Welcome to the 8-week MBCT program. MBCT stands for mindfulness-based cognitive therapy. It is a program specifically designed to help you deal with persistent unwanted mood states.
MBCT has been tested in research and proven effective for depression, as well as for anxiety and a wide range of other problems.
You can use this book in a number of ways: as a member of a professionally guided MBCT class, as part of individual therapy, or as self-help.
We wish you well as you embark on this voyage—to discover how you may best nourish your deepest capacity for wholeness and healing.
If you've ever been deeply unhappy with your life for any length of time, you know how difficult it can be to do anything about it. No matter how hard you may try, things just don't get better—or not for long. You feel stressed out, exhausted with the effort of just keeping going. Life has lost its color, and you don't seem to know how to get it back.
Gradually you may come to believe that there must be something wrong with you, that fundamentally you are just not good enough.
This sense of inner emptiness might come from an accumulation of stresses over a long period of time or from one or two traumatic events that unexpectedly dislocate your life. It might even just arise out of the blue without any apparent cause. You might find yourself lost in inconsolable sorrow; feeling profoundly empty; or painfully disappointed with yourself, with other people, or with the world in general.
If these feelings escalate, they may become severe enough to be called clinical depression. But the sort of unhappiness we are speaking of here touches all of us from time to time.
For any of us who find ourselves with low mood of any magnitude or duration—whether it's major depression; persistent, nagging unhappiness; or intermittent periods of the blues that feel disruptive or disabling—the despair and demoralization, the sheer joylessness typical of depression, are never very far away.
When things get overwhelming, we may distract ourselves for a while, but questions keep nagging at the back of the mind: "Why can't I pull myself out of this?" "What if it stays this way forever?" "What's wrong with me?"
Bringing Back Hope
What if, despite what your thoughts may try to tell you, there is nothing wrong with you at all?
What if your heroic efforts to prevent your feelings from getting the best of you are actually backfiring?
What if they are the very things that are keeping you stuck in suffering or even making things worse?
This book is written to help you understand how this happens and what you can do about it.
Mindfulness-Based Cognitive Therapy (MBCT)
In these pages we will guide you, step by step, through the MBCT program.
This research-based 8-week course is designed to give you the skills and understanding that will empower you to free yourself from getting entangled in painful emotions.
Of course, depression often arrives hand in hand with anxiety, irritability, or other unwanted emotions. The good news is that while MBCT was developed and has proven extremely effective for depression, research is now also showing powerful effects of MBCT on persistent anxiety and other destructive emotions.
The heart of MBCT is gentle, systematic training in mindfulness (we'll say more about what mindfulness is later).
This training frees us from the grip of two critical processes that lie at the root of depression and many other emotional problems:
1. the tendency to overthink, ruminate, or worry too much about some things,
2. a tendency to avoid, suppress, or push away other things.
If you have suffered long-term emotional difficulties, you'll have already discovered that worrying or suppressing doesn't really help.
But you may feel powerless to stop it.
Redoubling your efforts to switch off your troubled mind may give temporary relief, but it can also make things worse.
Your attention is still hijacked by whatever is troubling you: it's so difficult to prevent the mind from being dragged back again and again to the very place from which you want to escape.
What if it were possible to learn wholly new skills that allowed you to cultivate a radically different way of working with your mind?
Mindfulness training teaches exactly these skills: it gives you back control of your attention so that, moment by moment, you can experience yourself and the world without the harsh self-critical voice of judgment that may so often follow you around.
Daily practice of mindfulness reduces the tendency to brood and worry about everything.
You wake up to the small beauties and pleasures of the world.
You learn to respond wisely and compassionately to the people and events that affect you.
We developed MBCT, and we have seen, over and over again, how it liberates people from their burden of low mood and the stress and exhaustion that goes with it. We've seen the extraordinary consequences of their discovery that there is a way to live life more fully than they ever imagined.
Who Is This Book For?
This book is for anyone who wishes to take the 8-week MBCT program.
This might be as part of a class taught by an instructor, as part of individual therapy, or as a form of self-help, working through the program by yourself or with a friend. Whichever of these routes you take, you will be supported on a daily basis by the guided practices recorded on the CD or audio downloads that come with the book.
