Mindfulness-based Cognitive Therapy (MBCT) is increasingly used in adult mental health treatment. Compare and contrast the effectiveness of MBCT to other approaches.
Mindfulness-Based cognitive therapy (MBCT) is a relatively new class-based program designed by Segal, Williams and Reasdale, 2002. The program was designed to prevent future relapse for people who suffer from major depression (Coelho, Canter, Ernst, 2007). This approach to psychological prophylaxis, based on current metacognitive concepts on information-processing, was designed based upon the integration aspects of CBT (Beck et al., 1979) and the ‘mindfulness-based stress reduction programme’ (MBSR) developed by Kabat-Zinn and colleagues 1990.(REFERENNCE)
Recently there has been a growth of interest in mindfulness-based psychotherapeutic approaches across a range of medical problems. Although the current empirical literature includes many methodological flaws, findings suggest that mindfulness-based interventions may be helpful in the treatment of several disorders such as pain, stress, anxiety, depressive relapse, and disordered eating. (Baer, 2003) Mindfulness based cognitive therapy combines the practice and clinical application of mindfulness meditation with the tools of cognitive therapy. This paper aims to explore mindfulness based cognitive therapy in terms of schema theory in contrast to Wells S-REF model.
A number of theorists have raised concerns over the limitations of schema theory, and have put forward revised frameworks for the conceptualization of cognitive processing in emotional disorders. Teasdale and Bernard (1993) believe that if people think negatively then that is the consequence of depression, rather than the cause of it, and the dysfunctional attitudes during an episode return to normal after recovery. Alladin (1985) conducted a longitudinal study which provided evidence that challenged the belief that negative cognitions caused depression.
The primary focus of schema theory and cognitive therapy has been on the content of thoughts and beliefs rather than the cognitive processes. However, Beck’s schema theory explains the content of people’s thoughts but not on the style of their thinking. For example, overcritical parents, who never praised their child for success maybe the explanation for the definitive core believe (‘I am a failure’) through the theoretical framework of schema theory. Although the model explains the content of people’s thoughts it does not give an explanation for the development of the distinct mode of thinking, for example, only processing information that backs up the failure theme, which is, the mistakes the person has made and the goals they have not achieved. However, Wells (2000) considers that these issues are ‘missing links’ between cognitive theory and therapy. It is seen that how people think is an important dimension that has implications on the maintenance of psychological disorder and recovery. (REFERENCE)
Teasdale et al. (2002) investigated the effectiveness of the mindfulness-based approach in prevention and relapse. Teasdale had 145 recovered randomised depressive patients to continue only ‘treatment as usual’ or to receive mindfulness-based cognitive therapy. The patients were assessed over a 60week period the results showed that, for patients with three of more depressive episodes in the past, Mindfulness-based cognitive therapy reduced the risk of relapse, moreover, patients with only two depressive episodes sited no change. Teasdale et al. (2000) concluded that these results were clinically significant because the relapse rates of the group with the highest risk of reoccurrence had been halved.
Teasdale et al. (2002) found that the combination of cognitive therapy and mindfulness-based cognitive therapy, as a result, metacognitive awareness is increased and depressive relapse is reduced. It can be seen that both approaches encourage a shift in a person’s relationship with negative thoughts rather than a change of the thought itself.
Despite the overall efficacy of the mindfulness approach, there are still theoretical limitations which need to be addressed which might lead clinical developments further in cognitive therapy. Baer 2003 emphasized a number of methodological problems whilst the research studies where taking place, noting that there were a major limitation to this approach. Baer criticizes the majority of studies examining the effects of mindfulness training, as they never used control groups. Moreover, TAU (treatment as usual) consisted of medical or unspecified psychotherapy approaches which does not allow the comparison of the effects of mindfulness interventions with specific psychological approaches. Bishop 2002 also questions the result from Teasdale et al. 2000 study, by stating that combining two forms of treatment together; it is difficult to draw any solid conclusions about the effectiveness of mindfulness-based approach in prevention of depressive relapse. Furthermore Bishop 2002 refers to problems with the conceptualization of mindfulness. Western descriptions up to now have been consistent with the Buddhist tradition which normally does not go beyond a descriptive nature. As of yet there have been no attempts to develop any qualities or the criteria of the mindfulness approach which have not been operationalised. Individuals experience and judge the effectiveness of ‘mindfulness’ in different ways, which presents the problem of the determination of the criteria which are responsible for preventing patients from relapse and depression more difficult. Therefore the validity is in question due to the lack of evidence to support the definition of the construct. Bishop 2002 goes on to argue a conceptual definition is needed before the validity is tested.
