Friday, December 26, 2008

Mindfulness Based Cognitive Behaviour Therapy (MB-CBT)

Meditation is easily, and correctly, regarded as a relaxation exercise, but it is also about increasing awareness of yourself and your surroundings. Both of these aspects can contribute to healthy living and overcoming psychological problems. Studies have shown meditation to decrease anxiety, fatigue, and suicidal ideation, as well as being beneficial to treating addictions, phobias, pain and to help prevent relapse into depressive states. Yoga has been found to increase spatial memory in adolescents and to also benefit adults suffering from depression (in conjunction with psychiatric medications).

There are many negative assumptions made against meditation categorising it as quiet time for new-age type people or as a spiritual or religious exercise. While this can be true, meditation is something that can be practised by everybody on their own terms. In fact, it is sometimes better to avoid using the term ‘mediation’ and instead refer to it as cognitive therapy, a relaxation method, or, depending on the patient, avoid labels altogether and simply try to guide them through homework exercises. Removing the stigmas associated with labels can increase patient participation in a potentially helpful augmentation to other therapies.

The word ‘mindful’ is commonly used on its own without associations to either meditation or CBT with the term being explained as experiencing the details of sensory information in discrete units without becoming overloaded, to enjoy each sensory experience, and to observe without having to immerse the self in the perceived chaos of environment, thoughts, and beliefs.

The point of that exercise is to respond to all the baggage people carry about what meditation is. We want to dispel those notions right away. So we say, "Look, the first exercise we'll do isn't breathing; it isn't sitting in the full lotus posture and pretending you're in a fine arts museum, or standing on your head. We're just going to eat a raisin—but eat it mindfully, with awareness."
You look at the raisin—feel it, smell it, and with awareness bring it to the mouth gradually, and see that saliva starts to get secreted just as you bring it up. Then you take the raisin into the mouth, and you begin to taste this thing that we usually eat automatically. From there it's a very short jump to realize that you may not actually be in touch with many of the moments of your life, because you're so busy rushing someplace else.
” (Kabat-Zinn)

New research is being done on the usefulness of MB-CBT in treating eating disorders (MB_EAT). Negative symptoms stem from the relationship between the self and food and distorted perceptions of that relationship including guilt and poor self-image. In persons suffering from eating disorders, the physiological mechanisms for appetite and the neurological pleasure response to eating are less active. It is therefore hypothesized that mindfulness based exercises, by increasing awareness of physical sensations particularly those accompanying eating, appetite, and digestion, can be helpful in treating unhealthy eating habits. However, this is still very new and much more research will need to be done in the area.

In spite of all the limitations, mindfulness is still an exercise that can prove to be very beneficial, at least on a patient-by-patient basis (as with most psychiatric treatments). It can also be modified for children by decreasing the length of exercises and using age appropriate topics/objects in the awareness exercises. Parents should also be encouraged to practise the techniques with their children. Whether adult or adolescent, it is important to practise the techniques regularly and consistently. For people who are interested, I suggest reading about the different approaches and follow the suggestions of practice.

Self-treatment exercises, though not sufficient alone to treat major psychiatric disorders, can help temper symptoms until next visit with physician thereby keeping people out of hospitals which can be distressing environments (but I do encourage people who are in crisis and need assistance to use the emergency services available to them, including the Emergency Department at hospitals) and give a person more sense of control over their symptoms.

References and Links:
-Bill Moyers interview with Dr. Jon Kabat-Zinn (developer of raisin meditation) who describes mindful meditation
-contains different mediation techniques for children in various age groups
- another site with meditation exercises for children
-mindful meditation instruction; also has instructions for different meditation styles

Sharma VK, Das S, Mondal S, Goswami U, Gandhi A. Indian J Physiol Pharmacol. 2006 Oct-Dec;50(4):375-83. Effect of Sahaj Yoga on neuro-cognitive functions in patients suffering from major depression.

Manjunath NK, Telles S. Indian J Physiol Pharmacol. 2004 Jul;48(3):353-6. Spatial and verbal memory test scores following yoga and fine arts camps for school children.

Williams JM, Duggan DS, Crane C, Fennell MJ. J Clin Psychol. 2006 Feb;62(2):201-10. Mindfulness-based cognitive therapy for prevention of recurrence of suicidal behavior.

R . Wall. Journal of Pediatric Health Care. 2005. Volume 19, Issue 4, Pages 230 – 237. Tai Chi and mindfulness-based stress reduction in a Boston Public Middle School.

Kristeller, Jean L. Mindfulness, Wisdom and Eating: Applying a Multi-Domain Model of Meditation Effects. Constructivism in the Human Sciences. 2003.

1 comment:

  1. While feelings or emotions are considered as the outcome of our thoughts, the experts in this therapy act in a reverse direction to change the course in a desirable way and get results. Cognitive behavioral therapy is one of those professional ways.