Depression and anxiety, being the largest single cause of disability in our society are serious and the most common debilitating mental illnesses associated with significant human and economic costs (Mind, 2009). NICE guidelines states people diagnosed with these conditions should be offered evidence based therapies as an effective treatment (DH, 2011) and has approved Cognitive-behavioural therapy (CBT) and mindfulness to be available in the NHS (NHS, 2011).
CBT considers thought, emotion, and behaviour to be interrelated seeking to help clients monitor their cognition and actions so as to help improve their emotional health and life satisfaction (APA, 2011). While mindfulness is intentionally being present in this moment in a non-judgemental way helping us break free from a downward spiral of negative thought and action enabling us to make positive choices while neutralizing fear and sadness (MHF,2012).
The purpose of this assignment is to describe various components of CBT and mindfulness, compare and contrast them in understanding and working with fear and sadness, their limitations and advantages and explain the reasons for my inclinations towards CBT before conclusion.
CBT is a goal-orientated, practical and structured therapy creating a collaborative and therapeutic rapport between client and therapist through ‘shared understanding’ in identifying common safety seeking behavioural patterns in response to the misinterpreted situations associated with fear and sadness; and changing the way of thinking(cognitive) and acting(behavioural) (RCPsych,2012).
CBT was developed by Aaron T. Beck in 1976 who contradicted psychodynamic theory of unconscious drives and defences by proposing a major reformulated coherent approach to treatment with clear and pragmatic strategies clinically used to disconfirm patients’ negative beliefs (Hollon, 2010). Beck believed cognitive errors cause our perception and thinking to be unrealistic and distorted in a damaging way resulting in dominated cognitions by biased information processing and a negative view of the self, the world, and the future—the so-called cognitive triad (Pössel,2011).
CBT helps to break the vicious circle of emotional state and behaviour triggered by thoughts of future threats and irrational depressive thought patterns leading to fear and sadness pushing the sufferer further into downward spiral of negative thinking onto isolation and withdrawal (Salkovskis, 2010, chapter 7, pp.163). CBT helps to break large tasks into small to challenge and rate client’s own negative behaviour making a list of what they need to do to find alternative solutions and motivating them to engage on behavioural activities or experiments like relaxation exercises (Garland, 2010). Consequently, ‘finding out how the world really works’ with the help of cognitive techniques using pie charts, thoughts records as proposed by Beck (1995, as cited in Salkovskis, 2010, chapter 7, pp.164-5 ).
Home works setting practical goals are followed between each session, encouraging client’s own involvement giving them variety of informed alternatives attuning their belief and values as Salkovskis explains person’s history, mood state and context influences those linked negative misinterpretations leading the sufferer trapped in the persistent patterns of negative responses (2010, chapter 7, pp.156-165).Evidence shows CBT has a clear enduring effects for nearly entire range of mental health problems like anxiety and panic attacks, Obsessive Compulsive Disorder(OCD),eating disorders, mood swings, phobias (BABCP,2012 ) and is proven to be more popular and widely used to treat fear and sadness (RCPsych, 2012).
CBT can be done in weekly/fortnightly in group or one-to one sessions and may last 6 weeks to 6 months (Clark, 2010). Known as the ‘gold standard’ of therapies, CBT is now highly researched and principally included in the government talking therapies project like IAPT (Improving Access to Psychological Therapies) (MIND, 2012). NHS approved self-help CBT programmes like Fear Fighter and Beating the Blues for anxiety and depression are also available online (RCPSYCH, 2012).
Mindfulness creates an inner space in which the emotion begins to transform itself creating “empty thought” which ceases to have any particular meaning or power to cause anxiety or suffering (Strong, 2011). Mindfulness follows on Buddha’s 2500 years old principles of 4 noble truths which Barker summarizes as facing and understanding our inner sufferings and roots of cravings and eventually ending the suffering by letting the cravings go and links the popularity of mindfulness to views projected by various authors relating Gautama Buddha’s story to the 21st century’s realisation that wanting more and desire to hold on to materialistic possessions only make us more anxious and sad (2010, chapter 8, p.171-2).
Although, mindfulness deals all conditions under the umbrella of `sufferings’, it does help us to see clear patterns of the mind to learn to recognise when our mood is beginning to go down in depression or when our mind gets anxious in fear (OMC,2012). Research shows its effectiveness in mental and physical problems like depression and anxiety disorders, addictive behaviour, chronic pain (MHF, 2012). Barker illuminates 3 important elements of mindfulness while dealing with fear and sadness (2010, chapter 8, pp.173-181);
1. Acceptance: Realising it’s about being not doing and accept emotions non-conceptually, realising they are impermanent halts the escalation of negative thoughts (kabat-Zinn, 2007).
2. Being present: Focusing on now, noticing the various present sensations in everyday chores succours us to battle our negative assumptions contrasting with states of mind where attention is focused elsewhere dominated by critical thinking, diverted attention in reliving the past or pre-living the future (OMC,2012).
3. Awareness: Realising past and future is just concepts, helping us to hold difficult and unwanted feelings rather than sinking deeper into them (Nanda, 2010).
Mace (2007) describes mindfulness as versatile practice learned through a mixture of guided instruction and personal practice which have been conceptualized as sets of skills taught independently of any religious belief system available to mental health and medical settings and done in one to one or group sessions. Mace describes sitting meditations attending to breathing and body sensations, yoga, mindful activity in everyday chores and mini-meditations like the ‘3 minute breathing space’ as the few formal and informal practices of mindfulness.
