Tag Archive | MBCT

Maps to #mindfulness – #Mindfulness-Based Cognitive Therapy #MBCT

If you examine the ever growing tree of mindfulness therapies, one of the main branches is Mindfulness-Based Cognitive Therapy (MBCT). Here is a little map of MBCT to start you on your way.

Another key mindfulness-based approach is Mindfulness-based Cognitive Therapy (MBCT), based on MBSR (Baer & Krietemeyer, 2006). The aim of the MBCT programme is “to help individuals make a radical shift in their relationship to the thoughts, feelings, and bodily sensations that contribute to depressive relapse, and to do so through changes in understanding at a deep level”(Segal, Williams, & Teasdale, 2002, p. 65). The way to do this is through mindfulness, learning “how to pay attention, on purpose, in each moment, and without judgment” (Segal et al, 2002, p. 87).

Having started off believing that cognitive therapy made improvements in a person’s depressed condition through “changes in the content of depressive thinking” (Segal et al, 2002, p. 38), new research showed that more central was a change in the relationship between the client and their thoughts (Segal et al, 2002), and specifically a decentering or distancing (Segal et al, 2002). Out of an Randomized controlled trial (RCT) carried out by Teasdale and others came an awareness of important differences between the technology of mindfulness, with its emphasis on insight meditation, and other meditative techniques which focus more on concentration which increases access to the relaxation response (Teasdale & Associates, 2000, quoted in Segal et al, 2002). In the wider awareness of insight meditation “the focus of a person’s attention is opened to admit whatever enters experience, while at the same time, a stance of kindly curiosity allows the person to investigate whatever appears, without falling prey to automatic judgments or re-activity” (Segal et al, 2002, pp. 322–323).

MBCT is scientifically and research-based. MBCT was developed for depression, and especially those clients prone to relapse (Segal et al, 2002). Segal et al developed a Randomized controlled trial (RCT) for MBCT (Teasdale & Associates, 2000, quoted in Segal et al, 2002). The question asked in their clinical trial was “Does MBCT reduce rates of relapse and recurrence in patients who have recovered from major depression?” (Segal et al, 2002, p. 315). The most important finding was that “participants with three or more previous episodes of depression (who made up more than 75% of the patients we studied), MBCT almost halved relapse/recurrence rates over the follow-up period compared to treatment as usual” (Segal et al, 2002, p. 318). Coelho, Canter, & Ernst stated that “there has been no critical systematic evaluation of the evidence” for MBCT (2007, p. 1000). MBCT research is still in its early stages and they concluded that further research is warranted (Coelho, Canter, & Ernst, 2007). Williams, Russell, & Russell, in response to the Coelho, Canter, & Ernst report, reanalysed the two main MBCT trials, and argue these analyses “reinforce the original findings” (2008, p. 524). There may well be further research now building on these foundations, do let me know if you have come across it.

If you want to read one book in order to understand MBCT then look at the very clearly written Mindfulness: a practical guide to finding peace in a frantic world, by Mark Williams and Danny Penman, published by Piatkus in 2011.

If you have come across any other good books, or research do let me know. MBCT is recommended by the UK’s National Institute for Health and Clinical Excellence and the Mental Health Foundation.

Baer, R. A., (2006). Mindfulness-based treatment approaches. Burlington: Academic Press.

Baer, R. A., & Krietemeyer, J. (2006). Overview of mindfulness and acceptance-based treatment approaches. In R. A. Baer (Ed.), Mindfulness-based treatment approaches (pp. 3–27). Burlington: Academic Press.

Brantley, J. (2007). Calming your anxious mind. California: Harbinger Publications Inc.

Chaskalson, (2011). The Mindful Workplace. Wiley-Blackwell.

Coelho, H. F., Canter, P. H., & Ernst, E. (2007). Mindfulness-based cognitive therapy: Evaluating current evidence and informing future research. Journal of Consulting and Clinical Psychology, 75(6), 1000-1005. Retrieved April 7, 2010, from PsycARTICLES database.

