| How can MiCBT help me?
There are several therapy approaches that incorporate mindfulness training, and 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 and 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 and 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 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 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 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 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 also incorporates the notion 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 more objectively and scientifically. We can detach ourselves from rigid views, which sometimes lead to stress and unhappiness.
How do we practice Mindfulness?
While we can practice being mindful in everyday life by observing what is happening around and within us, formal training by 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 with 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. 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 not to 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. 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 that integrates mindfulness and some of the basic principles of cognitive behavioural therapy (CBT) to help people improve the way they feel and change unhelpful behaviours. However, MiCBT allows people to make changes differently from 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 unrealistic thoughts and beliefs through mindfulness training. MiCBT helps change the process of thinking, not just the content of our thoughts.
The 4 Stages are:
This stage will teach you mindfulness skills to notice and let go of unhelpful thoughts and emotions to address life’s challenges successfully. Here you will develop deep insight and equanimity and realize that you don’t have to be prey to every thought that enters your mind and every emotion you feel.Stage 1
During Stage 2, you will learn to apply these self-regulation skills in situations you might be avoiding, which will result in an increase in self-confidence.Stage 2
In Stage 3, you will learn to develop better interpersonal understanding and communication skills in the face of tense situations with people and learn not to react to others’ reactivity.Stage 3
Changing Reactive Habits
Like cognitive behavioural therapy, MiCBT draws on exposure and desensitisation principles to help us change habitual unhelpful reactions or coping strategies. However, unlike traditional CBT, MiCBT regards reactive habits as the result of a habit of reacting to body sensations. Body sensations are the results of how 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 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 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 occurs at the end of Stage 4, 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 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.