CD for Mindfulness-Based Cognitive Therapy (MBCT)

Guided Meditations for Mindfulness Based Cognitive Therapy, by Donald Fleck

You can buy and download a complete set of guided meditations for Mindfulness-Based Cognitive Therapy, tracks by Donald Fleck, from CD Baby.

Note: clicking on the graphic below takes you to CD Baby, my distributor. At their site you can see the listing of tracks and album description, and decide if you want to buy certain tracks, or the whole CD.

Donald Fleck: Mindfulness- Based Cognitive Therapy tracks by Donald

Great source for mindfulness news

The University of Vermont has a Mindfulness Center for students, run by Miv London, one of the people who trained me in MBCT. Miv does a great job of finding interesting thinking about mindfulness, such as a recent one documenting that sex and mindfulness are the same to your brain. If you want to stay in the loop of mindfulness news, especially news that would be of interest to younger folks, join the UVM Mindfulness Practice Center, and click to receive updates. And thanks, Miv.

Radical acceptance of the good, and the not so good

Tara Brach lays out a way to deal with painful feelings, and to live life more fully. Her book Radical Acceptance, Embracing Your Life with the Heart of A Buddha, lays out her thinking.

Tara Brach is a clinical psycholotist, meaning she practices psychotherapy. She’s also a student of Buddhism, including mindfulness meditation. She has a lot to contribute to mindful psychotherapy.

The idea here is to embrace all of life, the good, the bad, and the boring. Want to eliminate suffering in your life? Forget it. Want to only experience joy? Forget it.   The way of mindfulness is to be with all experience, not to chase it away, even if it is unpleasant.  It just takes too much energy to chase away experience.   Avoiding knowing experience is a little like living in delusion.

The book’s title, Radical Acceptance, comes from the idea that it’s radical to accept negative experience, radical because in this society we’re brought up to minimize the bad and maximize the good. It really is radical to say that when we’re experiencing something unpleasant, we should allow ourselves to ‘be’ fully in that experience.  This doesn’t mean going out looking for unpleasant experience; just being with it when it comes.  Why practice this radical acceptance?  Because it works.

The Buddha was raised in luxury, his father a King, yet he wasn’t happy. He wanted to find enlightenment, and like many Hindus of his day began by depriving himself of all comfort: nearly starving himself, living the life of a homeless person. That didn’t work either, he nearly died, not at all the better of having lived in suffering.  Living in luxury hadn’t worked; living in suffering hadn’t worked, either.   He struggled to make sense of life, finally resolving to sit under the Boddhi tree until he understood things more deeply.  He realized the idea of embracing whatever experience came to him, the pleasant, the unpleasant, and the neutral (boring).  Life always included elements of happiness and elements of sadness. Enlightment meant accepting all of experience,  even as a child does, without preference.

This is a rather large teaching moment in Buddhism, and also for Tara Brach. She sees how we lead so much of our lives trying to avoid pain and suffereing, seeking after comfort, to no avail. The difficulties just keep on coming.

The change she teaches involves accepting all of experience, as the Buddha did.

It plays out like this:  The prime dissatisfaction for many of us is the sense that we are unworthy. We aren’t enough, we don’t do enough, we don’t have enough.  We live in a trance of unworthiness. It’s a trance because the pain of KNOWING the unworthy feelings is rather deep. So we keep really busy, so there’s no time to sit and feel. We embark on self-improvement projects to try to be good enough. We avoid risks to avoid more pain. We withdraw from knowing our current experience.  We become self-critics. And like most self critics, we also become critical of others.  Doing all this activity just to live in the delusion that everything should be pleasant. And to avoid knowing what’s life is really like.

Being caught in the trance  means losing sight of the self who’s connected, whole, in the ‘fullness of being.’ Breaking the trance of unworthiness involves being in close touch with the self that’s fearful, wanting, feeling alone and separate.

Brach’s way out?  “When we learn to face and feel the fear and shame we habitually avoid, we begin to awaken from the trance.” (p. 57)

A principal way for the beginner to do this is with the sacred pause. It’s a way to stop running from experience. Brach lays out in clear detail how to learn the sacred pause, although for many it is better learned with the aid of a professional helper, as the feelings that come out can be strong.  The sacred pause is sort of like saying, “Here I am, (name your experience)…. let me feel it fully, let me be with it, regardless of how I feel about it.”

