MBCT and Suicide – how to extend MBCT and treat those at risk

Mark Williams and his co-authors show how to adapt Mindfulness-Based Cognitive Therapy (MBCT) for people who have struggled with suicidal thoughts and impulses, and were in remission from Major Depressive Disorder at least 8 weeks.
This is an important work, extending on the understanding that MBCT is helpful to those most at risk for depressive relapse.

The book is Mindfulness-Based Cognitive Therapy with People at Risk of Suicide. The authors are J. Mark G. Williams, Melanie Fennell, Thorsten Barnhofer, Rebecca Crane, Sarah Silverton. A previous edition was titled Mindfulness and the Transformation of Despair: Working with People at Risk of Suicide.

Mark Williams, lead author, in 2003 moved from Bangor University in Wales to Oxford University to begin a 10-year research program, putting together a team that would together be able to research psychological processes underlying mindfulness and how they could “apply to those who suffered depression so severely that they became suicidal.” P 4

He continues the research tradition of MBCT. While basing changes on research slows things down (the 3 creators of MBCT began work in 1993, and the first edition of their treatment manual came out in 2002) the result is a treatment that is well understood both in what it does and what is not yet researched.

This book will be most useful for active MBCT practitioners who want to extend their range, but also offers gems for others. As Williams puts it,”MBCT is particularly useful for those people who are at the greatest risk of relapse or recurrence [of depression].” (P 302)

This book takes that understanding a big step further.Here are a few examples:

• How the authors refined the intake process to reduce dropouts and increase the numbers of people helped
• How to address 5th session teacher doubts (a frequent phenomenon related to the delicate nature of inquiry, in which it’s easy for the teacher to feel “I haven’t taught anything”)
• How to adjust a session after one that had absences
• An essay on the role of the curriculum, balancing first the need to stay close to the content of each session, against, second, the nature of inquiry, which requires flexibility
• A short essay on a potential direction for future research: adding in measures of the positive effects of MBCT (e.g. Increasing well-being) rather that focusing solely on reducing suffering.

• Description of the international training path
• How to work with “at risk” people
• The story of ‘Jane’, one participant, described in detail from intake through the 8 th week and 2 follow-up sessions; a very helpful illustration of how transformation can happen in MBCT
• Guided meditations recorded by Mark Williams, Zindel Segal and John Teasdale
• The role of individualized mentorship in preparing new MBCT teachers around the world (full disclosure: Donald Fleck is a recognized MBCT mentor)
• Accessing the doing and being modes of mind in the teacher, while teaching: using self awareness to be fully present, and most effective, during inquiry

• Insights into clients with suicidal depression
• Review of the extensive research on MBCT, which is rich with information for therapists developing a mindfulness-based practice

The Experience of Being an MBCT Teacher is explored creatively in a chapter I haven’t seen elsewhere. Teachers present and future can gain from this exploration of the subject to teaching MBCT. In includes
*The teacher’s own doing and being state of mind in teaching
*The role of supervision
*What makes a skillful teacher
*Responding in moments of discovery
*Holding the curriculum loosely and firmly at the same time (an adaptation of the increased focus in inquiry, in which the moments of learning are less controlled)
*Teacher doubts
*How to effectively use recordings of yourself teaching, for self-evaluation

The book is available at Amazon and other places. It is pubished by Guilford.

Mindfulness Workshop (MB-CT) Starts January 16, 2018

“Your class was probably the turning point in my life. I’ve been meditating regularly since then.” – DM

“It was an incredibly positive experience for me… I practice a lot of the lessons I learned from the workshop in my daily life.” – BD

“Knowing that I am the primary force in my own life gives me a confidence to assert myself.” – KR

This workshop is for people recovering from depression, those with remaining symptoms, and those with generalized anxiety. Participants learn mindfulness practices and cognitive skills to reduce the power of negative thinking, offering stability in general and at difficult moments.

The workshop meets weekly for 8 weeks, offering the complete Mindfulness-Based Cognitive Therapy curriculum. It includes all learning materials and 4 hours of guided meditations for your use.

There will be two groups meeting in the Flatiron area, Tuesday mornings 9-11, and Tuesday evenings 6:45-9:15. May be reimbursable as a mental health expense. The groups are forming now, space is limited.

