Sunday, October 4, 2015

An Introduction to Mindfulness Meditation Cognitive Behaviour Therapy

As I do some rewriting and additions to this piece three and a half years after first writing it in the fall of 2015 and have put more and more distance between my present self and the self that went through the worst of what many consider to be the most difficult to deal with psychiatric disorder (bipolar type I) and, it turns out, Chronic Traumatic Encepholapathy  (from about a dozen concussions earlier in life), along with major anxiety disorder and borderline personality disorder along with being homeless through a Canadian winter, I can look back with some added perspective as to how I not only managed to get through all of that but actually continue to handle my mental outlooks, moods, mental states, cognitive abilities, abilities to handle life's difficulties and so on in a much improved fashion. 

I have to be clear that one does not - at least at my age and for how long my brain has been a "bipolar brain" (and all the rest) - simply "stop" being bipolar. Chronic Traumatic Encepholapathy is an (as yet) incurable degenerative brain disease that doesn't exactly go away on its own either. All the potential forces those can give rise to (and they infamously powerful) are and will always be there, they always must be managed. A bipolar brain (the real ones, not the tragically misdiagnosed ones) and one with CTE is always going to be prone to certain reactions to life's stress and stressful events. It is never going to be easy to manage. There is always going to be potential for being blown way off the rails by life events and stressors outside of one's control. This is true of all long term disorders. 

Reflecting back, there was certainly no one magic bullet or even strategy that made 
the difference in learning to better manage the horrors and intense emotions and reactions my mind could produce so I need to think hard on what exactly made the biggest differences (aside from the basics of my Positive Difference Making Fundamentals). 

In various previous posts, I've talked some about thoughts and the power they have over us and while there is certainly more than just thoughts involved with major psychiatric disorders, there's no denying that how our thoughts are generated, what thoughts we have, and the directions our thoughts will steer our minds and lives is a very significant factor driving mental states and moods. 

Aside from thoughts are our "instinctive" reactions to life events, triggers, others' words and actions towards us and so on but even many of our own reactions arise out of our own thoughts, mental models and ingrained thought processes. (I'm going to have to leave reactions for a future post, and it is when we begin to study our reactions and how and why we react certain ways that understanding just how very autonomous our subconscious 
"zombie programs" are will really come to the fore).

And of course tied to both our reactions and thoughts are 
our emotions

So I'm going to go ahead and declare that it's a pretty safe bet that in rearranging my mind, moods, reactions, impulses and so on to create a more mentally stable, emotionally resilient and healthy me, learning to deal with my thoughts ranks pretty close to the top of the list of how I turned so many things around. 

Now, if someone had told me during the worst of my mental states that it was "just thoughts", I'd have been the first to freak out and scream "this is more than just thoughts!!". And my experience at the time was that it certainly seemed to me much more than "just thoughts". It felt for all the world that I was in the grips of something very, very powerful (and in a very real sense, I was). However, as I learned more and more about the neuroscience of thoughts and the power of thoughts and how thoughts could cascade into 
creating the stress and anxiety and resultant stress response system spikes that were causing my worst melt downs, I had to begin to admit to myself and come to accept that so much of what was driving my mental states was thoughts and their power (and I think I'll need several more key posts to further convince you the readers of the power your thoughts have over you), the question became how to control them. 

Thoughts, as I'm sure many of you who battle mental health disorders are aware, don't just go away because we ask them to. If only it were so simple. Thoughts are all generated by specific brain regions and networks (neuronal groups and the wiring networks that connect them, something I introduced in 
Chapter One - Neuroanatomy 101 and in this post introducing neuroplasticity) and it is part of our disorders that these "brain loops" (as I like to call them) become too dominant and ingrained in our overall brain functioning. 

Changing our thoughts, therefore, means changing brain regions and brain wiring, something that is known not to be easy. I liken it to a professional golfer trying to change his golf swing, even someone as great as Tiger Woods. To learn the new swing they have to also learn to "forget" the old swing for it is the old swing (which they are changing because it is now producing poor results) that will just naturally and automatically come back when they step up to a ball and initiate a swing. And they have to "overwrite" the old swing with a lot of conscious effort and repetition of the new swing. It's difficult because it requires breaking down old wiring networks and building new ones (this is what neuroplasticity is all about, folks). Even for a great athlete with top notch coaching it takes a great amount of work.

And it is exactly the same with thoughts, emotions, reactions and behaviours that could arise from those; like breaking any old habit we no longer want and building new habits, it takes a lot of conscious effort to be aware of what is now undesired, what we want to replace it with, and the efforts to implement and ingrain the new habit. 

The trouble with something like thoughts or emotions is that they have been so much a part of us, and likely so much a dominating part of us, we're hardly aware that they're even there, much less how much power they have over us and the damage they are doing to us. And we're almost certainly not aware that they don't have to be there and dominate our minds and lives so much.

As I've said numerous times previously in this blog, I stopped at nothing and investigated everything in looking at how to recognize and deal with mental health disorders of all kinds. As well, I attended and took part in several kinds of therapy and group therapy (including being introduced to the very excellent 
Core Program (1)) so in several different ways and through several different sources and at different levels, I came to understand Cognitive Behaviour Therapy and mindfulness meditation and somehow, though I no longer precisely recall how, the subject of this post - Mindfulness Meditation Cognitive Behaviour Therapy.

