Mindfulness based on cognitive therapy
MENTAL ILLNESS, a leading cause of disability and premature mortality in America, contributes to the use of a significant portion of health care resources. Individuals suffering from mental illness have a diminished neurobiologic threshold and subsequent increased vulnerability to environmental stressors. This vulnerability predisposes individuals to a characteristically chronic course of symptomatic episodes of relapse and remittance. An acute episode or exacerbation of psychiatric symptoms may lead to profound functional disability (Teasdale, J.D., Segal, Z.V., Williams, J.M.G., Ridgeway, V.A., Soulsby, J.M. and Lau, M.A., 2000. Prevention of relapse/recurrence in major depression by Mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology 68 4, pp. 615–623. Abstract | Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (306)Teasdale, et al., 2000; Young et al., 2001). Finding innovative and effective interventions for the treatment of serious mental illness are of major concern for our society (Astin, 1998). In Part I of this two-part article, the authors introduced principle concepts of mindfulness, and reviewed current research in the usefulness of mindfulness practice for treatment of psychiatric illnesses. The structure and content of mindfulness-based cognitive therapy (MBCT) was detailed and provided the theoretical basis for this treatment approach. In Part II of this article, we present a more detailed exploration of mindfulness-based therapeutic approaches for all phases of psychotherapy, and identify relevant research questions that will provide an empirical base to guide clinical practice. A case study illustrating mindfulness-based therapeutic interventions.
In mindfulness-based cognitive therapy, or MBCT (Segal, Williams, & Teasdale, 2002) blend mindfulness-based stress reduction program practices (Kabat-Zinn, 1990) with traditional principles and practices of cognitive therapy. The use of mindfulness-based interventions promotes meditative practice of increasing insight through focused attention on conscious thoughts, feelings, and bodily sensations. Segal and his colleagues created an approach where mindfulness is considered the primary skill to teach vulnerable individuals practices for preventing relapse of depressed mood, a heralding symptom of mental illnesses, particularly major depression disorder.
Research finding have shown that previously depressed individuals struggle with a mood-induced bias that focuses on negativity in their lives (Teasdale, et al., 2000). Informed by these findings, Segal and colleagues developed MBCT to prevent relapse in individuals recovered from chronic depression. Mindfulness is considered the primary skill to teach vulnerable individuals to prevent relapse of symptoms of mental illnesses (Segal et al., 2002). Traditional cognitive therapy models have focused on changing depressive thinking through self-dialogue, imagery, role-playing, reframing, examining evidence for thought validity, and restructuring thought patterns. The primary aim of MBCT is to prevent depressed mood that often heralds the onset of relapse.
Major assumptions and practices of MBCT are shared with traditional cognitive therapy. The central assumption is that an individual’s vulnerability to relapse is the result of that individual’s proclivity, or cognitive bias, towards negative thinking in the presence of depressed mood. This proclivity is triggered at the neuronal level by environmental, biological, and/or psychological stressors. For vulnerable individuals, even normal day-to-day sadness and/or anxiety can have the serious consequence of precipitating a ruminative pattern of negative thinking, a pattern that may ultimately culminate in relapse of depression. Research has shown that vulnerable individuals experience a cognitive bias towards maladaptive patterns of negative thinking precipitated by depression and individuals become less resilient with each recurring episode of depression (Segal, et al. 2002, Segal, Gemar, & Williams, 1999; Miranda & Pearsons, 1988, 1990; Segal, Williams & Teasdale, 1996 as cited in Segal et al., 2002). In their study of groups of previously depressed individuals, Segal et al., (2002) found MBCT to be successful in lengthening the duration of remission from depression. The efficacy for MBCT in diverse patient populations suffering from other psychiatric illnesses has not been explored. However, studies of clinical populations of individuals where mindfulness approaches have been integrated into therapy lends support for its use with individuals. Linehan (1995) has used mindfulness-based principles and practices within the dialectical behavioral therapy approach since the 1980s. Consistent with Linehan’s approach, MBCT’s psychoeducational framework teaches individuals skill-building techniques to manage their mental illness. In both therapeutic approaches but particularly, MBCT, core interventions are experiential, empowering, and educational. Integration of MBCT interventions can occur throughout all phases of individual psychotherapy.
Introductory phase of MBCT
The introductory phase of MBCT offers patients and therapists the opportunity to develop rapport and mutually assess the suitability of treatment prior to the working stages of therapy. Integration of MBCT for individuals in psychotherapy begins by explaining the philosophy and practices underpinning the therapy. Patient concerns and questions regarding this therapeutic method should be addressed during this introductory stage of therapy. For example, patients frequently inquire about the religious references for mindfulness and may be assured that mindfulness is addressed in all world religions including Judeo-Christian religions. Specific references to the Torah and the Bible may be helpful for concerned patients (Hirst, 2003) such as “Take therefore no thought of tomorrow; for tomorrow shall take thought for the thing of itself” …Matthew 6:34 (Revised Standard Version). This early phase of MBCT psychotherapy focuses on the development of the therapeutic alliance between patient and therapist. Exploration of the identified problem areas, treatment approaches, and treatment goals and expectations are also standard topics during this phase. These early introductory sessions also address the individual’s barriers to a cultivation of mindfulness. Personal recognition of obstacles, including time constraint, and resistance to change, is explored. Therapy interventions combine psychoeducational approaches and a focus on meditative practice for cultivating mindfulness. Individuals are taught the concept of interpreting thoughts as simply mindful events or mental constructions, and not truths and they learn to recognize how one particular objective situation can elicit very different individual reactions and responses. This exercise helps patients to draw conceptually links among thoughts, feelings, and behaviors, referred to in traditional cognitive therapy as the ABC model of distress. These mindfulness skills are later incorporated into the working phase of therapy.
Tags: Cognitive therapy