Journal of Psychology and Christianity
2017, Vol. 36, No. 1, 76-82
RESEARCH INTO PRACTICE
Mindfulness-Based Cognitive Therapy
(MBCT): Empirical Evidence and Clinical
Applications from a Christian Perspective
Aaron Rosales and Siang-Yang Tan
Graduate School of Psychology,
Fuller Theological Seminary
Mindfulness-based Cognitive Therapy
(MBCT) is an empirically supported treatment
developed by John Teasdale, Zindel Segal, and
Mark Williams in 2000. The approach primarily
draws upon Teasdale and Phillip Barnard’s
interactive cognitive subsystems (ICS) model
and John Kabat-Zinn’s mindfulness-based stress
reduction (MBSR) program (Segal, Williams, &
Teasdale, 2013). Initially, MBCT was devel-
oped as the result of an initiative to identify
and apply core elements of Cognitive Therapy
(CT) for reducing depression relapse (Segal et
al., 2013). From a historical vantage point,
MBCT is part of the third wave (or generation)
of behavior therapy (Hayes, Follette, & Line-
han, 2004), which is characterized by emphases
on mindfulness, acceptance, metacognition,
emotion, dialectics, and the therapeutic rela-
tionship (Hayes et al., 2004; Kahl, Winter, &
Schweiger, 2012). In contrast, the first wave
consisted of traditional behavior therapy that
relied on principles such as classical and oper-
ant conditioning, while the second wave con-
sisted of Cognitive Behavior Therapy (CBT;
Hayes, Luoma, Bond, Masuda, & Lillis, 2006).
In addition to MBCT, the third wave of behav-
ior therapy includes therapies such as Dialecti-
cal Behavior Therapy (DBT; Linehan, 1993) and
Acceptance and Commitment Therapy (ACT;
Hayes, Strosahl, & Wilson, 2012).
The theoretical foundation of MBCT is rooted
in a desire to move beyond the limitations in tra-
ditional Cognitive Therapy (CT; Segal et al.,
2013). Although the founders originally consid-
ered a simple maintenance form of CT that uti-
lized similar interventions, they later shifted
focus toward cost efficiency and treatment speci-
ficity (Segal et al., 2013). Parsing the efficacy of
CT therapy for depression reveals that
Correspondence concerning this article should be
addressed to Aaron Rosales, M.A. at the Graduate
School of Psychology, Fuller Theological Seminary, 180
North Oakland Avenue, Pasadena, CA 91101. E-mail:
aaronrosales@fuller.edu.
76
Copyright 2017 Christian Association for Psychological Studies
ISSN 0733-4273
relapse/reoccurrence is reduced by 20-36% when
CT is used alone without pharmacotherapy (Hol-
lon et al., 2005; Vittengl, Clark, Dunn, & Jarrett,
2007). This suggests that clients are learning
something from CT that helps to maintain
improvements even after 1-on-1 therapy has
ended (Segal et al., 2013). In an attempt to distill
what this key message of CT is, MBCT founders
took several considerations into account. First,
persistent dysfunctional attitudes do not predict
depression relapse, despite the strong logic based
on a CT understanding of negative thoughts
(Ingram, Atchley, & Segal, 2011). Second, Teas-
dale proposed the differential activation hypothe-
sis, which stated that sad moods can reactivate
entire schemas associated with those moods and
that such patterns can differ between individuals
(Teasdale, 1988). Furthermore, subsequent stud-
ies found that the degree to which mood activat-
ed dysfunctional attitudes predicted depression
relapse/recurrence (Segal, Gemar, & Williams,
1999; Segal et al., 2006). MBCT thereby under-
stands the key maintenance intervention to be
learning to be less reactive to dysphoric moods.
Within the framework, the goal then becomes
decentering from the emotional experience by
engaging the being mode of mind rather than the
doing mode (Segal et al., 2013; Williams et al.,
2007). In essence, decentering refers to the ability
to treat thoughts, emotions, and all experience as
passing through the body and mind rather than
identifying with them (Segal et al., 2013). For
example, the goal is to move from saying, “I am
bad,” to “I am having the thought that I am bad.”
