Mindfulness-based cognitive therapy

1. Introduction

Version followed: Segal, Williams & Teasdale, Mindfulness-Based Cognitive Therapy for Depression, 2nd edition (Guilford, 2013; paperback 2018), the 8-session group programme for people at risk of recurrent depression. The session names below are the 2013 chapter titles. The 2002 first edition and mbct.com use older names: Automatic Pilot; Dealing with Barriers; Mindfulness of the Breath; Staying Present; Allowing and Letting Be; Thoughts are Not Facts; How Can I Best Take Care of Myself; Using What's Been Learned to Deal with Future Moods. [source: Guilford contents page; mbct.com Classes page]

Caution on sources: Sources include the 2013 book's chapter structure (Guilford contents page) and the session components in published trial tables of MBCT protocols. The book text is not drawn on, so the step-level details below are paraphrased from the manual's known structure and corroborating sources. Any uncorroborated detail is tagged [uncertain].

What MBCT is: MBCT is a manualised 8-week group class. It combines mindfulness meditation training adapted from Kabat-Zinn's MBSR with elements of cognitive therapy for depression. It was designed mainly as relapse prevention for people who have recovered from recurrent depression. It is taught as a class with an instructor, not as individual therapy. Most of the work happens in daily home practice. [source: mbct.com Classes page; Guilford contents]

How change happens: After recovery, a dip in mood can reactivate old negative thinking. When people treat that mood as a problem to fix by thinking harder, they slide into brooding and rumination, and the spiral deepens. MBCT trains a different "mode of mind" (the book contrasts "doing" and "being"; ch. 4). In that mode, people notice the spiral early, take in experience directly without judging it, and allow thoughts and feelings to come and go rather than suppressing them. Thoughts come to be seen as mental events rather than facts. This lets people "nip it in the bud" and choose a skilful response. [source: mbct.com, "How does mindfulness help reduce downward mood spirals"; Guilford contents ch. 2, 4] The underlying cognitive-reactivity and differential-activation model (Teasdale; Segal et al.) is summarised from the book's framing. [uncertain]

2. Framework

Format: 8 weekly classes of about 2 to 2.5 hours, usually for groups of about 8 to 15. There is one individual pre-class interview and one day of mindful practice. The book places the practice day between Sessions 6 and 7; mbct.com says "between weeks 5 and 7". Home practice is about 45 minutes a day, 6 days out of 7, using guided audio (the 2013 book has 13 audio tracks). [source: mbct.com Classes; Guilford contents and audio list; Trials 2019 protocol table ("6 out of 7 days", 45-min body scan)] Group size and exact session length vary between services. [uncertain]

Overall arc: The book divides the programme into two halves [source: Guilford contents ch. 5 "The Eight-Session Program: How and Why"; arc paraphrased, uncertain on wording]:

• Sessions 1–4: learning to notice. Participants recognise automatic pilot, the chattering mind and aversion. They learn to gather and steady attention (body, breath, movement, sounds, thoughts).
• Sessions 5–8: learning to respond differently. Participants allow and let be, relate to thoughts as mental events, take care of themselves through action, and plan for the future.

[source: Guilford contents for titles; components corroborated by Trials 2019 (MBCT adaptation for caregivers) and BMC Psychiatry 2019 (MBCT for bipolar disorder) protocol tables. Both tables describe adapted versions, so allocation to particular weeks may differ from the 2013 manual. [uncertain]]

Typical class structure: Every class has the same rhythm. It opens with a practice, followed by inquiry into that practice. The group then reviews the past week's home practice and its obstacles. New material is introduced through practices and short exercises, with didactic teaching kept brief. Home practice is set, and the class ends with a short practice. [source: mbct.com Classes ("theme… explored through group inquiry and mindfulness practice"; home-practice obstacles discussed); exact running order paraphrased, uncertain]

Criteria for moving on: The programme is session-paced, not criterion-based. Every participant moves through the curriculum together. The MBI:TAC competence framework asks teachers to follow the curriculum's form while staying responsive, matching themes to the stage of the programme and pacing the session well. In practice, individual difficulty is met by adapting within the session (shorter practices, an extra conversation after class), not by holding the group back. [source: MBI:TAC summary, Domain 1; synthesis for the last point]

Who it is for: The original target group is people who have recovered from recurrent depression and are currently well. mbct.com describes the course for people who have been depressed and fear its return, or who are entering a vulnerable period. The commonly cited criteria are three or more past episodes and exclusion of people currently in an acute episode, active suicidality, psychosis or substance dependence. These come from trials not drawn on here. [uncertain] Adaptations exist for bipolar disorder, carers and other groups. [source: mbct.com mood-spirals page; BMC 2019 and Trials 2019 tables]

Teacher requirements: The developers insist on an instructor's own sustained daily mindfulness practice plus formal MBCT teacher training. mbct.com lists a training pathway, and AccessMBCT lists instructors. Competence is commonly assessed with the MBI:TAC (Bangor, Exeter and Oxford; versions 2010, 2018 and 2021). [source: mbct.com links; MBI:TAC summary; Guilford contents ch. 21] The specific pathway requirements (retreats, hours, supervision) are not drawn on. [uncertain]

