T he basis of Aaron Beck’s Cognitive Model that persistent “dysfunctional attitudes and assumptions” lead to emotional problems and behaviors has been found to lack empirical support, as does the argument that changing dysfunctional thinking and maintaining that change is the key to the changes seen with cognitive-behavioral approaches.
How Does Cognitive Therapy (CT) Actually Work?
Differential Activation Hypothesis Dysfunctional thoughts can be found in everyone, including those who have been through therapy. With susceptible individuals mood can activate dysfunctional thoughts, which in turn accentuate mood, which intensify focus on negative thoughts / perceptions / reactions, - resulting in a intense persistent depression, anxiety, etc. Relatively easy accessibility to negative material when mood is negative, even if only mildly so.
“ Ruminative response style ” – some people have a tendency (probably due to genetic / biochemical contributors) to over focus for prolonged periods of time on negative mood and material, generally in a obsessive belief that such attention will enable them to solve the “problem.”
Instead they increase and maintain the emotional state, while arriving at no “solution”.
CT appears to change the client’s relationships to their negative thoughts and feelings, and this is central to CT’s effectiveness, rather than the focus on cognitive change.
CT teaches the client a process of stepping back (also known as “distancing” or “decentering”) from cognitive content to assess it, resulting in seeing thoughts and feelings in a wider perspective, sufficient to be able to see them as simply “thoughts” rather than necessarily valid reflections of reality or central aspects of the self.
Feelings and thoughts are not facts! Feelings and thoughts are not facts! Feelings and thoughts are not facts!
Decentering also decreases rumination which is at the core of most mental distress.
If this is truly how cognitive therapy works, are there other ways to bring about a shift in a person’s relationship with their thoughts/feelings which would not have any of the unnecessary CT elements explicitly directed at changing thought content?
MINDFULNESS To pay deliberate attention to our experience from moment to moment, to what is going on in our mind, body and day to day life and doing this without judgment. Mindfulness, as a therapeutic tool, is the development of the ability to recognize and disengage from mind states characterized by self-perpetuating patterns of ruminative, negative thought.
The Being mode , is not motivated to achieve a particular goal. Thus there is no need to emphasize discrepancy-based processing. Instead the focus of the being mode is “accepting” and “allowing” what is, without any immediate pressure to change. Awareness rests in the present.
Past Future HERE & NOW Typical mind identifying with thoughts and images, lost in past and future, in doing mode. Present based mind in being mode. Thoughts, images, emotions, sensations Oh my God, what will I do! Did I pay that bill… I’m so unhappy. At least the weekend is almost here. I’ll feel better then. What if I loose my job. Living in a cardboard box. I’m hungry. Did I pay that bill. ---- What if I loose my job. Why didn’t I think of that? Anxious, anxious, anxious.. I need more money. Nobody loves me. Anxious, anxious. It’s going to be awful. I’ll fail. Why did I do that? I was so young. It ruined everything. I said that… why did it have to happen like that? I feel horrible. It was so sad. What is I said it differently? HERE & NOW Sex.. Feel good. 20 x 35 is ? I hate this. Always been this way.
attention/state of mind from the Doing/Not-in-the-Here
and-Now mode to the Being/in-the-Here-and-Now mode.
The basic tool to effect this change of mental modes, or shift of mental gears, is the intentional use of attention and awareness in particular ways.
This involves moving from a focus on content to a focus on process, away from cognitive therapy’s emphasis on changing the content of negative thinking, toward attending to the way all experience is processed.
The use of continual self-observation and acceptance are key to mindfulness.
alternative methods for teaching decentering skills.
Realization that most sensations, thoughts, and emotions fluctuate, or are transient “passing by like waves in the sea.”
training of patients to recognize when their mood is deteriorating.
preventing the ruminative thought-affect cycle.
provide means to stay connected with body and reality
Some therapeutic applications are derived from Vipassana, or Insight Meditation. Using a mediation format one focuses on a sensation, usually breathing, to develop a one-pointed attention to cultivate calmness and stability. Once this is established, one then moves beyond that focus by introducing a wider scope to the observing, as well as an element of inquiry.
When thoughts, feelings or sensations come up in your mind, you don't ignore them or suppress them, nor do you analyze or judge their content. Rather, you simply note any thoughts as they occur as best you can and observe them intentionally but non-judgmentally, moment by moment, as the events in the field of your awareness .
If your mind wanders just note “wandering” and bring your mind back to generally aware of the here and now.
The moment you realize you are not present, you are present. Whenever you are able to observe your mind you are no longer trapped in it.
