10/11/2018. Mindfulness Based Cognitive Therapy. Intentions for Training

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1 Mindfulness Based Cognitive Therapy TIM BAUTCH, MA,LPC, CSAC, ICS JOE DARCY, AAS, SAC IT, RECOVERY COACH CONNECTIONS COUNSELING, LLC MADISON, WI Tim Bautch, Therapist Tim is an Licensed Professional Counselor (LPC), Clinical Substance Abuse Counselor (CSAC), and Intermediate Clinical Supervisor (ICS). He has been in the Human Service field for nearly 30 years, and a Master s level clinician for nearly 15 years. His particular interest is working with persons with cooccurring disorders. He is also a DBT informed therapist. Mindfulness techniques have been a big part of his personal and professional life. In addition to his own mindfulness practice, he has incorporated it into therapy, as well as providing mindfulness training to adults and high school students. Joe Darcy AAS, SAC IT Joe is a Substance Abuse Counselor In Training (SAC IT) and a Certified Recovery Coach (CCAR). Joe was hired by Connections Counseling in March of 2016 as the primary TMS Technician at the TMS Center of Madison. TMS (Transcranial Magnetic Stimulation) is an FDA Approved protocol for treatment resistant depression, utilizing electromagnetic stimulation targeted at the prefrontal cortex of the brain. He is passionate about working with individuals struggling with mental illness and substance abuse. Joe identifies as a person in long term recovery, and has been sober/in recovery since September of Intentions for Training Develop an understanding of the philosophy behind Mindfulness Cognitive Therapy Understanding the interplay between cognitive techniques and mindfulness exercises Have an opportunity to experience Mindfulness Cognitive Therapy skills Considerations for establishing a group Anything you want to know? 1

2 How Our Group Got Started Joe: TMS Tech, Recovery Coach Tim: MH and AODA Therapist, experience in teaching mindfulness Agency was interested in having an aftercare group for persons who completed TMS Agency also interested in having more mental health focused groups Decided to offer a group both for people who completed TMS and Connections clients who are interested in a mental health focused group After speaking with potential members, decided a skills based group, rather than a process group, was of more interest Although primarily for depression, we called it Mindfulness for Mental Health and did have persons in the group who identified with anxiety as primary concern Characteristics of CBT Based on "rational thought." Fact not assumptions. CBT is structured and directive. Based on notion that maladaptive behaviors are the result of skill deficits. Emphasis on the Here and Now Based on assumption that most emotional and behavioral reactions are learned. Therefore, the goal of therapy is to help clients unlearn their unwanted reactions and to learn a new way of reacting. Homework is a central feature of CBT. Philosophy Driving CBT Negative emotions are elicited by cognitive processes Adverse life events elicit automatic processing Cognitive triad: Negative automatic thoughts center around our understanding of: Ourselves Others (the world) Future Focus on examination of cognitive beliefs and developing rational responses to negative automatic thoughts. 2

3 Three Waves of CBT First wave: Behavioral Therapies Second wave: Cognitive Therapies Third wave: Loose affiliation of modern theories empirically based on CBT Third Wave Acceptance and Commitment Therapy (ACT) Mindfulness Cognitive Behavior Therapy (MCBT) Trauma Focused Cognitive Behavior Therapy (TF CBT) Dialectical Behavior Therapy (DBT) 3

4 Experiential Activity: Imagine you are walking down the street and notice a friend from afar. As they are approaching, you wave and say hello. They continue past as if they do not notice you. What thoughts enter your mind following this interaction? How does the encounter seem to immediately affect beliefs about yourself? How does your current mindset impact your perception of the encounter? What feelings are experienced as a result? MINDFULNESS Paying attention in a particular way; on purpose, in the present moment, and non judgmentally Jon Kabat Zinn Background Of Mindfulness Origins in Buddhist philosophy and meditation Buddha: When we sit, we know we are sitting. When we walk, we know we are walking, When we eat, we know we are eating. Mindfulness is a way to separate pain from suffering (Dukkha) Was brought into Western, secular treatment by Jon Kabat Zinn in

5 When We Are Mindful, We Pay Attention To: Thoughts Feelings Behaviors Physiological Changes Three Core Elements to Being Mindful Intention: Your intention sets the stage for what is possible Attention: That which you pay attention to grows. Attitude: Non judging, Patience, Openness, Trust, Nonstriving, Acceptance, Letting go Jon Kabat Zinn 3 Minute Breathing Space Preparation: With intention, find a calm. Safe place. Adopt an attentive and relaxed posture. Maybe close your eyes. Commit to taking 1 minute to guide yourself through the following steps: Becoming Aware: Ask: What is my experience right now? What thoughts are going through your mind? What feelings are present? What body sensations are present? Gathering: Redirect your attention to focus on the physical sensation of your breath. Follow your breath into your body as inhale, noticing your body fill with air. Follow your breath out as you exhale. If your mind wanders, gently encourage your mind to return to your breathing. Expanding: Expand your awareness beyond your breath so it includes your whole body. If you notice any tension or resistance, breathe into it. As best you can, bring this expanded awareness to the next moments of your day. Williams, Teasdale, Segal, Kabat Zinn 5

