Mindfulness-Based Cognitive Therapy
Mindfulness-Based Cognitive Therapy (MBCT) teaches participants across 8 weekly sessions how to cultivate mindfulness in the context of a personal history of recurrent depression and anxiety. An evidence-based group therapy, MBCT has brought great benefit to many patients in Madison and around the world. Mindfulness is the intentional awareness of what is happening now, held with an open, non-judgmental attitude. A rapidly expanding scientific literature has shown that mindfulness-based interventions have a wide range of benefits: decreases in mood and anxiety symptoms and other physical and psychological stress-related symptoms, and increases in energy, enthusiasm for life, self-compassion, and the abilities to relax, manage chronic pain, and cope more effectively with short- and long-term stressful situations.
In particular, the core MBCT model has been shown to be effective in preventing relapses of depressive episodes in patients with multiple recurrences of major depressive disorder. We have extended MBCT to patients with chronic anxiety disorders, which are often similarly recurrent and impairing. Additionally, we introduce self-compassion practices to counter the deeply ingrained punishing and hostile self-attitudes that often accompany and complicate management of recurrent mood and anxiety disorders.
While mindfulness meditation practice has a wide-ranging capacity to be helpful to many different patients, it is important to appreciate that this group therapy modality focuses on helping patients with recurrent mood disorders and anxiety disorders. Patients not appropriate for MBCT include those with very severe depression and anxiety that substantially impairs cognition, primary trauma-related disorders who have not received evidence-based trauma-focused psychotherapy, unstable personality disorders (such as borderline personality disorder) who have not received relevant evidence-based psychotherapies (e.g., DBT), active substance use disorders, and primary psychotic disorders. Patients with treated bipolar disorder have benefitted from our MBCT groups and are welcome.
What is Mindfulness?
Mindfulness is paying attention to the present moment, on purpose, with an open, non-judgmental attitude.
Why is this useful?
Mindfulness has been shown to be helpful with a number of anxiety disorders and decrease rates of relapse of depression in individuals with multiple depressive episodes. There are preliminary studies suggesting that it may help partially responding patients reach remission. There is also some evidence suggesting that patients with treatment resistant depression may benefit from mindfulness-based cognitive therapy. The role for these groups is likely particularly powerful for those patients who have at least partially overcome an acute phase of illness and who are transitioning to prioritizing how to stay well in the midst of a chronic, recurrent pattern of psychiatric illness.
What do we do?
In 8 weekly group sessions, we use a combination of guided meditation practice, experiential inquiry, and psychiatrically-oriented exercises to facilitate the cultivation of mindfulness in relationship to depression, anxiety, and well-being. Practices include the body scan, mindful yoga, seated meditation, and self-compassion. We also explore the difficult experiences of depression and anxiety jointly, and help patients to develop plans for recognizing signals of relapse or symptom exacerbation, and tools for responding skillfully. Additionally, we offer a “Day of Mindfulness,” a 6-hour mindfulness Saturday retreat, that patients find to be of great benefit.
- To understand what mindfulness is and how to cultivate it.
- To help patients develop a formal and informal mindfulness practice.
- To cultivate mindful awareness of body sensations, thoughts, emotions, and behaviors.
- To use mindfulness to identify unskillful thought patterns, beliefs, and behaviors.
- To develop a skillful relationship with thoughts, emotions, and behaviors.
- To learn to work skillfully and compassionately with difficult emotions and mind states in order to prevent the escalation of mood or anxiety disorder symptoms.
- To appreciate the benefits of sustaining a mindfulness meditation practice after the completion of the group, and knowledge of different resources for supporting ongoing practice.
In our MBCT groups, we emphasize the importance of ongoing practice to help patients stay well. Patients develop their own mindfulness meditation practice that will happen primarily in the day-to-day settings of their lives. We provide extensive resources for sustaining practice after participation in the group. We also offer monthly mindfulness maintenance groups to provide an opportunity for alumni to continue to explore their practice. Finally, alumni of our program are invited to Days of Mindfulness that are conducted for our subsequent MBCT groups.