This approach can be described as learning to
relate differently to experience rather than con-
fronting it in a CT manner. Mindfulness-based
interventions provide an alternative posture and
quality of therapeutic relationship that may be
more palatable for some clients (Wilson & San-
doz, 2008). While still slightly confrontational
(e.g. disengaging the doing mode), MBCT’s
emphasis on open and non-judgmental awareness
of experience is fundamentally different than CT’s
attempts to restructure maladaptive cognition.
MBCT interventions subscribe to a standard
8-week group protocol that draws upon the
basic structure provided by mindfulness based
stress reduction (MBSR; Kabat-Zinn, 2013; Segal
et al., 2013). Segal and colleagues have also

recommended standard group sizes of approxi-
mately 12 participants (Segal et al., 2013). It is
also important to note that in addition to
adherence to the class material it is necessary
for the instructor to maintain a personal mind-
fulness practice (Segal et al., 2013; Williams,
Fennell, Barnhofer, Silverton, & Crane, 2015).
Additionally, MBCT is increasingly used with
clinical populations beyond depression relapse
prevention such as, anxiety (e.g. Sears, 2015),
suicide prevention (e.g. Williams et al., 2015),
or bipolar disorder (e.g. Deckersbach, Hölzel,
Eisner, Lazar, & Nierenberg, 2014). Treatment
with MBCT does not preclude the use of phar-
macotherapy, but MBCT is often highlighted as
an alternative to prolonged pharmacotherapy
(Segal et al., 2013). It is also noteworthy that
MBCT has been adapted to a shortened 1 hour
per session version (originally 2 hour sessions)
with some success (Tovote et al., 2013).
Of particular interest for the present article is
the current increase in attention third wave
behavior therapy is receiving from Christians. In
addition to a Christian perspective on DBT (Wang
& Tan, 2016) and ACT (Rosales & Tan, 2016; see
also Sisemore, 2014), mindfulness-based CBT
(Tan, 2011; see also Symington & Symington,
2012) has previously received some attention.
MBCT Core Components
MBCT posits that individuals who have experi-
enced multiple episodes of recurrent depression
are at higher risk for reactivating dysfunctional
cognitions when dysphoric mood states occur
(Dimidjian et al., 2016). In order to reduce this
risk, several key components are utilized: decen-
tering, nonjudgment, and present-focused aware-
ness (Dimidjian et al., 2016). These components
can be colloquially summarized as the being
mode—an ongoing state of allowing and accept-
ing that is the opposite of the doing mode (Segal
et al., 2013). The being mode stands in contrast to
the doing mode.
Doing Mode
The doing mode of mind can be categorized as
a frame of analytical problem solving. Much of
the time, the doing mode is useful and it is not
inherently problematic. However, the doing
mode creates more problems when used to
attempt to fix dysfunctional thoughts with critical
thinking (Williams et al., 2007). The result of the
fixes using the doing mode is rumination—which
MBCT highlights as one of the key dysfunctions
RESEARCH INTO PRACTICE 77
underlying depression relapse (Michalak, Hölz, &
Teismann, 2011; Nolen-Hoeksema & Morrow,
1991). Rumination does not itself cause depres-
sion, but it does heighten vulnerability because it
involves increased self-focused problem solving
(Segal et al., 2013). This ruminative style is prob-
lematic because when dysthymic moods are acti-
vated and the problem is understood to be within
the self—and potentially unsolvable—depression
is more likely to take hold.
Being Mode
The being mode of mind is not only the oppo-
site of the doing mode, but it is also the rumination
antidote. Although defining the being mode accu-
rately is difficult, it might be best understood as an
orientation or posture of openness and nonjudg-
ment that fosters full engagement with the present
moment. The fruit of entering the being mode is
four-fold. First, the allowing stance of being means
that discrepancy monitoring of the ruminative style
can be turned off so that a broader and fuller pre-
sent moment awareness can be enjoyed (Segal et
al., 2013). Second, the being mode is so focused
on the present moment, that no mental time travel-
ing to past pain or future anxieties is necessary
(Segal et al., 2013). Third, the accepting stance of
being means that there is no need to toil away in
judging each emotion and thought that enters
awareness (Segal et al., 2013). Fourth, these facets
of the being mode come together to give rise to
increased freedom and flexibility to be more
responsive to the present moment (Segal et al.,
2013). All together, the being mode facilitates an
individual’s ability to decenter from dysthymic
mood states and their associated rumination in
order to be more fully engaged in the vibrancy of
each moment. However, it is worth noting that
MBCT does not suggest that the being mode is
always to be preferred to the doing mode. It is
conceivable that the doing mode might greatly
benefit individuals who could benefit from inter-
ventions such as activity scheduling or any other
self-help plan (Segal et al., 2013).