And, of course, you don't have to have been seriously depressed to find the MBCT program valuable:
Research is constantly expanding the range of emotional problems that benefit from MBCT.
MBCT focuses on the core psychological processes that lie at the root of many different ways in which we can get stuck in unhappiness.
Why Another Book?
We have already written one book describing MBCT for a wide audience: The Mindful Way through Depression (coauthored with our colleague Jon Kabat-Zinn, the principal figure catalyzing and guiding the surge of interest in mindfulness that has swept the world in recent decades).
That book and this workbook complement each other; it is very helpful to use them in tandem.
If you have not read The Mindful Way through Depression, you may find it a useful general introduction to the MBCT approach. It gives a lot of background detail that might be particularly helpful if you are using this workbook on your own, as self-help.
If you have already read The Mindful Way through Depression, this workbook will give you all the additional tools and detailed practical guidance you need to take yourself through the MBCT program.
For many people, the most helpful approach might be to read The Mindful Way through Depression (or have it available for reference) along with using this workbook. Many find it most effective to do this in the company of others, working through MBCT in a group with a trained teacher.
The Shape of the Book
In Chapters 2 and 3 we consider the essential questions: Why do we find ourselves, time after time, sinking into depression or getting stuck in emotional distress? How do the practices and exercises of the 8-week MBCT program make a difference? How might all this help you?
With this understanding in place, Chapter 4 looks at how best to prepare for the course. Then, in the following seven chapters, we move, step by step, week by week, through the nuts and bolts of the program.
Finally, in the concluding chapter of the book we look to the future. We consider how, if you wish, you might further nourish and extend the ways in which mindfulness can transform and enrich your life.
Depression, Unhappiness, and Emotional Distress
WHY DO WE GET STUCK?
Jani would often wake very early in the morning, unable to sleep, with a heavy feeling in her body and thoughts going round and round, impossible to switch off. She'd sometimes get up to make a cup of tea, sitting in the kitchen with a blanket around her shoulders, reading bits of any magazine that she or her roommate had left lying around, or opening her laptop and trying to answer e-mails that had come in overnight. At last, exhausted, she'd go back to bed, only to find that the thoughts carried on, going round and round, but now with a new voice: "This is terrible. You'll be too tired to think straight today. Why is this happening again? Why can't you ever pull yourself together? What's wrong with you?"
For any of us it would be bad enough to wake up too early in this way. But Jani's mind just made things worse.
Reading through the story again, can you now see any similarities between the ways in which the "new voice" added its own twist to Jani's misery and your own past experience?
Put a [check] next to any of these that you recognize:
 The voice added its own catastrophic interpretation ("This is terrible") to the situation.
 The voice was certain there would be awful consequences ("You'll be too tired to think straight").
The voice asked unanswerable questions that had the effect of:
 bringing to mind times in the past when things had gone wrong ("Why is this happening again? Why can't you ever pull yourself together?")
 focusing attention on weaknesses and failings ("What's wrong with you?")
Jani's experience illustrates a crucial and unexpected truth:
Unhappiness Itself Is Not the Problem
Unhappiness is part of the normal human condition. It is a natural response to certain situations. Left to itself, it will pass in its own good time, often surprisingly quickly.
But, somehow, most of us don't feel able to let things take their natural course—when we feel sad or unhappy, we feel we have to do something, even if it's only trying to understand what's going on.
Paradoxically, it is those very attempts to get rid of unwanted unhappy feelings that get us stuck in ever-deepening unhappiness.
Let's look more closely at what's going on here.
We can distinguish three crucial stages:
Stage 1: Unhappiness arises.
Stage 2: The unhappy mood brings up negative thinking patterns, feelings, and memories from the past—this makes us more unhappy.
Stage 3: We try to get rid of the unhappiness in ways that actually keep it going and just make things worse.
The Echoes of the Past
A few years ago Jani had been totally stressed by the amount of work she was expected to do in the job she held at the time. She'd become very down and constantly tried to "pull herself together" before eventually going to her physician, who prescribed antidepressant medication, which helped a bit.
