By Daniel Jordan, published in Jack Hirose & Associates Summer Newsletter.
If you're reading this article chances are you've been to one or two Jack Hirose workshops. Over the years, Jack has brought in some of the big names in both Cognitive Behavioural Therapy (e.g. David Burns and Donald Meichenbaum) and mindfulness (e.g. Zindel Segal and Ronald D. Siegel). So I have to admit I thought the Bruno Cayoun workshop was going to be more of a review than new information. After all, I had heard many presenters on Cognitive Behaviour Therapy (CBT) and mindfulness before.
But the Bruno Cayoun presentation was anything but a review and proved, once again, that when it comes to workshops it’s all too easy to fall victim to, as the old saying goes, "judging a book by its cover."
The Overlap between Mindfulness and CBT
Psychotherapists who consider learning theory “old school” may be surprised that it dovetails quite nicely with mindfulness:
a) Extinction and Reinforcement
An important contributing factor to Dr. Cayoun’s integrated model is his recognition of the complementary nature of mindfulness and CBT. For example, by being able to sit still and allowing thoughts and body sensations to pass, developing mindfulness allows us to “witness the law of impermanence within.” 1 This law of impermanence is also reflected in the phenomenon of “extinction” where the practice of CBT helps clients reduce the frequency of a learned behaviour. Furthermore, mindfulness includes an awareness of the human tendency to grasp and “cling” to thoughts. CBT recognizes the power of attachments as demonstrated by the principle of “reinforcement.” These twin CBT principles of extinction and reinforcement have been part of Eastern conceptualizations of behaviour for over 2,500 years.
(1) Source: Cayoun, Bruno (2011-07-15). Mindfulness-integrated CBT: Principles and Practice (p. 14). John Wiley and Sons. Kindle Edition.
Equanimity is a goal of both mindfulness meditation and CBT and is defined loosely as balance and self-control. Dr. Cayoun defines equanimity as “a state of experiential acceptance that relies on awareness of thoughts and somatic sensations.” 2 Dr. Cayoun also suggests that developing equanimity also requires a greater objectivity about the event being experienced. This state of objectivity is endorsed by both CBT researchers and mindfulness teachers.
c) Interoceptive Awareness and Acceptance
One important application of equanimity is through interoception, or the ability to perceive body sensations, which was also reported by Russian behaviour scientists some 50 years ago and described in terms of “interoceptive conditioning”. 2 This interoceptive awareness and acceptance is also a core feature of mindfulness meditation as taught in the Burmese Vipassana tradition for over 2200 years. Feeling body sensations while preventing a learned response constitutes an exposure procedure.
(2) Source: Cayoun, Bruno (2011-07-15). Mindfulness-integrated CBT: Principles and Practice (p. 17). John Wiley and Sons. Kindle Edition.
How Bruno Cayoun’s MiCBT Treatment is Different
a) The Ability to Treat Multiple Disorders
While there are many mindfulness-based therapies out there, Dr. Cayoun’s Mindfulness-integrated CBT model (MiCBT) is different in that it integrates mindfulness meditation and traditional CBT to address multiple disorders, not just anxiety or depression. How is this accomplished? The answer, according to Dr. Cayoun, is detachment. As described in the equanimity section above, MiCBT trains clients to remain objective and nonjudgmental about transient thoughts and body sensations. Developing detachment can help clients “let go” of unhelpful reactions that contribute to maintaining a whole host of disorders including generalised anxiety, depression, panic, PTSD, impulse control disorder, chronic pain, etc.
b) A Focus on the Breath and Body
Bruno Cayoun’s teaching of mindfulness is different than others that focus principally on the breath. According to Dr. Cayoun, while mindful breathing is effective in redirecting attention away from distressing thoughts, it does not work as well for distressing emotions. According to Dr Cayoun, thoughts that are important to us “co-emerge” with body sensations, such as chest constriction or butterflies in the stomach, to which we then react to feel relieved. We do not react to thoughts directly. For instance, people who dissociate when they are very anxious tend to be less emotionally reactive because they are less able to feel body sensations, even though they can ve well aware of their unhelpful thoughts.
Moreover, the early onset of emotions, when things are still manageable, is, according to Dr. Cayoun, not accessible by conscious awareness (emotion are “automatic” and co-emerge with thoughts). Instead, Dr. Cayoun recommends that mindfulness also focuses on body sensations in a process known as “body scanning”, which helps minimize emotional reactivity during crises. Although there are other mindfulness-based methods that include body scanning (e.g., MBSR), the Burmese Vipassana tradition used in MiCBT specifically acts as exposure and response prevention method—rather than deep relaxation. According to Dr. Cayoun, focusing on the body is a natural place to focus because body sensations are the building block of emotions. Indeed, how do we know that we feel anger, fear or sadness? Through body sensations that co-emerge with thoughts.
In other words, MiCBT helps clients sustain attention on important daily events and activities and prevent the reinforcement of unhelpful thoughts by neutralising their co-emerging body sensations. MiCBT also helps clients notice and prevent reactive emotions by perceiving body sensations and preventing unhelpful learned responses. By perceiving thoughts and body sensations as impermanent and impersonal phenomena, MiCBT helps clients learn to distinguish their internal experiences from their sense of self.
After grappling with the content of the MiCBT approach during the 2-day workshop and reading the training manual, I have come to appreciate that mindfulness-integrated CBT is a therapy quite different from either mindfulness or CBT considered separately. As it is said, “the whole is greater than the sum of its parts”. Now that I have gotten past my assumptions about MiCBT, I can see the benefit for therapists and treatment centres that are looking to maximize their time spent with clients.
Recommended Reading & Viewing
Bruno Cayoun’s website … MiCBT Institute
Bruno Cayoun’s book … Mindfulness-integrated CBT: Principles and Practice
Here are post-therapy video interviews of real clients in therapy with Dr Cayoun.
Here’s a 20 minute YouTube video featuring Dr. Cayoun
About Bruno Cayoun
Bruno Cayoun is Director of the Mindfulness-integrated Cognitive Behavioural Therapy (MiCBT) Institute, which trains, accredits, and supports MiCBT practitioners. He is also a Clinical Psychologist in private practice and Research Associate at the School of Psychology, University of Tasmania. He is the principal developer of the MiCBT model, which integrates mindfulness skills training with well-established principles of traditional Cognitive Behavior Therapy.
About the Author
Daniel Jordan is a frequent exhibitor at Jack Hirose & Associates workshops and Director of Strategic Development at Sunshine Coast Health Center, a private residential addiction treatment facility located in Powell River, BC.