The Mindfulness Core
Mindfulness plays an integral role in the con-
ceptualization and execution of MBCT. Tradition-
ally, mindfulness has been defined as: “Paying
attention in a particular way: on purpose, in the
present moment, and nonjudgmentally” (Kabat-
Zinn, 1994, p. 4). Within the framework of the
doing and being modes, mindfulness serves two
main functions. First, mindfulness allows for the
decentering from thoughts, emotions, and bodily
78 RESEARCH INTO PRACTICE
sensations. This facilitates the capacity to shift
into the being mode from the doing mode (Segal
et al., 2013). Second, mindfulness is itself a dif-
ferent mode of mind that emphasizes allowing
and accepting as ongoing ways of relating to the
present rather than rumination (Segal et al.,
2013). Given this dual purpose, it can be difficult
to categorize mindfulness as either a trait (see
Brown, Ryan, & Creswell, 2007) or a state (see
Bishop et al., 2004). Nevertheless, mindfulness
fulfills both needs in the MBCT model and is
therefore indispensable.
MBCT utilizes several practices to teach these
vital mindfulness skills. Several of the exercises
employed draw directly from MBSR, e.g. the
body scan (focusing on one’s immediate experi-
ence or sensations from the feet up to the
head), sitting meditation starting with mindful
breathing (focusing on one’s breath), mindful
walking (focusing on one’s walking move-
ments), gentle yoga, and informal brief daily
mindfulness practice such as mindful breathing
(see Shapiro & Carlson, 2009, pp. 48-53). While
each of the mindfulness practices is important
for cultivating clients’ ability to shift into the
being mode, the 3-minute breathing space exer-
cise holds a central role. This key practice is
broken down into three main steps: (1) becom-
ing aware and open to internal experience such
as thoughts, feelings, and bodily sensations, (2)
gathering and redirecting focused attention to
the physical sensations of breathing in and out,
and (3) expanding awareness of breath through-
out the body and breathing into tension or pain
(Teasdale, Williams, & Segal, 2014). This
expanded awareness is then carried with the
practitioner throughout the rest of the experi-
ence once the 3-minute breathing space has
concluded. It is worth noting that the exercise
does not necessarily have to take the form of a
meditation or even last 3-minutes. The intent of
the exercise is to offer a mini-mindfulness prac-
tice that can be used to shift into the being
mode at any place or time (Segal et al., 2013).
Empirical Evidence for MBCT
As interest in MBCT continues to grow, there is
an increasing amount of research to support its
effectiveness in treating an array of clinical popu-
lations. MBCT for depression relapse prevention
gathered strong empirical support with at least six
notable meta-analyses (Baer, 2015; Dimidjian et
al., 2016). However, Dimidjian and colleagues
caution that a weakness of many of the trials
included is the lack of assessment for treatment
fidelity (Dimidjian et al., 2016). Although there
are randomized controlled trials (RCTs) that pro-
vide 34% relapse reduction (Piet & Hougaard,
2011), MBCT studies have been consistently cri-
tiqued as being of moderate methodological rigor
(Chiesa & Serretti, 2011; Galante, Galante,
Bekkers, & Gallacher, 2014). Additionally, there is
growing support for using MBCT to treat acute
depression (Lenz, Hall, & Bailey Smith, 2016).
However, the picture is still unclear when it
comes to using MBCT to treat acute anxiety symp-
toms because of the unstable results (Dimidjian et
al., 2016; Strauss, Cavanagh, Oliver, & Pettman,
2014). Despite the availability of waitlist con-
trolled studies supporting MBCT for remitted
bipolar disorder (e.g. Williams et al., 2008), a RCT
comparing treatment as usual (TAU) to MBCT for
acute bipolar disorder found no additional benefit
from MBCT (Perich, Manicavasagar, Mitchell, Ball,
& Hadzi-Pavlovic, 2013). In summary, there is
growing empirical support for MBCT with a vari-
ety of symptoms, but caution is still warranted.