More information: www.LearnMindfulnessNYC.com

Questions? Call 917-202-5148   or   E-Mail:   info@DonaldFleck.com

Mindfulness for your clients’ mental health

Give your clients the gift of mindfulness

Taught in a mental health context

Mindfulness-Based Cognitive Therapy (MBCT) is an evidence-based 8-week workshop giving clients the training to focus on the present, gain perspective on their negative thinking, and think through positive in-the-moment actions.

We begin the next group Tuesday, January 16, 2018, in Manhattan.

Please send us your referrals now.

Web Information for your clients

Clients who can benefit may have

  • Long histories of depression
  • Long struggles with generalized anxiety
  • Remaining depressive symptoms after treatment (treatment resistant depression)
  • A history of childhood trauma
  • A wish for non-medication solutions
  • An interest in mindfulness

Many more people benefit than originally perceived

A meta-analysis of all the randomized trials of MBCT was published in JAMA Psychiatry in June, 2016. The focus is on MBCT for prevention of depression relapse, but the large sample of this meta-analysis gave researchers a much finer lens through which to look at efficacy. From this study we get evidence that those with remaining depressive symptoms do especially well with MBCT, and that alone has important implications. The same study indicates that those with childhood trauma do well with MBCT.

In addition this meta-analysis showed that MBCT is effective across a wide range of demographics.

Implications for MBCT in the United States

Some 30% of people treated for depression have remaining symptoms, can be defined as treatment-resistant. Now MBCT can be rationally offered to those people. While we would wish to know how much remaining symptoms are appropriate, the research does not show that. Some experts in the field feel the defining element is “energy”, having enough recovery to be able to focus the mind and do the MBCT exercises that are critical for experiential learning.

More information for professionals

The 2016 JAMA article – Containing all the research details.

The related editorial by Dr. Richard Davidson, commenting and outlining ideas for future research.

The blog entry at the Oxford Mindfulness Centre, in which Dr. Zindel Segal and Dr. Catherine Crane clarify many of the implications of the research.

MBCT information site for North America, MBCT.com

Training Centers for teaching MBCT, and gaining general expertise

Centers for training in teaching MBCT, and in preparing to do related research

Note: Donald Fleck is a Mentor for those of you who’d like to begin teaching MBCT.

What to do now

Please review your client list, see who could benefit most from MBCT. Refer them to the workshop. We’ll do the intake to review suitability for each referral. After they complete the workshop, you can see for yourself the sorts of changes the workshop can encourage. Then consider beginning your own training to become an MBCT teacher.

New MBCT Sangha in NYC – Reserve your seat

NYC Sangha Supporting MBCT Therapists On Their Paths

(Manhattan location to come)

Free, supported by your dana contributions.

Sit with therapists and medical professionals preparing to use MBCT, or teaching already. By forming a supportive sangha group we help each other along the path of personal and professional development.

Welcoming professionals at any of these points:

  • Grads of the 5-day MBCT Intensive at Omega or other locations
  • Professionals who have begun MBCT groups
  • Professionals integrating MBCT into individual practice
  • Professionals planning to learn MBCT

We will sit together, walk together, share our mindfulness experience of the morning, and discuss our hopes around MBCT.

Questions: Donald Fleck 917-202-5148 or info@DonaldFleck.com

MBCT helpful for anxiety? Draft questions

I plan to ask the grads of my 35 Mindfulness/MBCT workshops how their practice is going. Here’s a draft of the questions. I am interested in your ideas and feedback on this.

My goal is to get feedback on effectiveness, and to relate this to whether they took the workshop primarily for anxiety or depression.


Please send your comments by using the Contact tab.

Draft questions:

  1. What was your reason for taking the Mindfulness Workshop (MBCT)?

(For example: depression, anxiety, panic, stress, etc.)



2. To what extent did the Mindfulness Workshop help you?

(For example: a lot, a little, varies, etc.)



3. What is your current mindfulness practice like?

(For example: extent of formal practice, extent of mindful awareness, extent of short practices, attendance at meditation events, etc.)



4. Has the Mindfulness Workshop or mindfulness helped you cope better?



5. Comments about mindfulness and the Mindfulness Worksop and MBCT (Mindfulness-Based Cognitive Therapy.)





Group Code: ______ (I will fill this in prior to sending the questionnaire, so I can relate answers to the amount of time passed since taking the workshop.)