3. Guiding principles

[source: MBI:TAC summary (Domains 1–6), mbct.com pages, Segal 2016 (mindful.org), Guilford contents ch. 4, 8, 12; one-line meanings are synthesis unless tagged]

• Teach from your own practice (embodiment). Model present-moment focus, steadiness and allowing in your own manner and pacing. Participants learn the attitude as much from how you are as from what you say. [MBI:TAC Domain 3]
• Shift from doing to being. Do not try to fix moods in class. Help participants notice the habit of fixing and taste a mode that simply registers experience. [Guilford ch. 4; mbct.com]
• Mind-wandering is normal, not failure. Every time someone notices the mind has wandered and returns, that counts as the practice, so frame it that way in every guidance. [MBI:TAC Domain 4]
• No promised outcomes. Do not sell practices as relaxation or calm. Avoid striving words such as "try" and "work". [MBI:TAC Domain 4] The breath focus is not for relaxation. [Sears, Session 2 page]
• Precise, spacious guidance. Say exactly where attention goes, use plain words and leave silences. [MBI:TAC Domain 4]
• Experience before explanation. Each theme is learned from participants' direct experience in practice. Didactic teaching comes after and stays brief. [MBI:TAC Domain 5]
• Process over content in inquiry. Ask how something was experienced (sensations, thoughts, impulses) rather than exploring the story behind it. Move through the layers: direct noticing, reflection, and links to wider learning. [MBI:TAC Domain 5; Guilford ch. 12]
• Curiosity, non-judgement, acceptance. Approach all experience, including boredom and dislike, with interest. Reactions are data, not mistakes. [mbct.com Classes; Sears Session 1 page]
• Kindness and self-compassion run through everything. In the 2013 edition this is carried mainly through the instructor's warmth and the tone of guidance rather than a separate kindness exercise. [Guilford ch. 8; "carried through instructor" is uncertain]
• Turn toward, rather than away from, difficulty, gradually. Start with small difficulties so people can succeed, then widen. [Sears Session 5 page; Guilford ch. 13]
• Thoughts are not facts. Treat thoughts, especially mood-driven ones, as mental events to notice, not as truths to obey or argue with. [Guilford ch. 14; Sears Session 6 page]
• Home practice is the course. The real work is daily practice between classes, so review it every week, explore obstacles without blame and problem-solve practically. [mbct.com Classes]
• The 3-minute breathing space is the spine. It is the bridge from formal practice to daily life and is returned to in every session from Session 3. [Guilford ch. 18; Segal 2016]
• Responsive adherence. Keep to the curriculum's form while adapting to the group in front of you. [MBI:TAC Domain 1]
• Hold a safe group container. Set clear agreements and confidentiality, attend to the group's development, and move from personal experience to universal themes ("this is how minds work"). Do not impose your own views. [MBI:TAC Domain 6]
• Trauma and diversity sensitivity. Offer choice of anchors and postures, watch for trauma responses, and attend to power, culture and social circumstances. [MBI:TAC 2021 revision]
• Actively monitor adverse effects. Do not rely on open questions. Ask specifically about sleep, anxiety, dissociation and intrusive memories. [Britton et al. 2021]

4. Intervention inventory

The entries below follow the order of the 2013 curriculum. Durations are typical. All example wording is my own and illustrative. Guide practices in your own words from your own practice, and do not read from a script. The book supplies scripts and audio; buy and use them rather than reconstructing them. [source: Guilford contents and audio list; MBI:TAC Domain 4]

4.1 Pre-class participant interview (individual, before Session 1)

• Purpose: Assess suitability and risk, explain the rationale, prepare the person for the time commitment and for practice becoming uncomfortable at times, and set up an alliance. [source: Guilford ch. 6 (title verified); content paraphrased, uncertain]
• Steps:
  1. Take the depression history: episodes, current mood, current risk, treatments and other diagnoses.
  2. Screen for current factors that make group meditation unwise now: acute severe depression, active suicidality, psychosis, active substance dependence, recent trauma with prominent dissociation. [synthesis, informed by Britton 2021 on dissociation]
  3. Explain the core idea of catching downward spirals early, the class format and the expected daily home practice (about 45 minutes, 6 days a week).
  4. Warn that practice can bring up difficult feelings and that you want to hear about it.
  5. Agree the person's own reasons for coming and their commitment to the course.
• Example language (illustrative): "This course asks for about three quarters of an hour of practice most days for eight weeks. That's a big ask. What would need to shift in your week to make room for it?"
• Watch for: Ambivalence about home practice; a current episode severe enough to block concentration; trauma histories that call for adapted anchors or individual preparation. A good outcome is a person who knows what they are signing up for and has a realistic practice slot.

4.2 Group orientation and agreements (start of Session 1)

• Purpose: Build a safe container for the group. [source: MBI:TAC Domain 6; Sears Session 1 page]
• Steps:
  1. Welcome participants and do brief introductions, for example name and what brought them.
  2. Agree confidentiality, the right to pass, self-care in practices and what to do if absent.
  3. Restate the course aims and the importance of home practice.
• Example language (illustrative): "In any practice, you're always free to open your eyes, change position or simply rest. Looking after yourself is part of the practice."
• Watch for: Over-disclosure early on, and anxiety about "doing it right".

