What is Mindfulness-integrated Cognitive Behaviour Therapy?
By Dr B. Cayoun and Dr K. Elbourne
There is a growing number of therapy approaches that incorporate mindfulness training.Mindfulness-integrated Cognitive Behaviour Therapy or MiCBT (pronounced M-I-C-B-T) is one of these approaches. It offers a practical set of evidence-based techniques derived from mindfulness training together with principles of Cognitive Behaviour Therapy (CBT) to address a broad range of psychological disorders and general stress conditions. Below is a brief overview of the foundations of MiCBT as well as the core mechanisms and basic practice components of this valuable therapeutic approach.
What is Mindfulness?
Mindfulness involves paying attention to each event experienced in the present moment within our body and mind, with a non-judgmental, non-reactive and accepting attitude. In learning to be mindful, we can begin to counter many of our everyday sufferings such as stress, anxiety and depression because we are learning to experience events in a more impersonal and detached way. Mindfulness used in MiCBT has its roots in Vipassana meditation which was taught in India 2500 years ago and spread across all of Asia. Vipassana means "insight" or "seeing things as they truly are". Central principles and mechanisms of mindfulness include equanimity and impermanence.
Equanimity is best described as a neutral response to something we experience. It is a state of awareness where we neither feel an aversion for unpleasant experiences nor craving for pleasant ones. Other ways of describing equanimity are balance, calmness and composure. The development of equanimity, or an equanimous mind as it is sometimes called, is an important part of mindfulness skills because it gives us the ability to remain less reactive and less judgmental no matter what is experienced, thereby giving us a feeling of ease, self-control and composure as we go about our daily lives.
Mindfulness training teaches us the omnipresent reality of impermanence, the changing nature of all things including our own mental and emotional experiences. By experiencing the changing nature of internal experiences, we can learn to see ourselves in a more flexible and objective way. We can detach ourselves from rigid views and habits that can sometimes lead to stress and unhappiness.
How do we practice Mindfulness?
While we can practice being mindful in everyday life by just observing what is happening around and within us, formal training by way of sitting meditation is most effective for developing mindfulness skills. This is because the formal meditation context prevents the inevitable entanglements with daily stimulations and allows us to focus specifically inside ourselves. Meditation enables us to reprocess our internal experiences, including painful memories, with more awareness, neutrality and acceptance.
During mindfulness meditation, we sit closed eyes and initially focus on the breath to develop concentration and take control of our attention. This alone helps decrease the intrusion of unhelpful thoughts that we may have. During this training, all sorts of thoughts frequently arise. Instead of being caught up in a thought, we learn to see it for what it is, just a thought, an impermanent mental event, no matter what the content of the thought may be, and go back to our focus of attention. In this way, we learn not to react to thoughts. We gain a direct experience that thoughts cannot truly affect us or define who we are.
Similarly, when we pay attention to our body sensations, we also learn to perceive a body sensation merely as a body sensation, regardless of how pleasant or unpleasant it is. Mindfulness training helps us realise that body sensations, like thoughts and all other experiences, are also impermanent by nature and no matter how pleasant or unpleasant they are, they pass away. As we become more mindful of this reality, it becomes increasingly easy to observe that body sensations are essentially an experience that cannot affect us unless we react to them. Body sensations are significant because they are the only means by which we can feel emotions. Accordingly, training ourselves to not react to them helps us accept and let go of emotions, rather than suffer from them. This is called emotional regulation.
What is CBT?
The way we think affects our emotions and behaviour and CBT or Cognitive Behaviour Therapy helps people with such conditions as anxiety and depression change the content of unhelpful thoughts and maladaptive ways of coping, such as avoidance or addictive behaviour. It can involve social skills training, such as assertiveness training, and exposure to situations we avoid out of discomfort but at the expense of mental rest. It can also involve having to verify the validity of our unhelpful beliefs.
MiCBT: Integrating Mindfulness and CBT
MiCBT is a four-stage therapeutic approach which integrates mindfulness and some of the basic principles of cognitive behavioural therapy (CBT) in order to help people improve the way they feel and change unhelpful behaviours. However, MiCBT helps people make changes in a different way to CBT. While CBT attempts to change maladaptive behaviour by modifying people's unrealistic thoughts and beliefs, MiCBT tries to help people learn to develop control over the processes that maintain the unrealistic thoughts and beliefs through mindfulness training. MiCBT helps change the process of thinking, not just the content of our thoughts.
Changing Reactive Habits
Like cognitive behavioural therapy, MiCBT draws on the principles of exposure and desensitisation to help us change habitual unhelpful reactions or coping strategies. However, unlike traditional CBT, MiCBT regards reactive habits as being the results of habit of reacting to body sensations. Body sensations are the results of the way we think, and we learn, often from early childhood, to react to the body sensations in certain ways in our attempt to feel better. Preventing such reactions, while remaining fully aware and accepting of bodily experiences, leads to rapid change in our habitual feelings and behaviours. We feel emotionally relieved.
MiCBT can not only help people change distressing thoughts, feelings and behaviours, it can also help people change their relationships with others. The skills we learn in MiCBT can help us not to react to others and foster a greater understanding and acceptance of ourselves and others. This usually culminates in more harmonious relationships and helps prevent relapse into habitual moods and behaviour. This is explained during stage three of the program.
Mindfulness and Empathy
The fourth stage of MiCBT teaches people to use the skills learned from the previous three stages to develop empathy for themselves and others. The three previous stages lead to the realisation that we are the first beneficiary of the emotions we produce, whether this is a positive or negative emotion. A deep sense of empowerment, acceptance and change usually takes place at the end of Stage 4, which is the last stage of the MiCBT program.
The MiCBT program generally requires about 8 to 12 sessions, but it may finish after 6 sessions or may also be extended as long as necessary, depending on the problem we intend to address or the skills we wish to develop. Sessions are best held weekly or fortnightly for optimum progress.
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