Mindfulness and cognitive behavioral therapy

I got a Master's Degree in Social Work way back in 1973 that exposed me to the fundamentals of counseling before I headed off in the direction of health services research and planning.

Then I married my second wife, Laurel, in 1990. She also had a MSW, but unlike me, pursued a career in social work, ending up after our marriage by starting a private psychotherapy practice.

Laurel would talk about how cognitive behavioral therapy (CBT) was used in her practice, since it is fairly short-term and insurance companies don't like paying for lengthy psychotherapy aimed at delving into the root causes of someone's problems.

They want results. Which is what everybody wants, really.

So when I saw that a series on "Mindful CBT" by Seth Gillihan had been added to Sam Harris' Waking Up app, I decided to listen to what Gillihan had to say. I've finished Part 1 of Mindful CBT, which includes eight short (8-10 minutes) talks by Gillihan. 

Here's some of what Gillihan had to say. I took notes, most of which I can actually read -- my handwriting is terrible, even to me -- but these aren't verbatim quotes.

In Fundamentals of CBT, I learned that traditionally thoughts, feelings, and actions comprise CBT. These interact with each other. You can change any one and affect the others. Integrating mindfulness introduces depth to thoughts, feelings, and actions. 

The quality of changes is based on the quality of attention. How do we relate to our thoughts, feelings, and actions? Instead of pushing away anxious thoughts, give them less weight. We shift from "should" to mindful acceptance. 

In Finding Leverage, Gillihan said that we have to match our intention with the right tools. Advice alone isn't very helpful. Willpower alone is a recipe for failure. For example, if someone is afraid of spiders, they need to start small and work up from there -- not by letting a giant tarantula crawl on your arm right off the bat. A ladder is a series of small steps. The question isn't why did I fail, but what can I do to succeed?

In Working With Thoughts, I heard that thoughts can cause anxiety and affect actions. But thoughts often are misguided in some way. We ask, what story is my mind telling me? Not objective facts, often, but a subjective story.

Examine the evidence underlying thoughts, like a scientist. What evidence is for and against the thought? What's true in the situation? Is there a more realistic way of thinking that fits the data better? 

These are some some common cognitive disturbances: (1) Fortune telling -- making predictions about a future that hasn't happened yet; (2) Catastrophizing -- seeing things in the worst possible light; (3) Mind reading of another person -- believing we know what someone else is thinking.

In Addressing Core Beliefs, Gillihan says that you become more aware of negative thoughts. Our core beliefs drive thoughts. These are regular patterns, a lens that guides how we see the world. Example: seeing disapproval everywhere, even though you're doing a good job. 

Thoughts can feed back into a core belief and strengthen it. This is circular, yet completely convincing. Instead, focus on what is actually happening right now. Minds invent stories that often aren't true. Be in a situation as it is. Brush off unhelpful thoughts.

Not "oh no" but "oh well." Just a mental event. One core belief might be that wellbeing depends on things working out for us. Don't assume how life has to go. Life doesn't have to meet our expectations.

In Thoughts Support Mindful Presence, I learned that mindfulness supports thinking and thinking supports mindfulness. Thinking is just what the mind does. We don't have to take thoughts too seriously. Thoughts can play a positive role in our lives. Meditation is being present with what is, noticing what's already there.

In Working With Behavior, I heard about Pavlov's dogs. Animals learn certain things go together. Ringing of a bell is followed by food. Dogs salivated just with the bell. This is classical conditioning. A baby begins to cry when at the doctor's office because previous visits were disturbing.

We also learn by consequences of actions. This is operant conditioning. We learn patterns in the world and outcomes of our behavior. Classical and operant go together. A cat goes to the kitchen after hearing the can opener.

Make it easier to do what you intend to do. Make exercising rewarding, right-sized, starting easy. Put things in place to guide actions when motivation leaves you.

