the middle way - จุฬาลงกรณ์มหาวิทยาลัย...full catastrophe...
TRANSCRIPT
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The Middle Way:Potential Strategies For
Augmenting Cognitive-Behavioral Therapy
Dr. Phang Cheng Kar (MD)National University of Malaysia
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Introduction…CBT has been shown to be efficacious for treatment of a wide range of psychological disorders.
Last 2 decades - fruitful integration of Buddhist thoughts & practices in CBT through the concept of mindfulness.
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Right ViewRight Thought
Right Speech
Right Concentration
Right Action
Right Livelihood
Right Effort
Right MINDFULNESS
Middle Way…
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Objective…To have an exposure to the lesser known aspects of mindfulness (Right Mindfulness), in the Middle Way.
To understand Right Mindfulness and its synergistic relationship with the other 7 practice guidelines of the Middle Way.
To be aware of the potential application of the Middle Way in an evidence-based CBT approach.
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Mindfulness-based CBT:Mindfulness-based Stress Reduction (MBSR - Kabat Zinn, 1990)
Mindfulness-based Cognitive Therapy (MBCT - Segal Z et. al, 2002)
Dialectical Behavioral Therapy (DBT - Linehan M, 1993)
Acceptance & Commitment Therapy (ACT - Hayes et al, 1999)
Mindfulness-based Eating Awareness (Kristeller & Hallett, 1999)
• Kabat-Zinn J. (1990). Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. Delacorte Press.• Segal Z, Williams JMG. & Teasdale J. (2002) Mindfulness Based Cognitive Therapy for Depression. John Wiley & Sons. • Linehan M. (1993). Skills Training Manual for Treating Borderline Personality Disorder. Guilford Press.• Hayes SC, Strosahl KD & Wilson KD. (1999) Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change. Guilford Press.• Kristeller JL & Hallett CB. (1999). An exploratory study of a meditation-based intervention for binge eating disorder. Journal of Health Psychology, 4, 357–363.
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Mindfulness means paying attention in a particular way on
purpose in the present moment & non-judgmentally
-Jon Kabat Zinn-
• Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain and illness. New York: Dell Publishing.
What is Mindfulness?
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Mindfulness: Cognitive information processing…
Meta-awareness (consciousness of thoughts)Cognitive de-centering (comprehension of thoughts as events instead of facts)Attentional detachment (attention is flexible and not anchored to any one event)Low conceptual processing (low levels of analytical and meaning based appraisals i.e. inner dialogue)Low goal directed coping (goals to remove or avoid threat are not paramount)
• Wells, A. Detached mindfulness in cognitive therapy: A metacognitive analysis and ten techniques. Journal of Rational -Emotive and Cognitive - Behavior Therapy (2005) 23(4):337-355.
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Baer’s 5 Factor Questionnaire…
• Baer, RA, Smith GT, Hopkins J et al. Using self-report assessment methods to explore facets of mindfulness. Assessment (2006) 13(1):27-45.
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CBT vs. Mindfulness-based CBTThere is more emphasis on changing the RELATIONSHIP with negative automatic thoughts (AT) and processes, embracing them with a sense of compassion and curiosity, instead of actively challenging them as in traditional CBT (Segal Z et. al, 2002).
Actively SUPPRESSING a thought, feeling or bodily sensation, including pain will ultimately increase it (Gold DM & Wegner DM, 1995; Wegner DM et. al, 1991; Cioffi D & Holloway J, 1993).
• Wegner DM, Schneider DJ, Knutson B & McMahon SR. (1991) Polluting the stream of consciousness: The effect of thought suppression on the mind’s environment. Cognitive Therapy and Research 15, 141-151.• Cioffi D. & Holloway J. (1993) Delayed costs of suppressed pain. Journal of Personality and Social Psychology 64, 274-282.• Gold DB & Wegner DM. (1995). Origins of ruminative thought: trauma, incompleteness, non-disclosure and suppression. Journal of Applied Social Psychology 25, 1245-1261.
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Mindfulness-based CBT trainings…
body scan exercisemindful breathing3-minute breathing space mountain meditation, yoga-like body stretching, mindful communication with Aikido-based exercisemindful daily activities e.g. eating, walkingmindful awareness of sounds, bodily sensations, feelings, thoughtslabeling of thoughts etc.
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The 8 practice guidelines can be grouped into 3 parts as follows:
Right Speech Right Action Right Livelihood
Sila
Right EffortRight Concentration Right MINDFULNESSRight MINDFULNESSSamadhi
Right View Right ThoughtPanna
CO
GN
ITIV
E-A
FFEC
TIVE
(M
enta
l Cul
tivat
ion)
G
uide
lines
The Middle Way
BEHAVIORAL Guidelines
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The 8 practice guidelines can be grouped into 3 parts as follows:
Right Speech Right Action Right Livelihood
Sila
Right EffortRight Concentration Right MINDFULNESSRight MINDFULNESSSamadhi
Right View Right ThoughtPanna
CO
GN
ITIV
E-A
FFEC
TIVE
(M
enta
l Cul
tivat
ion)
G
uide
lines
The Middle Way
BEHAVIORAL Guidelines
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Right Speech, Action & Livelihood…
Behavioral guidelines of MW – moral self-restraint
Rational guide for harmonious living instead of strict punitive rules
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MW – Behavioral guidelines…
ABSTINENCE (5 Precepts)
KillingStealing
Sexual misconductLying
Substance abuse
PERFORMANCE (5 Ennobling Virtues)
KindnessGenerosity
Sexual responsibilityTruthfulness
Clarity of mind
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MW – Behavioral guidelines…Forgiveness & repentance-based exercises prior to mental cultivation practice
Self-acceptance of mistake is part of mindful cognition (Carson SH & Langer EJ, 2006)
RCT of modified MBSR program for medical students – loving kindness & forgiveness (Shapiro SL, 1998)
May directly transform negative AT & emotions –enhance self esteem & happiness
• Carson SH. & Langer EJ. (2006). "Mindfulness and self-acceptance." Journal of Rational - Emotive and Cognitive - Behavior Therapy 24(1): 29-43.• Shapiro SL, Schwartz GE, & Bonner G. (1998). Effects of mindfulness-based stress reduction on medical and premedical students. Journal of Behavioral Medicine, 21, 581–599.
