of the most intriguing recent offshoots is an evidence-based cognitive therapy model based on mindfulness.
Introducing Meditation to the Mix
The great leap forward for evidence based cognitive therapy (and clinical psychology as a whole) happened many years after Beck first began theorizing about negative emotions and thoughts and their role in our experience of reality. It began with the creation of mindfulness based stress reduction, developed by Jon Kabat-Zinn.
Interestingly, Kabat-Zinn was not working in clinical psychology. He was a medical doctor with a degree in molecular biology from MIT. He was introduced to meditation by a Zen missionary and went on to study under Buddhist teachers. These teachers greatly influenced the development of mindfulness based cognitive practice. He eventually created a Stress Reduction Clinic at the University of Massachusetts, the first of its kind. This developed into a course, lasting eight weeks, called mindfulness based stress reduction.
Kabat-Zinn wanted the intervention to be an evidence based cognitive therapy, so he went to lengths to remove Buddhist teachings and maintain a scientific framework. The mainstream program of mindfulness based cognitive practice is secular today.
Still, modern meditation based cognitive therapy still draws heavily on the Buddhist tradition. Many meditation based cognitive therapy practices explicitly reference Buddhism.
MBSR was a huge hit, and mindfulness based cognitive treatments were born, although many vary from the eight weeks-long framework he originated.
Building on Mindfulness Based Stress Reduction
Kabat-Zinn’s teachings about mindfulness based cognitive practices spread and eventually reached therapists including Zindel Segal, Mark Williams, and John Teasdale, who lit on the idea of combining his ideas with existing evidence based cognitive therapy.
The typical MBCT program that one sees today is built on their work and uses the principles of mindfulness practice, which focuses on centering a person in their body and current moment, to enhance evidence based cognitive therapy.
Mindfulness based stress reduction used teachings on mindfulness to assist people in reducing their stress level. By combining this with evidence based cognitive therapy practices, these therapists found a way to help their patients go beyond the basics of cognitive therapy and reach more persistent and profound peace.
How Does MBCT Work?
Mindfulness based cognitive practices include a number of different techniques, which can be combined and arrayed in different ways depending on the particular patient’s needs.
Building on What’s Effective
Mindfulness based cognitive therapeutics build on the framework of evidence based cognitive therapy to enhance people’s ability to consciously attend to their thoughts and feelings.
In mindfulness based cognitive therapies, clients work to attain a mindful mood balance. Mindfulness based cognitive practices include the following.
To practice mindfulness, a person must learn to quell the stream of thoughts that often characterizes depressive symptoms and other mental health challenges, like bipolar disorder.
Meditative practices are extremely helpful for this as they help people identify bodily sensations, physical symptoms, and negative emotions.
Many of these practices are building on psychosomatic research to identify how physical processes play into mental distress and negative thought patterns.
Meditative practices are one of the first steps to cultivate mindfulness and are the basis of many mindfulness based interventions.
Meditation can be even more effective when practiced with others and is thus a very popular group intervention.
Yoga is an ancient group of physical, spiritual, and mental practices that has been used for centuries to control or “yoke” the human mind, and center a person in the present moment.
Psychosomatic research and mindfulness studies have both affirmed the usefulness of yoga poses in helping people to calm their inner mind and focus on the present moment.
Mindfulness based cognitive therapy (MBCT) courses often include yoga and some teacher certification programs have a yoga component, so many MBCT teachers are also yoga instructors.
Depending on the therapy approach you choose to go with and the teacher qualification status of your MBCT therapist, you may or may not use yoga poses to isolate body sensations, explore interactive cognitive subsystems, or zero in on mental health concerns.
Similar but distinct from yoga, mindful stretching revolves around extending your body to observe how it feels and center yourself in the present moment.
Mindfulness based stress reduction includes stretching elements and many mindfulness based cognitive practices and MBCT courses start with a stretching exercise.
