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What is MiCBT?
There is a growing number of therapy approaches that incorporate mindfulness training. Mindfulness-integrated Cognitive Behaviour Therapy or MiCBT is one of these approaches. It offers a practical set of evidence-based techniques derived from mindfulness training together with principles of Cognitive Behaviour Therapy (CBT) to address a broad range of psychological disorders and general stress conditions. This brochure will give a brief overview of the foundations of MiCBT as well as the core mechanisms and basic practice components of this valuable therapeutic approach.

What is Mindfulness?
Mindfulness involves paying attention to each event experienced in the present moment within our body and mind, with a non-judgmental, non-reactive and accepting attitude. In learning to be mindful, we can begin to counter many of our everyday sufferings such as stress, anxiety and depression because we are learning to experience events in a more impersonal and detached way. Mindfulness has its roots in an Eastern meditation technique called Vipassana and shares with it a number of central principles and mechanisms including what are known as equanimity and impermanence.

Equanimity
Equanimity is best described as a neutral response to something we experience. It is a state of awareness where we neither feel an aversion for unpleasant experiences nor craving for pleasant ones. Other ways of describing equanimity are balance, calmness and composure. The development of equanimity, or an equanimous mind as it is sometimes called, is an important part of mindfulness skills because it gives us the ability to remain less reactive and less judgmental no matter what is experienced, thereby giving us a feeling of ease, self-control and composure as we go about our daily lives.

Interpersonal Mindfulness
MiCBT can not only help people change distressing thoughts, feelings and behaviours, it can also help people change their relationships with others. The skills we learn in MiCBT can help us not to react to others and foster a greater understanding and acceptance of ourselves and others. This usually culminates in more harmonious relationships and helps prevent relapse into habitual moods and behaviour. This is explained during Stage 3 of the program.

Mindfulness and the power of empathy
The fourth stage of MiCBT teaches people to use their own resources for empathy towards themselves and others. The three previous stages lead to the realization that we are the first beneficiary of the emotions we produce, whether this is a positive or negative emotion. A deep sense of empowerment, acceptance and change usually takes place at the end of Stage 4, which is the last stage of the MiCBT program.

Contraindications
The MiCBT program is usually very safe and non-intrusive. However, practicing mindfulness meditation on your own during extremely distressed states is not advisable. People with lack of insight or poor understanding of the techniques who cannot handle very distressing thoughts can at times get worse. It is not recommended to practice mindfulness meditation while experiencing psychotic states (e.g., delusions, hallucinations, paranoia), manic states (e.g., extreme anxiety or anger, uncontrollable agitation or impulse) or suicidal states. In case you encounter increasingly distressing symptoms during your program, it is advised that you contact your MiCBT-trained therapist immediately and discuss the situation with her/him.

Program Duration
The MiCBT program generally requires about 8 sessions, but it may vary between 6 and 12 sessions, according to the problem we intend to address. Sessions are best held weekly or fortnightly for optimum progress.

Impermanence
Mindfulness incorporates the notion of impermanence, the changing nature of all things including our own mental and emotional experiences. By experiencing the changing nature of internal experiences, we can learn to see ourselves in a more objective and scientific way. We can detach ourselves from rigid views that can sometimes lead to stress and unhappiness.

How do we practice mindfulness?
While we can practice being mindful in everyday life by just observing what is happening around and within us, formal training by way of sitting meditation is most effective for developing mindfulness skills. During mindfulness meditation we sit closed eyes and initially focus the breath to develop concentration and take control of our attention. This alone helps decrease the intrusion of unhelpful thoughts that we may have. During this training, all sorts of thoughts frequently arise. Instead of being caught up in a thought, we learn to see it for what it is, just a thought, an impermanent mental event, no matter what the content of the thought may be, and go back to our focus of attention. In this way, we learn not to react to thoughts. We gain a direct experience that thoughts cannot truly affect us or define who we are.

Similarly, when we pay attention to our body sensations, we also learn to perceive a body sensation merely as a body sensation, regardless of how pleasant or unpleasant it is. Mindfulness training helps us realise that body sensations, like thoughts and all other experiences, are also impermanent by nature and no matter how pleasant or unpleasant they are, they pass away. As we become more mindful of this reality, it becomes increasingly easy to observe that body sensations are essentially an experience that cannot affect us unless we react to them. Body sensations are significant because they are the only means by which we can feel emotions. Accordingly, training ourselves to not react to them helps us accept and let go of emotions, rather than suffer from them. This is called emotional regulation.

What is CBT?
The way we think often affects our emotions and behaviour and CBT or Cognitive Behaviour Therapy helps people with such conditions as anxiety and depression change the content of unhelpful thoughts and their maladaptive ways of coping, such as avoidance or addictive behaviour.

MiCBT: Integrating Mindfulness and CBT
MiCBT is a 4-stage therapeutic approach which integrates mindfulness and some of the basic principles of CBT in order to help people improve the way they feel and change unhelpful behaviours. However, MiCBT helps people make changes in a different way to CBT. While CBT attempts to change maladaptive behaviour by modifying people’s unrealistic thoughts and beliefs, MiCBT tries to help people learn to develop control over the processes that maintain the unrealistic thoughts and beliefs through mindfulness training. MiCBT helps change the process of thinking, not just the content of our thoughts.

Changing reactive habits
Like CBT, MiCBT draws on the principles of exposure and desensitisation to help us change habitual unhelpful reactions or coping strategies. However, unlike other models of cognitive-behaviour therapy, MiCBT regards learned reactive habits as being the result of our own way of reacting towards the body sensations that result from our judgmental thoughts. Preventing such reactions, while remaining fully aware and accepting of bodily experiences, leads to rapid change in our habitual feelings and behaviours. We feel emotionally relieved.

…MiCBT helps change the process of thinking, not just the content of our thoughts….

Copyright © 2008 Dr Bruno Cayoun & Dr Kathryn Elbourne. May be reproduced for clinical and research purposes.