A Brief Conceptual Outline

Traditional cognitive therapy models attempt to alter maladaptive behaviour by modifying its concomitant dysfunctional thoughts and underlying assumptions. However, there is empirical evidence that our attempt to actively change aversive internal experiences (e.g., thoughts, emotions, body sensations) often multiplies our problems (e.g., in PTSD, GAD, pain etc). Consistent with Einstein's opinion that "we cannot change a problem with the means that created it", mindfulness and acceptance-based approaches take the view that attempting to change the content of incapacitating thoughts is less productive in the long term than learning to develop control over the processes that maintain them.

To achieve such control, mindfulness training involves paying attention to each event experienced in the present moment within the framework of one's body and mind, with a non-judgmental, non-reactive and accepting attitude. It may be broadly operationalised as a "generalised metacognitive and interoceptive exposure and response prevention" technique. Trainees begin with a set of breath concentration exercises to develop meta-cognitive awareness and minimise distractibility. This alone enables a more objective appraisal of what thoughts are, just "thoughts", rather than "truths" they have about themselves and the world.

Then trainees are taught how to scan their body systematically and develop an ability to feel both salient and more subtle sensations while purposefully inhibiting learned (automatic) responses. This entails a systematic desensitisation to whatever internal experience is encountered on the way.

Taken together, developing these skills involves the training of attentional functions which may engage the vigilance network (dorsolateral region of the prefrontal cortex and its reciprocal connections to a centralised area of the striatum) and the executive control network (orbital-frontal regions of the left prefrontal cortex and its reciprocal interconnections with the ventromedial region of the striatum).

Bruno Cayoun's (2004) model of Mindfulness-integrated Cognitive Behaviour Therapy (MiCBT) is a sophisticated integration of mindfulness core principles and traditional CBT, which rests on a neurophenomenological model of reinforcement, the co-emergence model of reinforcement. This approach involves a detailed account of micro-level reinforcement and extinction principles, as they are actually experienced. It suggests that once a trigger is perceived via sensory pathways, its judgmental interpretation at higher cortical levels leads unavoidably to some co-emerging body sensations, towards which one automatically ("mindlessly") reacts. Thus, reinforcement is regarded as being dependent upon learned reactions toward intrinsically coupled cognitions and body sensations.

Cayoun and colleagues' series of case studies and group outcome data demonstrate that preventing such reactions while remaining fully aware and accepting of bodily experiences leads to rapid extinction of conditioned responses, whatever is the nature of the disorder. Cognitive reappraisal emerges naturally from this freeing experience. "Self-worth", or rather satisfaction with life, springs from a deep sense of achievement, sense of self-control and self-efficacy.