MiCBT Research Lab
We research the transdiagnostic mechanisms, applicability and clinical efficacy of Mindfulness-integrated Cognitive Behaviour Therapy (MiCBT), from neurobehavioural mechanisms to measurements to real-world delivery.
The MiCBT Research Lab is an international collaboration studying the human response to co-occurring cognitive, interoceptive and behavioural mechanisms that trigger and maintain mental health conditions and their comorbid symptoms, and how those mechanisms can be retrained by integrating Buddhist psychology with modern psychology and neuroscience to reduce suffering.
Coordinated from the MiCBT Institute in Hobart, Australia, the Lab brings together clinical psychologists and psychiatrists, neuroscientists and psychometricians, implementation researchers and people with lived experience across Australia, New Zealand and North America, alongside independent research groups in Asia, the Middle East and Europe.
Mechanism
What triggers and maintains symptoms, and can it be interrupted effectively?
Measurement
Can it be measured, and does it hold up when tested?
Delivery
Does it survive contact with real services, other cultures, and self-implementation?
About the Lab
The bulk of psychological therapies attempt to address the cognitive-affective ‘content’ of distress: the feared situation, the negative belief, the depressive thought, the trauma memory. The MiCBT Research Lab works on the mechanism of distress: why and how does this kind of thinking mechanism keep returning and what is the mechanism of emotional reactivity?
Rather than attempting to reduce symptoms by addressing unhelpful beliefs, the Lab works on a different question: why does this kind of thinking and reactivity keep returning?
The Co-Emergence Model
The Lab’s answer, formalised in the co-emergence model of reinforcement (Cayoun, 2011; Cayoun & Shires, 2020), is that evaluative thought, those related to topics of personal importance, co-arises with body sensation, and that humans’ repeated automatic reaction to those sensations, rather than to the external trigger, is what reinforces distress-related behaviour. One reacts to either decrease the intensity of unpleasant sensations or increase the intensity of pleasant ones. Once a successful act of reducing unpleasant sensations or increasing pleasant ones has occurred, the behaviour is ‘negatively’ or ‘positively’ reinforced, respectively. Hence the locus of reinforcement is the interoceptive cue co-emerging with a thought, even when it is subconscious, and not the trigger. As over-reliance on self-referential thinking and reacting to body sensations gets established, a disequilibrium between mechanisms and their brain correlates occurs: reduced effectiveness of the insular cortex and executive networks and increased activity of amygdala and default mode network. Multiple studies across disorders suggest that this disequilibrium state maintains symptoms of anxiety and depression in a wide range of disorders and comorbid conditions, including chronic pain. Consequently, the therapeutic target is not what the person thinks or inherently believes, but how they habitually react to ‘what thinking makes them feel’ – the co-emergence of thoughts and body sensations.
Therapeutic Targets
Over two decades the Lab has specified the mechanism of behaviour maintenance and change, built and validated instruments to measure it, seen it tested by independent investigators in randomised controlled trials, watched independent teams replicate it across health systems and cultures, and followed it into routine clinical practice. Our effort is now to make the MiCBT intervention reachable by people who currently receive minimal or no support.
The research team
Dr Bruno A. Cayoun
Principal Investigator &
Clinical Psychologist
Dr Bruno Cayoun is a clinical and research psychologist and founder of the MiCBT Institute based in Hobart, Australia. He has spent over two decades developing and researching Mindfulness-integrated Cognitive Behaviour Therapy (MiCBT), a transdiagnostic, evidence-based treatment approach effective across a wide range of mental health conditions.
Dr Cayoun is the developer of the Co-Emergence Model of Reinforcement (CMR) – the theoretical underpinning of MiCBT – a neurophenomenological framework that explains the mechanisms underlying cognitive and behavioural reinforcement, and the way in which the mind makes predictions that create unhelpful thoughts and emotion dysregulation. His work bridges classical cognitive-behavioural therapy with contemporary neuroscience and Buddhist psychology, offering clinicians a unified theoretical understanding of how psychological disorders develop and how they can be effectively treated.
