MiCBT Research (Selected Studies)

Research and Publications on Mindfulness-integrated CBT.

Effect of a brief Mindfulness-based Interoceptive Exposure Task on distress associated with Premenstrual Syndrome: A pilot study

Sunday, October 29, 2017

Joelle Fa 1 Alice Shires 2 Bruno Cayoun 3
1 Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
2 University of Technology Sydney, Sydney, NSW, Australia
3 Mindfulness-integrated CBT Institute, Hobart, TAS, Australia

Premenstrual Syndrome (PMS), when severe, is a debilitating experience shared by more than 80% of women throughout their lifetime. Many women prefer non-pharmacological treatments to avoid side effects and contraindications they may incur. Mindfulness-based strategies have demonstrated effectiveness in reducing distress in chronic pain patients, through learning greater acceptance and non-judgement of pain. However, not all women with PMS are amenable to undergo a full mindfulness-based program and maintain daily practice. Accordingly, the following pilot study applied a task extracted from a second-generation MBI, Mindfulness-integrated Cognitive Behaviour Therapy, which consisted of a self-guided 30-second mindfulness-based interoceptive exposure task (MIET), to painful and distressing sensations in 9 women who endorsed moderate to severe PMS. Participants using the MIET repeatedly over three menstrual cycles learned not to identify with pain, by focussing on the subcomponents of interoception (mass, motion, temperature and cohesiveness), while remaining equanimous.

Results did not find a significant effect of treatment on distress within session, however, distress between post-treatment and follow-up sessions showed a significant decrease F (2, 23) = 3.75, p < .05. Neither was there a significant decrease in pain catastrophising, premenstrual symptom severity, menstrual attitudes, nor emotional distress, however preliminary data showed a trending decrease on all measures. Belief in the predictability of the onset of menstruation was the only exception, which increased significantly from pre-treatment to follow-up. Despite this, participants reported the tool to be relatively acceptable, and qualitative data saw themes of increased manageability and acceptability of pain emerge.

Despite limitations, preliminary findings offer valuable insight into the feasibility of the MIET as a transdiagnostic tool as applied to a particularly complex socioemotional and physiological disorder that is PMS. Overall, our findings are sufficiently provocative to warrant further exploration of such a novel tool within an important domain of female health.

Immediate and Lasting Chronic Pain Reduction Following a Brief Self-Implemented Mindfulness-Based Interoceptive Exposure Task: a Pilot Study

Thursday, October 05, 2017

Bruno Cayoun 1   Akeesha Simmons 2    Alice Shires 2 3

1.Mindfulness-integrated CBT Institute Hobart Australia
2.University of Technology Sydney Sydney Australia
3.University of Sydney Sydney Australia


Recent imaging research shows that approximately 80% of people who transit from acute to chronic pain produce neuroplasticity linking pain pathways to learning areas of the brain, thus showing physiological evidence that chronic pain is largely learned. Mindfulness meditation programs have been used successfully to teach people a way of decreasing pain-related distress and unlearning their unhelpful relation-ship to pain.

However, not all chronic pain patients are amenable to undergo a full mindfulness program and then maintain daily practice. Accordingly, we conducted a pilot study of a task extracted from a second-generation MBI, Mindfulness-integrated Cognitive Behavior Therapy, which consisted of a self-guided 30-s mindfulness-based interoceptive exposure task (MIET) to pain sensations in 15 medically diagnosed chronic pain patients.

Participants using the MIET repeatedly over 15 days learned not to identify with pain and focused on four subcomponents of interoception (mass, motion, temperature, and cohesiveness) while remaining equanimous. This led to significant reduction in pain anxiety (p = .001; d = 0.96), pain duration (p = .01; d = 0.86), and pain intensity after each30-s exposure (p < .001; d = 1.37). These effects were maintained, and some further improved, at 2-month follow-up. Marked decrease in depression, anxiety and stress were also observed (p < .001; d = 0.81).While participants rated the task as highly acceptable and some reduced their use of analgesic medication; no other change in medical or psychological treatment was required.

These early results show the potential for the MIET to be use as an adjunct to traditional treatments of chronic pain, although controlled studies are needed to establish the validity of our results. Brain-imaging studies are also needed to assess the possible unlearning effect of the MIET on corticolimbic regions, a process that may be termed "central desensitization".

ORIGINAL PAPER First Online: 03 October 2017
Cayoun, B., Simmons, A. & Shires, A. Mindfulness (2017). https://doi.org/10.1007/s12671-017-0823-x

Efficacy of mindfulness-integrated cognitive behavior therapy in patients with predominant obsessions

Tuesday, March 21, 2017

Ajay Kumar1, Mahendra P Sharma1, Janardhanan C Narayanaswamy2, Thennarasu Kandavel3, YC Janardhan Reddy2

1 Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
2 Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
3 Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India


Background: Cognitive behavior therapy (CBT) involving exposure and response prevention is the gold standard psychotherapeutic intervention for obsessive-compulsive disorder (OCD). However, applying traditional CBT techniques to treat patients with predominant obsessions (POs) without covert compulsions is fraught with problems because of inaccessibility of mental compulsions. In this context, we examined the efficacy of mindfulness-integrated CBT (MICBT) in patients with POs without prominent overt compulsions. 

