For the past few weeks we’ve been discussing the theory and practical applications of Acceptance and Commitment therapy among college students in detail, drawing from the edited volume Mindfulness and Acceptance for Counseling College Students. Today we will explore and compare another useful modality for college counseling centers: mindfulness-based cognitive therapy. Here are a few key points about the Mindfulness-Based Cognitive Therapy (MBCT) modality:
· MBCT integrates mindfulness meditation, using structures drawn from mindfulness-based stress reduction (MBSR) (Kabat-Zinn, 1990) with principles of cognitive therapy (Segal et al., 2002)
· It is a small group program of up to 12 participants, across eight weeks, initially developed for the treatment of recurrent depression
· MBCT aims to interrupt the ruminative habits that fuel depressive relapse
· It uses intensive meditation practice to train the ability to “decenter” or “step back from” the content of current experience and to strengthen discernment regarding self-care
· It involves a post-practice investigative progress, facilitated through a dialogue between student and teacher, which aims to draw out whatever participants noticed during the practice and to encourage them to reflect on and explore their experience
· MBCT draws a distinction between two modes of mind: doing mode and being mode. Doing mode pertains to goal-oriented actions, where we are striving towards what we want or away from what we don’t want (Crane, 2011). Being mode is characterized by an intentional placement of attention on the present moment and direct contact with the world through one’s senses (Crane, 2011)
· The goal of MBCT is to increasingly cultivate the being mode through mindfulness meditation
MBCT vs. ACT
Experiential exercises are utilized in both MBCT and ACT in order to help individuals become aware of automatic patterns of expectations and reactions. By practicing both, individuals are increasingly able to identify and investigate the “workability” of their coping behaviors. Both modalities promote acceptance of uncomfortable experiences, encouraging individuals to move forward with discomfort by creating a different relationship with difficult experiences that is based on acceptance and equanimity (MBCT), or by maintaining a perspective on life’s bigger meaning and purpose (ACT). Both MBCT and ACT promote psychological flexibility and the idea that thoughts are merely verbal events, not actual events.
Of course, both therapies incorporate mindfulness (i.e. present awareness and nonjudgmental acceptance). But the way mindfulness is presented varies in each. MBCT utilizes systematic meditation practices to develop mindfulness skills experientially, “off the meditation cushion,” so to speak. Formal meditation practices are generalized to everyday activities of living. The aim of MBCT is to cultivate decentered awareness, to separate oneself from the contents of one’s consciousness (such as thoughts and emotions), and thus to view moment-to-moment experience with greater clarity and objectivity (Shapiro, Carlson, Astin, & Freedman, 2006).
Mindfulness exercises in the ACT program, however, combine aspects of acceptance, defusion, self as context (awareness that one is more than one’s thoughts, feelings and experiences), and contact with the present moment (Strosahl, Hayes, Wilson & Gifford, 2004). Guided visualization is used, often alongside mindfulness instructions, and formal mindfulness meditation practice may or may not be included in ACT protocols. When formal meditation practice is included, the duration of in-session mindfulness practices tends to be shorter than in MBCT.
MBCT and ACT for College Students: Empirical Considerations
There is growing evidence for the inclusion of mindfulness in interventions promoting the well-being of college students.
· Among undergraduate students, higher mindfulness was related both to a lower frequency of negative automatic thoughts and to an enhanced ability to let go of those thoughts (Frewen, Evans, Maraj, Dozois, & Partridge, 2008).
· A randomized control trial found that participation in MBSR was associated with decreased stress and enhanced forgiveness among college students (Oman, Shapiro, Thoresen, Plante, & Flinders, 2008).
· In a recent study of MBCT for students, participation was associated with a reduction in negative affect and and increase in mindfulness, and these variables were significantly negatively correlated (Collard, Avny, & Boniwell, 2008).
· In a study comparing MBCT and ACT for students, college students completing either the MBCT or ACT course reported a significant decrease in psychological distress—a change of moderate to large magnitude—and large increases in mindfulness and acceptance (Renner and Foley, 2012).