He is the author and co-author of five books on MiCBT, and his research has been published in leading peer-reviewed journals. Beyond clinical psychology research and practice, Dr Cayoun has maintained a deep engagement with Buddhist psychology and Vipassana meditation, particularly within the Burmese Theravada tradition of S. N. Goenka, U Ba Khin and Ledi Sayadaw since 1989.
Dr Andrea Grabovac
Clinical Professor of Psychiatry
Dr Andrea Grabovac, MD, FRCPC, is a Clinical Professor of Psychiatry at the University of British Columbia and Co-Director of the North American Chapter of the MiCBT Institute. With over twenty years in inpatient psychiatry and fifteen in psycho-oncology consultation-liaison psychiatry, her clinical work applies mindfulness-based treatments across acute, complex and medically comorbid presentations. She trains and mentors clinicians internationally in MiCBT and in Mindfulness-Based Cognitive Therapy through the UCSD Mindfulness-Based Professional Training Institute. She has published on the adverse effects of insight-oriented meditation practice and on clinician competency standards for their recognition and management, and is an active member of the International Mindfulness Integrity Network. As an affiliated scientist with the Meditation Research Program at Harvard Medical School, her research examines the clinical relevance of stages of meditative development, including current work on meditation-related adverse effects. She is co-author of MiCBT for Well-being and Personal Growth (2nd edition) and the MiCBT Mindfulness and Meditation Workbook for Anxiety and Depression, and has practised in the Burmese Theravāda Vipassana tradition since 2002.
Dr Alice Shires
Clinical Psychologist
Dr Sarah Francis
Psychologist
Dr Sarah Francis is a registered psychologist at the Melbourne Mindfulness Institute where she offers both individual and group-based programs in MiCBT. After receiving training in MiCBT with its developer, Dr Bruno Cayoun, Sarah subsequently collaborated with Dr Cayoun in training and research projects including co-authoring “The Clinical Handbook of Mindfulness-integrated Cognitive Behaviour Therapy” Cayoun, Francis and Shires, Wiley, 2019. She conducted research on the measurement of mindfulness, led an RCT into the effectiveness of MiCBT in group format with a range of mental health conditions (2020) and published on the comparison of MiCBT with MBCT (2022). Sarah convenes the MiCBT Interest, Research and Peer Supervision Group which has members from a variety of Australian states and overseas locations.
Prof Chris Krägeloh
Professor of Psychology
Chris Krägeloh is a Professor of Psychology in the Department of Psychology at Auckland University of Technology, New Zealand. His current research interests are psychometrics, outcome measurement, quality of life, well-being, mindfulness, and psychosocial factors in social robotics. He is a founding member of the New Zealand World Health Organisation Quality of Life Group and the Psychosocial Aspects in Robotics (PAIR) Lab. He is an author on over 150 articles in international journals, lead author of a mindfulness research book, and an author and editor of several other books on research methods and well-being. He was co-Editor-in-Chief of the journal ‘Mindfulness’ (Springer Nature) and is currently co-Editor-in-Chief of ‘Journal of Psychology and AI’. Chris is also an editor of two major live reference works: ‘Handbook of Assessment in Mindfulness Research’ and ‘International Handbook of Behavioural Health Assessment’.
Dr Oleg Medvedev
Senior Lecturer
Oleg N. Medvedev is a Senior Lecturer at the University of Waikato whose research combines health and developmental psychology, psychometrics and data science. A ScholarGPS Highly Ranked Scholar (2025), he ranks 6th globally in Mindfulness, in the top 2% of scholars across all fields, and in the top 1% globally in Generalizability Theory and the Rasch model. He applies advanced psychometrics (Rasch analysis, generalizability theory and network analysis) alongside machine learning and AI to build fairer assessment and to develop risk-prediction algorithms for stroke and dementia, and he develops and evaluates mindfulness-based and digital-health interventions that prevent and treat a broad range of mental health conditions. He has authored 170+ peer-reviewed journal articles among more than 200 publications, with over 5,700 citations (h-index 40; Google Scholar) and lead-author work in Nature-portfolio journals, and serves as Editor-in-Chief of Mindfulness (Springer Nature, Q1) and co-founding Co-Editor-in-Chief of the Journal of Psychology and AI (Taylor & Francis). His work reaches well beyond academia through globally adopted tools such as the WHO-endorsed Stroke Riskometer, with a consistent focus on equity for Māori and Pacific peoples, and he has secured over NZ$1 million in funding and completed 40+ postgraduate supervisions.