Having learned the pause, readers are encouraged to practice it often. The book introduces vipassana or mindfulness meditation to come into contact with experience, and metta or loving-kindness meditation to develop compassion for the deeper self that comes clearly into view.

People of all walks of life can gain from this book. Each chapter ends with the text of a guided meditation to practice and directly experience her teachings.

For professionals: In the process of describing Radical Acceptance Brach lays out an approach to mindful therapy that reveals itself only through the accumulation of examples she uses. But revealing it is, and worthy of study by the psychotherapist.  For the professional psychotherapist who wants to learn more, Dr. Brach has also taught workshops on Radical Acceptance for professionals. I studied this with her, and found it most helpful.  With some of my psychotherapy clients it becomes the focus of our work.

A helpful interview with Tara Brach occured in Elisha Goldstein’s blog at PsychCenral, 9/4/09.

Latest research on Mindfulness for Depression

Mindfulness for depression continues to do well in research.

The latest study found that Mindfulness Based Cognitive Therapy for depression was about as effective as anti-depressants.  This is the third major study showing MBCT’s usefulness.  A word of caution: my  experience as an MBCT teacher is that is just as effective if a person is taking anti-depressants or not.  Any medication decisions need to be taken with your doctor or psychiatrist.  Medications don’t have much to do with thinking patterns.

The real benefit of MBCT is that it helps a person learn a new way to deal with negative thinking, a new way to be with low self-esteem.  I’ve pasted below parts of an article on the latest study. Major points are highlighted in blue.

Depression Treatment: Mindfulness-based Cognitive Therapy…

ScienceDaily (Dec. 2, 2008) — Research shows for the first time that a group-based psychological treatment, Mindfulness Based Cognitive Therapy (MBCT), could be a viable alternative to prescription drugs for people suffering from long-term depression.

In a study, published December 1, 2008 in the Journal of Consulting and Clinical Psychology, MBCT proved as effective as maintenance anti-depressants in preventing a relapse and more effective in enhancing peoples’ quality of life. The study also showed MBCT to be as cost-effective as prescription drugs in helping people with a history of depression stay well in the longer-term.
The randomised control trial involved 123 people from urban and rural locations who had suffered repeat depressions and were referred to the trial by their GPs. The participants were split randomly into two groups. Half continued their on-going anti-depressant drug treatment and the rest participated in an MBCT course and were given the option of coming off anti-depressants.
Over the 15 months after the trial, 47% of the group following the MBCT course experienced a relapse compared with 60% of those continuing their normal treatment, including anti-depressant drugs. In addition, the group on the MBCT program reported a higher quality of life, in terms of their overall enjoyment of daily living and physical well-being.
During the eight-week trial, groups of between eight and fifteen people met with one therapist. They learned a range of meditation exercises that they could continue to practice on their own once the course ended. Many of the exercises were based on Buddhist meditation techniques and helped the individual take time to focus on the present, rather than dwelling on past events, or planning for future tasks. The exercises worked in a different way for each person, but many reported greater acceptance of, and more control over, negative thoughts and feelings.
…MBCT takes a different approach – it teaches people skills for life. What we have shown is that when people work at it, these skills for life help keep people well.”

Mark Epstein on psychoanalysis and meditation

I studied Mark Epstein’s Thoughts Without A Thinker to learn how a psychoanalyst integrates mindfulness into psychotherapy.

Mark Epstein’s credentials are impeccable. He is a long-time meditator, student of Buddhism, a psychiatrist practicing psychodynamic psychotherapy. He was mentored by some rather eminent scholars of Buddhism: Joseph Goldstein and Jack Kornfield.

The first part of the book lays out classical Buddhism in a framework of psychodynamic understandings. It is a fine introduction for the psychoanalyst, as he frequently describes Buddhism from the point of view of Freud’s teachings. The second part describes Buddhist meditation and explains its workings psychodynamically. The third part presents a model of how Buddhist meditation can work hand-in-hand with psychotherapy.