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The 8 practice guidelines can be grouped into 3 parts as follows:
Right Speech Right Action Right Livelihood
Sila
Right EffortRight Concentration Right MINDFULNESSRight MINDFULNESSSamadhi
Right View Right ThoughtPanna
CO
GN
ITIV
E-A
FFEC
TIVE
(M
enta
l Cul
tivat
ion)
G
uide
lines
The Middle Way
BEHAVIORAL Guidelines
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Right Effort…Fourfold - Preventing , Reducing , Generating ☺, Nourishing ☺
Contentment or gratitude-based interventions (Emmonds & McCullogh, 2003; Burton CM & King LA, 2004; Parks AC & Seligman MEP, 2004)
Tailored to cultural background e.g. protective chanting/mantra, melodious hymns, inspirational metaphors, meaningful rituals, invocation of spiritual powers
• Emmons RA & McCullough ME. (2003). Counting blessings versus burdens: an experimental investigation of gratitude and subject wellbeing in daily life. J. Personal. Soc. Psychol. 84(2):377–89. • Burton CM & King LA. (2004). The health benefits of writing about intensely positive experiences. J. Res. Personal. 38(2):150–63B.• Parks AC & Seligman MEP. (2004). Treating mild-moderate depressive symptoms with a positive intervention. Presented at Int. Positive Psychol. Summit, 3rd, Oct.
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Right Concentration…One-pointed attention of the mind - the ability to keep the mind anchored to an objectJHANA – super-concentrated or absorption mental states e.g. loving kindness meditationComparable to Flow (Csikzentmihalyi, 2002; Kwee MGT & Taams MK, 2006; Wright JJ et. al, 2006)
Neuroscience research – reduction in emotional reactive behavior (Brefckynski-Lewis JA, 2007)
• Csikszentmihalyi M. (2002). Flow: The classic work on how to achieve happiness. London: Rider.• Kwee MGT & Taams MK. (2006). Buddhist Psychology & Positive Psychology. In A. Delle Fave (Ed.), Dimensions of well-being: Research and Intervention (pp562-582). Milano, Italy: Franco Angeli.• Wright JJ, Sadlor G, Stew G. (2006). Challenge-Skills and Mindfulness: An Exploration of the Conundrum of Flow Process. OTJR: Occupation, Participation and Health 26(1): 25-32.• Brefczynski-Lewis JA, Lutz A, Schaefer HS, Levinson DB & Davidson RJ. (2007). Neural correlates of attentional expertise in long-term meditation practitioners. Proceedings of the National Academy of Sciences, 104, 11483–11488.
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Right Mindfulness…
Morality-based guidelines as foundation
‘Sati’ = To remember – use of memory triggers e.g. gathas, ring tone, screen saver, mindfulness bell
Right Effort + Right Concentration + Right Mindfulness – RIGHT THOUGHT (AT) & RIGHT VIEW (CB)
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The 8 practice guidelines can be grouped into 3 parts as follows:
Right Speech Right Action Right Livelihood
Sila
Right EffortRight Concentration Right MINDFULNESSRight MINDFULNESSSamadhi
Right View Right ThoughtPanna
CO
GN
ITIV
E-A
FFEC
TIVE
(M
enta
l Cul
tivat
ion)
G
uide
lines
The Middle Way
BEHAVIORAL Guidelines
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Right Thought & View…
Right Thought ~ positive automatic thoughts (AT) = compassion, generosity & service
Right View ~ positive core beliefs (CB) = acceptance of the 3 omnipresent & inter-related realities of life…
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UNSATISFACTORINESS(Dukkha)
IMPERMANENCE(Anicca)
NON-SELF(Anatta)PERSONALIZE ITLAST FOR LONG TIME
DEPRESS
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UNSATISFACTORINESS(Dukkha)
IMPERMANENCE(Anicca)
NON-SELF(Anatta)PERSONALIZE ITLAST FOR LONG TIME
DEPRESS
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Happiness correlates with…
Degree of CONTENTMENT
Ability to embrace CHANGE
SELFLESS way of life
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Relaxation breathing + Right View Affirmation…
“Breathing in, I’m contented, breathing out, I’m peaceful. Breathing in, I embrace change, breathing out, change is beautiful. Breathing in, I’m selfless, breathing out, I’m full of joy”
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Conclusion…CBT has been shown to be effective in treatment of various psychological problems.Buddhist thoughts have been integrated into CBT through the concept of mindfulness - mindfulness-based CBT interventions. Mindfulness is only 1/8 of the MW, where the concept of mindfulness originated.The current concept of mindfulness can be further enhanced by adopting an expanded concept as in the Middle Way, and formulating it in relation with the other 7 practice guidelines.Right Mindfulness & other MW guidelines have great potentials to be implemented in an evidence-based CBT approach.
