Teens with mental health or substance use issues often feel their emotions are out of control.
Whether it’s anxiety, depression, anger, or a combination of things, many adolescents are regularly overwhelmed by their emotions. They find it impossible to calm down or regulate themselves.
Mindfulness-based cognitive therapy (MBCT) merges the ideas of cognitive therapy with mindfulness practices. This evidence-based modality teaches teens how to become more mindful as a way of decreasing their emotional reactivity. When adolescents experience negative thoughts or upsetting emotions, MBCT teaches them to observe and identify these feelings internally, interrupt the automatic thought loops, and respond in a productive way.
What is Mindfulness?
Being mindful means slowing down and paying close attention to what’s happening in the reality of the moment. It means staying aware of the present. In mindfulness training, therapists teach teens how to accept each moment, as it arrives and passes, without judgment. Awareness without judgment is the first step toward improving emotional dysregulation, a primary symptom of many mental health issues.
History of Mindfulness
To discuss the history of MBCT, it’s important to understand the history of mindfulness and mindfulness-based stress reduction (MBSR).
Mindfulness practices, as we know them today, derive mainly from Zen Buddhism. Thich Nhat Hanh, a Buddhist monk from Vietnam, receives credit for the popularization of mindfulness in the Western world. He came to visit Princeton University in 1960 and started teaching a unique brand of Buddhist meditation to thousands of students.
Dr. Jon Kabat-Zinn, from the University of Massachusetts, was one of Hanh’s notable pupils. In 1979, Kabat-Zinn began adapting the Buddhist teachings on mindfulness by stripping away their religious associations and studying mindfulness within a secular, scientific context. At the University of Massachusetts Medical School, Dr. Kabat-Zinn examined how deep breathing and other mindfulness exercises reduce pain and stress. He started teaching people not to push pain away, but instead to recognize, embrace, and work through the pain using mindfulness. Instead of distraction, he encouraged acknowledgment. This method, which later became his pilot mindfulness-based stress reduction (MBSR) program, saw promising results among the healthcare community. Neuroimaging studies now show that mindfulness improves emotional regulation by triggering physiological changes in the brain.
History of MBCT
After Dr. Kabat-Zinn, a cognitive therapist named Dr. Zindel Segal received a grant from the MacArthur group to adapt an existing treatment for depression to better prevent relapse. Dr. Segal, along with colleagues Mark Williams and John Teasdale, wanted to understand whether specific triggers made individuals in recovery experience relapse in depression. They knew that recovering from depression was one half of the problem, while staying well was the other. Through initial research, they found that people who experienced depression in the past often fell back into depressive episodes when negative thoughts and thought patterns arose.
As Dr. Segal explained in a Ted Talk in 2014:
“When people are depressed, [sadness] is a symptom. But when they’re no longer feeling depressed, sadness can…bring to mind judgmental, critical and harsh ways of viewing oneself… that can cause people to tip over into a new episode of depression.”
This idea was consistent with cognitive therapy, developed by Dr. Aaron T. Beck in the early 1960s, which stated that negative thoughts can lead to negative moods, and that negative moods can spiral into depressive episodes.
Dr. Segal’s goal was to see whether there was a way to prevent typical, everyday feelings of sadness or unhappiness from transforming into depressive episodes. He and his colleagues felt that by merging the concepts of cognitive therapy with mindfulness practices, they could teach people how to develop a new relationship with their sadness – not to eliminate feelings of unhappiness altogether, but to work with them and through them.
Like Dr. Kabat-Zinn’s MBSR approach, MBCT encourages people not to try and push away their feelings of negativity, but to simply acknowledge the presence of these thoughts and feelings. By being mindful – intentionally being aware of the present moment without judgment – people could let their feelings of sadness simply pass through them, instead of letting them take over.
The process works for adolescents as well as adults.
After stepping back and taking a mindful, objective view of their negative feelings – whether sadness, anxiety, or stress – teens can choose an appropriate, productive response to their negative thoughts.
The Difference Between MBCT and Cognitive Therapy (CT)
Both MBCT and cognitive therapy (CT) aim to interrupt a downward of thought, mood, and emotion.
