Mindfulness and other 3rd wave CBT

approaches20th October, 2015

Dr. Pamela Jacobsen, Clinical PsychologistNIHR Clinical Research Fellow

Session Plan1)Mini mindfulness session

2) Theoretical background

3) Clinical applications

1) Mini mindfulness session

Ground rules• Confidentiality (safe space, keeping things within the group)• Respect (for yourself and each other, everyone’s experience will be

different)• Talking (please talk if you wish to but not if you don’t, only one

person speak at a time)• Taking care of yourself (move around if needed, keeping warm,

comfort break)• Leaving• Mobile phones (off during session – if urgent please leave room to

answer call)• Stay within your own experience and allow others to do the same

2) Theoretical background

3rd wave CBT approaches• Mindfulness (Jon Kabat-Zinn)• Acceptance and commitment therapy (ACT; Steve Hayes)• Compassion focused therapy (CFT; Paul Gilbert) • Dialectical behaviour therapy (DBT; Marsha Linehan)• Metacognitive Therapy (MCT; Adrian Wells)

……………….to name but a few!

3rd wave CBT approaches - commonalities• Trying to change how we think, not what we think• Relationship to experience, not content of experience• Recognising that attempts to control the form or frequency

of experiences (e.g. thoughts, emotions) might be part of the problem not the solution

• Re-focusing on goals and values

You have an interview for a job you really want

3) Clinical applications

Applications of Mindfulness Mindfulness-based Stress Reduction (MBSR)

- chronic pain, physical health problems

Mindfulness-based Cognitive Therapy (MBCT)- recurrent depression

Mindfulness for psychosis - distressing psychotic symptoms

MBSR for physical health difficulties• Pioneered by Jon Kabat Zinn - founded Stress Reduction Clinic at

the University of Massachusetts Medical School http://www.umassmed.edu/cfm/about-us/

• Structured 8 week program• Key components: psychoeducation, formal meditation practice

(body, breath, movement), teacher-led enquiry and discussion, daily homework practice and exercises

• Participants learn to recognize habitual, unhelpful reactions to difficulty

• Learn instead to bring an interested, accepting and non-judgmental attitude to all experience, including difficult sensations, emotions, thoughts and behaviour

MBCT for recurrent depression

MBCT for recurrent depression (Segal, Williams & Teasdale, 2002)• Adapted from original 8-week MBSR programme with added components from

cognitive therapy• Designed for people with a history of depression to undertake when in remission,

in order to prevent relapse• Based on findings that depressive relapse is associated with reinstatement of

automatic models of thinking, feeling and behaving• Intended to teach people to become more aware of the bodily sensations,

thoughts and feelings associated with depressive relapse • Recognise “automatic pilot” mode and learn skills into stepping out of this mode• Decentred awareness (e.g. thoughts are not facts), acceptance of difficulties

with self-compassion, grounding in the current moment to open up more choices of how to respond skilfully

• Developing an action plan that sets out strategies for responding when they become aware of early warning signs of relapse/recurrence

MBCT for recurrent depression• Strong evidence base – recommended in NICE guidelines

for depression, for people with >3 previous episodes• Reduces risk of relapse/recurrence of depression compared

to treatment as usual (Piet & Hougaard, 2011)

• As good as maintenance anti-depressants in reducing risk of relapse - but no evidence of superiority (Kuyken et al, 2015)

• MBCT provided significant protection against relapse for participants with increased vulnerability due to history of childhood trauma, compared to an active therapy control group (Williams et al, 2014)

Distressing experiences in psychosis

Applying Mindfulness in Psychosis• Relatively recent application of mindfulness pioneered by

Paul Chadwick & colleagues (2005, 2009)• compatible with the theoretical basis of CBT for psychosis

– patients’ distress does not arise directly from the psychotic symptoms themselves, but rather from the patient’s threatening interpretations and maladaptive reactions to their symptoms

• Patients who are distressed by their psychotic symptoms often either:– engage in experiential avoidance strategies– get lost in the struggle of rumination and confrontation of symptoms.

• Mindfulness offers a third way: an alternative way of relating to symptoms

Rationale for applying mindfulness in psychosis

Chadwick et al., 2005

AVOIDANCETrying to run away/block out experiences

STRUGGLEGetting caught up in fighting

against experiences

VS.

ALTERNATIVE

MINDFULNESSNon-judgemental acceptance of moment by moment experience

Mindfulness (Newman-Taylor & Abba– in Gaudiano, (Ed). 2015)

•Taught as a skill•Stepping out of automatic pilot•Noticing habitual patterns of relating to internal experiences

•Responding with acceptance & compassion as alternatives to rumination & avoidance

Adaptations to Mindfulness when working with psychosis (Chadwick, 2006)

• Meditation practices limited to 10 minutes

• Prolonged silences are avoided, frequent anchors provided

• Use concrete, everyday language in guidance

• Give prior permission for the person to stop the practice at any time if needed

Mindfulness groups for psychosis – Jacobsen, Morris, Johns & Hodkinson, 2011

Compassion for voices – A tale of courage and hope

Produced by: Dr. Charlie Heriot-MaitlandAnimation by: Kate Anderson

That’s all folks – thanks for your participation!

• Contact: Pamela.Jacobsen@kcl.ac.uk

@pamelacjacobsen