Mindfulness: Addressing Despair Through CBT Part 4

Mindfulness in psychotherapy has made a rapid rise over the last few years, and has now entered a phase of popular attention. As an act of meditation and awareness, Mindfulness has its roots in the Eastern Buddhist tradition, with a varied and factored approach of attention to inner life, comprehension, awareness, breath, and personal liberation. For psychotherapy in the United States, mindfulness is associated most commonly with Jon Kabat-Zinn and his pioneering use of Mindfulness Based Stress Reduction (MBSR) in health research at the University of Minnesota in the late 1970's. Since that time, Mindfulness has become a part of many different therapy practices.

I personally am still undecided on the application. CBT relies almost entirely on logic and finding counter evidence to one's thinking patterns and beliefs, which is a skeptical position that matches my outlook and ethics. Mindfulness introduces many things that cannot be refuted or invalidated, and can be used as an ad hominem against an individual. For example: "you aren't meditating correctly, which is why we did not obtain the promised result." Since it is rapidly becoming part of CBT, I present mindfulness here more from an educational and informative perspective than a personal one, as I am still looking into it

Cognitive Behavioral Therapy and Mindfulness come together in what are called Third Wave Cognitive Behavioral Therapies. The emphasis in not only on cognitive misperceptions, automatic thoughts, and core beliefs, as I have covered in the last three articles, but also on self-awareness, and the relationship one has to their thoughts and feelings. Mindfulness in CBT is a method for more clearly discerning this thought process, and for reaching a state where one can become aware of maladaptive behaviors and thoughts, and work to change them.

To illustrate, let's look at an example from my second article on Automatic Thoughts. I listed some thoughts that instantaneously enter my mind related to RA: "I will always be in pain," "It will never get better," and "I hate living like this." Each of these thoughts generally occurs within a specific context, and is accompanied by strong emotion. For example, I told the story of how I was trying to shovel snow, and how my inability to do so left me feeling pathetic, and saying things like, "I can't live like this! I hate this!"

Mindfulness would be used in just such scenarios, where the intensity of emotion is triggered by the circumstance, and one begins acting or thinking in ways that are familiar, but not always helpful. In the example under discussion, rather than sitting down and becoming engulfed in my negative thoughts, ruminating on how difficult RA is and wishing my life were different, I could try to get some emotional perspective on the intensity of the situation. I would want to take some deep breaths, become aware of my feelings, and see if I can focus my thoughts on something like the sensation of the snowfall on my skin, the soft sound of the cool wind rustling the needles of the pine trees, or the feeling of my breath as I inhale and exhale. Some people use mental imagery to create this space. By focusing attention on sensation, the thoughts are no longer about the future and "I can't live like this," or a strong knee-jerk emotional reaction "I hate this!" but on the present moment. The goal is to view these emotions as if from a distance, like a spectator. In that way one can see their lack of permanence, understand the context more fully, and get some time to calm down without jumping to conclusions and falling into negative thinking spirals.

Mindfulness offers a window of opportunity to offset automatic reactions, which is why it compliments CBT and why many therapists use it. It is also a varied and multifaceted approach. I have discussed it here in a singular manner within the context of CBT as it pertains to the preceding three articles. There are many other methods and techniques.

I personally believe there is a limit to the application of psychological theory to RA. Pain reaches levels where any sort of mental focus or psychological technique will hardly touch the intensity of the hurt. I have known such levels of pain with Rheumatoid Arthritis and serious injuries. Many people with the disease live in a permanent state of needing pain relief. I worry that "mind over matter" can be overgeneralized, and that it happens frequently and in ways that do harm to people struggling with chronic pain. In none of my discussion of CBT have I believed it to be a panacea for RA. I find that using logic and critical thinking is very helpful for fighting the depression and frustration I often feel with the myriad difficulties the disease brings. I have found that focusing on how I think can reduce stress, which helps with some symptoms, but only to a point. I believe that psychological tools and theories can be useful, but that the claims should be modest. We do the best we can with something few people understand. The suffering of RA is real, it is not in our heads.

This concludes the four part series on CBT. It is my hope that using my own experience of Rheumatoid Arthritis and Cognitive Behavioral Therapy as an illustration has been helpful to others.