Integrating CBT and mindfulness

January 10, 2008 6:47 AM

Can cognitive behavioral therapy be reconciled with mindfulness into a single, integrated approach to the world?

Cognitive behavioral therapy proposes that our minds distort or corrupt our view of reality with unrealistic, negative perceptions of our world. CBT encourages the use of talk therapy and systematic exercises to readjust our thinking so that it conforms more closely with reality.

Mindfulness, primarily a meditative skill in many schools of Buddhism, is based on the idea that the activity of the mind itself, regardless of the content of our thoughts, leads to dissatisfaction (sometimes called "suffering"). Thoughts, be they positive or negative, trick us into assigning permanence to our ever-changing, ever-fading reality. Mindfulness, a disciplined activity that usually occurs in meditation, is a system whereby we observe the thoughts in our minds without judging them. In doing so, we gradually learn to separate from and let go of our thoughts.

Can these two practical philosophies be integrated into a systematic approach to the world, and to the everyday problems we confront as we go about our lives?

posted by Gordion Knott to religion & philosophy (18 comments total)

I don't know if this will be deleted as chatfilter, but I assume it has some special significance to your particular life.

My own belief is that they are two separate tools for two separate tasks, but that is because I discount mindfulness somewhat, I think.

I would liken cognitive-behavioral therapy to forensic excavation. You are trying to discover the roots of misperceptions in order to stop them.

Mindfulness, if I understand it correctly, is increased awareness, sensory and otherwise. That has its uses for perception and meditation. Heightened perception is useful in many circumstances; I personally don't believe I'd have the discipline to be mindful as a consistent state of mind.

So can they be integrated? Given that they seem by your description to be directly opposed to each other, I don't believe they can. But I do believe that each is a tool that can be used, without excluding the other one, to one's benefit for a healthy mentla and emotional life.
posted by WCityMike at 7:04 AM on January 10, 2008

Yes, they can, here. This guy is very good:

ACT and Steven Hayes
posted by Blacksun at 7:09 AM on January 10, 2008

In general, I think you are oversimplifying mindfulness. In its simplified form, you may be able to find some meaningful correlations between CBT and mindfulness, and may be able to integrate them into a personally meaningful approach to the world.

However, isolating "mindfulness" from the other traditions and teachings of buddhism makes it a much different teaching. I think the world-view of most schools of buddhism and CBT, if you dig a little deeper, may have some nice similarities, but are ultimately irreconcilable. Others may disagree.
posted by milarepa at 7:09 AM on January 10, 2008

They can be integrated in a single approach to life; they are both part of Dialectical Behavioral Therapy, a program designed for treating Borderline Personality Disorder. Mindfulness training is used to increase distress tolerance.
posted by RussHy at 7:15 AM on January 10, 2008

Fascinating, important question. I think they are completely reconcilable — indeed, that they may actually just be different perspectives on exactly the same model of thought and emotion.

Mindfulness has to do with seeing thoughts as thoughts, rather than identifying with them as "reality"; Buddhism (as I understand it) teaches that suffering arises from this identification (attachment). Buddhist teachers are often at pains to stress that meditation is not about stopping or squashing or reducing the incidence of thought, but rather relating to thoughts in a fundamentally different way.

Learning to be 'mindful' of automatic thoughts and previously unquestioned explanatory styles, etcetera, is of course an essential first stage in CBT — the very idea that our thinking can be readjusted first requires that we understand it to be thinking, not a simple reflection of the world — that we begin to learn to "see" our thoughts. And likewise, once you begin to see that you can adjust your thoughts and thereby affect your emotional state, a more non-attached approach to any specific thoughts seems to me bound to follow.

(Where the disconnect appears to exist is in the "positive thinking" school of self-help, which bastardizes CBT to the point of suggesting that you can force your old thoughts out, replace them with new ones, and everything will be fine. That approach would seem to mean letting go of one set of thoughts only to grasp tightly to a new set.)
posted by game warden to the events rhino at 7:24 AM on January 10, 2008 [11 favorites has favorites]

Married to a CBT-trained psychologist. Lots of people in the field are strongly interested in mindfulness. Seconding Steven Hayes and ACT. You might also be interested in the work of Richard Davidson.
posted by escabeche at 7:26 AM on January 10, 2008

Yes
posted by sid at 7:29 AM on January 10, 2008

I totally combine them everyday. To be honest, CBT is based on buddhism to a certain extent. I find that the meditation helps me see emotions I am avoiding and allows me to correct the dysfunctional thinking that causes me pain. I think good CBT does not rely on positive thinking, but discards the positive/negative analysis for a clear look at the good and bad facets of each part of our lives. Bad CBT tells you that you can get what you want by visualizing it. Not so. Good CBT tells us that life will be a series of ups and downs and that there is nothing wrong with us if something goes wrong--we are not a unified entity that can be condemned if bad things happen, even if our actions caused some of the bad things.