The “Pause Exercise”* is a brief exercise that can be used anytime and anywhere. It helps us shift gears from begin wrapped up in our thinking about future or past and come to settle in the present. This is one of the mindfulness practices which many people find useful when they take a mindfulness group and will continue after the group is finished. At first you can try it in the quiet of your home to get a feeling for the exercise. Then as you gain confidence you can use it to pause in the middle of your day or in the face of a stressful experience. After you finish you simply make the next best choice for you and move back into your activities.
Below are some formal written instructions.
- Pause – Awareness: Stop what you are doing. If sitting, sit upright in a dignified but not stiff posture. If standing, stand upright but not rigid. Be aware of what is happening in your experience. Take a moment to take note of seeing, hearing, body sensations, thoughts, emotions. Notice liking, disliking or spacing out. Simply observe, acknowledge and register your experience, even if it is unwanted. Come home to this moment as it is right now. The essence of the pause is being aware of your present moment’s experience, however it is.
- Relax- Dropping into the Body: Relax the body and gently redirect full attention to the body. Feel the support of the contact places of the body, the feet, the buttocks, the back of the thighs, the hands, the lips, the eyelids. Feel the direct experience of the sensations, touch, pressure, softness, firmness, warmth or coolness. Open to the sensations and your physical experience throughout the whole body.
- Breathe: Direct your attention to your breath. Feel each in and out breath. Let it be in its own natural rhythm. Your breath and body can function as an anchor to bring you into the present and help you tune into a state of awareness and stillness.
- Open – Expanding: Expand the field of your awareness around your breathing, so that it includes a sense of the body as a whole, your posture, and facial expression. Open up to the breath and body and sounds. Open up to the breath and body and sounds and sights. Open up to all senses as you move into your life.
“The breathing space provides a way to step out of automatic pilot mode, out of rumination or reactivity to strong emotion, to reconnect and open to the present moment.” The Mindful Way Through Depression
* In Mindfulness-based Cognitive Therapy this is called the “Breathing Space”. The “Pause Exercise” is used in Mindfulness-based Stress Reduction and is a variant of the Breathing Space exercise.
There are three major areas that will be covered during the class: mindfulness, cognitive therapy, acceptance and commitment therapy.
Mindfulness is the awareness of what is happening now without judgment, commentary or decision. This is the power of being present to the present moment with acceptance. This cultivates beginners mind which opens possibility. Fixed beliefs on the other hand tend to close down options and create passivity and hopelessness. We will work to gradually cultivate mindfulness in its different arenas, awareness of the body, thought, emotion, and behavior. After we have cultivated some basic mindfulness we will spend time working with how to use mindfulness with difficult mind states which tend to lead to downward spirals in mood. Mindfulness is a very healthy and skillful mind state because its tendency is to bring balance, openness and ease to the mind and body.
Cognitive behavioral therapy/Acceptance and commitment therapy
We will cover cognitive distortions, hidden beliefs which lead to anxiety and worsening of anxiety. We will cover working toward acceptance of anxieties and fears, particularly with mindfulness tools. We will work with understanding and confronting avoidance behaviors. We will identify values and goals to help confront avoidance behaviors.
Stuart Jones, MD
Dr. Stuart Jones is a psychiatrist with the University of Wisconsin Department of Psychiatry. Stuart received his medical degree from the Chicago Medical School at Rosalind Franklin University of Medicine and Science in 2011 and completed his residency training here at the University of Wisconsin. Involved with leading mindfulness meditation groups for patients with depression and anxiety at WISPIC since 2015, Stuart is interested in meditation practice as it relates to psychiatric care, psychotherapy and the promotion of psychological health and well-being.
