Gray N White

Mind over Matter: Mindfulness-based Cognitive Therapy

Introduction

“Mind over Matter”, “We are the masters of our own universe”, “Our life is what our thoughts make it”

These terms are not foreign to us. While the perception of the meaning behind it differs, when dwelled into the science of it, each of these terms holds a significant meaning. 

Mind over Matter– Our thoughts interact with the physical world, whether or not we know it, affecting change all the way down to the subatomic realm. 

We are the master of our own universe– The mind has the ability to alter the state of matter itself, and more importantly, the mind has the power to encourage the physical world to move in one specific direction. Our life is what our thoughts make it– The nature of our reality is shaped by our thoughts, feelings, and emotions that we experience every day.

Through all of these, we come close to one conclusion that our thoughts define our reality and that, one can take control of this reality and make adjustments to it which can enhance the overall quality of life. One of the tools that help us learn to recognize and understand our thought and feeling patterns, intending to create new, more effective patterns is Mindfulness-based Cognitive Therapy (MbCT). [15]

Mindfulness-based cognitive therapy (MbCT) is defined as an approach towards psychotherapy that applies cognitive-behavioral therapy (CBT) methods. In collaboration with mindfulness meditation practices and similar psychological strategies, it helps individuals better understand and manage their thoughts and emotions to achieve relief from feelings of distress. 

Born from the union of cognitive therapy and meditative principles, MbCT Comprises of:

  • Cognitive therapy: aims to help clients grow and find relief from symptoms of mental illness through the modification of dysfunctional thinking (Beck Institute, 2016).
  • Mindfulness can be summed up as the practice and state of being aware of our thoughts, feelings, and emotions on a continuous basis (Greater Good Science Center, 2017). 

 

The combined outcome of these ideas is MbCT, a powerful therapeutic tool that can be successfully applied to the treatment of depression, anxiety, bipolar disorder, and more.

The Story behind and the Development since:

Mindfulness practices have their root in Buddhist traditions extending back over 2500 years. In recent decades, there has been an ever-increasing interest in applying mindfulness in the context of Western medical treatments.

1991 saw the creation of a multilevel concept of the mind called “Interacting Cognitive Subsystems” (ICS) by Philip Barnard and John Teasdale. The ICS model’s foundation is laid out on Barnard and Teasdale’s concept, and it frames out that the mind has multiple modes that are responsible for receiving and processing new information cognitively and emotionally. This concept linked an individual’s vulnerability to depression with the degree to which he/she relies on only one of the modes of mind, inadvertently blocking themselves while doing so. The mind has two main modes that are the “doing” mode and the “being” mode. The “doing” mode can also be termed the “driven” mode. The “being” mode is the second main mode. This mode does not focus on achieving specific goals, rather the emphasis is on “accepting and allowing what is,” without any immediate pressure to change it. The MbCT program emphasizes the “being” mode, as this mode is believed to promote lasting emotional change, specifically for individuals experiencing recurrent depressive episodes.

The central component of ICS is metacognitive awareness: the ability to experience negative thoughts and feelings as mental events that pass through the mind, rather than as a part of the self. Individuals with high metacognitive awareness can avoid depression and negative thought patterns more easily during stressful life situations, in comparison with individuals with low metacognitive awareness. Metacognitive awareness can be exercised by an individual through their ability to decenter. Decentering is the ability to separate yourself from your own thoughts and feelings. Your thoughts and feelings are not you; they are simply indications of what is happening within yourself. This therapy was also a creation of Zindel Segal and Mark Williams and was partially based on the mindfulness-based stress reduction program, developed by Jon Kabat-Zinn. The basis of mindfulness-based theories is based on simply being in the present moment and understanding that whatever has happened cannot be changed, nor can us dwelling on the consequences of something unrelated to our present situation help the current stressors we’re faced with, we are often better able to cope with whatever disappointments or feelings of depression we’re currently feeling. This is because practicing mindfulness allows us to deal with things rationally and realistically as opposed to getting stressed out about hypotheticals.

