Extensions and Mechanisms of Mindfulness‐based Cognitive Therapy: A Review of the Evidence

Abstract

Mindfulness-based cognitive therapy (MBCT) was originally developed to prevent depressive relapse and recurrence and has also been widely extended to new patient populations and target problems over the last 14 years. We provide a comprehensive review of this literature, examining the strength of the evidence base for specific populations and target problems and identifying questions for future research to address. Specifically, we review studies addressing the use of MBCT for depressive disorders (prevention of depressive relapse and treatment of residual and current depressive symptoms), the use of MBCT in the treatment or management of other mental disorders (bipolar disorder, anxiety disorders, mixed anxiety and depression symptoms, disordered eating, personality disorders, and psychosis), and the use of MBCT in behavioural medicine contexts. Additionally, we discuss the extension of MBCT during specific developmental periods, like childhood, pregnancy and post-partum, and adult caregiving, and, finally, we address the use of MBCT among clinical health-care providers. In the second section, we review hypothesised mechanisms of change in MBCT and reflect on implications for theories of how MBCT works in the application to various patient populations and target problems. We also consider research addressing active ingredients and what is known about the "dosage" of meditation practice. We conclude with a summary of recommendations for future research. What is already known on this topic1 Mindfulness-based cognitive therapy (MBCT) is a group intervention delivered over 8 weekly sessions that integrates mindfulness meditation and cognitive-behavioural therapy. 2 Current treatment guidelines specify MBCT as a relapse prevention approach for patients with histories of multiple depressive episodes. 3 Few studies have formally tested mechanisms of change in MBCT. What this paper adds1 The application of MBCT has been extended to a wide range of psychiatric populations, behavioural medicine contexts, developmental periods, and clinical healthcare providers. 2 The empirical support for MBCT among novel populations differs by population and target problem. Although recommendations for future research vary by area, comparative trials with active control conditions, comprehensive long-term outcome and mediator measurement, and clear primary and secondary outcomes are needed. 3 It is not yet known what quantity or frequency meditation practice-or what "dosage" of meditation-is necessary for individuals to benefit from the MBCT program.Mindfulness-based cognitive therapy (MBCT; Segal, Williams, & Teasdale, 2013), which represents a unique integration of mindfulness meditation and cognitive-behavioural therapy (CBT), was first reported in the empirical literature in 2000 . Its original development and investigation were motivated by an understanding of the risk factors for depressive relapse and recurrence and an awareness of the need for more effective options to promote long-term wellness among individuals with histories o...

Mindfulness-based cognitive therapy for residual depressive symptoms and relapse prophylaxis

“…Looking outside the scope of mood disorders, preliminary efficacy data have been shown for using MBCT with a variety of disorders such as; bipolar disorder, eating disorders, developmental life stages, and medically ill populations, such as cancer or diabetes [22]. Similarly, MBCT may be effective in reducing depressive symptoms found in traumatic brain injury patients [23], in changing pain-related cognitions, such as increasing pain acceptance in chronic pain patients [24], and in facilitating self-acceptance in patients with medically unexplained symptoms [25].…”

The Evolution of Mindfulness‐based Cognitive Therapy

“…However, these latter findings are based on a very limited number of studies. Indeed, Metcalf and Dimidjian () provide an updated review of studies that have extended the applications of MBCT to populations other than individuals with recurring MD episodes. As Metcalf and Dimidjian conclude, although the findings are promising, the effects of MBCT as applied to anxiety, medical, and developmental populations are still very much in its infancy.…”

“…To date, the strongest evidence base for MBCT is based on randomised, controlled studies that have supported the use of this intervention in preventing relapse and managing residual symptoms in individuals who have experienced three or more MD episodes. Metcalf and Dimidjian () recommend the need for more research that directly compares MBCT with other empirically supported therapies for depression. To this end, traditional CBT has also been documented to be effective for depression and anxiety disorders, with clinically significant large effect sizes (0.95; Butler, Chapman, Forman, & Beck, ).…”

“…The article “ Extensions and mechanisms of mindfulness‐based cognitive therapy ” by Metcalf and Dimidjian () provide an updated focused review of the mindfulness‐based cognitive therapy (MBCT) literature. In particular, the aim of this review is fourfold.…”

Grist to the Mill: A Qualitative Investigation of Mindfulness‐Integrated Cognitive Behaviour Therapy for Experienced Health Professionals

“…Mindfulness training is increasingly provided to healthcare professionals and trainees to reduce stress, improve wellbeing, and develop clinical skills (Metcalf & Dimidjian, 2014). Although clinicians across Australasia, Europe, and North America have received training in mindfulness-integrated cognitive behaviour therapy (MiCBT: Cayoun, 2011), no peerreviewed studies into the approach have been published to date.…”