Dahl, J., & Lundgren, T. (2006). Acceptance and commitment therapy (ACT) in the treatment of chronic pain. In R. A. Baer (Ed.), Mindfulness-based treatment approaches (pp. 285–305). Burlington: Academic Press.

Hayes, S.C. (2005) Get out of your mind and into your life: The new acceptance and commitment therapy. Oakland: Harbinger Publications Inc.

Kabat-Zinn, J. (2008). Full catastrophe living. London: Piatkus Books.

Lynch, T. R., & Bronner, L. L. (2006). Mindfulness and dialectical behaviour therapy (DBT): application with depressed older adults with personality disorders. In R. A. Baer (Ed.), Mindfulness-based treatment approaches (pp. 217–236). Burlington: Academic Press.

Mental Health Foundation, Mindfulness Report 2010

Roth, B.,& Calle-Messa, L. (2006). Mindfulness-based stress reduction (MBSR) with Spanish and English-speaking inner-city medical patients. In R. A. Baer (Ed.), Mindfulness-based treatment approaches (pp. 263–284). Burlington: Academic Press.

Segal, Z., Williams, M., & Teasdale, J., (2002). Mindfulness-based cognitive therapy for depression. London, The Guilford Press.

Semple, R. J., Lee, J., & Miller, L. F. (2006). Mindfulness-based cognitive therapy for children. In R. A. Baer (Ed.), Mindfulness-based treatment approaches (pp. 143-166). Burlington: Academic Press.

Speca, M., Carlson, L.E., Mackenzie, M.J., & Angen, M. (2006). Mindfulness-based stress reduction (MBSR) as an intervention for cancer patients. In R. A. Baer (Ed.), Mindfulness-based treatment approaches (pp. 239-261). Burlington: Academic Press.

Teasdale, J. D., Moore, R. G., Hayhurst, H., Pope, M., Williams, S., & Segal, Z. V. (2002). Metacognitive awareness and prevention of relapse in depression: Empirical evidence. Journal of Consulting and Clinical Psychology, 70(2), 275–287. Retrieved April 8, 2010, from PsycARTICLES database.

Williams, M., Russell, I., & Russell, D. (2008). Mindfulness-based cognitive therapy: Further issues in current evidence and future research. Journal of Consulting and Clinical Psychology, 76(3), 524–529. Retrieved April 7, 2010, from PsycARTICLES database.

Williams, M., Teasdale, J., Segal, Z., & Kabat-Zinn, J. (2007). The mindful way through depression. London, The Guilford Press.

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Maps to mindfulness – some definitions of #mindfulness in psychology

The tree of mindfulness research and therapies is growing rapidly. It is hard to keep up-to-date with all the developments as they happen. But we can start somewhere. Important work is being done to arrive at consensus on such matters as defining mindfulness, and I’ll come back to that another time. In the meantime here are some definitions.

Mindfulness means different things. It is only fully understood by examining its historical situatedness. Mindfulness within most Western clinical practice has Buddhist roots, although it is not exclusive to Buddhist thought. Mindfulness in Dialectical Behaviour Therapy (DBT) has a different topography deriving from Christian contemplative practices and Zen Buddhism (Lynch & Bronner, 2006).

Kabat-Zinn pioneered the use of mindfulness through Mindfulness-based Stress Reduction (MBSR) defining it as “the way of awareness” (2008, p. 19). Brantley, also an MBSR practitioner, calls mindfulness a “basic human quality” (2007, p. 4). It is a human quality based on inner capacities for relaxation, paying attention, awareness, and insight (Brantley, 2007). Brantley further defines mindfulness as “paying attention on purpose, nonjudgmentally, and with a welcoming and allowing attitude. It means turning towards present-moment experience rather than away from it” (2007, p. 5).

