Contents
Acknowledgements ix
Foreword by Mark Williams xiii
Introduction xvii
Abbreviations used xxiii
Part 1 THE DISTINCTIVE THEORETICAL FEATURES
OF MBCT 1
1 An integration of Mindfulness-Based Stress
Reduction and Cognitive Behavioural Therapy 3
2 Underpinned by the cognitive theory of
vulnerability to depression 9
3 Learning skills to reduce the risk of depressive
relapse 15
4 The signi®cance of automatic pilot 21
5 Modes of mind: ``doing'' 27
6 Doing mode in action: the effects of
rumination 31
7 Doing mode in action: the effects of
experiential avoidance

8 Reacting and responding to experience:
avoidance and approach 39
9 Modes of mind: ``being'' 43
10 Body sensationsÐa door into the present 49
11 Ways of approaching and welcoming what is 53
12 Developing a new relationship with experience 59
13 Awareness as a container of our experience 65
14 Working with general and speci®c vulnerability 69
15 The MBCT evidence base 73
Part 2 THE DISTINCTIVE PRACTICAL FEATURES
OF MBCT 79
16 Course content and structure 81
17 Session themes 93
18 Assessment and orientation 97
19 Eating a raisin with awareness 101
20 Body scan practice 105
21 Mindful movement practice 109
22 Sitting meditation practice 115
23 The Three Minute Breathing Space 119
24 The importance of home practice 125
25 Mindfulness practice in everyday life 129
26 Pleasant and unpleasant experiences 133
27 Cognitive behavioural curriculum elements 137
28 Investigating experience 143
29 The MBCT learning environment 149
30 Teaching through embodiment 155
Further resources 165
References 169
Index 173


The intention of this book is to concisely lay out the distinctive
features of Mindfulness-Based Cognitive Therapy (MBCT). My
hope is that it serves as a basis for understanding the key
theoretical and practical features of MBCT and becomes a
basis for further exploration. By de®nition it is incomplete. The
risk of articulating such a complex and multidimensional
approach in a concise and structured way is that this might be
perceived as the whole pictureÐwhich is far from the case.
It is particularly challenging to articulate theory in relation
to mindfulness practice and many longer term practitioners and
teachers would smile at attempts to do so! One teacher likened
this to trying to pin jelly to the wall! Mindfulness practice and
teaching are pointing us towards subtle, profound and inde®nable
characteristics of the mind that go way beyond easy
psychological description. The endeavour to articulate the processes
that we believe to be in action when we practice mindfulness
is thus inherent with paradox and could be seen as
reductive. However, incomplete as it may be, it is useful to
work to clarify and articulate our understandingsÐso long as
we hold in mind all that we don't know as we do this! I ask you
to remember this as you read. This book may convey the
impression that the theory is more de®ned and solid than it
really is.
The parents of MBCT are Mindfulness-Based Stress
Reduction, which itself draws from the 2500 year legacy of
mindfulness teaching within its Buddhist context, and also from
cognitive-behavioural scienti®c and therapeutic principles.
Those who want to go more deeply into their understanding
of MBCT will need to give space and time to an exploration of
these areas that gave rise to it. There is a wealth of resources
that can support this, some of which are cited at the end of the
book.
The opportunity to write this book came to me through my
work as a teacher and trainer within the Centre for Mindfulness
Research and Practice, Bangor University. I have been privileged
to play a central role in the development of this centre over
the last six years, along with the colleagues and friends who form
the teaching group and the administrative team. Founded by
Professor Mark Williams, while he led the Bangor arm of the
®rst research trial of MBCT, the centre gathered together the
expertise and interest that had formed during this time. As an
occupational therapist engaged in offering one-to-one and group
therapy within a local community mental health team, this
research trial on my doorstep caught my professional interest.
The personal pull was equally strong. Through an interest that
arose during my student years, supported by a range of wonderful
teachers and retreat periods, I had a personal mindfulness
practiceÐa deeply important bedrock within my life. Although
mindfulness practice was central in informing my personal
process while I was engaged in therapy with clients, it was not an
explicit part of my work. The possibility of joining the threads of
my life was compelling.
Mindfulness practice and teaching reminds us that the personal
and the universal are forever entwined. For me this time
of developing mindfulness-based training programmes within
the Centre for Mindfulness Research and Practice has taken
place while my children were in their youngest years, with all the
turbulence, wonder and celebration that this time holds for
many of us. One of the gifts of teaching mindfulness within our
professional lives is the ``wake up call'' it brings to us to hold an
intention to live the approach as fully as we are able in our
personal lives. The (often challenging) reality check that my
family has offered to me has been an invaluable teaching! Similarly,
as a group of teachers, we hold an ongoing intention to
apply the same rigour to our personal and group development,
as we bring to the development of our training programmes.
More than at any other period in my life, I have discovered in
these years that this intention to live as consciously as we are
able within the detail of our lives, is the food that nourishes our
explorations and understanding in a wider sense.
It is an exciting time to be engaged in this work. There is an
upsurge of interest and development at the interface of contemplative
traditions and psychology: a growing sense of the
potential for mindfulness within therapeutic settings. However,
the current evidence base for MBCT is still quite small.
Juxtaposed alongside this is wide interest in and enthusiasm for
its potentialÐa potential that is equally relevant to the professionals
as it is to their clients and patients. Although many
become interested in mindfulness because of the hope it seems
to offer to their clients, they soon ®nd that it isn't possible to
discover the approach other than through a very personal
engagement with it. Most experience this engagement as challenging
but also tremendously rewardingÐ``The practice has
helped me to see my life through new eyes''; ``I feel nourished in
ways which go way beyond the immediate relevance of this to
my clinical practice''. The experience and practice of mindfulness
may be challenging to describe, yet when it touches us it
does so in ways that fundamentally change our orientation to
ourselves and the world.
This book focuses on a particular expression of the current
interest in the integration of mindfulness and therapeutic
approaches: the MBCT programme offered in a group context