4.3 Raisin exercise (Session 1)

• Purpose: Show the difference between automatic pilot and deliberate, sense-by-sense attention, and introduce the theme of the course. [source: Sears Session 1 page; Trials 2019; BMC 2019; MBI:TAC Domain 4 lists it]
• Steps:
  1. Give each person a raisin (offer an alternative item for allergies or eating difficulties [synthesis]).
  2. Guide slowly through holding, seeing, touching, smelling, placing it in the mouth, chewing and swallowing, as if meeting it for the first time.
  3. Leave pauses so participants can notice thoughts, likes and dislikes, and impulses.
  4. Finish with inquiry.
• Example language (illustrative): "See if you can look at this as though you'd never seen one before… noticing any thoughts about it, and coming back to what you can actually see."
• Inquiry questions (from source): What did you notice? How was that different from how you usually eat? Why might we do this in a course on depression? [Sears Session 1 page]
• Watch for: Disgust or boredom, which are useful to explore as reactions. For people with eating difficulties, make the exercise optional and do not frame it around food intake. [synthesis] It is working when participants spontaneously contrast it with their usual habits.

4.4 Body scan (Sessions 1–2 in class; home practice Weeks 1–2; again in Session 8)

• Purpose: Train moving attention deliberately around the body, noticing sensations as they are, and returning from mind-wandering. It is an early training in the "being" mode. [source: Trials 2019 (45-min body scan, 6 of 7 days); BMC 2019; MBI:TAC Domain 4]
• Steps:
  1. Lying down, or sitting if preferred, guide awareness of the body's contact with the floor or chair, and of the breath.
  2. Move attention region by region, typically from the toes of one foot upward through the whole body. At each region, notice whatever sensations are there, including no sensation.
  3. Repeatedly normalise mind-wandering and invite returning.
  4. End by resting in awareness of the whole body.
  5. In class, use a shorter version (about 13–30 minutes). The home audio is about 40–45 minutes.
• Example language (illustrative): "There's nothing to achieve here, not even relaxation. Just noticing what's here in the left foot right now… and when the mind wanders, noting where it went and coming back."
• Watch for: Sleepiness (suggest eyes open or sitting up); "I couldn't do it", which you can reframe as noticing; increased pain or anxiety. Trauma-related reactions to lying down or attention to certain body areas call for choice of posture and permission to skip regions. [MBI:TAC trauma considerations] It is working when participants report noticing wandering more quickly, and noticing judging.

4.5 Mindfulness of a routine activity (home practice, Weeks 1–2 onward)

• Purpose: Carry the practice into daily life by bringing full attention to one ordinary activity. [source: Sears Session 2 page; Trials 2019; BMC 2019]
• Steps: The participant picks one routine activity, such as showering, brushing teeth or taking out the rubbish, and does it with full attention each day for the week. They choose a different activity each week.
• Example language (illustrative): "Pick something you do every day anyway. This week, see if you can be fully there for it, like the raisin."
• Watch for: Forgetting. Suggest a cue. It is working when people report "waking up" in ordinary moments.

4.6 Thoughts and feelings exercise, "walking down the street" (Session 2)

• Purpose: Show directly that feelings follow interpretations, that interpretations vary with mood, and that the same event can produce very different reactions. [source: Sears Session 2 page; Trials 2019 ("thoughts and feelings exercises")]
• Steps:
  1. Ask participants to close their eyes and imagine walking down a familiar street.
  2. They see someone they know on the other side, call or wave, and the person does not respond and walks on.
  3. Ask them to notice what they thought and felt, including any body sensations.
  4. Collect responses on a board in columns for thoughts and feelings.
  5. Draw out how different interpretations led to different feelings, and how current mood shaped the interpretation.
• Example language (illustrative): "So two people in the same imaginary street, same friend, same non-wave—one feels hurt, one feels nothing much. What made the difference?"
• Watch for: Debating which interpretation is "right". Steer to the process: interpretation is fast and automatic and colours feeling. Sears adds an ABC-model framing; that is his teaching addition, not necessarily the manual's. [uncertain]

4.7 Pleasant experiences calendar (home practice after Session 2)

• Purpose: Practise noticing the parts of an experience (body sensations, feelings, thoughts) as it happens. Pleasant events are used because they are easier to notice and are often missed in depression. [source: Sears Session 2 page; Trials 2019; BMC 2019]
• Steps: Each day the participant notes one pleasant event: what it was, whether they were aware of it at the time, the body sensations, moods and feelings, the thoughts, and what they think now while writing.
• Example language (illustrative): "This isn't about having more pleasant moments. It's about noticing the ones that are already there, and what they're made of."
• Watch for: Unlike a CBT thought record, this is for observing, not changing or challenging, so correct any drift toward disputing thoughts. [Sears Session 2 page] It is working when participants can name body sensations, not only thoughts.