Mindfulness based therapies are recommended by NICE guidelines to help people avoid repeated bouts of depression and anxiety (NHS, 2012). The principles of mindfulness have also been compared and linked to existential and humanistic therapies and its third wave has been branched out into various other therapies (Barker, 2010, Chapter 8, pp.172-3).
Despite the varied origins, there are similarities and fundamental differences between CBT and mindfulness. While CBT is specifically one of the logical approaches used to help client identify their cognitive errors, replace irrational thoughts with rational ones and incorporating into their life helping to deal with other conditions along the way (NHS,2010); mindfulness interventions are acquired skills proven to help sufferers deal with all sorts of conditions and can be used as prevention strategy as unlike CBT it does not judge and assume pathology or emphasize the goal of change where undesirable emotions are “pushed away,” but rather because people learn to live with and accept their psychological and physical limitations (Hamilton, Kitzman and Guyotte, 2006).
Both the therapies are short-term and cost-effective; while CBT is the most researched of all mind–body interventions, mindfulness-based activities are also receiving increasing interest and study for its usefulness in physical as well as mental conditions (Brown and Ryan, 2003).
In CBT and mindfulness, therapeutic alliance is established between client and therapist; aiming to develop personal practical skills for the individual to attribute improvement in their problems through home works and activities (BABCP, 2012). Although, online and self-help approaches are widely used to practice both the therapies. Both therapies focus on the present moment rather than past; however CBT requires client’s brief history to assess its impact on client’s perceptions and behaviour (Salkovskis, 2010, chapter 7, p. 156). But considering more to the present moment, both therapies can be criticized as failure to identify the underlying causes of the mental conditions which might have had great impact like childhood traumas and in encouraging clients to change their thoughts and behaviour, family and social issues may be overlooked (NHS,2010).
CBT has been proven to work as well as antidepressants for many forms of depression and even slightly better than antidepressants in helping anxiety (RCPsych, 2012). Alternatively, mindfulness embraces anxiety and depression under common Buddhist concept of sufferings (Barker, 2010, Chapter 8, p.173) which could arguably attach a religious logo. Nonetheless, neurobiological and neuropsychological studies indicate that mindfulness interventions are associated with significant improved level of changes in brain function in attention, memory, and executive functions as well as reduced emotional reactivity and imbalance (Chiesa, 2012).
Both the therapies can be one-to-one and in groups and follows practical relaxation and breathing exercises in dealing with anxiety and depression. Nonetheless, mindfulness practices embraced by everyone as a daily discipline can give false assumption as just another ‘relaxation technique’ (BU, 2002). Likewise, CBT’s structured process may not be suitable for people who have more complex mental health needs or learning difficulties (NHS, 2010).
Concentration and open monitoring skills are essential for correct development of mindfulness which could arguably be difficult to practice for everyone and in the process may lead an untrained mind the need to refocus repeatedly away from the constant narrative mind (Chiesa, 2012).Hence, Barker (2010, chapter 8, p.183) warns repeated unsuccessful attempts to eradicate depression and anxiety might contradictorily throw the patient right back into suffering. Oppositely, even though CBT requires practicing, it is flexible as it allows family involvements in helping the client to achieve the proposed goal through ‘guided discovery’ and considers the client to be an expert along with the therapist (Barker, 2010, chapter 7, p.156). However, CBT has a specific treatment plans for specific pattern of treatments; mindfulness has more holistic approach (Kross, 2001).
Despite the differences, CBT and mindfulness principles have been merged together in the form of ‘third wave’ as mindfulness-based cognitive therapy (MCBT) (Barker, 2010, Chapter 8, p.172). Nevertheless, combining CBT and mindfulness isn’t without criticism as it contradicts mindfulness principles of acceptance and gets into diagnosis or eradication of fear/sadness which might throw the client back into suffering (Barker, 2010, chapter 8, p.183). Similarly, CBT’s ‘transdiagnostic’ categorical divisions have also been condemned. But Salkovskis (2010, chapter 7, pp. 151-2) argues its importance in formulation and shared understanding of different dimensions of anxiety disorders.
This logical, structured therapeutic approach makes me drawn towards CBT which has been proved helpful working along with medicine therapy by teaching the brain to respond to medicines in a healthier way with more enduring effect (Hollon, 2004). The goals set at the beginning of CBT are also helpful in understanding and rediscovering one’s original motivation and even though CBT does not work for everyone all the time, its efficacy for the treatment of anxiety/depression has been scientifically proven and researched giving the sufferer confident skills to deal with other problems (Salkovskis, 2010, chapter 7, p. 157).
With rise in fear and sadness in the society, CBT and mindfulness interventions have become increasingly popular and have been moulded into government therapy programmes. Even though increasing research has been going on for mindfulness’s scientific evidence; CBT’s effectiveness in modern psychology seems to be closely studied. CBT’s structured approach focuses on collaborative and therapeutic relationship and effective strategies for reaching determined goals eventually helping people to cope with fear and sadness. Mindfulness though simply accepts any emotion in a non-judgemental way helping to neutralize any feelings of anxiety and depression. Mindfulness’s versatility to be applied in any settings without any stigma attached has made it flexible and versatile. Nonetheless, the need for rigorous practice and time-commitment cannot be ignored. Hence, my inclination is towards CBT as it provides logical approach allowing the support of family when needed. Regardless of both therapies being diametrically opposite in practice, they are working towards the same outcome of reducing fear and sadness; promoting safe mental health, autonomy and practical skills whilst providing sense of fulfilment.
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This assignment has helped me to learn important aspects of CBT and mindfulness, helping me to develop skills to deal with my own fear and sadness issues. Though, finding facts to compare and contrasting both therapies and squeezing too much information in a set format was a challenge I faced.