Mindfulness Based Cognitive Therapy (MBCT)

Anabel Salimian is a Research Assistant with the CAPPC and an Undergraduate student at UCSB majoring in Biopsychology, minoring in Applied Psychology.

Mindfulness Based Cognitive Therapy:

A Positive Psychology Approach to the Treatment of Depression

Anabel Salimian

University of California, Santa Barbara

Major depressive disorder is a condition that is experienced differently across individuals, but still ranks among the top three most common mental health disorders in America. Based on the 2017 National Survey on Drug Use and Health (NSDUH), 17.3 million adults have been affected by at least one major depressive episode, with the highest percentage being those aged 18-25. Out of the adults facing a severe depressive episode, 63.8% were accompanied by severe impairment (Substance Abuse and Mental Health Services Administration, 2019). This type of depression is characterized by losing interest in previously enjoyable activities, feeling restless and fatigued with a lack of energy and motivation, a change in appetite, and difficulty concentrating or making decisions (National Institute of Mental Health [NIMH], 2019). 

Major depressive disorder (MDD) can be diagnosed through a psychological assessment conducted by a medical or mental health professional. Medication and psychotherapy are the most effective treatments for depression, with selective serotonin reuptake inhibitors (SSRIs) being the most common prescription medication. However, antidepressant medication treatments (ADMs) are symptom-suppressors more than they are cures due to the manner in which they affect human neurobiology (Derubeis et al., 2008). Since the “causal mechanisms of depression are unchanged by ADM treatment”, patients have a risk of their depressive symptoms returning when medication use is stopped (Derubeis et al., 2008, p. 789). 

Besides the benefits to prescription medication use in lowering current symptoms, researchers are uncovering the lack of long term advantage and lack of future protection against recurrent symptoms. The primary goal of treatment for depression is to achieve a state of remission, which is also the hardest outcome to accomplish through the use of antidepressants alone (Halfin, 2007). Morgan (2003) states that “treatment with medication is helpful in alleviating a current episode but limited because it must be maintained long afterward or risk allowing that episode to reappear” (p. 124). ADM is reported to have a high risk of relapse, in terms of having another depressive episode soon after discontinuing treatment (Derubeis et al., 2008; Morgan, 2003). Research on mindfulness-based cognitive therapy (MBCT) and relapse rates showed that adding mindfulness-based cognitive therapy led to a significant decrease in the relapse/recurrence rates, decreasing recurrence by half (Teasdale et al., 2000). Furthermore, the sudden cessation of antidepressant use can elicit the phenomenon of “antidepressant discontinuation syndrome” (ADS), with patients reporting uncomfortable “somatic, mood, and psychomotor symptoms'' (Antai-Otong, 2003, p. 127). ADS can be a very traumatic experience and may cause patients to continue antidepressant use even if the medication is no longer needed solely in order to prevent the described “withdrawal” effects. Hence, preliminary studies have begun to investigate the benefits of MBCT over the use of antidepressants alone for stronger long-term benefits in the treatment of depression. 

MBCT is becoming more prevalent as a source of treatment and prevention. Mindfulness itself focuses on personal awareness of sensation, bodily states, emotions, and the environment in the present moment without judgment, often taught through meditation exercises (Edenfield & Saeed, 2012). By practicing mindfulness meditation, undesirable and unwanted internal experiences can be dealt with calmly instead of with anger, frustration, and sadness. Specific to treating depression and anxiety, MBCT is one of the more common treatments because it encourages people to become more aware of their internal states and to work on changing the way their thoughts affect their daily lives. The key to accomplishing this is to move away from automatic negative thought processes. Learning to stop these patterns  reduces the future risk of relapse (Kocovski & Mackenzie, 2016). MBCT has been seen to significantly decrease the risk of relapse in those with recurrent depression, however more research is needed to be able to draw strong conclusions (Kocovski & Mackenzie, 2016). 

In a meta-analysis, Boiler et al. (2013) described results showing that positive psychology interventions such as self-help interventions, group training, and individual therapy improve subjective and psychological well-being and reduce depressive symptoms. This meta-analysis compiled 39 studies and measured subjective well-being, psychological well-being, and depression levels. Following up three months and six months after the course of treatment, results were significant for maintained improvements. The researchers found that the treatment approaches with the larger effect sizes were those that utilized positive psychology interventions with longer durations (Bolier et al., 2013). However, there are other studies that fell short in their ability to draw definite conclusions regarding MBCT as a monotherapy. Studies such as that of Sorbero et al. (2015) have identified MBCT as being effective in reducing depressive symptoms as well as reducing relapse when used in conjunction with another form of treatment, but also reported  insufficient evidence supporting MBCT as a stand-alone treatment for depression. 

In a study examining the differences among cognitive therapy (CT), ADM, and a placebo treatment after 16 weeks, researchers found significant improvements for the treatment groups compared to the placebo. From the two treatment groups, CT or ADM, “76% of the ADM responders relapsed following medication withdrawal, compared with only 31% of the patients who had been treated with CT” (Derubeis et al., 2008). This indicates the presence of a long-term benefit that is observed in cognitive therapy over medication. Previous studies have found medication treatments to be effective in order to suppress symptoms of acute depression and can be preventative during the duration of use, but there are no findings to suggest that they can prevent the future risk of depressive episodes once medication has been stopped. This is why there is increased worry about the use of antidepressants, with literature investigating psychotherapy as an alternative with fewer risks and better long-term outcomes, which prepare people for life without reliance on medication (Antonuccio et al., 2002). 

The subject of positive psychology is a very broad and expansive realm with many different subcategories and practices. For the purpose of this review, we looked at the effects of mindfulness-based cognitive therapy, a subcategory of positive psychology, and the effects on lowering depressive symptoms in the long term in comparison to prescription medication use. Since MBCT is a more sustainable and healthier alternative to antidepressants such as SSRIs, it is expected that those engaged in MBCT will show a significant decrease in depressive symptoms leading to longer lasting and sustainable improvements in mental health.

References 

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