4.8 Short breath practice and sitting meditation with breath (from Session 2) and with breath and body (Session 3)

• Purpose: Build a steadier focus and the skill of returning, using the breath as an anchor. In Session 3 attention widens to the body as a whole. [source: Trials 2019; BMC 2019; Sears Session 2 page]
• Steps:
  1. Help participants into an upright, dignified, comfortable posture on a chair or cushion.
  2. Guide attention to the physical sensations of breathing at a chosen place: belly, chest or nostrils.
  3. When the mind wanders, note briefly where it went and escort attention back, kindly.
  4. Later, expand attention to the body as a whole, sitting and breathing.
  5. When intense sensations such as discomfort arise, there are two options: shift posture mindfully, or bring attention into the sensation and explore it.
  6. Length: about 10 minutes for home practice in Week 2; 30–40 minutes in later sessions.
• Example language (illustrative): "You don't need to control the breath. Just feeling it as it is… and each time you notice you've drifted, that moment of noticing is the practice."
• Watch for: Breath-focus anxiety or panic (offer alternative anchors such as feet, hands or sounds [MBI:TAC trauma considerations]); striving for calm. It is working when people find the noticing-and-returning cycle more familiar and less self-critical.

4.9 Brief seeing or hearing practice (Sessions 3–4)

• Purpose: A short opening practice of a few minutes that gathers attention through one sense. It shows the difference between perceiving and labelling. [source: Trials 2019 ("seeing and hearing practice"); BMC 2019 ("awareness of surroundings")]
• Steps: Invite participants to look out of a window or listen to the sounds around them. Notice colours, shapes, pitch and volume as raw sensation, and notice the mind's urge to name and judge.
• Example language (illustrative): "See if you can let the sound just be sound, before the mind says 'car' or 'annoying'."
• Watch for: Over-intellectualising.

4.10 Mindful movement or stretching (Sessions 3 onward; home practice)

• Purpose: Bring awareness to the body in motion and to physical limits, and practise working gently at one's edge. It offers an easier route into the body for people who find stillness hard. [source: Trials 2019; BMC 2019 (floor and standing yoga)]
• Steps:
  1. Guide simple, slow stretches (standing or on the floor, drawn from hatha yoga), with attention to sensation and breath during and after each movement.
  2. Repeatedly invite people to stay within their limits and to modify or skip movements.
• Example language (illustrative): "Only go as far as feels right for your body today. Noticing the edge, and resting there rather than pushing through."
• Safety: Ask about injuries, pregnancy and medical conditions beforehand. Offer chair-based options. Never encourage pushing into pain. [synthesis; MBI:TAC practice-specific safety]
• Watch for: Competitive striving and self-criticism about the body. It is working when people treat their limits with interest rather than judgement.

4.11 Three-minute breathing space, regular (from Session 3; three times a day at set times)

• Purpose: A short, portable practice that moves people from automatic pilot into awareness during the day. The book calls it the "spine" of the programme (ch. 18). [source: Segal 2016, mindful.org; Guilford ch. 18; Trials 2019 (three times daily)]
• Steps (Segal's 2016 wording of the three steps):
  1. Attend to what is, about 1 minute. Adopt an alert posture and broadly notice and acknowledge the thoughts, feelings and body sensations present, without needing to change them.
  2. Focus on the breath, about 1 minute. Narrow attention to the physical sensations of breathing.
  3. Attend to the body, about 1 minute. Widen attention to the body as a whole, including posture and any sensations.
• Shape: Segal calls it a "choreography of awareness": wide, then narrow, then wide. [Segal 2016] The manual's common teaching image is an hourglass. [uncertain]
• Example language (illustrative): "First, just checking in: what's here right now? … Now gathering attention to the breath, here in the belly… and now letting awareness spread out to the whole body, just as it is."
• Watch for: Use as a relaxation or escape trick, which it is not. It is working when participants start using it unprompted at difficult moments. Segal reports it as one of the most durable practices after the course ends. [Segal 2016]

4.12 Unpleasant experiences calendar (home practice after Session 3)

• Purpose: Turn toward unpleasant events and break them down into sensations, feelings and thoughts. This builds the ground for recognising aversion in Session 4. [source: Trials 2019; BMC 2019]
• Steps: Same format as 4.7, recorded for one unpleasant experience each day.
• Example language (illustrative): "Notice what happens in the body when something unwelcome happens. Where do you feel it first?"
• Watch for: Recording becoming rumination. Keep entries brief and focused on the body. It is working when participants notice the tightening and bracing of aversion as it happens.

4.13 Mindful walking (from Session 4; home practice option)

• Purpose: Bring awareness into movement and the soles of the feet. This option is useful when agitation makes sitting hard. [source: Trials 2019; BMC 2019]
• Steps:
  1. Walk slowly back and forth along a short path.
  2. Attend to the sensations of lifting, moving and placing each foot, and the shift of weight.
  3. When the mind wanders, return to the feet.
  4. Speed can vary.
• Example language (illustrative): "No destination—just this step, then this one."
• Watch for: Self-consciousness in a group. Arrange the room so people are not watched.

