Mindfulness-based cognitive therapy (MBCT)

Mindfulness-based cognitive therapy (MBCT) is an 8-week group class for people who have had depression. It mixes mindfulness meditation with ideas from cognitive behavioral therapy (CBT). Its main goal is to help you stay well, so depression is less likely to come back.^1,5

Depression often returns, even after a person feels better. MBCT teaches you to notice the early signs of a dip in mood and to respond in a new way, before it grows. This page explains what the research shows, what the class is like, and who it suits.

What MBCT is

MBCT grew out of mindfulness-based stress reduction (MBSR). It adds exercises from cognitive therapy that show how thoughts and feelings link together.⁹ It was designed for people with recurrent depression (depression that has happened more than once) and for people with low mood that lingers.¹³

Here is the idea behind it. After depression, the link between a low mood and gloomy thinking stays in place, even once you feel better. A small dip in mood can then wake up old thoughts like "I am a failure." Brooding over what went wrong can pull you down into a full episode.⁶ MBCT aims to catch that slide early.

How it differs from regular CBT. In CBT, you learn to question and change unhelpful thoughts. In MBCT, you mostly learn to notice thoughts, feelings and body sensations without getting caught up in them. The aim is to change your relationship to thoughts, not argue with them.⁴ You learn to see a thought as a passing event in the mind, not a fact.

What the research shows

Keeping depression from coming back

This is where the evidence is strongest.

• A large combined analysis (2016). Researchers pooled data from 9 trials with 1,258 people, most of them women, average age 47. Over 60 weeks, people who took MBCT had about a 31% lower risk of relapse than people who did not.¹ In everyday terms, MBCT cut the chance of depression returning by roughly a third.
• Compared with other treatments. MBCT also did a little better than other active treatments, including antidepressants. Its risk of relapse was about 21% lower.¹
• Who gained the most. People who still had more depression symptoms before the class seemed to benefit more. Age, sex, education and the number of past episodes did not change the benefit much.¹

The MBCT developers point to benefit in people who have been depressed three or more times.⁷ Most classes are aimed at people with a history of repeated depression.

Guidelines

• The VA/DoD guideline for depression (2022) suggests MBCT, along with CBT or interpersonal therapy, for people at high risk of relapse. It found no clear winner among the three.² It also lists MBCT as one of several talk therapies to consider for first treatment of depression. Both are "weak for" recommendations. That means the guideline supports them, but the evidence has limits.²
• The UK's NICE guideline (2022) lists group mindfulness programs such as MBCT as one treatment choice for depression.⁴

Treating depression you have right now

MBCT was not first built for people in the middle of a depression. Some research suggests mindfulness programs help current depression and anxiety about as well as other proven therapies.⁸ Moderate evidence But fewer studies follow people for a long time.⁸ If you are depressed now, talk with your doctor about the full range of treatments for depression.

What happens in an MBCT class

1. A first talk. Some teachers meet with you before the class starts. They ask about your health and explain what the course asks of you.
2. Eight weekly group sessions. Classes usually last about 2 hours. A group often has 8 to 15 people. Ideally, two trained leaders run it.^3,4
3. One longer practice day. Many courses include an all-day session of quiet practice, usually between weeks 5 and 7.³
4. Guided practices. You learn to focus on the present moment. You watch your breath, body sensations, thoughts and feelings.⁴ Practices may include a body scan and sitting quietly with the breath.
5. Learning about depression. You learn how mood spirals start and what your own early warning signs look like.⁶
6. Home practice. Much of the real work happens at home, between classes, with guided recordings.^3,4 Expect to practice most days. Ask the teacher how much time to plan for.

Toward the end, many courses help you make a plan for what to do when you notice the first signs of low mood. Our lesson on mindfulness in daily life shows a short practice you can use in hard moments.

Who MBCT suits

Older adults. In the main research, the average person was about 47.¹ So we know less about how well MBCT works for people in their 70s and older. Still, the practices can be done sitting in a chair or lying down. Tell the teacher about hearing, vision, pain or mobility needs. See depression in older adults for more.

People with memory problems. An 8-week course with daily home practice may be hard for someone with dementia. Simple, short practices may suit better. See our mindfulness hub for gentle ways to start.

Is it safe?

Mindfulness is usually low risk, but it is not risk-free. In a review of 83 studies, about 8 in 100 people had a bad reaction to meditation. The most common were more anxiety or low mood. That rate is similar to other talk therapies.⁸

One careful study looked closely at people taking MBCT. Most people (83%) had at least one unpleasant experience linked to practice. About 1 in 3 (37%) had effects that got in the way of daily life. A smaller group, about 6 to 14 in 100, had effects that lasted, such as feeling on edge or feeling detached from yourself.¹⁰

How to find an MBCT course

• Ask your doctor or therapist. Some hospitals, clinics and university mindfulness centers offer MBCT groups.
• Search a directory. Access MBCT is an international listing of professionals who teach MBCT.¹¹
• Veterans. Ask your VA mental health team about mindfulness groups. Mindfulness-based stress reduction is widely taught in the VA.⁹
• Online classes. Some teachers offer MBCT by live video. This can help if travel is hard.

Questions to ask a teacher:^5,14

• What training do you have in MBCT? How long have you taught it?
• Is this the standard 8-week MBCT course? Is it for people with depression?
• How big is the group? Is there a talk before the class starts?
• What does it cost? Is there a sliding scale (lower price for lower income), or does insurance help?
• What should I do if practice stirs up something hard?

Our pages on finding a therapist and paying for therapy can help. If you have Medicare, see Medicare and mental health care.

Common questions

Do I have to be religious, or sit cross-legged on the floor?

No. MBCT is taught as a set of mental skills, not a religion. You can sit in a chair, lie down, or stand.

Can I learn MBCT on my own from a book or app?

You can learn mindfulness skills on your own, and our 4-week mindfulness lessons are a free place to start. But MBCT is designed as a group course led by trained teachers.^3,4 A group also gives support and helps you keep going.

Does MBCT work if mindfulness feels hard for me?

Many people find mindfulness hard at first, especially when the mind is very busy.¹² That is normal. Gentle movement, like slow walking, can help when sitting still feels like too much.¹² If practice keeps making you feel worse, tell your teacher or doctor.

How is MBCT different from MBSR?

Both are 8-week mindfulness classes. MBSR is for stress in general. MBCT adds cognitive therapy ideas and focuses on depression.⁹ See our page on MBSR.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.