By Andrea D. Grabovac, MD and Bruno A. Cayoun, DPsych, MACPA, co-authors of The Mindfulness and Meditation Workbook for Anxiety and Depression
MiCBT combines two important evidence-based therapeutic approaches: mindfulness training and cognitive behavior therapy (CBT). The mindfulness practices in MiCBT are designed to help you approach the symptoms of anxiety and depression objectively, and skillfully address any patterns of reactivity that may be maintaining them.
Mindfulness
“Mindfulness” has become a bit of a buzzword these days, so it’s important to clarify what we mean. Mindfulness is often defined as paying attention in the present moment without judgment, but it’s also more than that. Informed by traditional Buddhist understanding, mindfulness can be described as a receptive, accepting, and nonreactive observation of our internal experience in the present moment (Grabovac, Lau, and Willett 2011). It is a way of relating to our inner experience without biased assumptions, reactivity, or identification with the experience. As we’ll discuss in the next two chapters, emotional reactivity is the degree of intensity and swiftness with which one’s emotions are triggered; it plays an important role in the development and maintenance of anxiety and depression. Sometimes the description of mindfulness as a “nonjudgmental attitude” is misunderstood as needing to accept or agree with whatever is happening. On the contrary, mindfulness skills include carefully distinguishing between helpful and harmful actions, mental attitudes, and circumstances. Mindfulness is not relaxation, although it can be very relaxing. It’s not a way of changing how we feel in the moment or trying to feel calm or “better,” although it can relieve distress. It’s not about adopting a positive attitude or stopping our thoughts either, although it allows negative thoughts and attitudes to pass quickly.
In short, mindfulness is an unbiased tool for investigating the nature of our experience. As you embark on your journey with MiCBT, we invite you to use mindfulness skills to explore and understand your own experience, including how certain patterns in your thoughts, emotions, and behaviors can become associated with depression and anxiety. We’ll explore these patterns objectively, in a way that’s grounded in your direct experience. This can lead to valuable insights that support you in making informed and skillful choices to enhance your well-being.
When Mindfulness Meets CBT
The integration of mindfulness and CBT in MiCBT offers many benefits, as these approaches complement each other in unique and powerful ways. CBT provides valuable skills for changing the content of unhelpful beliefs, while mindfulness offers a practical and effective approach to understanding and changing the processes or mechanisms of our thinking. Additionally, mindfulness helps us recognize early signs of emotions in the body and prevent reactivity, while CBT teaches strategies for changing our unhelpful behaviors once we recognize what’s driving them. Lastly, CBT also provides a systematic way of applying mindfulness skills in daily life. The sophisticated integration of core CBT skills with mindfulness training in MiCBT does not allow any aspect of thoughts, emotions, or behaviors to fall through the cracks, so to speak. All aspects of anxiety and depression can be addressed.
The MiCBT Program
In this section, we provide a brief outline of the structure and content of the MiCBT program, which has four stages, each focusing on different aspects of your well-being.
Stage 1
Stage 1, the personal stage of MiCBT, focuses on skills that address internal experiences such as unhelpful thoughts and emotions. During this stage, presented in weeks 1 to 4 of the MiCBT program, you’ll begin by gently training your mind to stay in the present moment, using your body as an anchor for attention during progressive muscle relaxation practice. The more you’re able to focus on the present, the less likely you are to be worrying about the future or ruminating about the past. You will also learn to relax any potential muscle tension through this practice. This will not only help you recognize the difference between tension and relaxation during daily life but can also be a rewarding method of self-care. The following week, you’ll learn how to not engage in ruminative, obsessive, and catastrophic thinking by training awareness of thoughts during the practice of mindfulness of breath. In the last two weeks of stage 1, body scanning practices are introduced. These train the ability to feel physical sensations with acceptance and nonreactivity, and through this process you’ll begin to decrease distressing emotions. Over the course of stage 1, you’ll develop the ability to regulate attention and emotion and to significantly reduce your symptoms.