Mindfulness Meditation Cognitive Behaviour Therapy (or mindfulness based cognitive behaviour therapy) has got to be one of the most cumbersome, unwieldy and syllable laden expressions ever devised to describe something that's actually more straight forward than would seem. So before we get too far, we'd better unpack just what exactly all that means. 

I was actually practicing this before I came across the term, read what it was about and realized, "oh, that's what I've been doing" but understanding better what I'd already been doing did help me to improve my practice of it. I'll get to how we're going to approach the practice of <deep breath> mindfulness meditation behaviour therapy in a minute but first let's break it down and remove some of the mystery and what I'm going to assume is a bit of an intimidation factor.

Mindfulness Meditation has its roots - of course - in meditation, a mind training practice that itself originated in Hinduism and Buddhism healing and spiritual practices nearly 2,500 years ago. Mindfulness meditation - to quote:

relies on techniques of mental training that suggest non-judgmental awareness of here-and-now mental or somatosensory* experience positively influences accurateness of perception and acceptance of one's own life experiences. The mindful practitioner thus amalgamates a focused attention component with a non-judgmental attitude of openness and receptivity when trying to pay attention to and non-reactively monitor the content of present-moment experience. 

[* "somatosensory" is a term which in this context distinguishes physical experience from mental experience]

Cognitive behaviour therapy is a form of long standing and often very successful psychotherapy that arose out of combining the principles of cognitive and behaviour therapies. Cognitive refers to our thoughts and mental patterns, and behaviours to our reactions to life around us or the actions we habitually take. CBT is designed to help us work through our thoughts, behaviours/actions, and feelings (emotions) and to understand their relations to each other within us. Its goal is to help us gain more control over all three aspects and to hopefully build more optimal thoughts, behaviours (or actions/reactions) and emotions that are more adaptive to our life situations. It is designed to bring these all into more harmony within us - which, I can assure you, can go a long ways in settling down a great deal of the inner turmoil and conflict we experience and which has such an unsettling effect on our overall mental states and peace of mind.

This illustrates what we were looking at above - how our thoughts, feelings/emotions and behaviours/reactions all tie together. I early on recognized the benefits of CBT, however the trouble was that I in no way could afford a one on one therapist skilled in teaching and applying CBT. Group therapy can be effective but the problem is finding a good group that is affordable and within convenient distance of where one lives. 

For the vast majority of those suffering mental health disorders, finding therapy of any kind, let alone therapy that is personalized and effective is extremely challenging, if not downright impossible. 

Which is the situation I faced - I not only could not find therapists trained and able to deal with my complicated and difficult case (2), in no way could I have afforded it even if I could (though again, I did find some groups at various times which were beneficial in some way or another at the times). 

So what to do?

I very early on in my race to discover ways to manage or overcome mental health disorders starting at the beginning of 2013 began to come across many ties between the study of the brain and meditation, chiefly that meditative practices could change the brain in very important and positive ways. As I started looking more into meditation, I came across the concept of mindfulness meditation. As I was already studying the neuroscience of consciousness and various means of "altering" consciousness, I grasped the fundamentals of mindfulness meditation quite quickly but at the same time I could see and sense this gulf between how "normal" practitioners practiced it and how we peeps with poor mental health could utilize it. This is a beef with me with meditation and yoga; two very useful practices made overly complicated, too advanced and difficult for the majority of people to gain from. 

So setting aside all what you may have read or learned elsewhere about mindfulness meditation, I'm just going to get to how I combined mindfulness meditation and CBT and further, how I learned to do them on my own without too much complication and difficulty.

To better understand how I approach mindfulness I'm going to ask that we have another brief look at consciousness. Regular readers will recall that we looked at consciousness in the previous posts An Introduction to Meditation and On Consciousness, Thoughts and Meditation. In those posts I likened consciousness to our computer screens and speakers and just as those peripherals display only a small portion of what your computer is capable of (through its own programs, memory stored and what it can bring in through the Internet) for you to work on at any one time, consciousness is like a "screen" or "working plate" created by our brains at any one time out of all of what our brains are capable of producing through our senses, our brains' programming and the vast amounts of memory stored there. 

It is also necessary to recall that our brains often, or maybe always, don't give us much choice of what is put up on our "awareness plates" or consciousness. It is also necessary to recall that our brains keep vast amounts of inner activities outside our conscious awareness (and thus we're not aware of what's causing so many of our behaviours that are driving us batty and which we'd like to change). 

So we're going to learn how to better manage our "conscious plates" or "conscious computer screens and speakers" and we're going to do that with mindfulness meditation, or at least my version of it. And with mindfulness meditation, we're going to tie it in to CBT and thus learn how to better manage our thoughts, behaviours, and feelings/emotions. 

