MiCBT Research (Selected Studies)

Research and Publications on Mindfulness-integrated CBT.

Co-emergence Reinforcement and Its Relevance to Interoceptive Desensitization in Mindfulness and Therapies Aiming at Transdiagnostic Efficacy

Tuesday, December 29, 2020
Bruno A. Cayoun1*  Alice G. Shires2,3

  • 1MiCBT Institute, Hobart, TAS, Australia
  • 2Mindfulness Integrated Therapies and Research Clinic, University of Technology Sydney, Ultimo, NSW, Australia
  • 3School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia

Interoception, the ability to feel the body’s internal sensations, is an essential aspect of emotional experience. There is mounting evidence that interoception is impaired in common mental health disorders and that poor interoceptive awareness is a major contributor to emotional reactivity, calling for clinical interventions to address this deficit. The manuscript presents a comprehensive theoretical review, drawing on multidisciplinary findings to propose a metatheory of reinforcement mechanisms applicable across a wide range of disorders. We present a reconsideration of operant conditioning through the co-emergence model of reinforcement, which is a neurophenomenological account of the interaction between cognition and interoception, and its consequences on behavior. The model suggests that during memory processing, the retrieval of autobiographical memory (including maladaptive cognition) is dependent upon its co-emerging interoceptive cues occurring at the encoding, consolidation and reconsolidation stages. Accordingly, “interoceptive reinforcement” during emotional distress is a common factor to all emotional disorders and a major cause for relapse. We propose that interoceptive desensitization has transdiagnostic benefits, readily achievable through the cultivation of equanimity during mindfulness training and can be integrated in cognitive and behavioral interventions to permit a transdiagnostic applicability. We summarize the contributions of this approach into 10 specific and testable propositions.

Frontiers in Psychology, 22 December 2020 | https://doi.org/10.3389/fpsyg.2020.545945

Development and Validation of the Equanimity Scale-16

Saturday, October 03, 2020

Holly Rogers1*, Alice Shires1, 2 and Bruno Cayoun2

1 University of Technology, Sydney, NSW Australia
2 MiCBT Institute, Hobart, TAS Australia


Objectives: Equanimity is a non-reactive attitude that is increasingly recognized as a central component of mindfulness practice and a key mechanism of mindfulness-based interventions that is currently lacking means of measurement. The present study aimed to develop a self-report measure of equanimity, explore its underlying factor structure, validity and reliability. 

Methods: An initial pool of 42 items was selected from existing mindfulness questionnaires and measures of related constructs, and subsequently reviewed by researchers and selected based on majority agreement on their construct validity. The Qualtrics online platform was used to administer these items and other questionnaires used to assess validity and collect demographic information in 223 adults from the general community (66.8% females and 33.2% males, age range = 18–75). Questionnaires were then re-administered to assess test-retest reliability..

Results: In agreement with past research, exploratory factor analysis revealed two underlying factors, Experiential Acceptance and Non-reactivity. A final 16-item measure showed good internal consistency (⍺ = .88), test-retest reliability (n = 73; r = .87, p < .001) over 2–6 weeks and convergent and divergent validity, illustrated by significant correlations in the expected direction with the Nonattachment Scale, Depression Anxiety and Stress Scale, Satisfaction with Life Scale and Distress Tolerance Scale.

Conclusion: Based on this initial study, the Equanimity Scale-16 appears to be a valid and reliable self-report measure to assess trait equanimity, and may be further explored in future studies as a tool to assess progress during mindfulness-based interventions, and to assist in the investigation of their underlying mechanisms.

Full Article

Mindfulness https://doi.org/10.1007/s12671-020-01503-6

Effects of Mindfulness-integrated CBT on selective attention and frontal lobe EEG asymmetry in patients with multiple sclerosis and healthy controls

Sunday, February 16, 2020

Lida Sabagh Kermani (M.Sc)1, Masoud Fazilat-Pour (Ph.D)*2, S. M. Hossein Mousavi Nasab (Ph.D)1, Hossein Ali Ebrahimi Mimand (Ph.D) * 3

1 – Dept. of Psychology, Shahid Bahonar University of Kerman, Kerman, Iran
2 - Dept. of psychology, Shiraz University, Shiraz, Iran
3- Kerman Neurology Research Center [KNRC], Kerman University of Medical Sciences, Kerman, Iran

Introduction: The present study was designed to investigate the effectiveness of mindfulness-integrated cognitive behaviour therapy on emotional states (depression, anxiety, & stress) and quality of life (physical health and mental health) of adults with multiple sclerosis. 

Materials and Methods: The studied population included all patients who referred to Kerman MS society among them 30 patients were selected using purposive sampling method and they were divided by random into the intervention group of MiCBT and a control group. Depression, Anxiety, stress scale (DASS-21) and quality of life of people with MS [MSQOL-54] questionnaire was employed as the measurement tool.