Lacey Schmidt, PsyD
Dr. Lacey Schmidt is a psychologist at the UW Health Yahara Clinic. She received her Psy.D. from Pacific University College of Health Professions in 2013 and completed her internship and postdoc hours at the Wisconsin Department of Corrections. Before starting with UW Health Behavioral Health in 2016, she worked in a residential PTSD program at the VA for 2 years providing assessment and treatment for veterans. Lacey currently has a meditation practice of her own and regularly utilizes mindfulness and meditation practices in her clinical work to help patients manage mental health symptoms and life stressors.
Dr. Jack Nitschke is a clinical psychologist, neuroscientist, and associate professor in the Department of Psychiatry. His NIH-funded research used brain imaging to answer questions about anxiety, depression, and emotion. His clinical work using psychotherapy spans 25+ years and brings the advances in our understanding of the brain and neuroplasticity directly into his psychotherapy utilizing various evidence-based treatments with adolescent and adult patients suffering from a broad range of mental disorders. In addition, Jack has been an instructor of traditional martial arts in Tae Kwon Do and meditation practitioner since the early 1990’s.
Group will run for eight (8) week sessions and will typically start in February, June and October. All groups will be held at Wisconsin Psychiatric Institute and Clinics (WisPIC) at 6001 Research Park Blvd, Madison. We will meet in Room 1616.
Participants will be expected to commit to at least 6 of 8 classes. Participants will be asked to do homework daily with a goal of 30-60 min per day. Homework consists of mindfulness exercises, which are guided with audio files available on the class website, or CD hard copies on request.
Quartz and Medicare A&B will cover this class. Co-pays will still apply. Other insurances may cover this as group therapy depending on the policy and prior authorization requirements. There will be a $20-60 cost for materials that is out of pocket.
Who Might Benefit:
Research shows patients who have had three or more major depressive episodes who are in remission will likely benefit most from this group. There is some preliminary research to suggest it to be helpful for patients with depression with partial responses to treatment and treatment resistant depression. In our clinical experience, we have found it to be helpful for chronic stress induced depression, dysthymia, and people who suffer with low self-esteem and/or high self-criticism. People with active depression can benefit if there is not a continuous state of depression that impairs the ability to have modest levels of concentration, function and periodic breaks from the negative mind states.
Those who have active severe symptoms of depression such as impaired thinking, constant negative rumination, psychotic thoughts or hallucinations, high risk of self-harm or such severe motivational problems that they will be unable to do homework assignments. People with a history of severe post-traumatic stress disorder who have flooding, dissociation or psychosis when they are exposed to relaxation or lack of structure for short periods of time. These people may benefit from mindfulness under the careful instruction of their therapist but are likely inappropriate for this group. Severe agoraphobia where the person is likely to miss more than two classes. Patients with active substance use disorders would be better served to address their substance use problem prior to considering group consideration. Additionally, patients with substantially impairing personality disorders, especially poorly compensated borderline personality disorder, are more appropriate for evidence-based treatment modalities like Dialectical Behavioral Therapy (DBT) especially if they have never participated in DBT treatment.
Each person will have an individual interview to review their diagnosis, suitability, and appropriateness of timing for group participation. We are asking people for a substantial personal commitment for eight weeks. This class supports the possibility of growth and change in the context of acceptance and non-doing. This will only happen with regular effort and practice, the majority of which will take place outside the group setting. However, we will gladly help participants adapt the practices to fit into the real conditions of their lives. If the participant needs medication management or safety management, they must have another mental health provider other than group facilitators to manage their medications and any acute safety issues. Participants are asked not to come to class intoxicated and would be asked to leave if under the influence of nonprescription drugs or alcohol.
What to wear:
Please wear clothing appropriate for sitting cross-legged, lying on the floor and doing gentle mindful yoga. If you have your own yoga mat or meditation cushions that you prefer you may bring them to use. We will have these available for participants (when online classes resume).
For information, contact Megan Kasdorf: firstname.lastname@example.org.