6 Mindfulness Based Cognitive Therapy (MBCT); Kabat Zinn s Mindfulness Based Stress Reduction (MBSR) led to the decision to combine mindfulness and CBT techniques. Developed by Teasdale, Williams, and Segal (2000) Aimed at the prevention of depressive relapse Integrates cognitive and clinical science with Buddhist psychology and mindfulness meditation Why MBCT? Research has shown that people who have been clinically depressed 3 or more times who learned these skills helped to considerably reduce their chances that depression will return. The evidence from two randomized clinical trials of MBCT indicates that it reduces rates of relapse by 50% among patients who suffer from recurrent depression. The Depression Cycle: Early Research Study by Beck: People who identify as depressed tend to only process things that confirm their emotional state. Early depressive Sx influence one s perception of the world As one finds things that confirm the depressive Sx, spiral into more intense Sx As Sx increase, stop doing things that may decrease the Sx During the episode, a connection has formed between the depressive mood and the negative thinking patterns Cognitive therapy can be difficult at this time, as one starts believing the distorted cognitions When the intensity decreases, cognitive techniques may be more effective 6

7 How This Spiral Effects Subsequent Episodes When a negative mood happens again (for any reason) a relatively small amount of such mood can trigger or reactivate the old thinking pattern. People start to think they have failed, or are inadequate even if it is not relevant to the current situation. People who believed they had recovered may find themselves feeling back to square one. They end up inside a rumination loop that constantly asks what has gone wrong?, why is this happening to me?, where will it all end? Such rumination feels as if it ought to help find an answer, but it only succeeds in prolonging and deepening the mood spiral. When this happens, the old habits of negative thinking will start up again, negative thinking gets into the same rut, and a full blown episode of depression may be the result. Sustaining recovery from such depression depends on learning how to keep mild states of depression from spiraling out of control. How does mindfulness help reduce downward mood spirals? Helps one see more clearly the patterns of the mind; and to learn how to recognize when the mood is beginning to go down. Helps to halt the escalation of negative thoughts and teaches one to focus on the present moment, rather than reliving the past or pre living the future. Helps one move from the mode of mind dominated by critical thinking (likely to provoke and accelerate downward mood spirals) to another mode of mind in which one experiences the world directly, non conceptually, and non judgmentally. Helps one develop a willingness to experience emotions, even painful ones. Helps one to allow feeling distressing moods without battling with them. Can discover that difficult and unwanted thoughts and feelings can be held in awareness, and seen from an altogether different perspective a perspective that brings with it a sense of warmth and compassion to the suffering one is experiencing. 7

8 ABC Model in MBCT Emotions are consequences of a situation plus an interpretation Automatic emotional reactions result from barely noticeable running commentary Mindfulness allows for B to be seen more clearly and prevent emotional distress Format of the Group 8 week closed group Week 1: Awareness and Automatic Pilot Week 2: Living in Our Own Head Week 3: Gathering the Scattered Mind Week 4: Recognizing Aversion Week 5: Allowing/Letting Be Week 6: Thoughts Are Not Facts Week 7: How Can I Best Take Care of Myself? Week 8: Maintaining and Extending New Learning General Format of Group Start with a Mindfulness Activity Check in/homework Review Discussion of Handout/Experiential Activity Mindfulness Activity Assign Home Practice for the week 8

9 Developing an Action Plan Cumulation of the 8 weeks Questions asked: What are early signs that you are experiencing depression? Who in your support system is aware of these signs? How can they talk to you about their observations? In the past, what has helped you when you were becoming depressed? What might be a skillful response to the pain of depression? How can you best care for yourself at this time? Questions? Thank you! Tim Bautch tim.bautch@connectionscounseling.com Joe Darcy joe.darcy@connectionscounseling.com References Segal, Z. V., Williams, J. M., & Teasdale, J. D. (2013). Mindfulness based cognitive therapy for depression. New York: Guilford Press. Neurostar TMS Therapy for Depression. neurostar.com Kabat Zinn, Jon. (1994)Wherever You Go. There You Are. New York: Hyperion Press. mbct.com future therapy/ therapy.html 9