It is this third part that is of great value to the therapist seeking ways to integrate meditation or mindfulness with treatment. In it, Epstein uses Freud’s essay “Remembering, Repeating and Working Through.” While I recommend reading this third part of the book carefully, as it is full of important insights, a brief synopsis might be helpful:

Epstein sees psychotherapy and meditation as going hand in hand. He does not see them used consecutively, or side-by-side, but rather being closely integrated.

Epstein focuses on the concept of the need of patients to deal with the `basic fault,’ the feelings of inadequacy left over from growing up with parent(s) who did not devote enough attention to the child. He sees this as a sense of emptiness that must be dealt with in therapy, rather than dealing with specific incidents with the parents.

There are some problems of using meditation without the support of a therapist. Epstein writes, “meditation is often extremely efficient at bringing out the basic fault, but rather silent about dealing with it.” (pg179). (In my experience as a therapist, this problem, as it is encountered by beginning meditators, can result in great discomfort, often so great the defenses keep it out of awareness. It can be a cause of many beginners finding reason to discontinue meditation just when they get started. Those who can verbalize it might call it a sense of emptiness.)

Also, meditation can stir up projections and transference that the classic meditation teacher may not know how to respond do. The therapist would see this as a natural and expected occurrence, and of course has the necessary training to use it productively with the patient.   Thus the need for therapists versed both in therapy and meditation.

A huge benefit of meditation to the therapist comes from developing her or his own meditative practice. It has been said that the therapist’s person is the first and foremost element in healing. The therapist who meditates can achieve a much more advanced `presence’ with the client, and this can result in a stronger, more productive therapeutic relationship. The presence involves listening, but also an attitude of acceptance and openness, elements often nourished by meditation.   For Epstein this means sitting with the patient without

-an agenda

-trying to force an experience

-thinking h/she knows what is happening

-feeling h/she knows the patient
As for the therapeutic process, Epstein writes, “Much of my work as a therapist with a meditative perspective involves teaching people, in the context of therapy, how to pay attention to what they are repeating in a manner that is both meditative and therapeutic.” (pg. 193)

In discussing `working through,’ Epstein defines it as `changing one’s view.’ While this will be a very challenging adjustment for experienced therapists, it is helpful once the nature of meditation is understood. It goes with the idea that `working through’ means less an outpouring of emotion and more an ability to sit with emotion and see it differently, thus `changing one’s view.’ Many therapists will need to develop their own meditation practice before fully accepting this premise!

Epstein describes how emotion can be experienced in the body and thus experienced as part and parcel of the `I’ rather than as split off elements. When emotion is experienced through the body it can be seen as something that arises and falls away, rather than as a feared, stuck part of the self.

In attempting to describe meditative states of mind, and the shifts in perception and attitude that can result, Epstein does a good job, but this is not easily summarized. Imagine writing an essay on the experience of swimming, for one who has never swum, versus offering the experience of swimming itself. Experiencing mindfulness meditation is much more than most authors can hope to adequately describe. Nevertheless, Epstein’s core idea is that the patient needs to arrive at a place of feeling Robert Thurman’s `injured innocence,’ basically an indignation at the treatment received from loved-one(s), and then is most open to having a shift in feelings about that. It’s sort of like moving from a position of swimming in the emotions, to a position a little bit away from them, where an `I’ can observe them from a few feet away. The transition from there to a deeper appreciation of the `I’ who is experiencing the suffering, rather than being consumed by the suffering itself, is an important part of growth.

Epstein has succeeded in explaining one way that meditation can help the patient. This conceptual framework is very important for any therapist wanting to provide more than superficial change, and deserves careful reading, followed by developing her or his own practice. Based on my experience, the therapist cannot go much further without jumping into the water and experiencing meditation firsthand.  And that need not be seen as a price-of-entry to meditative therapy, since this very jumping in can help the therapist develop the choiceless awareness within the session that is so vital and valuable.

There are many exciting developments in the use of mindfulness and meditation in psychotherapy. A Buddhist approach is one of them. What gives such value to Epstein’s approach, though, is his success at giving an overall theoretical psychodynamic framework. This book is an excellent statement on the `how it works’ of meditation in psychotherapy. What is needed after a close reading of this material, are specifics on the `how to’ of actually doing and using meditation within a psychotherapy practice.

For now, learning the `how to’ in individual psychotherapy will remain the province of supervision, as approaches are developed client by client.