Mindfulness-Based Cognitive Therapy: Practicing Greater Awareness

When you're on autopilot, you're not "mindful" about what you are doing or why you are doing it. You're not paying attention. And if you aren't tuned into why you're doing what you're doing, how can you turn around your negative thought patterns in order to change your behaviors?

Improving mindfulness through guided meditation, breathing meditation and other present-moment awareness techniques is at the core of Mindfulness-Based Cognitive Therapy (MBCT). Here is a closer look at the connection between mindfulness training, cognitive therapy, meditation and mental health.

What is Mindfulness-Based Cognitive Therapy?

Mindfulness-Based Cognitive Therapy is modeled after Mindfulness-Based Stress Reduction (MBSR), an approach created by medical professor Jon Kabat-Zinn. He combined mindfulness psychotherapy and meditation practices to help people cope psychologically with illness, stress, anxiety and chronic pain. This form of therapy is particularly effective in managing symptoms of depression and other depressive disorders, mood disorders, anxiety and stress. MBCT can also help in trauma recovery.

Initially intended as a treatment intervention for depression, MBCT practices are now widely used to address a variety of mental health conditions and promote emotional well-being. Mindfulness meditation and other MBCT practices guide you in processing negative emotions, managing anxiety and responding to stress in productive ways that shift your awareness and perspective. For example, if you are struggling with chronic depression, you will feel sad at times and that's perfectly okay. Feel sad, experience it on a physical and psychological level. This is the mindfulness shift in perspective (thinking) that can help you actually change gears (behavior).

How does Mindfulness-Based Cognitive Therapy work?

Originally developed to treat those struggling with recurring bouts of depression, Mindfulness-Based Cognitive Therapy incorporates an array of mindfulness training and processes—such as meditation and guided exercises for awareness and relaxation—with traditional Cognitive Behavioral Therapy (CBT) mental health interventions. This mindfulness focus opens the door to changing the way you think (cognitive therapy) in order to change the way you act.

Psychology Today describes the relationship between depressive relapse, mindfulness therapy and meditation this way. "Sometimes normal sadness is a powerful trigger for someone who has recovered from a depressive state to relapse into another bout of depression. Rather than try to avoid or eliminate sadness or other negative emotions, one learns to change their relationship with these emotions by practicing meditation and other mindfulness exercises."

Mindfulness meditation techniques increase your awareness of how your body feels before, during and after negative thoughts or behaviors. In this way, MBCT and mindfulness practices can help you identify emotions, thoughts or sensations that could trigger a depressive relapse or heightened anxiety.

Does it define everything about you? No. It's a feeling, an emotion, and it will pass. This is the shift in perspective (thinking) that can help you actually change gears (behavior).

How do mindfulness practices help patients?

Your thoughts precede your behaviors and how you feel. So when you pay attention to your thoughts in the moment—without judgment—this mindfulness relieves the stress and dilemma of having to solve a problem. On the other hand, if you allow yourself to get wrapped up in not being able to solve the problem at hand, the negative self-talk can start up, leading to the familiar cycle of thoughts and feelings that make coping difficult. The goal with Mindfulness-Based Cognitive Therapy isn't to eliminate unpleasant thoughts and feelings; it's to change your response to them. Don't sidestep those thoughts, don't overreact to them, don't give them meaning and power, just accept them as a normal part of life and let them pass. Becoming more aware of your internal dialogue through mindfulness allows you to avoid a knee-jerk reaction or habitual response. And in letting go of the negative mental chatter, you can move forward and improve your mental health.

Why does MBCT work?

MBCT techniques and psychotherapy practices increase your awareness of triggers or cues that lead to negative thinking. Once you become aware of what's happening in your mind, you are more likely to recognize and prevent negative thought patterns from becoming negative behaviors.

When you're mindful that you're experiencing emotional discomfort and you come back into the present moment, you are training your brain to notice and focus on just one thing. It's impossible to be fully present in the moment and, at the same time, ruminate on negative thoughts.

How does MBCT affect brain function?

On a neurological level, mindfulness therapy works to deactivate areas of the brain associated with negative reactions and impulsivity. Consider the example of a person who is so worried about the future she doesn't notice what's right in front of her. Apprehensive thoughts feed feelings of anxiety and depression. It's a cycle. And some people are so accustomed to this way of thinking, they don't know how to be any other way. These habits create patterns of neural pathways in the brain. When negative patterns are interrupted and positive coping skills replace those reactive, compulsive, deeply ingrained habits, new neural pathways are formed, essentially short-circuiting the old behaviors.

Can mindfulness therapy change the essence of who a person is?

No. Changing your thoughts doesn't change who you are as a person; it changes how you react, respond or behave, enabling you to reframe negative thinking. Mindfulness meditation strengthens your ability to function and cope amid stress, pain or other difficulties in life. There's an expression that "pain is inevitable, suffering is optional." When you play the same scenario over and over in your mind and internalize the problem continuously magnify the negative aspects, that's suffering. Mindfulness is about in the present moment, where you have the choice and the ability to create a new path for yourself.

What does it mean to be mindful?

Mindfulness involves hitting the "pause" button and becoming present in the here and now. Mindfulness practices include yoga, guided meditation, breathing space and body scans. Mindful practices involve focus, observation, description, participation and acceptance of what's happening. First and foremost, mindfulness practices are based on a compassionate, nonjudgmental observation of self in the present moment.

What are some different Mindfulness-Based Cognitive Therapy techniques utilized in addiction treatment?

• Mindfulness meditation, which is often misinterpreted as a form of relaxation, involves becoming acutely attuned to your thoughts without getting attached to them. Mindfulness meditation trains you to visualize thoughts as clouds—they come and go. The idea of grabbing onto a cloud and letting it take you into a storm is the equivalent of hanging onto "what if" thinking that can lead to relapse. In mindfulness meditation, you acknowledge your experiences in a compassionate, nonjudgmental way.
• Body scan is a form of guided meditation that focuses on paying attention to one body part at a time, moment-to-moment, while lying down or in a seated position. Much like a professional dancer practices singular moves and exercises to build muscle memory for leaps or pirouettes, body scan exercises train your mind to tune in and focus on the here and now.
• The SOBER technique stands for Stop, Observe, Breathe, Expand, Respond. If you're in a high-risk situation, stop. Observe what's going on physically. What are you feeling? What are you craving? Breathe. Escape the "fight or flight" response. Expand—what are your options? Now you can respond.
• Gentle stretches and breathing exercises in yoga, tai chi or qigong cultivate healing energy and help with stress reduction. 
• Mindful walking and eating are practices that help you become more aware of what you're doing and how you're doing it, so that there's less space in your mind for intrusive, negative thinking.
• Urge surfing, a mindfulness-based relapse prevention technique, helps you practice how not to respond to a craving or impulse. By envisioning the urge as a wave, you can "ride" that urge and stay on top of it until it subsides.

Do people who practice Mindfulness-Based Cognitive Therapy need to have formal training?

Yes. Do your research when seeking mindfulness therapy or any type of clinical psychology services. Check the credentials of those who are "teaching" and make sure you find an MBCT-certified therapist. Ineffective use of mindfulness techniques and mediation practices can be ineffective—even dangerous.