Abstract
Since the first edition of this landmark book was published in 2002, interest in mindfulness-based interventions has grown exponentially, paralleled with a growing understanding of the physiological and neuroanatomical correlates of meditation practice. Mindfulness-based cognitive therapy (MBCT) is now recommended by the UK’s National Institute for Health and Clinical Excellence (NICE) for people who are currently well but have previously experienced three or more episodes of depression.
This new edition is therefore a timely update to a seminal work, from the clinicians who pioneered MBCT. It builds on the first edition, refined with many new insights, and includes a description of the rapidly expanding evidence base that supports this novel approach. There are new chapters covering a range of topics including the pre-class interview, the inquiry process and the three-minute breathing space.
Mindfulness in this context has been described as ‘paying attention in a particular way: on purpose, in the present moment and non-judgmentally’ (Kabat-Zinn, 1994, p. 4). Eastern meditation techniques have sought to cultivate mindfulness as a means of spiritual development. MBCT has its origins in such techniques.
The book is divided into three parts. In part one, there is a description of the problem of recurrent depression and the cognitive mechanisms that are thought to underlie relapse. This is followed by a fascinating account of the history of MBCT. The authors embark on their journey expecting to develop a technique based on conventional cognitive therapy. They end up meeting Jon Kabat-Zinn, a physician at Massachusetts General Hospital, who had developed a structured, eight-week programme for treating chronic pain based on the principles of Buddhist meditation. The authors learn that a basic principle of this method is that the relationship to or interpretation of thoughts, feelings and body sensations, rather than these experiences in themselves, causes suffering. This principle fitted comfortably with what was known about the way in which cognitive therapy protected against depressive relapse in some people, by apparently bringing about a change in the relationship to one’s thoughts. With this in mind, the authors developed what has become known as MBCT by combining mindfulness meditation with principles of cognitive therapy.
Part two of the book outlines the structure and content of the eight-week programme, session by session, as a clinical manual. There is a strong emphasis on developing a daily practice at home and homework exercises are provided each week. Reproducible handouts are included for each session, as well as access to online audio recordings.
In the first four sessions, participants learn to direct their attention through exercises such as bringing awareness to the breath or to bodily sensations. As mindfulness develops, there is a shift from a ‘doing’ mode into a ‘being’ mode, where internal experiences such as thoughts and feelings are to be noted in a non-judgemental manner, with a spirit of gentle curiosity and without a sense of needing to change anything. Handling difficulties and mood shifts is the focus of sessions five to eight.
Part three of the book reviews recent evidence and discusses how MBCT might exert its beneficial effects.
New insights from the authors’ clinical practice over the past decade include an emphasis on the importance of the instructor’s experiential understanding, which can only be developed through their own mindfulness practice. Indeed, they suggest that prospective instructors should practise daily for at least a year before they begin teaching others. There is also a greater emphasis on the role of compassion and how a compassionate attitude in the instructor can inspire self-compassion in the student.
The book is aimed primarily at those intending to train as MBCT instructors but is accessible enough for the general reader, particularly those interested in depression, psychological therapies or mindfulness meditation. It is well written in an engaging style and the authors’ enthusiasm is evident. It is good value for money and is highly recommended.