She'd eventually left that job, but somehow she still blamed herself for giving in. Now, 7 years later in the early hours, as she struggled with not being able to sleep but not being really awake either, thinking of the day ahead, this echo of the past was making her feel worse.
There are actually two different kinds of words in this list. Some are simply descriptions of moods or feelings (dejected, depressed, despondent, low, sad, unhappy). The others describe feelings that also seem to say something about the kind of person you are (a failure, inadequate, a loser, pathetic, unlovable, useless).
Research using this list of words has revealed something very important.
If you have been seriously depressed in the past, when you start to feel low now—whatever the reason—you are much more likely to begin to feel bad about yourself (and so check off words like a failure) than someone who has never been so depressed.
This is because, whenever we are very down, the mind is taken over by patterns of extremely negative thinking—thoughts that we are worthless, thoughts that we have let people down, thoughts that life is full of insurmountable difficulties, thoughts that the future is hopeless.
Links get forged between these thinking patterns and depressed, unhappy mood.
The result? Sad mood arises now and old negative thinking patterns are right behind.
Tragically, these are exactly the feelings and thought patterns that would make anyone even more depressed.
And so the cycle continues: if you have been deeply depressed, it is much easier to slide back into depression again.
It's not only thinking patterns that can get reawakened. Spells of depression will have often been triggered by experiences of major loss, rejection, or failure.
When you feel sad or depressed again, memories of these losses and rejections—and all the weight of their tragedy—can break over you like a tidal wave. In that way, these thoughts and memories will make you even sadder, adding their own twist to a spiral of worsening mood.
For Jani, her frustration with not getting to sleep and her fears about not being able to cope with her job evoked memories that made her feel even worse:
Just like Jani's depression, other emotions can color our experience in subtle (and not-so-subtle) ways, with consequences we cannot always see clearly.
Feelings of anxiety can reawaken worrisome patterns of thinking—creating more anxiety, worries, and fears.
Feelings of irritation and frustration can make us blame and criticize others, making us even more angry and frustrated.
If we are overstressed by excessive demands, feelings of pressure may reawaken fears of being overwhelmed and force us to greater busyness and stress.
The good news is that, with the right understanding and skills, we can break out of these mood–thought vicious cycles.
Over and over, we have seen people learn to recognize these thought patterns for what they really are—just thought patterns—and then gracefully disengage from them by refocusing their attention.
The problem is that, through no fault of our own, most of us don't have the appropriate understanding and skills. In fact, you may have found that your best-intentioned efforts often have exactly the opposite effect to what you intended.
Let's see how.
How Trying to Dig your Way Out of Trouble Can End Up Digging You In Deeper
If you have experienced low mood spiraling down to deeper depression in the past, you will know just how horrible that can be. It's completely understandable to feel the urge to get rid of the mood and stop the slide into something deeper.
Equally, if feeling constantly exhausted and unable to enjoy life reawakens a deep doubt about your worth as a person, what could feel more important than doing something about that?
If we look carefully, we can see what is happening here:
The mind is trying to get rid of unhappiness by thinking its way out of the problem.
These kinds of questions have no clear answer. Nonetheless, we feel compelled to keep chewing away at them—a process that psychologists call rumination.
Psychologist Susan Nolen-Hoeksema spent many years investigating rumination and its effects. Her conclusions are stark:
Ruminating just makes us feel even worse:
We suffer the frustration of not being able to come up with answers.
We dredge up memories of failures and difficulties from the past to try to understand how we get things wrong. But focusing on our weaknesses and deficiencies in this way only drags us down further.
We anticipate the problems that will arise in the future if things don't change and dread the prospect of having to face the days, weeks, and months ahead.
We may even begin to wonder whether life is worth living at all.
Far from freeing us from the downward spiral, our attempts to get rid of unhappiness by thinking our way out of it are the very things that can deepen and prolong our sad moods. These moods then bring up more unhappy memories and thoughts, and we now have new material to ruminate on.
If you have been clinically depressed in the past, rumination can create a slide in mood that will tip you into another episode of depression.