1. Mindfulness-Based Cognitive Therapy (MBCT; Segal et al., 2002)
Segal, Z. V., Williams, M. G., & Teasdale, J. D. (2001). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. NY: Guilford.

2. Main tasks of CBT
The following steps may shift in order at times, but mostly the following happens in CBT:
Catch yourself whenever your mood shifts and catch your thoughts, whatever is going through your mind
First task here: Realizing your thoughts
Second task: Note it (in mind, on paper),
Third task:
Tackle them in sessions evaluating the thought in light of evidence,
alternative options found to tackle difficult thoughts,
rehearsed in therapy, then
Fourth task: Apply these skills in everyday life
All the while, teaching vigilance for long-term beliefs, attitudes, assumptions and look out for situations that will trigger them

3. Techniques of CBT Activity scheduling Rating mastery and pleasure
Thought monitoring and challenging
Cognitive rehearsal generating alternative options
Noticing dealing with dysfunctional schemas/attitudes

4. What is the evidence
Evidence supports that CT is at least effective as ADM in treating depression and CT
Evidence shows that when ADM is discontinued, the rate of relapse was between %
Evidence shows that rate of recurrence for the CT group was about %

5. What is the evidence? What is the mechanism of relapse?
Difference between those who are never depressed and who are recovered: the DAS scores (the vulnerability)? The answer is: ?
The reaction to sad mood: Evidence showed that the people with a previous history of depression reacted to sad mood induction with similar sadness levels but their cognitive response was exaggarated
Differential activation hypothesis (Teasdale, 1988) or cognitive reactivity
The more times depressed an individual had been, the easier pathways to relapse are activated by slighest negative event and sad moods
Nolen-Hoeksema research: Ruminative mind
For those who were once depressed:EVEN DAY TO DAY SADNESS COULD TRIGGER A SERIOUS VICIOUS CYCLE OF THINKING NEGATIVELY SPIRALING DOWN TO DEPRESSIVE ROUTE

6. Mindfulness-Based Cognitive Therapy (MBCT; Segal et al., 2002)
Goal: Prevention of relapse of depression
Relapse happens because:
Cognitive reactivity to ordinary sad moods increases risk for relapse
Depressive content in schemas is activated by sad moods
The more times depressed an individual had been, the easier pathways to relapse are activated by slighest negative event and sad moods
Ruminative mind: The way the mind of depressed individuals work

7. Mindfulness-Based Cognitive Therapy (MBCT; Segal et al., 2002)
VICIOUS CYCLE:
Relapse happens because previously depressed individuals react to ordinary sad moods with undesirable, negative thoughts and they catch themselves.
What they do then is trying to avoid past patterns of thinking, behaving, and feeling  Increased rumination about the problematic states and further avoidance as a way to reach the desired state  Depression

8. Mindfulness-Based Cognitive Therapy (MBCT; Segal et al., 2002)
Why CBT works in recovery and relapse?
Reducing belief in depressive thoughts and dysfunctional attitudes – not much empirical evidence here!
Alternative account: Maybe CBT teaches individuals implicitly and indirectly (via questioning the validity of content) to change their perspective on negative thoughts – called cognitive ‘distancing’ or ‘decentring’
Why then MBCT?
Proposes different and perhaps more direct ways to change how individuals relate to their thoughts, in short alternative ways of ‘decentring’ as a way to prevent relapse
The skills learned via MBCT can help individuals to stop the following from triggering depressive episodes via decreasing cognitive reactivity and ruminative thinking

9. Mindfulness and related skills in MBCT
Being in the moment,
Decentering from negative thoughts (also constructed by Marsha Linehan in DBT)
This is not moving away from or fighting with thoughts
This is moving away to look at thoughts more closely with a nonreactive attitude with kind awareness so to more clearly see what needs to be done
acceptance/nonaversion,
nonattachment,
kind awareness,
letting go,
“being” rather than “doing,”
Non-goal attainment,
bringing awareness to the manifestation of a problem in the body.

10. The core skill
Moving away from a focus on content of thinking to a focus on the process of thinking
via the intentional use of attention and awareness, via choosing what we are going to attend to and how
Changing from the default ‘doing’ mode to a ‘being’ mode

11. Modes of mind: Doing mode
When the mind sees the things are different from what things are expected/ought/wished to be...
So there is a discrepancy between desired vs. actual states
If action can’t be taken in order to reduce this discrepancy/mismatch  a recurring sense of frustration, dissatisfaction etc… your mind is fixated at finding ways to correct this mismatch.
This is an automatic, unintentional process

12. Modes of mind: Being mode
Being mode is not motivated to achieve a goal (reverse is true for doing mode)
“Accepting and allowing what is, without any immediate pressure to change it.” because there is no standard state to achieve…
Doing mode: past and future oriented…
Being mode: present-focus
Thoughts are passing events as other objects of awareness.

13. Goal: Balancing Doing and Being Mode

14. Decentering: “I am not my thoughts”
“Metacognitive awareness”
Negative thoughts and feelings are experienced as transient mental events, rather than to define as what is called the “self.” (Teasdale et al., 2002)
“The phenomena comtemplated are distinct from the mind contemplating them” (Goleman, 1980)
Stepping back from any immediate perspective and perceiving the experience within a broader, more detached, context of awareness

15. MBCT- The Eight-Session Program
Structure:
Start with practice (choosing body scan, sitting meditations, or yoga stretches)
Letting the dialogue flow, interwoven with stories or poetry
Further practice

16. For therapists Experiential component
Using MBCT along with personal experience, only intellectual knowledge will not suffice.
Planning and preparation for sessions
Be responsive and flexible to here-and-now needs
Suspend judgment and invite participants do the same
‘Don’t try too hard-whatever comes up accept it, for that is what you are feeling right now.”

17. Structure Initial interview Classes
Outline theme and curriculum for each 8 classes
Class size: 12 for research, 30 or larger in Kabat-Zinn practice

18. Core Aims
To help people who have suffered from depression in the past to learn skills to help prevent depression coming back
To become more aware of bodily sensations, feelings, and thoughts, from moment to moment.
To help participants develop a different way of relating to sensations, thoughts, and feelings
To help them be able to choose the most skillful response to any unpleasant thoughts, feelings, or situations they meet

19. Sessions Sessions 1-4 Learning to pay attention
Awareness of how little we pay attention
Learn how to bring your focus back to a single focus, first with reference to your body, then the breath
Learn to become aware of how this mind wandering can allow negative thoughts and feelings to occur

20. Sessions Sessions 5-8 Handling mood shifts
Whenever negative thoughts or feelings arise, let them be there, before responding to them skillfully
Skillful responding to negative affect or thoughts
Bringing attention to their breathing for a minute or two (breathing space),
Then expanding attention to the body and here-and-now
(for instance, expand attention to the parts of the body that the thought or emotion affects, and use the breath to open and soften the sensations)

21. Core themes Core themes I
Exploring how best to prevent the establishment and consolidation of patterns of negative thinking
Core themes II
Unhelpful automatic cognitive routines, motivated by escaping/avoiding depression or life situations:
Automatic pilot (example experiences: Raisin exercise, body scan)
Driven by an overriding wish to get rid of the negative mood
Constant monitoring/comparison of present and desired states
Reliance on verbal problem-solving skills

22. Other components of MBCT
Core skill: letting go, be mindful
Experiential learning
Empowerment
What is to be learned:
Concentration
Awareness/mindfulness
Being in the moment
Decentering
Acceptance/nonaversion, nonattachment, kindly awareness
Letting go
Being rather than doing, non-goal attainment, no special state
Bringing awareness to the manifestation of a problem in the body