How does MbCT work?

MbCT is a package of 8 consecutive weekly sessions, each of 2 hours’ length. Instructions include various formal and informal meditation practices. These include guided body scans, sitting and walking meditations, mindful movement (based on Hatha yoga), 3-minute breathing spaces, and focused awareness of routine daily activities. The beginning sessions involve guided meditations, bringing attention to breathing or bodily sensations. In the next stage, there is more emphasis on developing an independent practice and expanding mindful awareness of mental events, including thoughts and emotions that may previously have been avoided. Self-practicing at home is an essential element of treatment, and patients are encouraged to spend 45 minutes daily practicing mindfulness activities, often using guided meditation recordings. This practice also includes elements of cognitive therapy and psychoeducation about depression. Individuals learn that attempting to resist or avoid unwanted thoughts or feelings may intensify distress and perpetuate depression, rather than help resolve it. Further behavioural elements include supporting activities that enhance well-being, ones like taking a bath, listening to pleasant music, or going for a walk. Patients develop action plans that identify early warning thoughts or feelings that signal worsening symptoms, along with steps to take when they occur.

MbCT places little emphasis on changing or altering thought content, rather, it focuses on participants’ awareness of their relationship to their thoughts and feelings and aims to enhance metacognitive awareness. This is till the degree to which thoughts, feelings, or beliefs are experienced “as mental events rather than as aspects of self or direct reflections of truth.”  This approach for allowing the aspects of our emotional and mental experience that have been the focus of efforts of change or avoidance can be uncomfortable and maybe frankly incongruent with messages received from past therapies. Therefore, the leaders need to have their mindfulness practice to be able to serve as a genuine resource to patients as they practice a new way of relating to thoughts and feelings. This includes embodying a mindful stance at that particular moment towards any negative effect that may arise within groups.

Why is MbCT necessary?

Mindfulness cannot be termed as a singular phenomenon, and there have been recent efforts to establish an operational definition and delineate the facets of what constitutes mindfulness. As defined for participants of MbCT, “Mindfulness is the awareness that emerges through paying attention on purpose, in the present moment, and in a non-judgmental way to things as they are”. 

  • MbCT is both an effective and efficient intervention for the prevention of depression relapse and shows promise in the treatment of active depression
  • MbCT is signified by promoting an enhanced awareness of one’s relationship to thoughts and feelings, rather than changing specific thought content
  • MbCT may exert its psychological mechanisms of action through increasing acceptance, self-compassion, present-moment awareness, and ability to selectively deploy one’s attention while enhancing cortical regulation of limbic circuits involved in affective disorder
  • Mindfulness helps the patients discover their own thought and mood patterns
  • It helps the individual learn how to be present and appreciate the small pleasures of everyday life
  • It teaches the client how to stop a negative thought from spiraling out of control
  • Individuals can “shift gears” from their present state of mind to one that is more aware, more balanced, and less judgmental
  • Clients can use an alternative approach for dealing with difficult emotions and moods .
  • It is effective for patients diagnosed with depression.

Evaluation of Effectiveness

The ground of mindfulness is constantly expanding, requiring updated reviews regularly. Mindfulness seems to improve acceptance of symptoms that are difficult or impossible to change, install a cognitive meta reflective capacity that enhances the degree of freedom of patients, and help patients change their focus by emphasizing the experience of the present moment, leading them to receive interest from clinicians and researchers. These potential mechanisms are not part and parcel of the established therapy programs, and hence, mindfulness promises to deliver something new to patients. 

Two experiments testing the efficacy of MbCT on depression were conducted. The studies demonstrated that relapse rates for the disorder decreased (Kuyken et al., 2008; Teasdale et al., 2000), while more recent studies have shown the applicability of MbCT in treating a variety of ailments, including anxiety, depression, and ADHD in clients from multiple age groups (Haydicky, Carly, Wiener, & Ducharme, 2015; Kishita, Takei, & Stewart, 2016; Schroevers, Tovote, Snippe, & Fleer, 2016). 

