Mindfulness in Cognitive Behavioral Therapy

There are a number of recently developed forms of Cognitive Therapy (CT) that have been termed ‘third wave therapies’. The first wave was Behavior Therapy, the second, Cognitive Behavior Therapy (CBT) and this third wave comes with a variety of names. These include Dialectic Behavior Therapy (DBT), Meta-Cognitive Therapy (MCT), Mindfulness Based Cognitive Therapy (MBCT) Acceptance and Compassion Therapy (ACT) and others.

The new therapies all tend to incorporate Mindfulness or Detached Mindfulness as a therapeutic technique. There have been some significant advances in understanding the cognitive mechanisms that underlie the clinical conditions that CT addresses today. These advances have been the basis for including Mindfulness in treatment programs. Albert Ellis was the first to recognize that a major factor that both
intensifies and perpetuates a person’s depression or anxiety is the ‘Secondary’ thoughts, feelings and behaviors about the initial distress.

For example someone may have a simple phobic fear, perhaps of flying, which they have managed by avoiding planes. Secondarily, however they may feel there is something wrong with them, they are weaker than others and it means their mental health is on the decline and could get worse. They may realize they do not go on the same holidays as others, which indicates to them how serious it is. They fear what others think of them and become increasingly depressed about themselves and the effect this has on their life. This process reflects what is now understood as meta-cognitions and meta-emotions.

MINDFULNESS IN COGNITIVE THERAPY

Dr. Ron Seigel of Harvard Medical School points out in his book that life inevitably involves pain and discomfort. Suffering occurs when we resist discomfort and pain in life. Much of our suffering involves worry and  anxiety about the future or sadness, guilt or regrets about the past. Mindfulness is aimed at focusing on the present, while accepting discomforts that enter into our experience. It is also aimed at practising compassion toward ourselves and others. The clinical application of Mindfulness techniques are not only effective at reducing the suffering of anxiety and depression, they are associated with measurable beneficial effects on brain function.

GETTING THE MOST FROM OUR RESEARCH ANALYSIS

Research indicates 45 minutes of Mindful Meditation a day yields enormous psychological benefits.

In depression, people may experience a mood change that is sad or blue. This mood change may be the result of a recent real or perceived loss. It is often due to a sense that ‘I should have done better’ or ‘I shouldn’t have made that mistake’. Once these initial feelings are activated, people often strive to immediately relieve their initial discomfort. To do this, they begin to ruminate with thoughts like: ‘why do I do those things, why do I get so depressed about it, I need to fix it, I shouldn’t feel this way, if I can’t analyze it and fix it it will happen over and over’. They may also think ‘I am weak or vulnerable for feeling this way, I may stay depressed and never feel better’. People often wake up and check their mood first thing in the morning (when most of us feel pretty sluggish) and think I don’t feel right, I am depressed and the daily ruminations and depression begin.

The ultimate goal of Mindfulness techniques in cognitive therapy is to accept variations in thoughts and feelings as part of normal life. It has been found that non-judgemental, compassionate acceptance of
even very sad, depressing thoughts and feelings or extreme anxiety provoking thoughts and images goes a long way to allowing them to dissipate and pass without becoming chronic conditions.

Life is inevitably associated with hardship and discomfort. Excessive energy is directed to avoiding or escaping pain. Suffering = pain x resistance

SMARTER THERAPY: Mindfulness Principles

1. Accept the experience. It is instinctive to try to end discomfort. But trying to avoid negative emotions often makes them worse.
2. Be in the Moment. Recognize I may feel bad now, but it will pass. Stay focused on the present.
3. Be Compassionate. Accept discomfort with loving kindness and an attitude of self care.

A Publication of the Centre for Cognitive Therapy. Written by Dr. Arthur Blouin.