Results: Results showed that physical health, mental health and quality of life, in general, was significantly increased and depression, anxiety, stress were significantly decreased in the MiCBT group when compared with the control group. 

Conclusion: As a result, mindfulness-integrated cognitive behaviour therapy is suggested as an effective intervention in decreasing psychological problems of people with MS, including depression, anxiety and stress and in improving their quality of life.

(Manuscript submitted for publication)
* Corresponding author 1. +98 9167027800 fazilat1348@gmail.com  
* Corresponding author 2. +98 9131404516 ebrahimi.ha@gmail.com

Study protocol for a randomized control trial to investigate the effectiveness of an 8-week mindfulness-integrated cognitive behavior therapy (MiCBT) transdiagnostic group intervention for primary care patients

Sunday, February 09, 2020

Sarah Frances1,2*, Frances Shawyer1, Bruno Cayoun3, Joanne Enticott1,4 and Graham Meadows1,5,6

1 Southern Synergy, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria 3800, Australia
2 Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Dandenong Hospital, Victoria 3175, Australia
3 MiCBT Institute, Hobart, Tasmania 7000, Australia
4 Department of General Practice, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
5 Mental Health Program, Monash Health, Melbourne, Victoria, Australia
6 Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, 3010, Australia


Background: Effective transdiagnostic treatments for patients presenting with principal or comorbid symptoms of anxiety and depression enable more efficient provision of mental health care and may be particularly suitable for the varied population seen in primary healthcare settings. Mindfulness-integrated cognitive behavior therapy (MiCBT) is a transdiagnostic intervention that integrates aspects of CBT, including exposure skills targeting avoidance, with training in mindfulness meditation skills adopted from the Vipassana or insight tradition taught by the Burmese teachers U Ba Khin and Goenka. MiCBT is distinguished from both cognitive therapy and mindfulness based cognitive therapy by the use of a theoretical framework which proposes that the locus of reinforcement of behavior is the interoceptive experience (body sensations) that co-arises with self-referential thinking. Consequently, MiCBT has a strong focus on body scanning to develop interoceptive awareness and equanimity. Designed for clinical purposes, the four-stage systemic approach of MiCBT, comprising intra-personal (Stage 1) exposure (Stage 2), interpersonal (Stage 3), and empathic (Stage 4) skillsets, is a distinguishing feature among other mindfulness-based interventions (MBIs). The aim of this study is to investigate whether and how group MiCBT decreases depression and anxiety symptoms for patients with a range of common mental health conditions.

Methods: Participants (n = 120) recruited via medical practitioner referral will be randomized to MiCBT or a wait-list control. Inclusion criteria are age 18–75; fluent in English and having a Kessler Psychological Distress Scale (K10) score of 20 or more. The MiCBT treatment group receive an 8-week MiCBT intervention delivered in a private psychology practice. Participants complete a suite of online self-report measures and record the amount of meditation practice undertaken each week. The control group receive usual treatment and complete the measures at the same time points. Primary outcome measures are the Depression Anxiety Stress Scale-21 (DASS-21) and K10. Analysis will use mixed-model repeated measures.

Discussion: The potential ability of MiCBT to provide a comprehensive therapeutic system that is applicable across diagnostic groups would make it an attractive addition to the available MBIs.

BMC Psychiatry (2020) 20:7 (Open Access: https://rdcu.be/b1okX)

Differential efficacy of MiCBT, MCT, ACT, and CBT in decreasing OCD symptoms: A pilot randomized controlled trial

Wednesday, December 04, 2019

Derakhtkar, A.1, Fazilat-Pour, M.1, Cayoun, B. A.2*

1 Faculty of Education and Psychology, Shiraz University, Shiraz, Iran
2 MiCBT Institute, Hobart, Tasmania 7000, Australia


Background: While various cognitive and behavioral approaches have shown varying degrees of efficacy in reducing the symptoms of obsessive-compulsive disorder (OCD), there is a lack of comparative studies on their effects. This randomized controlled study compared the effects of Cognitive-Behavior Therapy (CBT), Acceptance Commitment Therapy (ACT), Metacognitive Therapy (MCT), and Mindfulness-integrated CBT (MiCBT) on the symptoms of 100 adults with OCD.

Method: All participants were randomly allocated to four experimental groups (MiCBT, MCT, ACT, and CBT) and a control group and filled in the Yale-Brown Obsessive-Compulsive Scale at three time points (pre-treatment, post-treatment and follow-up).

Results: The results showed that all four interventions were efficacious in the short-term decrease of OCD symptoms, but only participants in the MiCBT and ACT groups maintained their therapeutic gains at follow-up. In addition, there was no significant difference in the long-term efficacy between the MCT and CBT approaches.

Discussion: According to these early results, MiCBT and ACT appear to be preferred approaches than MCT and CBT for reducing OCD symptoms. We discuss the possible active mechanisms causing these differences and the importance of replication studies.

(Manuscript in preparation)
*Corresponding author

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