Mindfulness meditation is different from other meditative techniques (Brantley, 2007). Brantley states that “Mindfulness is an awareness that is not thinking” (2007, p. 52). This is underlined by meditation teacher Larry Rosenberg who says “Mindfulness is often likened to a mirror; it simply reflects what is there. It is not a process of thinking; it is preconceptual, before thought”.

Mindfulness-Based Cognitive Therapy (MBCT) talks about shifting mental gears from Doing to Being: ‘Mindful awareness -or mindfulness – spontaneously arises out of this Being mode when we learn to pay attention, on purpose, in the present moment, without judgment, to things as they actually are’ (Mark Williams & Danny Penman, Mindfulness: a practical guide to Finding Peace in a Frantic World (p.35).

Mindfulness in Acceptance & Commitment Therapy (ACT) is defined as “learning to see your thoughts in a new way” (Hayes, 2005, p. 6). Mindfulness in DBT is defined as “a state or quality of awareness that involves keeping one’s consciousness alive to the present reality” (Lynch & Bronner, 2006, p. 218).

Mindfulness as a universal human capacity needs to be distinguished from the meditative or mindful awareness practices that cultivate mindfulness, like paying attention to your breath, eating a raisin (or chocolate) mindfully etc. Most of these mindful awareness practices are   ‘reality-focused’, they have no religous or spiritual component.

In the Being mode we learn to see differently, ‘It’s a different way of knowing that allows you to see how your mind tends to distort ‘reality’ ‘ (Williams & Penman, p. 35). These four treatments, MBSR, MBCT, ACT and DBT are the four main therapies out of many that are now  incorporating mindfulness or are based on mindfulness.

I am also interested in mindfulness as it appears in Christianity, as well as in Buddhism. A very good introduction to mindfulness within psychology is Finding Peace in a Frantic World by Mark Williams and Danny Penman. This is especially true because if mindfulness is to be truly understood, I think it needs to be practiced – and this book helps you do that, as well as understand your mind.

Mindfulness needs to be understood and practiced and reflected upon. Christians need to engage with it as they have some important distinctives to talk about, including mindfulness of God.

Here are some other books that I have referred to, or will refer to.

Baer, R. A., (2006). Mindfulness-based treatment approaches. Burlington: Academic Press.

Baer, R. A., & Krietemeyer, J. (2006). Overview of mindfulness and acceptance-based treatment approaches. In R. A. Baer (Ed.), Mindfulness-based treatment approaches (pp. 3–27). Burlington: Academic Press.

Brantley, J. (2007). Calming your anxious mind. California: Harbinger Publications Inc.

Dahl, J., & Lundgren, T. (2006). Acceptance and commitment therapy (ACT) in the treatment of chronic pain. In R. A. Baer (Ed.), Mindfulness-based treatment approaches (pp. 285–305). Burlington: Academic Press.

Hayes, S.C. (2005)   Get out of your mind and into your life: The new acceptance and commitment therapy. Oakland: Harbinger Publications Inc.

Kabat-Zinn, J. (2008). Full catastrophe living. London: Piatkus Books.

Lynch, T. R., & Bronner, L. L. (2006). Mindfulness and dialectical behaviour therapy (DBT): application with depressed older adults with personality disorders. In R. A. Baer (Ed.), Mindfulness-based treatment approaches (pp. 217–236). Burlington: Academic Press.

Segal, Z., Williams, M., & Teasdale, J., (2002). Mindfulness-based cognitive therapy for depression. London, The Guilford Press.

Maps to mindfulness – brief overview some main treatments #mindfulness

 

Literature on mindfulness within psychotherapy is increasing dramatically. Germer (2005) lists connections with cognitive behavioural therapy, psychodynamic psychology, humanistic psychology, brain science, ethics, spirituality, health psychology and positive psychology.