Dr Sarah Strohmaier
Psychology Lecturer
Dr Sarah Strohmaier (Victoria University, Melbourne) is a lecturer and researcher in mindfulness-based interventions with expertise in dose-response relationships, personalisation, meditation practice quality, and approaches to predicting treatment outcomes to further our understanding of these mechanisms, both from a wellbeing and a neuroscience perspective. She leads the real-world MiCBT outcomes program.
Dr Strohmaier does research with both clinical and non-clinical populations, with novice as well as experienced mindfulness practitioners. Additionally, Sarah is interested in how evidence-based mindfulness programs and practices can be made more accessible to increase wellbeing in the community and society. She also has an interest in positive psychology applications, and how they can improve wellbeing in the general population.
Dr Glenn Bilsborrow
Clinical Psychologist
Dr Glenn Bilsborrow (DPsych) is a registered clinical psychologist in private practice and has a longstanding interest in understanding the processes underpinning psychological change. With a particular interest in improving the measurement of mindfulness and the mechanisms that produce lasting therapeutic change, he has completed advanced training in Acceptance and Commitment Therapy, Dialectical Behaviour Therapy, Cognitive Behaviour Therapy, and Schema Therapy. He has also undertaken extensive training in Mindfulness-integrated Cognitive Behaviour Therapy (MiCBT), which he first incorporated into his clinical practice in 2005 and has used as his primary therapeutic approach since 2011. He has worked with a broad range of psychological presentations, with particular interest in emotional processing, trauma, anxiety disorders, obsessive compulsive disorder, autism and ADHD, and personality functioning. He is a Research Associate at the MiCBT Institute and published peer-reviewed research. His research focuses on the mechanisms through which mindfulness enhances emotional awareness and psychological wellbeing.
Dr Fateh Sohrabi
Clinical Psychologist
Dr Fateh Sohrabi is a clinical psychologist based in Sanandaj, in the Kurdistan Province of western Iran, working with crisis intervention with severe and chronic disorders in a psychiatric setting. His main interest is in the transdiagnostic methods and structures used in MiCBT and their effects in different clinical and subclinical populations, with a particular interest in health psychology. Dr Sohrabi was initially trained in MBCT and later in MiCBT under the supervision of Dr Bruno Cayoun. Since 2012, he has been using MiCBT and produced the Persian translation of the main MiCBT resources, including the 2015 self-help book for clients and the clinical handbook for therapists, as well as all audio instructions used in the MiCBT program. He is also a faculty member at Kurdistan University of Medical Sciences, where he teaches and supervises students. He completed his PhD thesis at Shahid Beheshti University of Medical Sciences, Tehran, where he compared the desensitization model of MiCBT (combined interoceptive and exteroceptive desensitisation) with standard exposure therapy for anxiety symptoms. He also evaluated the effect of MiCBT on diabetic patients with depression and published his research in a Springer journal.
Research streams
Mechanism
We study the application of the co-emergence model of reinforcement (Cayoun, 2011; Cayoun & Shires, 2020), which links evaluative cognition, interoception, and operant learning into a single account of symptom maintenance. Current questions include how equanimity toward interoceptive cues (body sensations) exerts its effect across conditions, whether it mediates outcomes consistently across diagnoses, and how the model relates to contemporary interoceptive and predictive-processing accounts of emotion. The model’s central mediation prediction has now been supported in a randomised trial and in routine clinical care.