In Mindful Action, Gillihan says that mindfulness determines the quality of actions. With more awareness, you experience a walk more fully. But beware of this taking on a moral quality: you're bad if you're not mindful. 

Sometimes it's helpful to be on autopilot, like while driving, when you can carry on a conversation or listen to the radio. But there are costs when we're in divided attention much of the time. We'll have richer memories if we're more present.

Act in ways that align with reality. Mindful action doesn't try to force an outcome. Stop struggling against what is. Notice when your actions are at odds with reality.

In Working With Distress, I learned there are three ways to feel better in Mindful Cognitive Behavioral Therapy. Shift thinking. Act differently. Practice mindfulness. However, sometimes these tools don't work, so we need to make peace with discomfort. 

Respond with openness and curiosity to discomfort. Maybe it will feel interesting, not bad. Mindful acceptance helps us endure uncomfortable situations. Stop fighting against reality. Change your life to match your limitations. 

Focus on what's happening right now. Don't subject yourself to future pain that you're anticipating, but hasn't happened yet, and may never happen. Be present with uncomfortable feelings. Stand up for issues you care about even if it upsets some people.

Wellbeing doesn't depend on eliminating stress. Can I open to this?

Comments

[808]

Nice article! Thank you… lots to think about. 😊

[Fancy Free]

The irony of Mindfulness is that the mind is happiest when it sort of “disconnects”, if you will, from the body…

The mind feels entrapped by this lump of clay we refer to as our human selves. It’s the ethereal that the mind truly aspires to join.

If you don’t believe me, just try ketamine.

[Roger]

When a need can be met, the mind will not worry. Hopefully so.

We have very few basic needs to survive and thrive as human beings.

For most, those needs can be met without worrying about such.

However, there are many THINGS physical, emotional, psychological, or any combination thereof, that we can use to make life easier.

Although it might take some effort to obtain those THINGS, they too can be gained without worrying about it.

The worrying aspect of the mind arises on the basis that we want some THING as opposed to needing some THING.

The wise realize that no THING has any degree of permanence or substantiality in or of themselves.

The fool thinks they do, and live continuously based on wanting THINGS to be other than they are, and continue to worry.

Wisdom is realizing the difference between a need and a want, responding to both in a way that is appropriate, and therein providing the most helpful opportunity to develop or maintain Peace of Mind.

[Tucker]

Ah, memory lane...remember when the court ruled that ss marriage is legal? Pundits in support scoffed at those who said it was a slippery slope. How absurd! Yet here we are not even 10 years later with pronoun enforcement at corporations, men in girl's college (and high school!) locker rooms, and a huge shift in young people's ss ideation, with a blessing for underage breast removal and castration.

Ah, remember those 2 years they told us that covid was so dangerous? Covid is still here...but funny, no one seems to know anyone who died from it who wasn't fat as truck, ill, or very old. "The shots save the world!" Sure they did. "The virus didn't come from a lab in China, you racist!" Uh yeah it did, obviously.

Ah, remember Jan 6. "They killed 4 police officers!" Actually, no. "Horns guy was a terrorist!" Actually no, "Trump must have given secret orders!" Actually, no.

Ah, remember a year ago. "Ukraine is winning!" "Putin is crazy, his army is losing, he wants to take over Europe!" Actually, no. "Zelinksy is a hero"! Actually, no. Zelinsky lied, and you can bet he's extremely wealthy right now. The neocons who cheered on this war have only many thousands of dead Ukrainians to show for their ardent lust for bumfights on the other side of the planet. Ukraine never had a chance of winning, but our media told us otherwise, and if you disagreed, "you're a tool of Putin!"

"Spending hasn't caused this inflation!" Uh, yeah it did Janet.

"Gas stoves kill children!" Uh, no.

"No more gas powered cars allowed, we must save the planet from burning up!" Uh no.

So tired of being lied to. So tired of seeing the masses blindly accept lie after lie after lie.

[Goya]

Tucker, check out Russel Brand’s podcast. You’ll like it.