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Mindfulness-Based CBT

By January 14, 2010January 14th, 2021Anxiety

When everyone recognizes beauty as beautiful, there is already ugliness;
When everyone recognizes goodness as good, there is already evil…
–Lao Tzu

“Mindfulness” is rooted in Eastern thought. The Chinese term it “Taoism”. Tao in its purest sense is not a religion or philosophy, nor is it psychology or a type of science. Tao is a way and view of life. Then what is mindfulness? Mindfulness is part of that way of life to reduce suffering.

Many of us waste our time either ruminating over past mistakes or worrying about future catastrophes. We can’t change the past. So why live in it? There are no guarantees for the future. So why jump to conclusions? Of course it is intelligent to plan for the future. It is also smart to learn from our past mistakes. However, it is irrational to worry over what we can’t control – e.g., the past and the future. Living in the “now” allows us to be present, mindful, and experience the passing of time. Whatever emotion or thought you are experiencing, whether positive or negative, over time, has to pass.  Every moment is moving toward the next moment. Being present in THIS moment as it occurs leads to mindfulness.

In Cognitive-Behavior Therapy (CBT), this is coined the “process of habituation”. The passage of time allows our triggered fight-or-flight response to exhaust itself. If you are feeling anxious with fearful thoughts, this will pass. Similarly, if you are feeling joy with happy thoughts, this too will pass. No one thing can ever be static. Everything evolves and passes. And time cannot be recycled.

When someone asks, “How are you?” how often have you responded with, “I just am.”? When you respond with “I am fine.” or “I am upset.” you are basically adding judgment to your statement. Judgments of good and bad always leave an aftertaste of unnecessary emotions. However, since society can’t do without such judgments, it is important to recognize and be mindful that one cannot exist without the other. With good, comes bad. Without bad, one will not comprehend what is good.

In CBT, it is fundamental to identify these black-and-white irrational judgments, and reappraise the situation accurately so that it is representative of reality. These all-or-nothing cognitive distortions keep you from perceiving experiences for what they actually are. All-or-nothing thinking is only one of many cognitive distortions that keep you from being mindfully aware of reality.

Working with anxiety, worry, fear and uncertainty keeps you either in the past or the future, and has a domino effect. One negative thought typically triggers another and another and yet another. And more often than not, these negative thoughts consist of cognitive distortions in various forms. Before you realize it, your mind is spiraling into a tornado of irrational thoughts. Because mindfulness requires you to be in the present, it allows you the opportunity to quickly identify these negative thoughts. Being aware of these mental connections allows you to interrupt negative thought cycles. The goal is to identify the cognitive distortions and revalue them to represent reality accurately. Rather than giving more meaning to the distorted thought than it is worth, or overvaluing the unnecessary emotion, focus on the now to let time pass and habituation occur.

In my practice, there are a number of mindfulness methods I’ve integrated with traditional CBT. I will review a few of the most concrete ones here.

Bird’s Eye View

First and foremost, I instruct patients to imagine viewing themselves from a bird’s eye perspective. The emphasis is on being mindful of each of the five senses (visual, auditory, olfactory, taste, tactile) individually, until the patient is able to integrate all five senses. Many patients falsely believe that mindfulness meditation is a relaxing technique where your mind is free to wander off to Never Never Land. On the contrary, it actually takes a concerted effort to empty your mind and allow your five senses to absorb your surroundings to keep you in the present. To assist in this training, patients are also instructed to practice mindfulness eating and walking. The goal is to engage slowly in only one activity at a time, while being mindful of all 5 senses in the process.

Shoulds and Buts

One of the more tangible elements of mindfulness training is what I call the “Shoulds and Buts”. Both of these words have a negative connotation and, as such, don’t deserve a rightful place in your vocabulary. “Should” is a conditional word used to express expectations, criticisms, and judgments. Whether you are “should’ing” yourself, others, a situation, or even an inanimate object, you are pointing a finger, criticizing in some manner, and triggering a negative feeling. Just try it and experience what you feel afterwards.

The word “but” negates everything said before its placement, and is often used as a defense or an excuse. For example, “Johnny, you did a great job on this project, BUT you left out this detail.” If you are going to negate what you say, then why say it to begin with? As you become more mindful of the word “but,” you’ll be amazed at how often the word is used illogically in all sorts of placements within a sentence. Since these words are virtually unnecessary, why not increase your mindfulness of their occurrences by scratching them from your vocabulary altogether? LITERALLY. I have my patients carry around a pocket-sized notepad scratching an ‘X’ for each “should” and “but” they say aloud or even think quietly. Like any true CBT practitioner who measures just about everything, my patients are instructed to tally all the ‘Xs’ each day with the goal of seeing a gradual decline in the ‘Xs’ and usage of these words.

Narrative Writing

Narrative writing is a powerful mindfulness training that incorporates the process of exposures. This exercise requires patients to write about their feared situations. Exposures via writing require the highest level of cognitive functioning. Unlike visual or auditory processing that comes and goes, when you write you make a concerted effort to mindfully process your thoughts before externalizing them onto paper. This is infinitely more effective than exposure alone. Even if a patient exposes to a feared situation in vivo, s/he can avoid or escape the anxiety-provoking situation mentally. However, it takes much more effort to be avoidant when you have to be cognitive and mindful of your writing. To increase mindfulness, the rules of narrative writing include: 1) staying in the present moment by using the present tense; 2) using active versus passive verbs; and 3) being as descriptive and detailed as possible.

“Oh Well”

Finally, the “Oh well” method encourages you to let go of those situations that are outside of your control – which occur more often than not. Certainty and control gives you a false sense of security. Not only do you not have control over people, objects, and situations outside of yourself, you don’t even have direct control over your own emotions or what thoughts enter and exit your mind. You only have control over your behaviors, which include actions and reactions to thoughts and emotions. If you are mindful of this fact and accept it, then you will not have a need to control those areas outside of your behaviors, and will be able to let go of situations outside of your control. So, the next time you are stuck in traffic, “Oh well”-it since there is really nothing you can do in that very moment. Rather than working up a frenzy of one negative thought after another, just breathe and empty your mind. Those negative thoughts aren’t doing your mind or body any good anyways.