4.14 Sitting meditation: breath, body, sounds and thoughts, and later choiceless awareness (Sessions 4 onward)

• Purpose: Extend the sitting practice step by step, from breath to body, to sounds, then to thoughts as events arriving and passing "like sounds". This trains decentering from thoughts. Later sessions add open, choiceless awareness. [source: Trials 2019; BMC 2019; MBI:TAC Domain 4 ("sounds and thoughts"); Sears Session 4 page (observing thoughts; movie-theatre analogy)]
• Steps:
  1. Settle with the breath, then the body as a whole (as in 4.8).
  2. Move attention to sounds as they arise and fade, without labelling.
  3. Then shift to thoughts. Notice them as events in the mind, appearing, lingering and passing, like sounds or like images on a screen.
  4. Notice when you have been carried off by a thought, and come back to watching.
  5. Optionally, rest in open awareness of whatever is most prominent.
  6. Length: 30–40 minutes.
• Example language (illustrative): "As best you can, letting thoughts come and go the way sounds do—noticing a thought arrive, noticing it leave."
• Watch for: Thought practice can be destabilising for people prone to rumination or dissociation, so offer a return to the breath or body at any time. It is working when participants report seeing a thought as a thought ("there's the 'I'm useless' one again").

4.15 Exploring the territory of depression (Session 4 didactic exercise)

• Purpose: Help participants recognise depressive thinking and symptoms as a common, predictable pattern ("the territory") rather than personal truth. This is the main cognitive-therapy psychoeducation element. [source: BMC 2019 ("recognizing and managing depression symptoms"; "negative automatic thoughts"); specific use of a published automatic-thoughts questionnaire and of diagnostic criteria is uncertain]
• Steps:
  1. Present the standard symptoms of depression and a range of typical negative automatic thoughts, using the manual's handouts or an equivalent licensed list (do not reproduce questionnaire items).
  2. Ask participants how believable such thoughts feel when they are depressed compared with now.
  3. Draw out that these thoughts are symptoms of a state, shared by many people.
• Example language (illustrative): "Notice how these thoughts sound almost identical across people. That suggests they belong to depression, not to you."
• Watch for: Shame or activation of current low mood. Pace carefully and link back to the breathing space.

4.16 Responsive (coping) breathing space, and breathing space with added instructions (from Session 4)

• Purpose: Use the breathing space not only at set times but whenever unpleasant thoughts, feelings or sensations arise. Later sessions extend it into a doorway to further steps. [source: Trials 2019 ("responsive 3-minute breathing space"; "with added instructions whenever unpleasant feelings arise"); BMC 2019 ("coping breathing space")]
• Steps:
  1. Do the three steps (4.11), triggered by noticing difficulty.
  2. After the breathing space, choose a next step. The manual describes several options: re-entering the body (bringing attention to where the difficulty sits; Session 5), seeing thoughts differently (Session 6), and taking a skilful action (Session 7). [the "doors" framing is uncertain]
• Example language (illustrative): "When you notice the slide starting, that's the cue. Step out of autopilot for three minutes, then ask what's needed next."
• Watch for: Using it to make feelings go away, which is aversion in disguise. Gently point that out.

4.17 Working with difficulty in sitting practice (Session 5; "sitting with difficulty")

• Purpose: Turn toward difficult experience in the body with allowing rather than aversion. This is exposure-like work. Sears identifies it as the element that most distinguishes MBCT from MBSR. [source: Sears Session 5 page; Guilford ch. 13 "Allowing/Letting Be"; detailed steps paraphrased: uncertain]
• Consent and safety (exposure): Explain beforehand what the practice involves. Make clear that bringing a difficulty to mind is optional. Advise choosing a minor, current concern, not a trauma or the worst problem. Sears: start with small irritations so people succeed first. Stress that anyone can return to the breath or open their eyes at any time. Contraindications for this step at this time: acute suicidality, unprocessed trauma with flashbacks or dissociation, active psychosis. For these, keep the practice to breath and body anchors and follow up individually. [synthesis; Britton 2021 on trauma re-experiencing and dissociation]
• Steps:
  1. Begin with sitting practice on breath and body.
  2. If a difficulty is already present, notice it. Otherwise, invite participants to bring a small current concern to mind.
  3. Notice where in the body it shows up and bring attention to the strongest area of sensation.
  4. Explore the sensations with curiosity (location, quality, intensity, change), perhaps directing the breath into and out from that region.
  5. Offer an allowing attitude, for example silently acknowledging that it is already here and can be felt.
  6. Note softening or opening rather than bracing, without making relief the goal.
  7. Return to the breath or body as a whole if it becomes too much, and end with the breath.
• Example language (illustrative): "Just seeing whether it's possible to let this be here, because it already is… not wanting it, just allowing it room."
• Watch for: Flooding, rising panic, dissociation (numbness, unreality) or intrusive memories. Stop, ground the person (eyes open, feet, room) and follow up individually. It is working when participants report noticing the body's bracing and some loosening, or a changed relationship to the difficulty even if the difficulty itself remains.