To me this is what buddhism strives for, freedom from karma.
posted by Ironmouth at 7:51 AM on January 10, 2008 [2 favorites has favorites]

Yes, of course. CBT works after you recognize your irrational thoughts. Mindfulness helps you recognize them in the first place.
posted by callmejay at 7:51 AM on January 10, 2008 [3 favorites has favorites]

You may also be interested in the works of Stephen Batchelor, who takes an agnostic approach to Buddhist meditation. I am thinking mainly of Buddhism without Beliefs.
posted by shothotbot at 7:53 AM on January 10, 2008 [1 favorite has favorites]

Yeah...I was gonna go for mentioning DBT as well. It's been a major help in my own life, even though it was really designed for people with borderline personality disorder. People who have had to deal with other mental health issues (primarily depression in my experience) also can really, really take a lot away from participating in a DBT skills training program.
posted by Stewriffic at 7:55 AM on January 10, 2008 [2 favorites has favorites]

CBT is relentlessly structured, methodical, and involves an enormous amount of tedious paperwork. All that structure is what enables it to help when you are much too anxious to get anything useful out of any kind of meditation, but I find it hard to imagine that anyone without serious problems would want to stick to doing CBT work every day for the rest of their lives. Mindfulness meditation, on the other hand is something that many people choose to do in order to enhance their lives, even when things are basically OK. I don't see any philosophical clashes between the two approaches but I think they are generally appropriate for different circumstances.
posted by teleskiving at 9:35 AM on January 10, 2008

The works of Zen teacher Cheri Huber are very much compatible with both.
posted by Zed_Lopez at 9:40 AM on January 10, 2008

They are the same thing: Mindfulness is a strategy for "not adding content" to the sensory experience of reality. The content not to add could be either cognitive or non-cognitive. The purpose of not adding content is to devalue it.

Cognitive Behavioral Therapy, in the abstract, is a process of first making content cognitive, and then dismantling it through a rational cognitive process of analysis and devaluation.

Zen occasionally argues that non-sensory content is inherently valueless in the face of reality. Some CBT theorists argue that non-sensory content that doesn't map to reality is the basis of the "sensory accurate" mental disorders (those that don't involve hallucinations or other cognitive failure).
posted by ewkpates at 10:25 AM on January 10, 2008

Also some general comments on the links:

1. Mindfulness is not zen. The two are not related. Many people who value mindfulness do not understand zen.

2. Cheri Huber may be calling her perspective zen. It's not. This and this make that clear. When one uses the word "compassion" this often suggests a humanism that betrays it's "little wheel" attachment.

3. Richard Davidson is writing about mindfulness and valuation, with some big wheel references. Note that the wiki article on big wheel says Zen is a part of big wheel. Unless it's the kind that kids ride around on, this is merely a historical association error. Zen didn't come from the sixth patriarch either. He was merely re-explaining what Mr. B had previously explained.

Wow. How much information did you want?
posted by ewkpates at 10:52 AM on January 10, 2008

Your definition of CBT is a bit off. I'd change it to, "Cognitive behavioral therapy proposes that our thoughts, behavior, and emotions influence each other, which means that distorted thinking can create negative emotions or unwanted/unhelpful behavior (and vice versa). CBT encourages the use of talk therapy and systematic exercises to identify distorted thoughts and behaviors and replace them with more realistic/supportive/helpful/balanced thoughts and behaviors, in order to improve our emotional state."

CBT comes at a similar idea of mindfulness, it's just couched in western scientific terms. The idea is that the mind comes up with all sorts of weirdness, we latch onto that weirdness, latching onto that weirdness creates overwhelming emotions, overwhelming emotions cause the mind to come up with more weirdness (stories) to explain them, and we're back on the neverending wheel of unhappiness (aka depression or anxiety). CBT generally advocates writing down the weirdness, rationally asking, "Is that really true? Do I really believe that? Do I really need to believe that? Is there a more balanced way of looking at this?" and then learning to recognize the distorted thought when it comes up, and learning to let it go rather than get emotionally caught up in it.

I do think it's kind of like meditation for beginners. But the basic idea, that our thoughts, behaviors, and emotions are in a feedback loop that can take us further and further away from the actual moment at hand, seems to align.
posted by occhiblu at 1:10 PM on January 10, 2008 [3 favorites has favorites]

Also, check out this: http://cbtinstitute.com/
posted by kenzi23 at 7:49 PM on January 10, 2008 [1 favorite has favorites]

The book Mindfulness-Based Treatment Approaches discusses four different mindfulness-based treatment approaches: mindfulness-based stress reduction (MBSR), mindfulness-based cognitive therapy (MBCT), dialectical behavior therapy (DBT) and acceptance and commitment therapy (ACT).
posted by euphotic at 2:28 PM on January 19, 2008 [1 favorite has favorites]