MINDFULNESS AND CBT

WHAT IS MINDFULNESS?

Sea mindfulness
When our mind wanders, we often stop noticing the world around us.

A simple definition is that mindfulness is the opposite of mindlessness. It’s estimated that people spend almost half of their time thinking about something other than what they are doing at the moment. It’s easy to stop noticing the world around us and become preoccupied with memories, worries or future plans during these mind-wandering moments. As one study put it, “a human mind is a wandering mind, and a wandering mind is an unhappy mind” (1).

 

The practice of mindfulness aims to interrupt this day-to-day autopilot mode. It is about training yourself to pay attention in a non-judgemental way, directing attention to what is happening in the present moment and “waking up from a life on automatic” (2).

 

Core mindfulness practices such as the body scan help to foster present-moment awareness of physical sensations, thoughts and feelings. Besides cultivating awareness, focus and concentration, mindfulness-based cognitive therapy (MBCT) emphasises the value of acceptance strategies, of ‘allowing’ and ‘letting be’.

 

 

IS MINDFULNESS A RELIGIOUS OR SPIRITUAL PHENOMENON?

No. Mindfulness is simply a method of mental training. Its benefits are enjoyed by atheists, agnostics and believers alike.

 

 

MINDFULNESS: MENTAL HEALTH BENEFITS

Shell mindfulness
Mindfulness helps us to experience afresh things we may be taking for granted.

Purposefully concentrating on the present moment helps people to experience afresh things they may be taking for granted. Crucially, it can also improve mental well-being by making people more aware of their thoughts and feelings and by enabling them to better tolerate and cope with emotional distress. Professor Mark Williams, one of the pioneers of mindfulness-based cognitive therapy (MBCT), notes that it’s “easy to lose touch with the way our bodies are feeling and to end up living 'in our heads' – caught up in our thoughts without stopping to notice how those thoughts are driving our emotions and behaviour” (3).

 

 

 

 

 

 

 

IS THERE HARD EVIDENCE OF THESE BENEFITS?

Yes. The National Institute for Health and Care Excellence (NICE) recommends mindfulness-based cognitive therapy as a way of preventing depressive relapse in people who have had three or more bouts of depression in the past. Studies show MBCT reduces rumination and can help people to cultivate self-compassion, helping to reduce depression, anxiety, stress, irritability, exhaustion, and physical pain. Brain imaging studies show that regular mindfulness practice can actually shrink the amygdala, the part of the brain associated with fear and emotion. While the amygdala shrinks, the pre-frontal cortex – a region of the brain associated with higher-level brain functions such as awareness, concentration and decision-making – becomes thicker.

 

One word of caution: although the evidence base for mindfulness-based approaches is growing, some researchers point to methodological shortcomings in some MBCT studies. Consequently, they caution that its benefits should not be oversold. Mindfulness alone is not a panacea for life’s troubles; it is, however, a very useful tool that can complement tried-and-trusted cognitive behavioural therapeutic approaches.

 

MINDFULNESS AND ACCEPTANCE STRATEGIES IN CBT

Lake calm mindfulness
Calmly viewing troubled thoughts as passing events can help ease emotional distress.

The traditional cognitive behaviour therapy (CBT) approach focuses on actively tackling and rebutting the negative intrusive thoughts commonly seen in people with anxiety, depression or low self-esteem. Over the last 15 years, newer models of CBT – often known as third-wave CBT therapies – have also incorporated techniques involving mindfulness and psychological acceptance.

 

Rather than always actively challenging troubled thoughts, third-wave CBT therapies recommend that people calmly view such thoughts as passing events. This sense of calm can be especially useful in cases where people are in danger of over-analysing, of thinking too hard. While third-wave therapies such as MBCT differ from traditional CBT in some respects, both approaches encourage people to view thoughts as mental events rather than facts, to “observe their thoughts rather than being led by them” (4).

 

 

ACCEPTANCE AND CBT: EXAMPLES

Beach foot mindfulness
Mindfulness and acceptance strategies can help enrich our lives.

The value of acceptance strategies in CBT has become especially evident in recent years. To give one example: in the early days of CBT, back in the 1970s, researchers emphasised the importance of a rational outlook whereby people re-evaluated catastrophised worries. For example, this might mean demonstrating that a dreaded medical fear, far from being likely, only happens to one in 100 people. However, this neglected the fact that extremely anxious people are liable to say, “what if I’m the one?” Over the last 15 years, CBT researchers have recognised that intolerance of uncertainty is the core feature of worry, and that rather than battling uncertainty, clients must accept and embrace the fact that life is inherently uncertain.

 

With low self-esteem, a mindful, accepting approach can also nicely compliment the active critical thinking skills taught in CBT. The goal of treatment in clients with low self-esteem is not high self-esteem, but self-acceptance – being able to recognise both your strengths and weaknesses and to say, ‘I’m not perfect, but I’m ok’.

 

A mindful, accepting approach can also help people to neutralise their self-critical inner voice. US author, columnist and financial planner Carl Richards author has written about his own experiences in this regard, how he would commonly hear an accusatory ‘Who do you think you?’ inner voice that would accuse him of being a fraud. Learning about Imposter Syndrome, as it is termed in psychology, helped Richards, but the same thoughts still pop into his head. The difference is in how he responds to these thoughts – with equanimity, rather than distress. “The impostor syndrome has not gone away, but I’ve learned to think of it as a friend”, he writes. “So now when I start to hear that voice in my head, I take a deep breath, pause for a minute, put a smile on my face and say, ‘Welcome back old friend. I’m glad you’re here. Now, let’s get to work’” (5).

 

 

MINDFULNESS, ACCEPTANCE AND CBT: A GROWNG FAMILY

Mindfulness and acceptance strategies have much to offer clients living with depression, anxiety and other emotional difficulties. The CBT family has multiplied and diversified in recent years but fundamentally, good CBT is centred around “learning new ways to deal with old difficulties” – the choice is not “’either/or’ but ‘both/and’ at different times”(6).

 

REFERENCES

1: Killingsworth, M.A. and Gilbert, D.T., 2010. A wandering mind is an unhappy mind. Science, 330(6006), pp.932-932.

2: Siegel, D.J., 2007. The Mindful Brain: Reflection and Attunement in the Cultivation Of Well-Being. WW Norton & Company.

3: Williams, M. http://www.nhs.uk/conditions/stress-anxiety-depression/pages/mindfulness.aspx

4: Christensen, B.K., Carney, C.E. and Segal, Z.V., 2006. Cognitive processing models of depression. The American Psychiatric Publishing Textbook of Mood Disorders, pp.131-144.

5: Richards, Carl, 2015. Learning to Deal With the Impostor Syndrome, New York Times. https://www.nytimes.com/2015/10/26/your-money/learning-to-deal-with-the-impostor-syndrome.html 

6: Blenkiron, P. (2011). Stories and Analogies in Cognitive-Behaviour Therapy. West Sussex: Wiley.

 

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