4.18 Poems and readings (from Session 5 and throughout)

• Purpose: Convey themes such as acceptance, welcoming difficult guests and kindness indirectly. [source: Sears Session 5 page ("poetry and discussion"); MBI:TAC Domain 5 (stories, poems)] Rumi's "The Guest House" is commonly used in Session 5. [uncertain: name not in the sources] Do not reproduce texts; read from a licensed copy.
• Steps: Read slowly once, pause, then invite responses in the form "what did you notice in yourself as you heard it?"
• Watch for: Participants feeling pressured to welcome everything. Acknowledge how hard that is.

4.19 Moods, thoughts and alternative viewpoints exercise (Session 6)

• Purpose: Show directly that mood shapes interpretation, so that thoughts are seen as products of a state, not facts. [source: Trials 2019 ("mood, thoughts and alternative viewpoints exercise"); Sears Session 6 page; Guilford ch. 14]
• Steps:
  1. Present a brief social scenario: Sears uses a colleague who says they have no time to talk.
  2. Ask participants to imagine it first after an upsetting event, then after a pleasing one.
  3. Note the thoughts and feelings each time.
  4. Compare how the same event reads differently depending on mood.
• Example language (illustrative): "Same words, same colleague. What changed was the mood you walked in with."
• Watch for: Debate about the "real" meaning. Return to how mood colours thinking. It is working when participants can say "that's the mood talking".

4.20 Ways of relating to thoughts (Session 6)

• Purpose: Give participants a range of ways to step back from compelling thoughts. [source: Sears Session 6 page (five ways); Guilford ch. 14; correspondence to the manual's handout: uncertain]
• Steps: Offer and practise options such as:
  1. Just watching thoughts come and go without needing to follow them.
  2. Noticing the feeling beneath a recurring thought.
  3. Seeing a thought as a mental event that may not match reality.
  4. Writing thoughts down to see them from outside.
  5. Staying with a difficult thought in mindful attention until it changes or passes.
• Example language (illustrative): "Instead of arguing with the thought, could you notice it as a thought, and maybe note the feeling that's driving it?"
• Watch for: Slipping into disputing the content, which is classic CT. MBCT emphasises changing one's relationship to thoughts rather than their content.

4.21 Day of mindful practice (between Sessions 6 and 7)

• Purpose: Extended practice, largely in silence, to deepen and integrate the practices. [source: Guilford ch. 15; mbct.com (all-day session between weeks 5 and 7); BMC 2019 (six-hour silent day)]
• Steps:
  1. A sequence of the course practices: sitting, body scan, movement, walking, mindful eating and breathing spaces.
  2. Silence is kept for most of the day.
  3. Close with a brief transition back to speaking and a short inquiry.
  4. Participants from other groups and graduates may attend. [uncertain]
• Example language (illustrative): "Silence today isn't a rule to get right; it's a chance to notice what the mind does with more space."
• Watch for: Distress or lasting after-effects. Britton 2021 found only a small fraction of adverse effects linked to the retreat day, but monitor it all the same. Offer a check-in at the end and contact details.

4.22 Activity and mood: nourishing and depleting activities (Session 7)

• Purpose: Link daily activity patterns to mood and plan more nourishing activities. This is the behavioural element of the course. [source: Sears Session 7 page (nourishing/draining); Trials 2019 ("activity and mood exercise")]
• Steps:
  1. Participants list the activities of a typical day.
  2. They mark each as nourishing (lifts mood, energises) or depleting (lowers mood, drains).
  3. They consider how to increase nourishing activities, and how to reduce or relate differently to depleting ones.
• Example language (illustrative): "Looking at your list, where is there a little room to tip the balance?"
• Watch for: All-or-nothing plans. Encourage small, realistic changes.

4.23 Mastery and pleasure activities, and the breathing space as a step toward action (Session 7)

• Purpose: When mood is low, motivation follows action rather than leading it. Participants plan small actions that give pleasure or a sense of mastery, chosen after a breathing space. [source: Guilford ch. 16 title ("How can I best take care of myself?"); Sears Session 7 page (breathing space before mindful action); the mastery/pleasure terminology is uncertain]
• Steps:
  1. Take a breathing space.
  2. Ask: what do I need now? How can I best take care of myself?
  3. Choose a small activity that gives pleasure, or one that gives a sense of achievement or control.
  4. Do it as an experiment, without expecting the mood to lift immediately.
• Example language (illustrative): "Even something small counts, like a five-minute walk or clearing one drawer. Notice afterwards, without judging, what changed and what didn't."
• Watch for: Measuring success by mood change. The aim is acting kindly toward oneself.

