Mindfulness-based cognitive therapy

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Mindfulness-based cognitive therapy (MBCT) is an approach to psychotherapy that uses cognitive behavioral therapy (CBT) methods in conjunction with mindfulness meditative practices and similar psychological strategies.^[1] The origins to its conception and creation can be traced back to the traditional approaches from East Asian formative and functional medicine, philosophy and spirituality, birthed from the basic underlying tenets from classical Taoist, Buddhist and Traditional Chinese medical texts, doctrine and teachings.

Recently, mindfulness therapy has become of great interest to the scientific and medical community in the West, leading to the development of many new innovative approaches to mental health. One such approach is the relapse-prevention treatment for individuals with major depressive disorder (MDD).^[2] A focus on MDD and attention to negative thought processes such as false beliefs and rumination, distinguishes MBCT from other mindfulness-based therapies.^[3] Mindfulness-based stress reduction (MBSR), for example, is a more generalized program that also utilizes the practice of mindfulness.^[3] MBSR is a group-intervention program, like MBCT, that uses mindfulness to help improve the lives of individuals with chronic clinical ailments and high-stress.^[4]

CBT-inspired methods are used in MBCT, such as educating the participant about depression and the role that cognition plays within it.^[5] MBCT takes practices from CBT and applies aspects of mindfulness to the approach. One example would be "decentering", a focus on becoming aware of all incoming thoughts and feelings and accepting them, but not attaching or reacting to them.^[6] This process aims to aid an individual in disengaging from self-criticism, rumination, and dysphoric moods that can arise when reacting to negative thinking patterns.^[3]

Like CBT, MBCT functions on the etiological theory that when individuals who have historically had depression become distressed, they return to automatic cognitive processes that can trigger a depressive episode.^[7] The goal of MBCT is to interrupt these automatic processes and teach the participants to focus less on reacting to incoming stimuli, and instead accepting and observing them without judgment.^[7] Like MBSR, this mindfulness practice encourages the participant to notice when automatic processes are occurring and to alter their reaction to be more of a reflection. With regard to development, MBCT emphasizes awareness of thoughts, which helps individuals recognize negative thoughts that lead to rumination.^[8] It is theorized that this aspect of MBCT is responsible for the observed clinical outcomes.^[3]

Beyond the use of MBCT to reduce depressive symptoms, a meta-analysis done by Chiesa and Serretti (2014) supports the effectiveness of mindfulness meditation in reducing cravings for individuals with substance abuse issues.^[9] Addiction is known to involve interference with the prefrontal cortex, which ordinarily allows for delaying of immediate gratification for longer-term benefits by the limbic and paralimbic brain regions. The nucleus accumbens, together with the ventral tegmental area, constitutes the central link in the reward circuit. The nucleus accumbens is also one of the brain structures that is most closely involved in drug dependency. In an experiment with smokers, mindfulness meditation practiced over a two-week period totaling five hours of meditation decreased smoking by about 60% and reduced their cravings, even for those smokers who had no prior intentions to quit. Neuroimaging among those who practice mindfulness meditation reveals increased activity in the prefrontal cortex.^[10]