| What is MiCBT?

Below is a brief and simplified overview of the foundations of MiCBT, as well as the core mechanisms and basic practice components. Please click on the bracketed links within the text for more detailed information to see published articles.

Mindfulness-integrated Cognitive Behaviour Therapy or MiCBT (pronounced M-I-C-B-T) is an evidence-based therapy approach that integrates mindfulness training in the Burmese Vipassana tradition of Ledi Sayadaw, U Ba Khin and S. N. Goenka [1, 2] with core methods of Cognitive Behaviour Therapy (CBT) to address a broad range of psychological disorders, stress conditions, and pain symptoms [3, 4]. The theory underlying MiCBT is strongly based on interdisciplinary scientific research, particularly on clinical neuroscience, without losing its foundation in Buddhist psychology [3].

MiCBT is one of the well-established approaches known as a “second-generation mindfulness-based intervention” [5, 6] because it includes important beneficial elements of the “Eightfold Noble Path” in Buddhist psychology: a training in ethics, a training in compassion for self and others, and a training in reducing the emphasis on the self [7]. The formal definition of MiCBT is “a theoretically congruent and technically complementary integration of traditional mindfulness training and CBT, which provides a transdiagnostic approach to address emotional distress across a wide range of disorders” [15, p.5]. 

History

Following over a decade of conceptualization and model development between 1989 and 2000, MiCBT emerged independently from other mindfulness-based interventions between 2001 and 2003. The initial name, “Equanimity Training” (2001-2003), was changed to Mindfulness-based CBT (MCBT) and kept between 2003-2006, then finalized as MiCBT from 2006 to avoid confusion with MBCT. MiCBT arose from Dr Bruno Cayoun’s interest in bringing Vipassana meditation into a scientific and clinical context to assist with the personal growth required to transcend the sources of unnecessary suffering [8]. MiCBT was developed as a manualized transdiagnostic psychological treatment, which is being used and researched internationally [9, 10, 11] and produces beneficial brain changes in depressed patients [12]. 

The first formal pilot evaluation commenced in 2003 at a psychiatric hospital, and unpublished training manuals became available to MiCBT clinical trainees from this time. Further piloting and refinement occurred until 2010, culminating in the first published MiCBT clinical text [13]. The MiCBT program, while retaining its basic structure, has been revised from an 8-weeks to a 10-week duration [14, 15]. For further details on the history of MiCBT, see the Clinical Handbook of MiCBT [15]. 

MiCBT: Integrating Mindfulness and CBT

MiCBT is composed of four stages. We begin by developing insight into internal experiences and skills to manage thoughts and emotions. As we progress along the subsequent stages, attention is increasingly externalized toward others, and mindfulness skills are invested into cultivating a more fulfilling way of relating to the world. The programme generally requires about ten sessions, but the pace can be slowed when needed, and the programme can be flexibly extended to further sessions as long as necessary. Sessions are best held weekly or fortnightly for optimum progress. Unpublished theses showed that MiCBT is equally effective when implemented individually or in groups.

Stage 1: Intrapersonal Regulation

Mindfulness

The first stage of MiCBT is called the “Personal Stage”. It teaches several mindfulness skills to improve attention and emotion regulation. Mindfulness is much more than being present or paying attention [16]. It 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. Because we are learning to meet internal experiences in a more objective, impersonal, and detached way, mindfulness deepens insight into the profound nature of our experiences. Vipassana means “insight” or “seeing things as they truly are”. Perceiving daily stressors with a deeper understanding helps to promote resilience and self-efficacy. Central principles of the vipassana approach to mindfulness are metacognitive and interoceptive insight, equanimity, and impersonality. 

Metacognitive and Interoceptive Insight

Metacognitive insight is both the ability to be aware of thoughts as they emerge in conscious awareness and the understanding of the impermanent and impersonal nature of these thoughts. Interoception is the ability to feel the body’s internal sensations, an essential aspect of emotional experience. Interoceptive insight is the understanding of the impermanent and impersonal nature of all body sensations, including those experienced during emotions. There is now a large body of interdisciplinary evidence that interoception is impaired in common mental health disorders and that poor interoceptive awareness is a major contributor to emotional reactivity [19]. The fact that mindfulness meditation practice in the vipassana tradition used in MiCBT trains people in interoceptive insight may partly explain its efficacy. 

Equanimity

Equanimity is best described as a neutral response to something we experience [17, 18]. It is a state of awareness where we neither feel an aversion for unpleasant experiences nor crave 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. It allows us to remain less reactive and less judgmental, no matter what is being experienced, thereby giving us a feeling of ease, inner resilience, and confidence that we can regulate emotions in our daily lives.

Impersonality

Mindfulness also incorporates the teaching of impermanence, the changing nature of all things, including our own mental and emotional experiences. By integrating the simple yet profound reality that our internal experiences are in a constant state of change, we learn to see ourselves more objectively. We learn to reduce the habit of associating internal experiences with our sense of self. This reduces attachment to rigid views and unhelpful values, often leading to stress and dissatisfaction [3]. By learning to integrate the understanding of impermanence into our daily lives, we can develop a more flexible and adaptive personality.

Stage 2: Behavioural Regulation

Integrating Mindfulness, Equanimity and Exposure Methods 

The second stage of MiCBT is called the “Exposure Stage”. Here, we learn to apply the self-regulation skills learned in Stage 1 in situations that we may be avoiding to prevent feeling anxious but at the expense of mental rest. For this, CBT methods help to change maladaptive ways of coping, such as avoidant, addictive, compulsive, and any other unhelpful behaviours. Note that while the cognitive aspect of CBT attempts to change the content and patterns of maladaptive beliefs by testing their validity through thought disputation, MiCBT uses mindfulness skills to enhance executive control over the processes that maintain these unrealistic thoughts and beliefs. This reduces avoidance and increases equanimity, general self-confidence and self-efficacy while in challenging situations.

Stage 3: Interpersonal Regulation

Integrating Mindfulness and Exposure with Social Skills 

The third stage of MiCBT is called the “Interpersonal Stage”. During this stage, we apply the skills learned during Stage 1 and Stage 2 in tense or conflicting situations with other people. We learn a different way of seeing and understanding others’ reactivity as an expression of their suffering. Equipped with greater equanimity and more confidence, we train to prevent avoidance of situations where conflicts may occur and tackle others’ reactivity with more patience, tolerance, and mindful assertiveness to express our views and needs. Stage 3 helps promote more harmonious relationships.

Stage 4: Transpersonal Regulation

Cultivating Compassion and Preventing Relapse

The fourth stage of MiCBT is called the “Empathic Stage”. It consists of relapse-prevention skills cultivated through a training in compassion and ethics. It integrates mindfulness with the psychospiritual practices of ethics, compassion and egolessness, translated into scientifically grounded principles and contemporary language. Through the practice of loving-kindness meditation, we become kinder and more compassionate with ourselves and others and genuinely value others and the world around us. Concurrently, becoming increasingly mindful of the differences between wholesome and unwholesome intentions and actions facilitates the cultivation of ethics in daily life. Together, training in compassion and ethical living leads to a greater sense of self-worth and a deep sense of care and connectedness with people and the environment. The increased sense of self-worth and empowerment helps prevent relapse into emotional, addictive, and stress-related disorders.