MBCT does reliably produce significant reductions
in depression relapse, but conclusions about its
efficacy as equivalent to CBT or superior to psy-
choeducation are premature (Dimidjian et al.,
2016). As mindfulness based interventions (MBIs)
increase in popularity and gain further empirical
support, MBCT will likely continue to garner
focused research and expand with new adapta-
tions. Presently, of particular interest is the trend
for Christian counselors to utilize MBIs and MBCT
in their clinical work.
Clinical Applications from a
Christian Perspective
Given widespread interest in MBIs, it is unsur-
prising that attempts have been made to adapt
MBIs to faith based contexts. However, unlike
DBT (see Wang & Tan, 2016) and especially ACT
(see Rosales & Tan, 2016), MBCT has received
relatively little adaptation for Christian clients
(see Tan, 2011). Instead, Christian counselors
have often chosen to address and adapt MBIs in
general (e.g. Garzon, 2013; Symington &
Symington, 2012). Nonetheless, surveying Chris-
tians indicates that making the effort to adapt
MBCT for Christian clients may be worthwhile
(Van Aalderen, De Haas-de Vries, & Luiten-van
de Vliert, 2016). Writings specific to MBCT—as
opposed to MBIs—are summarized and elaborat-
ed upon here.

Modes of Mind
When considering MBCT’s modes of mind
from a Christian perspective it is helpful to make
a comparison to Christian contemplative prayer.
Knabb (2012) has provided such a comparison
(see also Hathaway & E. Tan, 2009). In his dis-
cussion of similarities, Knabb notes that Christian
living can also be understood as a dichotomy
between the two modes of action (doing) and
contemplation (being). Furthermore, Knabb
highlights the contemplative mode’s assumption
of superiority as the “only way to truly connect
to God” (Bangley, 2006: cited in Knabb, 2012, p.
918). Although both Knabb, Frederick, and
Cumming (2016) and MBCT (Segal et al., 2013)
advocate for the necessity of both modes, the
result is less like a dialectic and more like a
dichotomy. Thus, the analogy of “shifting gears”
into the being mode that is employed by MBCT
is problematic when mapped to Christian living
because the implication is that connecting to
God is not possible while acting. In this regard,
it may be more helpful to draw from the writings
of Christians like Brother Lawrence who have
placed more emphasis on seeking God in even
the mundane (Lawrence, 1982). Although Chris-
tian contemplative practices can play a central
role that parallels MBCT processes, a successful
adaptation for Christians would utilize passages
such as 1 Corinthians 10:31 to highlight the
importance of seeking God in all things we do.
Similarly, it may be helpful to frame being in
God’s presence in the context of finding rest as
we take Jesus’ yoke upon us (Matthew 11:28-29).
Nonetheless, Christian clients may find it helpful
to embrace a contemplative sense of God as
refuge that provides distance from negative
experiences as in Psalm 91.
Rumination and Decentering
Within MBCT, decentering remains the cognitive
antidote to the problem of rumination. Although a
Christian perspective should still acknowledge
rumination as a problematic cognitive obstacle to
hearing from and responding to the Spirit (Keating,
2009), decentering must be more nuanced. Knabb
has suggested that both MBCT and centering
prayer aim to distract from negative cognitive
experience (Knabb, 2012). Despite this being true
in a broad sense, MBCT is primarily about shifting
attention to a broader experience by decentering.
On the other hand, Christian contemplative prac-
tices are often apophatic (knowing God through
negation, wordless) and thus intentionally limiting
RESEARCH INTO PRACTICE 79
some forms of experience (Stratton, 2015). Never-
theless, these differences may be reconciled from a
Christian perspective by placing the emphasis on
learning how to decenter so that refocusing is pos-
sible. While the object of focus may differ
between self-experience and God-experience
(Knabb, 2012), cognitive decentering from the
“well-worn mental grooves” of rumination remains
the result (Segal et al., 2013, p. 35).