Stage 2
Stage 2, the exposure stage, is designed to help you work with and overcome avoidance of situations, as avoidance maintains anxiety and depressive symptoms. You’ll practice two mindfulness-based exposure methods, one using imagery and the other using real-life situations. Stage 2 typically takes about two weeks to complete (weeks 5 and 6 of the program). During this time, you’ll become more confident and able to readily approach situations and contexts you might once have avoided.
Stage 3
In stage 3, or the interpersonal stage, presented in weeks 7 and 8, you develop skills that help reduce your fear of conflict and improve your ability to express your views and needs more effectively. By applying specific mindfulness skills in challenging interactions, you can learn to remain empathic while communicating clearly and confidently. This helps you set stronger personal boundaries and can lead to improved relationships.
Stage 4
Stage 4, or weeks 9 and 10, is called the “compassion stage” because we focus on cultivating compassion grounded in kind and ethical actions towards ourselves and others. This helps prevent relapse into depression and anxiety by fostering a deeper sense of connection with others. During this stage and in the daily maintenance practice that follows, we prioritize developing ten skills and attitudes to support you in aligning your actions with your values, both in small day-to-day decisions and in larger life choices. Stage 4 can feel like the culmination of a transformative journey and the beginning of a new chapter of life, filled with possibilities and opportunities.
Committing to Learning and Changing
The effectiveness of the MiCBT approach depends on your commitment to practicing the skills it teaches. We understand that change can be challenging. It’s also completely normal to have moments of doubt or uncertainty when it comes to change, especially regarding mental health. That’s why, as we begin this journey together, it is important to take a moment to reflect on your readiness for change. A mindful stance toward our lives includes the ability to recognize both what we can’t change and what we can. It is common to find yourself feeling that aspects of the situation you’re in need to change before you can change. People who attend therapy sessions often say, “I wish my husband were different,” or “I wish my sister could change.” Parents might say, “I want my child to be more respectful,” while their teenagers say, “My parents don’t understand me at all.” We can ask ourselves whether we’re ready to take responsibility for addressing the situation we find ourselves in, and accept that we may need to make some changes to the ways we respond, even if our control over the situations themselves is limited. Are you willing to put in consistent effort and dedication to achieve your goals? If you commit to practicing the skills, you can experience real change in just a matter of weeks.
PP. 7-10 Excerpt taken from The Mindfulness and Meditation Workbook for Anxiety and Depression
Andrea D. Grabovac, MD, is a clinical psychiatrist practicing in Vancouver, Canada. She is codirector of the North American chapter of the MiCBT Institute, and is clinical professor of psychiatry at the University of British Columbia. With over twenty-five years of clinical experience, she trains mental health clinicians locally and internationally in the delivery of MiCBT and mindfulness-based cognitive therapy (MBCT). Grabovac is continually involved in mindfulness research, developing competency-based mindfulness training approaches, and regularly publishes in scientific journals. She practices mindfulness meditation in the Burmese Theravada tradition, and is a certified yoga teacher. She is coauthor of the Mindfulness for Men course, available on the HeadsUpGuys website.
Bruno A. Cayoun, DPsych, MACPA, is a clinical and research psychologist, and principal developer of mindfulness-integrated cognitive behavior therapy (MiCBT). He is director of the MiCBT Institute, the leading provider of MiCBT training and professional development to mental health services and professional associations internationally since 2003. Cayoun has practiced mindfulness meditation in the Burmese Vipassana tradition of S. N. Goenka since 1989. He has kept a private psychology practice in Hobart, Australia; implementing MiCBT with groups and individuals with a wide range of mental health difficulties for the past twenty years. He is author of several book chapters and books, including Mindfulness-integrated CBT, Mindfulness-integrated CBT for Well-being and Personal Growth, and coauthor of The Clinical Handbook of Mindfulness-integrated Cognitive Behavior Therapy.
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