A body-centering exercise in which participants are asked to move their awareness through each part of their body accompanied by the pace of their breathing, and should be practiced daily.
O ne approach of this exercise is to breath into the section of one's body being focused on. This has many individual and specific applications which can be of enormous benefit.
In Dialectical Behavior Therapy (DBT) There are Specific Skills “ What” Skills: Observe – not caught up in experience; not reacting; “teflon mind;” control attention, not experience; thoughts and images like passing clouds. Describe – put words on experience; describe to self what is happening. Participate – become one with experience; forgetting self; letting go of ruminating; act from “wise mind;” be skillful; practice; accepting self and situation as they are.
DBT “How” Skills Non-Judgmentally – don’t evaluate; focus on what not why or valuation; accept each moment; acknowledge helpful and unhelpful, but don’t judge them; when you find yourself judging, just notice and stop – don’t judge yourself. One-Mindfully – do each thing with your full attention: when you are eating, eat; when you are feeling, feel. If distractions arise, notice them, let go of them go back to what you are doing – again, and again, and again. Do one thing at a time! Effectively – focus on what works, avoiding judgments, meeting needs of situation at moment; accepting what is rather than shoulds and “what-ifs”; keep eye on objectives; let go of negative feelings that don’t help you to reach your goals.
“ Human beings struggle with the forms of psychological pain they have: their difficult emotions and thoughts, their unpleasant memories and their unwanted urges and sensations. They think about them, worry about them, resent them, anticipate and dread them.”
– Steven Hayes
Acceptance and Commitment Therapy (ACT) People suffer.
“ When we get up on the back of the black horse and ride to battle, fighting to win the war against anxiety, depression, thoughts about using drugs, whatever. It’s a war game. “ But there’s a logical problem here, and that is that from this posture huge portions of yourself are your own enemy.” You are living in a war zone within yourself in which there is no chance of winning.” -- Steven Hayes
Experiential avoidance is the process of trying to avoid our own experiences (thoughts, feelings, memories, bodily sensations, behavioral predispositions) even when doing so causes long-term behavioral difficulties (like not having social contacts due to social anxiety, or not exercising because you’re depressed). Of all the psychological processes known to science, experiential avoidance is one of the worst. “ Control is the problem, not the solution!” In the ACT model, attempts at controlling, avoiding, and/or eliminating unwanted private experiences lie at the heart of most unworkable change agendas.
Accepting absolutely everything about ourselves and our lives, by embracing with wakefulness and care our moment-by-moment experience. … we are aware of what is happening within our body and mind in any given moment, without trying to control or judge or pull away. . . .
It means feeling sorrow and pain without resisting. It means feeling desire or dislike for someone or something without judging ourselves for the feeling or being driven to act on it.
Staying with our experience, while not evaluating or focusing on problem-solving, depends on the ability, developed by mindfulness of breathing practice, to maintain a strong focus on what is occurring, while avoiding judging or problem-solving
The empirical literature on the effects of mindfulness interventions suggest that this approach may lead to reductions in a variety of problematic conditions, including pain, stress, anxiety, depression, personality disorders, disordered eating, and addictions, and it is growing in popularity in many fields, especially those related to healthcare.
Since the first uses of mindfulness in therapy, it has been found that to be effective in teaching and working with clients practitioners must establish their own mindfulness practice as well as learning skills and exercises with direct clinical application.
3. The way out of this self-created cell of suffering is accepting absolutely everything about ourselves and our lives, by embracing with wakefulness and care our moment-to-moment experience. This does not mean putting up with a truly harmful circumstance with ourselves or others.
4. “It is remarkable how liberating it feels to be able to see that your thoughts are just thoughts and that they are not ‘you’ or ‘reality.’ . . . . the simple act of recognizing your thoughts as thoughts can free you from the distorted reality they often create and allow for more clear-sightedness and a greater sense of manageability in your life”
Mindfulness practice is generally taught by having the individual sit still and keep their awareness focused on the sensations of their normal breathing without striving too hard. Breathing is important. You do it automatically, but when you are under stress your breath becomes restricted. Let it go. Allow your breathing to deepen in a very calming and natural way. Don't force it, just let go of your tension and feel the breath become slower and deeper.
This practice quiets the mind, and develops the “muscles” of concentration and undifferentiated awareness which enables a separation from the events occurring in one’s mind. Using Mindfulness of Breathing as a "home base" one is able to keep attention stable and alert, and one can than notice the other facets of experience as well.