Key observations from the MBCT vs. ACT study
A number of key observations across both conditions were made about the ways students engaged with the material. There was a strong tendency for intellectualizing in the early stage of the course, as students resisted the expectation for experiential learning. Students also tended to slip into a passive “lecture mode” at times, so the facilitators knocked the groups out of this “autopilot” mode repeatedly. The facilitators found that concepts needed to be repeated several times and across sessions for students to integrate them. Students required a lot of support in understanding the difference between mindfulness and distraction.
In the MBCT condition, students reported low levels of home practice and some struggled to connect with their current experience during in-session meditation. This meant that periods of inquiry were limited. The energy levels in MBCT groups were also lower than in the ACT groups, but despite the low participation at times, MBCT students reported that they “were getting a lot out of it” and seemed to assimilate the ideas by the end of the course.
The ACT program seemed to be better received by less-motivated college students over the MBCT program, given the interactive nature of the groups and more relaxed requirements for meditation practice. But the non-significant trend for MBCT in anxiety reduction may indicate that students with anxiety may have an enhanced response to the extended mindfulness practices. Encouraging “being” versus “doing” modes of mind seemed to provide an effective decentering perspective for anxious students.
The meaning of “values”
Values, one of the core concepts of ACT, raised significant challenges within the college student demographic. Students who over-identify with expectations of competitive academic achievement may readily understand values as goals to be attained rather than guiding principles for doing what matters in the present. In the MBCT vs. ACT study, the facilitators observed that the MBCT group, which focused on shifts in modes of processing and reflections on lifestyle (e.g., noticing nourishing and depleting activities) rather than explicit reference to values, often resulted in students spontaneously bringing up personal life meanings. This is consistent with the finding that MBCT may assist participants in clarifying their important goals and increasing their confidence in their capacity to move in valued life directions (Crane, Winder, Hargus, Amarasinghe, & Barnhofer, 2011).
Both MBCT and ACT approaches facilitate self-awareness through direct contact with experience and encourage participants to step back from the “control and elimination agenda” of human suffering to promote the value of living an engaged and meaningful life. These therapies offer explicit experiential training in adaptive self-regulation, aiding in psychosocial development and growth. Both MBCT and ACT work to reduce distress and promote important elements of psychological flexibility (mindfulness and acceptance). ACT may be the more practical approach for traditional-age students who are limited in time and motivation, given that its range of behavior change techniques allows for more active engagement with self and others. Motivated older students struggling with more chronic problems may gain more from MBCT.
Collard, P., Avny, N. & Boniwell, I. (2008). Teaching Mindfulness Based Cognitive Therapy (MBCT) to students: The effects of MBCT on the levels of Mindfulness and Subjective Well-Being. Counselling Psychology Quarterly, 21 (4), 323 –336.
Crane, C., Winder, R., Hargus, E., Amarasinghe, M. & Barnhofer, T. (2011). Effects of Mindfulness-Based Cognitive Therapy on Specificity of Life Goals. Cognitive Therapy & Research. Online publication 21 Jan, 2011.
Foley, E. & Renner, P. (in preparation). Acceptance Based Therapies for Students: An exploration of MBCT and ACT for the treatment of distress.
Frewen, P. A, Evans, E. M., Maraj, N., Dozois, D. J. A, Partridge, K. (2008). Letting Go: Mindfulness and Negative Automatic Thinking. Cognitive Therapy andResearch. 32 (6), 758-774.
Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. New York: Dell.Segal et al., 2002
Oman, D., Shapiro, S. L., Thoresen, C. E., Plante, T. G. & Flinders, T. (2008). Meditation Lowers Stress and Supports Forgiveness among College Students: A Randomized Controlled Trial. Journal of American College Health, 56 (5),569-578.
Shapiro, S. L., Carlson, L. E., Astin, J. A., & Freedman, B. (2006). Mechanisms of mindfulness. Journal of Clinical Psychology, 62, 373-386
Strosahl, K.D., Hayes, S.C., Wilson, K.G., & Gifford, E.V. (2004). An ACT primer: core therapy processes, intervention strategies, and therapist competencies. In S.C Hayes & K.D Strosahl (Eds). A practical guide to acceptance and commitment therapy (pp. 21-58). New York: Springer.