Clinical trial of stretching and other empirical evidence has demonstrated its usefulness as a technique as well. Stretching is obviously a major aspect of yoga and other types of traditional mindfulness practice.
MBCT program leaders will often facilitate mindful stretching to help people calm down before beginning clinical work; with advanced teacher training they may expand this to include exercises that incorporate speaking and stretching simultaneously.
Although similar to meditation, mindfulness practices are applicable for everyday activities and often don’t require you to stop and put everything down.
Instead they allow you to focus on the current moment and incorporate MBCT teachings into your activities to center yourself and focus, rather than being dragged down into negative emotions and mental events.
A specific type of exercise that appears frequently in mindfulness and meditation based cognitive therapy (MBCT) is the body scan, in which a person attends to all of the bodily sensations they are experiencing individually.
The body scan helps a person zero in on things that are causing them distress and is an important part of mindfulness meditation. Your MBCT therapist may ask you to start each session with a body scan.
Evidence for Effectiveness
As one of the fastest growing evidence based cognitive therapy practices, mindfulness and meditation based cognitive therapy (MBCT) is a hot topic, and has generated a lot of research gauging its clinical excellence.
Systematic Review Canadian Journal of Psychiatry Study
Can J Psychiatry, the Canadian Journal of Psychiatry, has published a systematic review of the evidence around MBCT and found that it is effective for relapse prevention in patients who are suffering from recurrent depression, and is even comparable in effectiveness to medication regimens at preventing depressive relapse.
Systematic Review by Mindfulness Journal
Another systematic review undertaken by the Journal Mindfulness has found that further research is needed to demonstrate the effectiveness of mindfulness based interventions on older people with anxiety and depression, although the study did not explore or comment on the effectiveness of mindfulness based treatment for people in other age groups and with other clinical psychology issues.
Oxford Mindfulness Centre Research
Researchers at the Oxford Mindfulness Centre have focused on depressive symptoms, particularly among young people. They worked in conjunction with the Mental Health Foundation to achieve their goals.
Researches at the Centre have applied a clinical psychology research lens to the issue and developed evidence that mindfulness based cognitive practices can prevent depressive relapse and curb depressive symptoms in adolescents.
Clinical Psychology Review Systematic Review
Acclaimed journal Clinical Psychology Review published a systematic review of the evidence around mindfulness based cognitive practices and found evidence for immediate effectiveness when treating dysphoric moods, as well as long-term effectiveness for treating recurrent major depressive disorder.
Clinical Psychology Review went on to state that mindfulness based cognitive practice is more effective than distraction for reducing dysphoric mood.
Ultimately Clinical Psychology Review concluded that mindfulness based cognitive practices are effective for treating multiple categories of mental health symptoms and preventing depression relapse.
Finding an MBCT Therapist
If you’ve done your research and decided that a mindfulness and meditation based cognitive therapy (MBCT) program is right for you, you may be wondering how to find someone to help you practice mindfulness based cognitive therapeutic techniques.
You can start by exploring the teacher qualification and teacher certification measures in the field and learning the teacher qualification status of your potential candidates.
There are multiple types of teacher certification and teacher qualification that MBCT teachers can acquire.
The MBSR Foundations course is the introductory level teacher qualification program for someone interested in working in mindfulness based cognitive therapies. This is the bare minimum to look for in any teacher offering mindfulness based cognitive therapies.
Advanced teacher training intensive
Ideally, you should find someone who has completed the Advanced Teacher Training Intensive. This is a 6 day retreat in which practitioners of mindfulness based cognitive therapies learn the more difficult techniques.
People who complete the intensive receive an advanced teacher certification. If someone has passed this program you can be assured that they are trained in relapse prevention and other specific modalities within mindfulness based practice as it is the most advanced of the teacher qualification programs.
Is MBCT Right For Me?
As noted above, mindfulness and meditation based cognitive therapy are effective for many different mental health issues. If you find that you struggle with focus, negative thinking, or recurrent episodes of depression, MBCT may be your ticket to a better outlook and a new way of thinking.