The Mindfulness-based Interoceptive Exposure Task (MIET) is a short, self-implemented technique that significantly reduces emotional distress and pain intensity within thirty to sixty seconds. It is an essential skill developed during MiCBT to recreate an equilibrium state between neural networks during distressing moments. The MIET is also a standalone interoceptive exposure method applied in a transdiagnostic manner and as often as possible. We study its immediate and cumulative effects, its boundary conditions, and who it suits. Work in this stream includes the original chronic-pain pilot, experimental studies of attentional bias as a moderator of MIET versus distraction, an online-delivery trial in mixed chronic pain, and convergent independent research using smartphone-delivered interoceptive exposure with neuroimaging for chronic back pain.
Measurement
A mechanism that cannot be measured cannot be tested. The Lab has developed and validated a suite of instruments (the Equanimity Scale-16, the Mindfulness-based Self-Efficacy Scale-Revised, and the Mindfulness Meditation Practice Quality Scales) using classical, confirmatory and Rasch methods, with cross-national measurement invariance work and independent validations in several languages. This stream is deliberately open: these instruments are freely available for research and non-commercial clinical use. They are frequently used by mindfulness researchers with no connection to the lab.
The MiCBT pivotal study was a pre-registered, appropriately powered randomised controlled trial in a transdiagnostic primary-care sample (Monash University, 2015–2020), showing sustained reductions in depression, anxiety and distress and improved flourishing at six-month follow-up, with equanimity the most influential mediator. Since then, independent teams with no developer involvement have run controlled trials in breast cancer, obsessive-compulsive disorder, multiple sclerosis, perinatal depression and polycystic ovary syndrome, across Australia, Iran, Turkey, India and China. A scoping review published in Mindfulness in 2025 synthesised this literature.
Delivery
To verify whether trials’ results can work in real-world conditions, we use outcome data from routine psychology clinics and apply machine-learning and survival-analysis methods to identify who enrols, who responds, who drops out and why, and to test whether the mechanism observed under trial conditions still operates under ordinary ones. The aim is to maximise the precision of delivery: matching support intensity to individual need rather than giving everyone the same dose.
One of our next studies is to examine the validity and utility of a smartphone application for the entirely self-implemented MiCBT program at very low cost to individuals with mild to moderate symptoms who cannot find, afford, or relate to a mental health therapist. The MiCBT Guide app carries the full ten-session program with guided practice, video instruction, progress tracking and embedded outcome measures. We want to know whether the program retains its effect without a therapist. We plan to investigate the validity of self-guided delivery, the adherence problem that self-guided meditation-based interventions face, dose-response measured directly through practice-quality instruments, and the clinical governance and escalation pathways that any AI-supported component must include.
The treatment gap is widest where clinicians are scarce. We work with regional partners on adaptation – not translation alone – of practice instructions, case examples and mental-health language, with studies and implementation protocols completed or in-progress in Persian, Vietnamese, Spanish, Hindi and Chinese. Interoceptive desensitisation methods require less linguistic and idiomatic adaptation than cognitively loaded procedures, but meaning-making around bodily experience remains culturally shaped, which is why localisation is led by partners in each region rather than from Australia.
This stream covers competency standards for MiCBT, accreditation and supervision models, university curriculum integration, qualitative work on how experienced clinicians actually experience the training, and health-system fit and reimbursement. To ensure that those who deliver MiCBT do so without losing fidelity, we encourage clinicians and researchers to be fully trained in the program. Accordingly, the MiCBT Institute has been offering scholarships to those in low- and middle-income countries so they can access training free of charge. Clinical researchers from Iran, Pakistan, India and Vietnam have benefited from this offering.
Current research collaborations
These studies are led by the listed institutions; the Lab contributes protocol design, validated measures, training and analysis.
| Study | Stream | Institution | Status | Ethics and registration |
|---|---|---|---|---|
| Pharmacotherapy versus pharmacotherapy plus MiCBT after hospitalisation for suicide attempt | Trials | Kurdistan University of Medical Sciences | Recruiting | IR.MUK.REC.1404.090 Trial registration |
| Interoceptive versus exteroceptive exposure in anxiety (partial dismantling) | Mechanism | Shahid Beheshti University of Medical Sciences | Active | IR.SBMU.MSP.REC.1400.238 Trial registration |
| Predicting treatment outcome, attrition and enrolment suitability | Real-world delivery | Canterbury Christ Church University (NZ) and Victoria University (AU) | Active | ETH2122-0142 |
Four additional studies are in design with collaborating partners:
- development and validation of the compassion subscale of of the MMPQS measure
- validation of the MiCBT Guide app for full self-implementation
- safety and screening protocols for unsupervised meditation-based delivery
- health-economic evaluation with primary health networks and with pain and oncology services.