In this vein, Baer (2003) postulates the necessity of more randomized control trials to clarify whether observed effects are due to mindfulness interventions of to confounding factors such as placebo or passage of time.
Furthermore, Wells (2000) criticizes the theoretical background of the ‘mindfulness’ approach, the interactive cognitive sub-systems model, and states that one of its greatest
limitations is the Implicational code concept and its circularity as it is difficult to define exactly what it means and where to locate implicational meaning in the information processing context. Moreover, Wells (2000) argues that the ‘mindfulness awareness’ concept does not describe which component of self awareness improves or worsens emotional disorders. Wells (2000) then presents an alternative model of self-regulatory information processing (S-REF) which overcome the limitation of interactive cognitive sub-systems by using metacognition and attention in the centre of development and emotional disorders, rather than implicational meanings (e.g., ICS).
Wells S-REF model is uniform with the schema theory, however it also incorporates aspects of cognitive architecture such as, regulation of attention and other components the individuals schema. The S-REF approach by Wells (2000) underlines the importance of restructuring maladaptive metacognitive beliefs as well as non metacognitive beliefs on schemas, which provides different clinical implications for cognitive behaviour therapy. New tools are then required for the restructuring of new therapeutic techniques in order to monitor and modify the metacognitive processes. An example of one of these new tools is ‘metacognitive profiling’ (Wells, 2000) is to identify metacognitions like meta-beliefs, coping strategies, attention or memory that are activated in stressful situations.
Wells (2000) and colleagues developed three different metacognitions questionnaires, an example of theses are , the Thought Control Questionnaire (TCQ) (Wells, 2000), which assess and monitor metacognitionin in patients during their treatment. Other than monitoring metacognitions, Wells (2000) presents two different techniques to restructure cognition, i.e., modify attention (Attention Training Technique (ATT) and Situational Attention Refocusing (SAR)), which have some similarity with the ‘mindfulness’ approach but without the focus on meditation. The theoretical model of self-regulation mechanisms in emotional disorder developed my Wells is important for the future development of cognitive therapy. The S-REF model seems to create the ‘missing link’ between cognitive theory and therapy that Wells (2000) identified and could possibly form a base for the advancement for cognitive therapy in the future (Scherer-Dickson, 2004).
It would be premature to attempt to draw conclusions about the effectiveness of Mindfulness based cognitive therapy as it is still in its early days of research. Given the growing interest in MBCT is should be seen as to consider the way in which future research should be directed, and not be critical on current effectiveness of the model. (Coelho, Canter, Ernst, 2007).
Evidence that is circulating gives some indication that MBCT may be effective in treating a cognitive style that is characterised with depression. Kingston et al., 2007 noted that MBCT may be useful in treatment of residual depressive symptoms, however, these findings are not due to any specific effects of MBCT. (Coelho, Canter, Ernst, 2007).
Further methodological testing is still required gain more insight into the developments to give this approach an even more robust foundation (Scherer-Dickson, 2004). New models developed on the basis of findings in cognitive sciences and cognitive theories about information processing and emotional processing (see Rachmann, 1980; Teasdale, 1999b) seem to have a major impact on the understanding of the development and maintenance of emotional disorders. The new models of cognitive processing do have clinical implications for cognitive therapy that goes beyond the framework of Beck’s schema theory (Beck et al., 1979). Apart from the development for prevention of relapse of depression with mindfulness-based cognitive therapy, Wells (2000) has gone on further to develop metacognitive aspects of emotional disorders. On looking at the models and theories outlined in this essay, changing the relationship that people have with the way they think, instead of changing the content of those thoughts, has a major impact on therapy outcomes and relapse prevention (Schere- Dickson, 2004).
It is clear to see that Mindfulness-based cognitive therapy for depression is a cost-effective treatment programme for prevention of relapse. It goes on to teach patients skills in which they can identify high risk situations, and change their attitude to accept the way in which they think. The programme works better for those who seem more vulnerable and enable them to break the cycle of lifelong course of recurrent depression. The high relapse rates for depression underline the importance of prophylactic treatment during periods that fall between acute depressive episodes. Group programmes, like the one presented, could have a major impact on health services as they are cost