for people with a particular clinical problemÐvulnerability to
depressive relapse. There are of course many other skilful means
to offer mindfulness-based approaches in therapeutic settingsÐ
although this book might inform these it does not speci®cally
address them. The main evidence base for MBCT is currently in
relation to its effects for people with recurrent depression. There
are, however, other targeted versions of MBCT being developed,
researched and used in clinical practice, including MBCT
for the recurrence of suicidal depression, for chronic fatigue
syndrome, for oncology patients, for anxiety disorders and
for general stress reduction. Many of the psychological processes
described in this book will be relevant to these other
populations but not all. Given the broader evidence base for
Mindfulness-Based Stress Reduction (MBSR), which demonstrates
positive effect sizes for a range of conditions, there
is good support for these developments. At this early stage in
the development of mindfulness-based applications, there is,
though, a gap between the evidence base and the promise that
the approach appears to hold. In the important process of
extending the use of MBCT to different client populations
and into new contexts, it is important to hold in mind what
we do not know and to proceed into new territory with caution
and care.
This book, in line with others in this series, is divided into 15
Points on the distinctive theoretical features and 15 Points on
the distinctive practical features of MBCT. Given the similarity
between MBCT and MBSR there are a range of features that
are distinctive to both approaches. In these instances the
generic label ``mindfulness-based approach'' or the ``eight-week
mindfulness-based programme'' is used. The theory that this
book primarily focuses on is the cognitive scienti®c background
to the work. There is also reference to the Buddhist underpinning
to mindfulness. There are other theoretical frameworks
that usefully contribute to the understanding of the teaching
process in MBCT (in particular learning theory and group
theory), which are not given space here.

Writing this has been a rich learning experience for me. I
hope that it contributes to your learning and in turn informs
the lives of the people with whom you work.
Rebecca Crane
March 2008


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