Mindfulness-based Cognitive Therapy (MBCT) & Mindfulness-based Stress Reduction (MBSR)
Mindfulness-based Stress reduction and Mindfulness-based Cognitive Therapy are two extremely similar 8-week mindfulness courses and many people ask “What is the difference between MBCT and MBSR?”. This page aims to provide a more thorough answer to that question than is often provided as it partly depends on whether you do the course in a healthcare setting or not. Broadly speaking however, MBCT & MBSR are 95% the same and for most people either course will provide the same benefit.
What MBCT and MBSR have in Common
The mindfulness component of the course, which constitutes at least 90% of the course, is identical. Both have the same meditation practices and both are aimed at learning to use mindfulness so as to ‘wake up’ to the beauty in life that is so easily missed.
Both courses also look in detail at the way in which difficult mental states (like stress or anxiety and low moods) arise in relation to life challenges. And both courses teach ways of using mindfulness to learn how to ‘be with’ and manage difficult experiences so that we don’t make them worse than they need to be. In particular there is an emphasis on learning to ‘nip in the bud’ any tendency to ‘make a drama out of a crisis’.
So Mindfulness itself is the active ingredient of both courses. However, this is not something we need to ‘add’ to ourselves. Mindfulness is a natural ability, that we all have, to be positively absorbed in what is happening right here right now. Some people experience this while doing sport, or a favorite hobby such as gardening or something creative. Some people experience it when positively engaged in a work task, or out in nature, or while talking with a good friend. However, this sense of natural curious open-minded attention to what is actually happening here right now is so easily hidden or eclipsed by ‘over-thinking’ – being caught up in plans, worries, the past, the future – or the pressure of getting through our ‘to do’ list. We can even, and often do, also ‘over-think’ about things that are happening right now, over-analyzing, and unhelpfully judging and comparing them with an idea of what we want to happen or think should happen. In this way we can end up almost continually ‘writing off’ current experience and straining after an ideal future that never quite arrives.
While thinking and planning are essential, they can easily take over so that we spend hardly any time in the ‘present moment’ and instead just experience a running commentary in our heads that never stops. For some people this can take the form of extremely negative thinking, while for others it is just annoying and frustrating- and it gets in the way of enjoying life.
Both MBCT and MBSR address this common habit we can all fall into of ‘over thinking’. Both courses explore how we can use mindfulness to disengage from ‘over thinking’ and instead learn to ‘tap into’ our natural inner stability and resourcefulness, so that we can manage life’s challenges more easily and also be more open to new opportunities and more appreciative and aware of positive life experiences that are already part of our lives.
What is the Difference Between MBCT & MBSR?
So what is the difference between MBCT & MBSR? Well, it depends partly on which client group the course is aimed at. MBCT and MBSR have ‘pure’ forms (the original clinical versions which were aimed at people with a particular diagnosis) and ‘generic’ forms (where the course is adapted to make it relevant to anyone).
MBCT & MBSR as Originally Taught in Healthcare Settings
MBSR was originally taught only to people with chronic pain and illness, and MBCT was originally taught only to people with recurrent clinical depression. Nowadays however, both courses are widely taught in non-healthcare settings and such in a way as to make them relevant for anyone who wants to live life more fully.
MBCT has always been a combination of most of the MBSR syllabus with some cognitive therapy exercises (like imagining particular scenarios and noticing what thoughts appear when you do that). These cognitive therapy are intended to reveal specific patterns of negative thinking which depressed people are particularly vulnerable to, but which we all experience to some degree. The cognitive therapy content of MBCT seems to be particularly helpful for people who have intensely negative and depression-inducing automatic thoughts which aren’t linked to a specific life situation but which keep getting activated every time something goes wrong. Examples of these kind of negative thoughts are: ‘There’s something wrong with me’ or ‘Nothing feels good any more’ or ‘I’m a failure’. Some people find that when something goes wrong these kinds of negative thoughts take over and they ruminate on them. A similar pattern can happen for people who take worry to the extreme. They can find themselves ruminating in a panicky way not just about one specific situation but repeatedly, most of the time and day in day out. (All of us, however are prone to ‘over thinking’ to some degree).
MBSR was originally designed to help people manage the stress of chronic illness so in the original program there is strong focus on managing pain and physical limitation.