Materials and Methods: Twenty-seven patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of OCD were recruited from the specialty OCD clinic and the behavior therapy services of a tertiary care psychiatric hospital over 14 months. Patients had few or no overt compulsions and were free of medication or on a stable medication regimen for at least 2 months prior to baseline assessment. All patients received 12–16 sessions of MICBT on an outpatient basis. An independent rater (psychiatrist) administered the Yale–Brown Obsessive-Compulsive Scale (YBOCS) and the Clinical Global Impression Scale at baseline, mid- and post-treatment, and at 3-month follow-up. 

Results: Of the 27 patients, 18 (67%) achieved remission (55% reduction in the YBOCS severity score) at 3-month follow-up. The average mean percentage reduction of obsessive severity at postintervention and 3-month follow-up was 56 (standard deviation [SD] = 23) and 63 (SD = 21), respectively.

Conclusions: Our study demonstrates that MICBT is efficacious in treating patients with POs without prominent overt compulsions. The results of this open-label study are encouraging and suggest that a larger randomized controlled trial examining the effects of MICBT may now be warranted. 

Keywords: Cognitive behavior therapy, mindfulness-integrated cognitive behavior therapy, mindfulness meditation, obsessions, obsessive-compulsive disorder Kumar A, Sharma MP, Narayanaswamy JC, Kandavel T, Janardhan Reddy Y C. Efficacy of mindfulness-integrated cognitive behavior therapy in patients with predominant obsessions. Indian J Psychiatry [serial online] 2016 [cited 2017 Mar 21];58:366-71.

Available from: http://www.indianjpsychiatry.org/text.asp?2016/58/4/366/196723

The Role of Adherence in the Effects of a Mindfulness Intervention for Competitive Athletes: Changes in Mindfulness, Flow, Pessimism, and Anxiety

Saturday, December 17, 2016

John Scott-Hamilton and Nicola S. Schutte
University of New England

Journal of Clinical Sport Psychology, 2016,10, 99-117 http://dx.doi.org/10.1123/jcsp.2015-0020 
©2016 Human Kinetics, Inc.


This study examined the role of degree of adherence in a mindfulness-based intervention on mindfulness, flow, sport anxiety, and sport-related pessimistic attributions in athletes. Twelve athletes participated in an 8-week mindfulness intervention which incorporated a mindfulness focus on movement training com­ponent. Participants completed baseline and posttest measures of mindfulness, flow, sport anxiety, and sport-related pessimistic attributions, and they filled out daily mindfulness-training logbooks documenting their frequency and duration of mindfulness practice. Participants were identified as either high adherence or low adherence with mindfulness-training based on a composite score of logbook practice records and workshop attendance. Athletes high in adherence, opera­tionalized as following recommended practice of mindfulness exercises, showed significantly greater increases in mindfulness and aspects of flow, and significantly greater decreases in pessimism and anxiety than low adherence athletes. Greater increases in mindfulness from baseline to posttest were associated with greater increases in flow and greater decreases in pessimism. Increases in flow were associated with decreases in somatic anxiety and pessimism.

The full paper may be downloaded here:The Role of Adherence in the Effects of a Mindfulness Intervention for Competitive Athletes: Changes in Mindfulness, Flow, Pessimism, and Anxiety

The Effects of Mindfulness Practice on Child and Parent Anxiety: A Multiple Baseline Case Series

Saturday, November 05, 2016

A report submitted in partial fulfilment of the requirements for the degree of Master of Clinical Psychology at the University of Technology Sydney, October 2016.

Lauren Winney
Principle Supervisor: Alice Shires (1, 2)
Co-Supervisor: Bruno Cayoun (2)

1 Graduate School of Health, University of Technology, Sydney, NSW Australia
2 MiCBT Institute, 277 Macquarie Street, Hobart, TAS, Australia


 Anxiety is a common, normative experience for both children and adults. However, elevated anxiety in childhood is predictive of adult anxiety disorders, which can have a considerable impact at both the individual and societal level. There is substantial evidence that mindfulness interventions can alleviate adult anxiety, however less is known about mindfulness effects with children. Furthermore, many existing mindfulness interventions neglect the family system, despite its central role in children’s development and wellbeing. This study therefore investigated the effects of a parent-child mindfulness meditation program on child anxiety, with additional investigations into parental anxiety. An A-B-A multiple baseline case series design was used to achieve this aim. Three mother-child dyads participated in the study, and all children initially met DSMIV criteria for two or more anxiety disorders. Two of the three dyads completed the 8-week program, which was based on Mindfulness integrated Cognitive Behaviour Therapy (MiCBT). The program provided training in mindfulness of breath and body sensations, and required children to undertake daily mindfulness practice. Results showed that the two retained children no longer met criteria for any anxiety disorder at post-treatment and follow-up. Both children experienced clinically significant and/or reliable reductions in anxiety symptoms and life interference, however only one child achieved improvements in self-reported mindfulness. One mother experienced a reliable reduction in anxiety symptoms, however neither mother demonstrated improvements in self-reported mindfulness. These findings provide some support for mindfulness as a means of alleviating child and maternal anxiety, and have implications for interventions, theory, and future research.

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