Williams and Zylowska in their Mindfulness Bibliography on the website of the Mindful Awareness Research Centre, UCLA Semel Institute, list six main clinical mindfulness treatments: Acceptance and Commitment Therapy (ACT), Dialectical Behaviour Therapy (DBT), Mindfulness-Based Cognitive Therapy (MBCT), Mindfulness-Based Stress Reduction (MBSR), Mindfulness Meditation and Training, Psychotherapy Integration (2009). They categorize MBSR and MBCT as mindfulness-based, using “formal mindfulness training (meditation) as a primary treatment modality” (Williams & Zylowska, 2009, p. 54). They categorize ACT and DBT as mindfulness-incorporating treatments (Williams & Zylowska, 2009, p. 31). These two treatments “include mindful awareness as a treatment goal and may or may not include formal mindfulness training” (Williams & Zylowska, 2009, p. 54).

Baer and Krietemeyer, in their overview of mindfulness-based approaches, list Mindfulness-Based Stress Reduction (MBSR), Mindfulness-Based Cognitive Therapy (MBCT), Acceptance and Commitment Therapy (ACT) and Dialectical Behaviour Therapy (DBT) as the four main approaches (2006).

 

Link to Mindful Awareness Research Centre: http://marc.ucla.edu/default.cfm

 

Mindful Conversation 1

Last night I met with some therapists who are Christians to talk about mindfulness. I wanted to know had they come across it, where had they come across it, what did they think of it?

I learnt a lot from the dialogue, and  I hope we can start many more conversations. One of the key learning points I think that came out of our discussion is the importance of clarifying definitions.

So we talked about mindfulness as a universal human capacity. What evidence do we have? I am interested in collecting examples! There is the attentiveness in nature-writing, the way poetry can lead us into mindful awareness. I came across some research recently trying to determine if tango dancing is as effective as mindfulness in reducing symptoms of psychological stress and promoting wellbeing (http://www.complementarytherapiesinmedicine.com/article/S0965-2299(12)00089-1/abstract).

We talked about the mindful awareness practices (mindfulness meditations) that help us develop mindfulness and their reality-focused nature. Christianity is an incarnational religion and so how might we scan our bodies?

We talked about the overlap and distinctives with Christian contemplative practices and their therapeutic as well as spiritual value. Our God is of course interested in our mental, physical and emotional health. Jesus came that we might live life in all its fullness.

It is also clear that intelligent and engaged study and dialogue with Buddhism and Buddhists is an important path to follow right now.

Someone asked what would be a good introductory book to read on mindfulness. I recommended ‘Mindfulness: a practical guide to Finding Peace in a Frantic World’ by Mark Williams and Danny Penman (http://franticworld.com/). Professor Mark Williams is one of the leading researchers into mindfulness and co-developer of Mindfulness-Based Cognitive Therapy (MBCT), and Dr Danny Penman is an award-winning journalist and author. MBCT is recommended by the UK’s National Institute for Health and Clinical Excellence as a treatment for depression.

It is very clearly written, well-researched and very human book, infused with a deep compassion for all who might read it. Read it and see what you make of it?

We mustn’t be the apocryphal little boy with his finger in the dyke, trying to hold back mindfulness. The dyke has long gone. What we had last night was intelligent, respectful and engaged dialogue.

Olympic crowds inspire athletes

The media and coffee shop conversation is all about how the crowds at the Olympic venues have lifted the athletes to new heights of glory. A case perhaps of the crowds becoming more than a crowd, actually becoming community. Many of the athletes have also talked about their inner mental battle to believe they could win their particular discipline. In the crisis moments the hugely positive encouragement of the crowds have helped them believe.

In their book ‘Mindfulness – a practical guide to Finding Peace in a Frantic World’, which is based on Mindfulness-Based Cognitive Therapy (MBCT) Professor Mark Williams and Dr. Danny Penman talk about one of the insights of MBCT and other therapies: the reality that we attack ourselves with self-critical thoughts and that our minds are a rumour mill, constantly making often false interpretations of the world around us.