MBSR and MBCT Courses as I Teach Them to the General Public
In the original programs there is more emphasis in MBSR on understanding the mechanisms underlying stress and there is more emphasis in MBCT on clarifying the mechanisms underlying depression. However, both MBCT and MBSR have now both been ‘generalised’ by many teachers like myself, such as to make them relevant for anyone. The ‘generalised’ versions of MBCT and MBSR that I teach both include an explanation of the mechanism behind stress as well as addressing how to relate more helpfully to negative thinking. So both MBCT and MBSR, as I teach them, include an in depth focus on managing stress in daily life.
When I teach MBCT (which was already more than 90% MBSR) I also include more of the original MBSR syllabus. Specifically I include more of an exploration of how stress functions and how mindfulness can intervene. I follow almost all of the original MBCT syllabus – though adapted to make it relevant for anyone. However, I don’t make the issue of managing depression the focus of the course. I also omit one of the MBCT exercises that is only relevant for people prone to depression.
When I teach MBSR, like many other teachers, I include more emphasis on understanding habitual negative thinking patterns that, as well as causing stress, also cause anxiety, low mood or depression.
It is is important to bear in mind that the exercises and components of the course that are unique to each program (MBCT and MBSR) actually make up a very small proportion of the class time, and in some respects could be said to point to the same general principles, i.e., of how to extricate ourselves from the ‘over thinking’ and ‘negative interpretation’ that reduce our enjoyment of life.
Should I do MBCT or MBSR?
For most people the answer to this question is that it doesn’t matter which course you do. People attend the MBCT and MBSR courses I teach for a wide range of reasons. Many don’t see themselves as particularly stressed or prone to emotional difficulties and it’s very common for people to come simply because their friends have said they found doing the course so beneficial. Other people do the course because they want to learn to manage anxiety or low moods or depression.
I generally advise doing whichever course is most easily available and suits your schedule. Both courses, as I teach them, provide a thorough grounding on how to use mindfulness to wake up more to life’s beauty and to come to understand the unique unhelpful mental habits we each have that lead us to miss that natural sense of ease and contentment. Both courses also aim to reveal the way that any of us can get caught up in ways of being in the world that actually increase our stress, anxiety and low moods (for some of us very subtly and for other people more seriously). In developing that awareness we can then lean how to live more peacefully and be less ‘thrown around’ by life’s trials and tribulations.
When it Might be Better to do MBSR?
There aren’t any circumstances where I recommend doing MBSR over MBCT because both courses, as I teach them, address optimizing wellbeing and managing stress and anxiety using mindfulness.
When it Might be Better to do MBCT?
Life-long Recurrent Depression
For people who have a history of recurrent depression, and for whom that is the main reason for doing the course, I would generally advise doing the MBCT course because the Cognitive Therapy exercises in that course are specifically designed to demonstrate how depression operates. Having said that, if this applies to you and yet the MBCT courses I offer simply don’t fit you schedule, you could do the MBSR course instead and after the course work through a book versions of the MBCT course. There is a book called ‘The Mindful Way Through Depression’ which explains how mindfulness can help reduce depression and gives an account of the course. There is also a workbook called ‘The Mindful Way Workbook – An 8-Week Program to Free Yourself from Depression and Emotional Distress’ which can guide you through the entire MBCT course. Both these books cover the Cognitive Therapy exercises that aren’t included in the MBSR syllabus. (These resources may be very helpful on their own though they won’t provide the experience of learning in a group and being guided by a teacher).
Please note: if you have experienced recurrent clinical depression I would also advise asking your doctor if you can be referred to do an MBCT course on the NHS as well (or instead of) doing my course. This is because you would probably benefit from being in a group with others who have similar life experience and in which learning how to manage depression was the primary focus.
Extreme Obsessive Rumination or Worry
Another condition which the MBCT course addresses is extreme and repetitive negative thinking or worrying. Almost all of us will experience some negative thinking, at least some of the time. For most of us this just happens occasionally – such as when we are feeling stressed or when things go wrong. For some people however, this is so acute that it doesn’t just happen when they are going through a difficult period in life or when they are facing a particular problem. Instead it has become a permanent way of life such that they can spending every day obsessively worrying, perhaps having thoughts like “Everything is going to go wrong”, “I’ll never make it”, “There must be something wrong with me” or “How can I sort myself out?”. With these kinds of thoughts they can mentally ruminate, going round and round in circles, to the point where they struggle to function in the world.
If you are prone to this kind of extreme worrying you may find the cognitive therapy exercises in the MBCT course very revealing and helpful. However, bear in mind that the MBSR course also addresses negative automatic thinking and how to relate more helpfully to troubling thoughts. Also, like MBCT, MBSR addresses the underlying unease which gives rise to these kinds of thoughts.