Mindfulness Based Cognitive Therapy: Why the Big Fuss?

 What Accounts for the Growing Popularity of Mindfulness Based Cognitive Therapy?

By: Jeremy D. Safran, Ph.D.

Over the past 10 to 15 years cognitive therapists have become increasingly interested in exploring the benefits of mindfulness practice as a therapeutic intervention. This growing emphasis on mindfulness and acceptance is commonly referred to as the "third wave" in behavioral therapy (the first and second waves consisting of respectively of 1) behavior therapy, and 2) traditional cognitive therapy). Mindfulness practice, which originated as a form of meditation in the Buddhist tradition, involves attending to one’s internal experience as it emerges in the here and now. The emphasis is on observing one’s thoughts, feelings and sensations, without judging or attempting to control them.  An important dimension of the practice involves cultivating an attitude of compassion and acceptance towards the self. In study after study researchers have demonstrated that structured forms of cognitive behavioral therapy that incorporate mindfulness interventions are helpful in the treatment of problems ranging from depression and anxiety to borderline personality disorder. In many respects this emphasis on mindfulness and acceptance can be seen as the leading edge in cognitive therapy. Research in the area is proliferating and new variants of mindfulness based cognitive therapy are emerging every day.



To my knowledge, little if any research had been conducted comparing the effectiveness of mindfulness based cognitive therapy to traditional cognitive therapy. But the absence of such research has not diminished the profession’s enthusiasm for this trend. Moreover, I’m willing to go out on a limb and predict that when a substantial amount of comparative research of this type actually accumulates, mindfulness based cognitive therapies will not be found to be more effective than traditional cognitive therapy. Making this prediction is not too difficult, since the failure to find differences in the effectiveness of treatments is the rule rather than the exception in psychotherapy research. Psychotherapy researchers refer to this common finding of therapeutic equivalence as the “dodo bird verdict” (alluding to the Dodo in Alice in Wonderland who pronounced:  "Everybody has won and all must have prizes.")

If there hasn’t been a substantial body of research demonstrating the superiority of mindfulness based cognitive therapy to traditional CBT, how can we account for its growing popularity? I believe that there are two important factors. The first is that the growing popularity of mindfulness and acceptance based approaches to cognitive therapy is a reflection of the growing acceptance interest of mainstream culture in Buddhism, meditation and mindfulness based approaches. The second is that the incorporation of mindfulness and acceptance based principles into cognitive therapy, is a subtle shift that nevertheless amounts to a much needed paradigm shift. There are many aspects of cognitive therapy that have led to its dominance of the mental health care field in our culture. These include the emphasis on short-term treatments, its pragmatic, action oriented nature, the emphasis on demonstrating its effectiveness empirically. Despite these apparent virtues, there is an internal contradiction in the logic of traditional cognitive therapy that cannot be resolved. 

One of the greatest appeals of cognitive therapy is its emphasis on learning to actively change one’s own thoughts and feelings, in order to overcome one’s problems. The problem, however, is that the goal of changing or controlling oneself is always in tension with the goal of self-acceptance. This is a tension which can never be resolved. So what does the incorporation of mindfulness and acceptance based principles into cognitive therapy do? It dissolves the internal contradiction through the use of paradox- the paradox of changing as byproduct of letting go of our efforts to change. Slight of hand? Maybe.... But this slight of hand has been an important strand in Buddhism from the beginning.