Cognitive therapy encourages correcting automatic, negative thought patterns, which often consist of magnified, false, or distorted judgments. The goal is to replace these thoughts with more realistic and/or positive ones.
MBCT, however, places less emphasis on altering thoughts and more focus on (first) noticing and acknowledging these thoughts. MBCT argues that when teens decide to relate to their feelings in a different way, the thoughts themselves have less power and control. Teens can then decide to respond in a productive way instead of falling into a spiral of depression or anxiety.
Who Does MBCT Help?
Evidence shows that MBCT is an effective stand-alone treatment for depression – as successful as antidepressants in maintaining recovery and preventing relapse. The treatment is especially effective for teens who struggle with recurring episodes of depression, which is defined as having at least three depressive episodes. Studies find that individuals who participate in MBCT are at least 50 percent less likely to relapse in their depression.
Though MBCT was initially developed for those with recurrent depression, the therapy has also shown promise with teens with anxiety, bipolar disorder, and general stress and irritability.
Teens with chronic/physical health conditions, such as cancer, diabetes, or traumatic brain injury, also see significant results from MBCT.
How Does MBCT Work?
In MBCT, teens learn practical mindfulness exercises and concrete ways of being mindful in their daily lives. First, they learn how to stay mindful through general day-to-day activities – eating, breathing, walking, and sitting.
After practicing mindfulness in a low-pressure, neutral environment, they then practice how to stay mindful when negative emotions come up. They learn that when sad or anxious thoughts and emotions arise, they can let these feelings wash over them instead of allowing them to take over completely. Mindfulness practices such as deep breathing, meditation, and guided imagery help teens stay calm and controlled. Once they’re in control of their emotions, adolescents have a much better chance of selecting an appropriate response to negative thoughts and patterns of thought.
For many teens, small triggers can cause a downward spiral of self-doubt and depression. Here, we’ll give a hypothetical example of how a teen might use the principles of MBCT to turn around a negative experience.
Dealing with Negative Events
We’ll start with something that happens almost every day in every high school across the country:
A teacher returns graded exams. He hands Jenna hers: she got a 70. She becomes short of breath. Her heart beats faster. She’s devastated and feels like she’s about to cry.
She automatically starts thinking “I’m going to fail this class,” then “I’m going to fail high school and never graduate,” then “I’m worthless and a failure at everything.”
Jenna’s mood plunges. She falls into an abyss. She feels sluggish and starts thinking about all the other times she failed in the past. Her emotions feel totally out of control. She can’t stop thinking about the bad grade – and her uncertain future – the entire day. When she gets home, she goes straight to her bed and doesn’t come out until the next morning.
If Jenna had learned mindfulness skills from MBCBT, here’s how that scenario might play out, instead:
Jenna takes her test from the teacher and glances at the grade: 70. A low “C.” Her chest automatically tightens, and her breathing starts getting shorter – but she notices. She notices her breathing has changed. She puts her hand on her heart and recognizes that her heartbeat, too, has gotten faster. She feels her body getting heavier. She feels pressure on her forehead. Jenna notices all these internal changes. She tells herself to stop and slow down. She takes a deep breath from her abdomen, exhales, and repeats.
Then she notices the thoughts rushing by in her head. She notices she’s experiencing the thought “I’m going to fail this class.”
That thought drifts by, followed by another thought: “I’m going to fail high school.”
She notices all these passing thoughts floating by as if they’re objects in a river. She also notices she feels disappointed and anxious.
Several seconds later, another thought drifts by – a thought influenced by her MBCBT.
This one says: “I got a 70 on one test. It doesn’t mean I’m failing the entire class. And it doesn’t mean I’m failing high school. I can do better on the next test, and maybe I can even ask the teacher how I can do extra credit work to make up for this grade.”
Though Jenna recognizes that she’s still upset about her grade, she goes on with her day.
In this case, MBCT skills break the toxic spiral of negativity. Jenna successfully nips depression and anxiety in the bud – before they take over her thoughts and mood completely.
Explanation: How Jenna Used Mindfulness
In the first scenario, Jenna catastrophized a negative situation, but didn’t realize that’s what she’d done.
In the second scenario, Jenna practiced mindfulness. She de-emphasized her negative thoughts and emotions and stayed aware of the physical sensations she was experiencing. By shifting away from her automatic thought patterns, she discovered that there were alternate responses available to her.