If I had listened to my self-critical thoughts my own book ‘A Book of Sparks – a Study in Christian MindFullness’ might never have come about. What brought about a change in my thinking was the encouragement of others as well as becoming aware that I was bigger than my self-critical thoughts, and my thoughts were not a direct readout of reality.

The encouragement of others in my community to write the book was hugely important. Simon Walker, an Anglican Vicar and author of ‘The Undefended Leader’ Trilogy acted a bit like a coach in pushing me to believe in myself, and gave me a lot of practical help. Another friend who was a professional editor did a lot of work on the book, followed by another friend who is a professional copy-editor who worked very hard on the original manuscript.

Yet other friends suggested possible publishers before a member of my congregation put me in touch with Instant Apostle the eventual publishers of ‘A Book of Sparks.’

When I was growing up in Kenya we didn’t have television and my mum taught me to read at the age of three. She was followed by a succession of English teachers who really motivated me to write. But why should we write? Simon Barnes who writes on sport for The Times wrote recently that Federer played not for fame or victory, but for playing’s sake, that he played with soul. We need to write not for fame or glory but just for writing’s sake – for the sheer joy of seeing words on a page. We need to write even if only one person reads what has been written.

Do you have a dream that you are not following because of self-critical thoughts? Is there someone in your life that you need to encourage to step out and dream?  Helen Glover the British Olympic  rowing gold medalist apparently only took up the sport four years ago. Her mother saw an advert in a newspaper calling for tall people to take up rowing.

If secretly you believe you have a book in you…start writing. Let’ s stop pulling people down and start building them up.

mindful eating

On Tuesday someone paid for us to go to Bel Canto the restaurant in London where the waiters and waitresses sing opera as you eat. It was an opportunity to eat mindfully as the starter and main course were exquisitely presented and full of flavour. It was probably the best fish soup starter I have ever savoured.

But what does it mean to eat mindfully, and who advocates it?

I first came across the idea of eating mindfully in Carl Honore’s book In Praise of Slow, where he talks about the Slow Food movement started in Italy by culinary writer Carlo Petrini. One of the ideas in this combatting fast food is to eat much more slowly and really savour the food as you eat – really paying attention to what you put on your plate and how you eat it. As someone who lived on a tea estate and was taught how to make a pot of tea with tea leaves and who lamented the rise of tea bags this really appealed to me.

I then came across mindful eating exerices in psychology. Therapies like Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT) have a mindfulness exercise where you eat one raisin, really paying attention to it with all your senses. Mark Williams and Danny Penman have a similar exercise in their book Mindfulness- a practical guide to Finding Peace in a Frantic World they call the Chocolate Meditation.

These mindful eating exercises are called reality-focused, that is they are not religious but neutral and can be used by anyone, even thought they have their roots in Buddhist Insight Meditation.

But should Christians eat mindfully? Of course they should, because Christians are called to be reality-focused. But also Christians should be able to add another dimension to mindful eating. One is to bring back the forgotten art of slowing down before you eat and giving thanks beforehand through what used to be called saying Grace. We can also emphasise the communal aspect of eating together in physical, emotional and spiritual attunement.

In the book of Genesis in the Bible in the first chapter God looks at all He has made and this is what it says, ‘God saw all that he had made, and it was very good.’ (1:31). God looked mindfully at all that He made and declared it very good. We should look at the food on our plate in the same way, with attention, mindfully and aware of its created goodness. And then we should give thanks for the Provider of this goodness.

As Christians we are called to scrupulously honest. We have forgotten to be thankful for the food we have been given, and have been sucked in to eating mindlessly along with most of the world. We haven’t shown the way in mindful eating. We need to be honest and admit that the mindful eating exercises in MBSR and MBCT are a good thing and that others have shown the way to mindful eating. The Slow Food movement is a good thing and we should be part of such a movement especially as it challenges food production values.

Daniel ate mindfully and with awareness (Daniel 1:12) and Jesus turned water into wine. With spiritual awareness our own meals can be transformed into an encounter with God’s grace.