Measures and research tools
Besides symptom-specific measures used in MiCBT research, MiCBT-specific instruments are important in order to capture the effects of central mechanisms. These measures are available at no cost for research and non-commercial clinical use. The only request is to cite the validation papers and, where possible, share psychometric findings with the Lab so the evidence base for each measure continues to accumulate.
These clinical research tools are freely available for academic, research, and non-commercial clinical validation purposes. Please submit a request to obtain the full administration guidelines, scoring keys, and translation files.
MiCBT measures
What they measure
Available in
Non-reactivity to pleasant, unpleasant and neutral experience
English, Dutch, Persian, Hindi, Spanish, Chinese, Turkish, and Vietnamese
Confidence in applying mindfulness skills across six life domains
English, Dutch, German, Portuguese, Japanese, Turkish, Arabic, Persian, Urdu, and Thai
Quality, not just quantity, of meditation practices
English
Lived experience in the research
The Lab works with people, whether or not they have completed the MiCBT program, who advise on design, materials and digital development.
Program improvements
- Reports from program graduates that chronic conditions needed longer to consolidate skills drove the extension of the program from six sessions to eight, then ten, now delivered weekly to fortnightly according to symptom severity – a defining feature of the current protocol.
- Feedback about practice load and posture produced graded practice durations and flexible options that lowered barriers for people with pain, fatigue or restricted mobility.
- Accounts of traumatic memories surfacing during body-scanning led directly to trauma-sensitive guidance in clinician training and materials.
- Requests for access without a therapist redirected the entire digital strategy, from a therapist-support tool toward full step-by-step low-intensity self-implementation – and, ultimately, toward the stepped-care model the Lab now works within.
- Beta-testing of the MiCBT Guide phone application by program graduates and clinicians led to structural changes in the digital program delivery.
- The self-efficacy measure (MSES-R) was built from, and worded in, patients’ own language.
For funded work, lived-experience collaborators will be remunerated at fair professional rates for co-design, workshops, materials review and advisory roles. Much of the program’s development predates current involvement standards, and the Lab regards the shift from informal acknowledgment toward structured, paid collaboration as part of the program’s maturation.
Continual lived-experience collaborators
The Lab’s work relies profoundly on active co-design. These advisors direct protocol development by bringing critical lived experience to the research loop. By aligning scholarly methodology with the insights of real-world recovery journeys, the team develops intervention protocols that are compassionate, robust, and directly functional, including with children with ADHD or behavioural complexities.
Work with the Lab
Researchers
The Lab supports independent evaluation, including by teams with no prior connection to MiCBT — validated measures, the manualised protocol, fidelity materials and letters of support for grants.
Clinicians & services
A practice-based research network brings clinicians’ outcome data into the literature — with benchmarked analysis of their own results, and co-authorship where warranted.
Lived experience
People with experience of anxiety, depression or related conditions join as paid advisors, co-designers and reviewers. No one is asked to share their personal story.
Students and higher-degree researchers
If you are interested in MiCBT research, whether you are an honours, masters or doctoral student, or a an established researcher, don’t hesitate to let us know. Write a paragraph or two on your interests. We are particularly interested in research assistance to examine the effectiveness of the MiCBT Guide app across disorders.
Translators & partners
Adaptation into new languages is led by regional partners, who hold authorship on the adaptation and validation outputs. Priority goes to the languages of low- and middle-income countries.
Funders & health systems
The Lab is preparing to work with commissioners, primary health networks and health services on implementation, evaluation and health-economic assessment.