4.24 Relapse signature and action plan (Sessions 6–7)

• Purpose: Identify personal early warning signs of relapse (thoughts, feelings, behaviours, body sensations) and write a plan for responding early, involving supportive others. [source: Sears Session 6 page (early warning system); Trials 2019 ("action plan for low moods"); BMC 2019 (relapse prevention plan)]
• Steps:
  1. List early warning signs, including subtle ones, ideally with input from people close to the participant.
  2. Write a plan for what to do when those signs appear: start with a breathing space, then practices and activities that have helped, people to contact, and professional help and crisis contacts.
  3. Include what to do if thinking feels too clouded to use the plan, for example a letter to oneself. [uncertain]
• Example language (illustrative): "When you're in the early part of a slide, what would you want your well self to have written down for you?"
• Watch for: Plans that are vague or too ambitious. Check that crisis contacts are included and that the plan is shared with the participant's clinician where relevant. [synthesis]

4.25 Session 8: body scan, review and looking forward

• Purpose: Consolidate learning, plan continuing practice and close the group. [source: Guilford ch. 17; Trials 2019 ("looking forward" and "preparing for the future" exercises; body scan); BMC 2019]
• Steps:
  1. Return to the body scan.
  2. Review the course: what participants learned and what was hard.
  3. Each person names their reasons to keep practising, linked to what they care about.
  4. Each makes a realistic practice plan (formal and informal, with breathing spaces).
  5. Close with a final practice and closing round. Some teachers give a small token object. [uncertain]
  6. Give information on follow-up or reunion classes if offered.
• Example language (illustrative): "What would you most want to remember from these eight weeks, and what's one practice you're realistically going to keep?"
• Watch for: Over-ambitious plans and abrupt endings for participants who are distressed by the loss of the group. Give clear next steps.

4.26 Inquiry (cross-cutting; after every practice)

• Purpose: The main teaching method. A dialogue about participants' direct experience of a practice that draws out the session's theme. [source: Guilford ch. 12; MBI:TAC Domain 5; Sears Session 1 page]
• Steps:
  1. Layer 1, direct experience: "What did you notice?" Ask for sensations, feelings, thoughts and impulses, and stay with specifics.
  2. Layer 2, reflection: "How is that different from or similar to how you usually are?"
  3. Layer 3, wider learning: "How might that relate to keeping well, or to depression?"
  4. Throughout, stay with the process rather than the story. Show curiosity and acceptance. Avoid praising "good" experiences or fixing "bad" ones. Link individual experience to universal patterns.
• Example language (illustrative): "When you noticed the irritation, where did you feel it? … And what did the mind do next?"
• Watch for: Drifting into therapy or advice-giving, one participant dominating, or the teacher lecturing. It is working when participants begin asking each other process questions.

4.27 Home-practice review (cross-cutting; each session)

• Purpose: Support the daily practice that carries the course, and use obstacles as learning. [source: mbct.com Classes; BMC 2019 ("Dealing with barriers")]
• Steps:
  1. In pairs or as a whole group, ask what happened in practice this week, including not doing it.
  2. Explore obstacles (time, sleepiness, boredom, "doing it wrong") with curiosity.
  3. Problem-solve practicalities.
  4. Hand out the next week's practice sheet and audio.
• Example language (illustrative): "Not practising is also something we can be curious about. What got in the way, and what did the mind say about it?"
• Watch for: Shame and avoidance. Normalise without lowering the expectation.

5. Handling problems

Sources: Britton et al. 2021 for adverse effects; MBI:TAC for trauma-sensitivity and group holding; mbct.com and Sears for home-practice obstacles. Everything else is tagged [synthesis].

Meditation-related adverse effects (most important MBCT-specific problem). In Britton et al.'s 2021 MBCT trial (n = 96 completers), 58% reported at least one negative meditation-related effect. 37% reported effects that harmed functioning, and 6–14% had lasting bad effects (from over a day to over a month). The most common effects were anxiety and panic, insomnia, problems with concentration and planning (executive dysfunction), re-experiencing trauma, and dissociation: emotional blunting, derealisation and disturbed sense of self. Open questions missed about 70% of them. [source: Britton 2021]

• Respond by monitoring actively: In the weekly check-in or individually, ask specifically about sleep, anxiety, numbness or unreality, intrusive memories, and concentration. [source: Britton 2021 recommendations]
• Watch the strongest warning signs: Emotional blunting, derealisation, self-disturbance, executive dysfunction and insomnia. These rare signs predicted lasting harm. Do not simply encourage "accepting" them, because Britton found non-judgemental acceptance alone was not enough to prevent impairment. [source: Britton 2021]
• Adjust the practice: Shorten practices; switch to eyes-open, movement or walking practice; use external anchors such as sounds, feet or hands instead of the breath; reduce time spent on difficult material; pause home practice temporarily; refer for individual assessment. Higher informal-practice frequency after the course was linked to lasting effects, so do not push more practice as the answer to distress. [source: Britton 2021 (practice-amount association); the specific adjustments are synthesis]
• Example language (illustrative): "Some people notice sleep changing, or feeling oddly flat or unreal after practice. Has anything like that happened for you this week?"