MBCT’s Mindfulness
MBCT draws its practice of mindfulness directly
from Kabat-Zinn’s MBSR. In fact, Kabat-Zinn has
written the foreword for and even co-authored
some of the most important MBCT resources
(Segal et al., 2013; Teasdale et al., 2014; Williams
et al., 2007). However, attempting to differentiate
the mindfulness employed as the core of MBCT
from other MBIs such as ACT or DBT is difficult.
A simplistic differentiation is possible by placing
the approaches on a spectrum from MBCT’s pro-
motion of a mindful way of living to ACT’s utiliza-
tion of mindfulness as a technology, with DBT
somewhere in between (Hayes et al., 2012; Line-
han, 2014; Segal et al., 2013). Given this under-
standing, it should come as no surprise that the
spirituality of mindfulness is most felt in MBCT
compared to other third-wave approaches (Pieris,
2010; Stratton, 2015). Although mindfulness is
derived from Buddhism, MBSR has made an
attempt to secularize it (Kabat-Zinn, 2013).
Nonetheless, the current Christian literature is full
of references to Buddhism and the cultivation of
the no-self or similar concepts (e.g. Symington &
Symington, 2012). Notwithstanding the impor-
tance of comparisons with Buddhism, there is a
growing consensus in the Christian literature that
mindfulness can be appropriately used with Chris-
tian clients (see Rosales & Tan, 2016; Symington
& Symington, 2012; Tan, 2011; Wang & Tan,
2016). Of course, adaptations and qualifications
are necessary and may prove helpful.
An overarching distinction that should be made
is that MBCT seems to understand mindfulness as
the way, whereas Christians might better under-
stand mindfulness as “a stepping-stone to an
awareness of God” (Merton, 2003). Keeping this
distinction in mind may help to address further
concerns such as MBCT’s overemphasis on the
present moment to the exclusion of historical wit-
ness and eschatological hope (Tan, 2011). A
Christian perspective on MBCT’s mindfulness will
acknowledge that the present moment is filled
with not only the presence of God, but also hope
80 RESEARCH INTO PRACTICE
rooted in Christ’s life, death, and resurrection
behind—and new creation in which every tear
will be wiped away ahead (cf. Revelation 21:4).
Similarly, MBCT’s mindful postures of accepting
and allowing can be reinterpreted within a Chris-
tian perspective to mean surrendering to God’s
will—“letting go and letting God” (Tan, 2011, p.
246). This can be even further nuanced by
reminding Christians that accepting difficult expe-
riences is not the ultimate goal, but Christians are
to take every thought captive to Christ’s control
(cf. 2 Corinthians 10:5) while simultaneously
embracing God’s grace (cf. Romans 5:1-2). Addi-
tionally, a contemplative understanding of bodily
sensations as a hindrance (see Bangley, 2006)
can be counterbalanced with an emphasis on the
need to “watch and pray” (cf. Matthew 26:41)
and to treat the present moment as an offering to
God (de Caussad, 2012; Laubach, 2007).
Although there is significant overlap between
mindfulness and Christian contemplation and tra-
ditions, there continue to be many points where
adaptation is needed and potentially beneficial.
Concluding Comments from a
Christian Perspective
Despite the apparent level of compatibility
between MBCT and Christian faith, further qualifi-
cations should be addressed in ongoing attempts at
faith-based adaptations. The role of biblical truth
continues to be an important area of discussion for
MBCT because of the devaluing of thoughts (Tan,
2011). Given that Christians are “transformed by
the renewing of our minds” (Romans 12:1-2) and
“the truth shall set us free” (John 8:32), a Christian
perspective should acknowledge Scripture’s place
in Christian faith. In regard to mindfulness prac-
tices such as the 3-minute breathing space, caution
and sensitivity should still be exercised with Chris-
tian clients. While utilizing concepts of Christian
contemplation may be helpful, a more thorough
referencing of various Christian traditions and
Scripture would enrich the dialogue. As a starting
point, Hathaway and E. Tan (2009) suggest devel-
oping a robust theological framework based on
historic theologians such as Gregory and Augus-
tine. Such deep and foundational work is desper-
ately needed.
Despite areas needed for continued growth,
the recent efforts to develop adaptations for
Christian faith-based MBCT are commendable
for their integrative work and provide promise
as MBIs continue to increase in usage. This
article has highlighted the compatibility of a
Christian faith with MBCT, with some nuances
and needed adaptations.
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