This is what happens when teens receive mindfulness training. After learning to identify both the internal and external signs of their negative feelings and emotions, it becomes easier for teens to react more appropriately. Without mindful self-awareness, teens under stress – especially teens with mental health or alcohol/substance use disorders – are more likely turn to non-productive coping mechanisms, such as self-harming, drinking, or drugs.
The Structure of MBCT Treatment
The original MBCT program design introduced a formal group intervention that lasted eight weeks, and included one, two-hour session per week . However, in teen residential treatment centers (RTC), partial hospitalization programs (PHP), and intensive outpatient programs (IOP), MBCT is usually adapted to meet the specific needs of adolescents in treatment for an array of mental health and substance use issues.
At Evolve, clinicians incorporate MBCT both in individual therapy and in the group setting. MBCT exercises are also incorporated, on an informal basis, throughout the day. At a typical meal, for example, it’s not uncommon for teens to hear counselors and clinicians promote slow, mindful eating. Mindful walking is encouraged during a day trip or hike, while mindful breathing can be a valuable exercise when watching a sunset or taking a short break during the day.
Teens are also assigned more formal meditation exercises, such as breathing techniques and guided meditations, on a weekly basis. Therapists ask teens to keep thought logs or thought records to help them pay attention to their thinking patterns. The goal is to incorporate mindfulness into daily life and get teens to recognize how to stay mindful of what’s going on within them and around them.
Here are some examples of the types of exercises therapists at Evolve might assign to teens.
Sample Mindfulness Exercises
Basic Introductory Practice
- Sit comfortably on the floor or in a straight-backed chair or lie on your back on the floor. Settle down, relax, and get comfortable.
Can you focus your attention on your emotional state?
Can you locate where in your body you feel your emotions?
Can you identify, without judgment, what your emotional state is?
This a simple yes/no assessment.
- Sit comfortably on the floor or in a straight-backed chair or lie on your back on the floor. Settle down, relax, and get comfortable.
Can you focus your attention on your breath without distraction?
To go one step further, start timing yourself. Situate yourself so you can see a clock, your watch, or the timer on your phone. Start the timer and return your focus to your breath.
When your mind wanders from your breath, check your time.
How long did you last?
Your first goal is to focus on just your breath for one minute. Repeat this exercise until you can focus on your breathing for at least five minutes.
Close your eyes. Imagine you’re lying on the sand in a tropical beach, with the quiet sound of the waves lapping at the shore and the heat of the sun warming their face. If a beach doesn’t do the trick for you, think of a relaxing place that does. It might be a certain hiking trail, or a thicket of woods near your house, or even the public library if you enjoy going there for the peace and quiet. Imagine you’re there. Where exactly are you sitting or standing? What do you see? What do you feel?
Start from your abdomen, and try to breathe out more slowly than you breathe in. A good pattern is 4 seconds in and 6 seconds out, but if you can’t sustain this, just breathe out for longer than you breathe in. Keep your hand on your abdomen and feel it expand and contract. This ensures you’re doing the exercise correctly
Sit down in a chair, with your feet touching the ground. Focus all your senses on something you can see, something you can touch, something you can smell, something you can hear, and something you can taste. Focusing your attention on the five senses connects you to the present moment in the simplest way possible.
Mindfulness + Cognitive Therapy = Practical Tools for Adolescents
MBCT integrates mindfulness training with cognitive therapy to help teens reduce stress, depression, anxiety, and the symptoms of PTSD. It also helps decrease rumination, which is defined as persistent, negative rethinking of events or situations that happened in the past or will happen in the near future.
Through mindfulness techniques, teens learn how to step back and observe everything going on in their mind and body like they’ re impartial, outside observers. When teens learn to slow down and pay attention, they discover they’re neither at the mercy of their thoughts nor victims of their emotions. Teens learn they have the power and ability to react to their thoughts and emotions however they decide: listen to them, feel them, counter them, ignore them, or simply let them be until the pass.
Though MBCT was originally created to help those with depression, any teen with a mental health or substance use disorder can benefit. When you become more in-tune with your mental and emotional states, you learn how to respond to stress in a productive, life-affirming way.