Overwhelm during practice (panic, flooding, flashbacks). Ground the person: eyes open, feel the feet, name objects in the room, and stand or move if useful. Make clear they can stop at any time. Afterwards, check in privately, agree on modified anchors and, if needed, liaise with the person's clinician. In the next session, re-offer the safety options to the whole group without singling anyone out. [source: MBI:TAC 2021 trauma considerations; specifics synthesis]

Breath focus triggers anxiety. Offer anchors outside the breath (soles of feet, hands on thighs, sounds) and let the person choose. Frame this as an equally valid practice. [synthesis; MBI:TAC trauma-sensitive guidance]

Non-adherence to home practice. Explore the obstacle with curiosity in the review (4.27). Problem-solve the timing and setting: the same time daily, linked to an existing routine. Accept shorter practices as a start, while keeping 45 minutes as the course expectation. Use the breathing space as the minimum daily practice. Explore the self-critical thoughts about not practising as material for practice. [source: mbct.com (home practice as the main work; obstacles discussed); specifics synthesis]

"It's not working" or striving for calm. Restate that the practice does not promise relaxation and is about noticing. Inquire into what "working" would look like and notice that as a "doing"-mode goal. Point to small signs such as noticing wandering sooner. [source: MBI:TAC Domain 4 (no promised outcomes); Guilford ch. 4; framing synthesis]

Sleepiness and boredom. For sleepiness: open eyes, sit more upright, practise at a different time of day, or move. For boredom: treat it as an experience to explore. [synthesis]

Stuck in story, or rumination during inquiry. Gently redirect from content to process ("and where was that in your body?"). Thank the person and widen the question to the group. Offer an individual conversation if personal issues need space. [source: MBI:TAC Domain 5 (process over content); technique synthesis]

Group dynamics: a dominant participant, a silent participant, conflict. Restate the group agreements. Use pair work. Invite but do not require speaking. Name universal themes so no one is isolated. For conflict, speak with individuals after class. [source: MBI:TAC Domain 6; specifics synthesis]

Ruptures with the instructor (for example, feeling judged, misunderstood or pressured). Acknowledge the experience without defending yourself and stay curious about it. If needed, have a brief one-to-one after class and repair openly. Modelling allowing and kindness in the repair is itself the teaching. [synthesis]

Re-emerging depression or suicidal thinking during the course. Follow standard risk assessment: ask directly about suicidal thoughts, intent, plans and protective factors, and agree a safety plan, including lethal-means counselling about safe storage or removal. Contact the person's clinician or GP according to your service protocol. Decide with the person whether continuing the group is appropriate now. Some can continue with modified practice and closer monitoring; others need to pause. Bring forward use of the action plan (4.24). Have a written risk protocol before the course starts and give crisis contacts to all participants. [synthesis; standard practice]

Turning toward difficulty is too much (Session 5). Return to a smaller difficulty or to body anchors only. Remind the person it is optional. Stay with the body rather than the narrative. Review in a one-to-one conversation. [source: Sears Session 5 (start small); specifics synthesis]

Physical pain or injury in movement practice. Offer modifications, chair options or visualising the movement, and stop if there is pain. Ask about medical conditions at the interview. [synthesis]

Missed sessions. Give the handouts and audio, offer a brief catch-up conversation and agree a re-entry plan. Many programmes set a minimum attendance. [synthesis; uncertain]

Adapting for individual therapy. MBCT is designed as a group class, and the manual is written for that. Using its practices in individual therapy is common but is an adaptation, not MBCT as manualised. If you do this, keep the session sequence, home practice and inquiry, and mark it as MBCT-informed. [synthesis]

Instructor's own practice lapses. The MBI:TAC treats embodiment as a core competence. Maintain daily practice, supervision and retreats. [source: MBI:TAC Domain 3; specifics synthesis]

Sources

Sources:

• Mindfulness-Based Cognitive Therapy for Depression, 2nd ed. — Table of contents (Guilford Press)
• Classes — MBCT.com
• How does mindfulness help reduce downward mood spirals? — MBCT.com
• The Three-Minute Breathing Space Practice — Zindel Segal, Mindful.org (2016)
• MBI:TAC summary — Bangor, Exeter and Oxford Universities
• Britton et al. (2021) Defining and measuring meditation-related adverse effects in mindfulness-based programs (PDF)
• MBCT protocol table — BMC Psychiatry 2019 (MBCT for bipolar disorder)
• MBCT protocol table — Trials 2019 (adapted MBCT for dementia caregivers)
• MBCT Session 1: Awareness and Automatic Pilot — R. Sears, Psychotherapy Academy
• MBCT Session 2: Living in our Heads — R. Sears, Psychotherapy Academy
• MBCT Session 4 — R. Sears, Psychotherapy Academy (preview only)
• MBCT Session 5 — R. Sears, Psychotherapy Academy (preview only)
• MBCT Session 6: Thoughts Are Not Facts — R. Sears, Psychotherapy Academy
• MBCT Session 7: Self-care — R. Sears, Psychotherapy Academy (preview only)

Further reading (not drawn on):

• Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2013). Mindfulness-Based Cognitive Therapy for Depression (2nd ed.). Guilford Press. (Primary manual; structure verified via the contents page.)
• Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-Based Cognitive Therapy for Depression: A New Approach to Preventing Relapse. Guilford Press. (First edition.)
• Britton, W. B., Lindahl, J. R., Cooper, D. J., Canby, N. K., & Palitsky, R. (2021). Defining and measuring meditation-related adverse effects in mindfulness-based programs. Clinical Psychological Science. https://doi.org/10.1177/2167702621996340

Further reading (not drawn on): the MBCT book text itself, the Wikipedia article, and the mbct.com training pathway. Details sourced only from the book are tagged [uncertain].