Mindfulness-based Cognitive Therapy (MbCT) is a promising psychosocial group-based relapse prevention program (Segal, Williams, & Teasdale, 2002). An MbCT-based program offered by the Tees, Esk, and Wear Valleys NHS Foundation Trust showed that measures of psychological distress, risk of burnout, self-compassion, anxiety, worry, mental well-being, and compassion for others all showed significant improvements after completing the program. Research supports that MbCT results in increased self-reported mindfulness, which suggests increased present-moment awareness, decentering, and acceptance, in addition to decreased maladaptive cognitive processes such as judgment, reactivity, rumination, and thought suppression. Results of a 2017 meta-analysis highlight the importance of home practice and its relation to conducive outcomes for mindfulness-based interventions.

MbCT and its Application

In particular, MbCT may be used as a primary treatment modality or in conjunction with other forms of therapy. Individuals experiencing certain medical concerns may also obtain benefit from MbCT. In 2013, Marta Parra-Delgado and Jose´Miguel Latorre-Postigostudy conducted a study on 33 women with fibromyalgia and found that those who were treated with MbCT demonstrated a significantly reduced impact of fibromyalgia, a significant decrease in depressive symptoms, and a slight decrease in the intensity of bodily pain when compared to those who did not receive MbCT [9]. Research has also clarified that patients with cancer, diabetes, chronic pain, and epilepsy who have incorporated MbCT into their treatment plans may see improvement in well-being .

MbCT was developed to serve as a relapse prevention treatment for individuals with major depressive disorder (MDD). Developed by Zindel Segal, Mark Williams, and John Teasdale in the 1990s for the treatment of recurrent depression, MbCT came to be known as an intervention program developed to specifically target vulnerability to depressive relapse. For the past 15 years, the results of numerous randomized controlled trials have shown that MbCT can be a powerful intervention for people who have experienced clinical depression three or more times. Evidence points that MbCT may reduce the rate of relapse for individuals with recurrent depression by 50%. MbCT has also been applied to mood and anxiety concerns other than depression, with reported success. A 2014 review of the usefulness of MbCT as a treatment modality for several health conditions, demonstrated that the approach may be effective when addressing issues such as depressive relapse, current depression, residual depression, bipolar, anxiety, food and eating issues, and psychosis, among others.

Conclusion

In a TED Talk by Richard J. Davidson on “How mindfulness changes the emotional life of our brains” quite a few things regarding this concept came to light. In a meeting with His Holiness Dalai Lama, Mr. Davidson was challenged with the words of the Dalai Lama which said, “Why can’t you use the same tools of modern neuroscience to study kindness and to study compassion, in addition to studying anxiety and fear and depression and stress?” 

The practice that Mr. Richardson and others have been doing is predicated on a critical insight in modern science: the insight concerning neuroplasticity. Our brains are constantly changing, constantly being shaped by the forces around us. But we have, typically, very little awareness of what those forces are. Our brains are changing wittingly or unwittingly. Most of the time, we are not aware, and we also have little control over those forces. The truth is, we can actually take more responsibility for our own brains by transforming our minds. 

As the speaker brought forward the various challenges and ways in which we can control our minds, he welcomed the end with a simple activity. The very same will be noted down below.

I request you to bring any one of your loved ones in your mind and in your heart. As you bring this item on in your mind, in your heart, how, cultivate the strong aspiration that they are happy and that they are free of suffering, and that they share the same wish for happiness and the same wish to be free of suffering as all human beings. And, you can envision a time in your life when they may be having some difficulty, and you can say simple praise your mind, “May you be happy, may you be free of suffering” , and simply notice whatever may come up to you and then we can do this for many categories and people including the difficult person. So, I am inviting you to this journey and the very future of humanity we think depends on it.

References

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