Q: Is Mindfulness-Based Cognitive Therapy helpful for intrusive thoughts related to OCD?

Fabrizio Didonna’s book Mindfulness-Based Cognitive Therapy for OCD is a great resource to understand how MBCT can be modified to address intrusive thoughts related to OCD. He also addresses this on his website: https://mbctforocd.com/

Question 1

Is Mindfulness-Based Cognitive Therapy helpful for intrusive thoughts related to OCD?

Zindel Segal · Accepted Answer

Fabrizio Didonna’s book Mindfulness-Based Cognitive Therapy for OCD is a great resource to understand how MBCT can be modified to address intrusive thoughts related to OCD. He also addresses this on his website: https://mbctforocd.com/

Question 2

Would you please discuss iatrogenic issues regarding MBCT?

Zindel Segal · Accepted Answer

As with many meditative practices, observing difficult thoughts, feelings or body sensations can present an opportunity for learning as well as generate discomfort and distress. For people who are not prepared to work with these mental contents, it can be jarring and lead to increases in anxiety, arousal or intrusive thoughts. It is generally recognized that different phases of meditation, including an initial phase in which the body and mind relax, followed by a phase of observing experience, include at times challenging material. In MBCT, participants are told that they are the ones who decide how far into the practice they wish to go at any given time.

Question 3

What principles of mindfulness are integrated into MBCT?

Zindel Segal · Accepted Answer

Mindfulness is taught in a number of ways to allow participants to experience a number of practices that can fit into their lives, including mindful eating, body scan, sitting meditation, walking meditation, introducing a difficulty into the practice and the three minute breathing space.

Question 4

Is MBCT suitable for people across all cultural backgrounds and religious beliefs?

Zindel Segal · Accepted Answer

To be honest, we emphasized a secular approach in designing MBCT that was intended to open the door as wide as possible for people from multiple cultural and religious backgrounds to be able to participate. If asked, teachers would openly acknowledge the Buddhist origins of mindfulness and meditation, but these practices do not require subscribing to any particular cultural or religious beliefs.

Question 5

What are some of the key things that MBCT includes as compared to CBT? For example, how does MBCT help people respond to negative self-thoughts? Does MBCT include a behavioral component in treatment?

Zindel Segal · Accepted Answer

When working with thoughts, the emphasis is firstly on building the capacity to observe and become curious about what one is thinking, developing the ability to watch thoughts come and go in the mind. It is only later, and if needed, that we might start to work on examining the degree of belief attached to certain thoughts. Also, in MBCT the practice of mindfulness sits alongside CBT strategies for mood regulation. Session 7 features ratings of mastery and pleasure, along with behavioral activation strategies for moments when moods drop. The important difference is that these skills are taught to folks who are by and large recovered from depression or have some residual symptoms. Teaching these skills requires that they be modified for this context.

Question 6

What are the key skills learnt in MBCT?

Zindel Segal · Accepted Answer

The key principles involve learning how to use mindfulness meditation to regulate negative affect. This includes developing a relationship to troubling thoughts and feelings that involves, as a first step, familiarity and curiosity, rather than avoidance.

Question 7

I've seen that MBCT is helpful in preventing depression relapse, but is it effective in treating current depressive symptoms?

Zindel Segal · Accepted Answer

MBCT has its strongest evidence base associated with preventing depressive relapse or treating residual depressive symptoms. There have been studies investigating its use with people who were in the midst of a depressive episode and, while findings from this work have been positive, my own feeling is that the program would need to be modified to be appropriate for this population (e.g. shorter mindfulness practices, less sitting and more movement). I do not see MBCT as suitable as a treatment for more severe depression. Probably best for when some measure of treatment response has been achieved via other interventions.

Question 8

What strategies does MBCT use to help with rumination?

Zindel Segal · Accepted Answer

The core work involves developing metacognitive awareness around rumination as a stream of thoughts occurring in the mind, but we don’t have to follow it. Bringing our attention to bodily sensations in the moment can take attentional resources away from the type of elaborative processing that feeds rumination. In this way, we don’t have to struggle to stop or eliminate rumination. Rather, it can do its thing and you can watch it without feeding it further.

Question 9

Can mindfulness help with emotion regulation?

Zindel Segal · Accepted Answer

Yes. A good deal of work in MBCT focuses on understanding emotions through bodily sensations and how they change over time. Also, a stance on emotion of allowing and letting them be gives people a chance to learn about emotions more directly compared to simply believing what our minds tell us is going to happen.

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