If one of these describes you, write and say which — the team will point you to the right person.
Take part in a study
Join the research register and the team will be in touch when a study opens that matches your circumstances. Details are never used for anything else, and you can withdraw at any time.
All studies conducted by the Lab are approved by a registered human research ethics committee before recruitment begins. Participation is always voluntary, and declining has no effect on any care you receive.
Funding and interests
Maintaining rigorous scientific integrity requires complete transparency in funding sources, institutional roles, and clinical research methodologies. Below are the academic alignments, funding structures, and conflict mitigation strategies associated with Dr Bruno Cayoun and the MiCBT Institute.
The Institute and its interests
The MiCBT Institute is a small private organisation in Hobart, Tasmania. It develops and delivers MiCBT clinician training, publishes program materials, develops the MiCBT Guide app and derives benefits from app subscriptions to maintain and improve the app. Dr Bruno Cayoun is its Director and the originator of the intervention. He and Institute-endorsed MiCBT trainers are paid to provide training to qualified mental health professionals. The Institute has received funding from an anonymous philanthropic donor, enabling the enhancement of its online teaching platform.
How this is mitigated
Several mitigations apply: the pivotal randomised trial was conducted at Monash University, led and analysed by investigators outside the Institute; a substantial and growing proportion of the trial evidence comes from independent researchers with no developer involvement and no commercial relationship with the Institute; the measures the Lab develops are released free of charge and validated by researchers outside its network; and outcome data from routine practice are analysed by university-based collaborators.
Mitigation Framework
- Clinical trial assessments conducted by blind, external assessors.
- Full disclosure of IP interests in all scientific publications.
- Oversight by independent research ethics boards.
Publications
The full, continuously updated index of MiCBT and related mindfulness research, including studies by independent groups, is maintained in the Research Studies index.
Selected foundational papers
- Cayoun, B. A., & Shires, A. G. (2020). Co-emergence reinforcement and its relevance to interoceptive desensitization in mindfulness and therapies aiming at transdiagnostic efficacy. Frontiers in Psychology, 11.
The theoretical model - Francis, S. E. B., Shawyer, F., Cayoun, B. A., Enticott, J., & Meadows, G. N. (2022). Group MiCBT reduces depression and anxiety and improves flourishing in a transdiagnostic primary care sample compared to treatment-as-usual: a randomised controlled trial. Frontiers in Psychiatry, 13, 815170.
The pivotal trial - Boldt, S., Shires, A., & Beattie, J. (2025). Mindfulness-integrated Cognitive Behaviour Therapy: a scoping review of randomised controlled trials. Mindfulness, 16, 3424–3438.
The evidence synthesis - Francis, S. E. B., Shawyer, F., Cayoun, B. A., Grabovac, A., & Meadows, G. N. (2024). Differentiating mindfulness-integrated cognitive behavior therapy and mindfulness-based cognitive therapy clinically. Frontiers in Psychology, 15, 1342592.
How MiCBT differs from MBSR and MBCT - Cayoun, B. A., Simmons, A., & Shires, A. (2020). Immediate and lasting chronic pain reduction following a brief self-implemented mindfulness-based interoceptive exposure task: a pilot study. Mindfulness, 11, 112–124.
The MIET - Hodren, N., Williamson, T., & Shires, A. (2025). Effectiveness of the brief self-implemented mindfulness-based interoceptive exposure task taught online in a mixed chronic pain group. Mindfulness, 16, 3518–3534.
The MIET delivered online - Rogers, H. T., Shires, A. G., & Cayoun, B. A. (2021). Development and validation of the Equanimity Scale-16. Mindfulness, 12(1), 107–120.
The mechanism measure - Cayoun, B., Elphinstone, B., Kasselis, N., Bilsborrow, G., & Skilbeck, C. (2022). Validation and factor structure of the Mindfulness-Based Self-Efficacy Scale-Revised. Mindfulness, 13(3), 751–765.
The self-efficacy measure
Contact
MiCBT Institute
277 Macquarie St
Hobart TAS 7000
Australia