I must tell you up front that this is no small task. I said above that I learned how to do it without too much complication and difficulty but by that I mean the actual practice of it needn't be complicated or difficult. This does not mean, however, that the mental work we must do is easy. We need to be aware of that and understand that it's not going to be easy because if we do that, we are less likely to become discouraged when we find that it can be tough. We are far better able to cope with difficulty (generally) if we know up front what to expect and how to deal with it (and we'll be learning techniques and the belief that we can deal with it). 

Now, without further ado, here we go. 

In the four years since first writing this I have done a great deal more study into consciousness of the human mind and subjective conscious experience (a good deal under the direct tutelage of renowned consciousness authority Bernard Baars), I have come to think of mindfulness meditative CBT differently, especially the "cognitive behaviour therapy" part. I think of it more now as "consciousness behaviour therapy" as it is our conscious experience that we must change and work on. 

As for what we have to do, I use it as a time set aside to specifically examine my thoughts, feelings and ongoing events in my life. I also think of it as a way to let my mind to slowly wake up in the morning in ways that I am paying close attention to. 

Mindfulness CBT takes a certain amount of bravery when you have the sort of thoughts that come with psychiatric disorders like bipolar and suicidal depression so let's keep that in mind as well. And with that in mind, lets just go ahead and give ourselves permission to be brave, to believe that we can do this, even if for only a short period of time each day. And like other forms of meditation, it is quite alright to do it only for short periods of time to begin with. I certainly started out with short periods but after I began to make some noticeable headway, I found I could stretch out the time I did mindfulness CBT longer and longer. 

I'm a morning person so in the beginning I tended to do mine first thing in the morning when everything was quiet and we do want quiet, undisturbed time to do this (and I realize what a challenge this is for many, especially for the parents out there among you). Since then (early 2014, about five years ago at the time of this rewrite) it's become a more natural thought process and I can apply it almost anywhere at any time. For you to start though, let's assume though that we can find some quiet time. 

Now, here's what we're going to do - and this is the scary part - we're going to allow all and any thoughts to come into our consciousness. But - and just for this period of mindfulness CBT - we're not going to judge them, we're not going to try push any aside; we're going to allow them to come in. But because we put ourselves in a brave state of mind and we're in a safe quiet place, this is going to be okay, if only for a short period of time. 

If you're like I was (and can still sometimes be), you're going to have an enormous number of possibly very disturbing thoughts vying for attention. But we're not going to pay attention to any particular thoughts just yet. And we're going to think of our mind like our computer screen metaphor and our thoughts as things that are popping up on that screen. 

As we saw above, the point of CBT is to learn how to examine and deal with our thoughts, behaviours and feelings (along with core beliefs and values), but today we're going to look at and just focus on thoughts, though we're also going to start examining the emotions that can come with our thoughts. Our minds can produce a lot of thoughts, in our cases often of the nuclear grade negative variety, so obviously dealing with our thoughts is an overwhelming and frightening sounding proposition. But again, we're going to give ourselves permission to be brave about this. And we're going to start to learn the concept that whatever our thoughts are, they are just thoughts. This will be very hard for many of you (and it certainly was for me) but again, for just this brief period of mindfulness CBT, that's how we're going to think of them. 

Now - and here's the important part - we cannot deal with all our thoughts at once; this is a big part of what drives us crazy, after all. So what we're going to do is to now begin to pay more mindful attention to our thoughts. We're going to lie here quietly and just sort of see what thoughts are going on.

They'll be swirling around, each trying to push the other aside. Or as one reader referred to it in a comment at the end of the post 
talking about bipolar and empathy (and empathy in general), the "blender in my head".  Through this tornado of thoughts, some are going to start to be more dominant. So what we're going to do is pay attention to the dominant ones and we're going to choose just one or two. 

Now, if I can get you to imagine your mind as being like that computer screen metaphor of ours, this is what we're going to do. You're going to imagine that our thoughts are like the tabs and various programs on your computer screen and that you have a mouse in your hand. Now, with that mouse, you're going to start "clicking" the "X" on the "tabs and programs" of thoughts to "close" the thoughts and feelings we don't want to look at just now.

So we've chosen a thought or two we want to examine more closely and all the others we're going to "close" in our mind, just like closing tabs, browsers, photo images or whatever else we might have open on our computer screen at any one time so that we can focus on just a few things without other distractions or bogging down the computer speed. 

This will not be easy at first. Like pop-up ads, many of these unwanted thoughts and images are going to pop up again again and again as soon as we close them. But for this period of Mindfulness CBT we're going to be persistent, just stick with it and mentally just  keep "clicking" on them and visualize them disappearing from your inner screen. 

I'll ask you to just imagine that for a few moments - clicking on unwanted pop-ups and tabs and so on and closing them. Now imagine doing that with thoughts in your mind and having the same power to close them.

Now, let's focus on the few thoughts we've chosen (and here's where general meditative practice begins to pay off - when we chose to focus on one or a few things and disregard others, those others will begin to naturally fade into the background). These thoughts we chose could be about anything - anything. They might be how we think of ourselves, our bodies, our situations. They might be about our jobs and money. They might be about our future. They are undoubtedly scary and worrisome. But, for this time at least, we're not going to feel afraid of them. 

I'll also ask at this time to please bear in mind that this takes practice and the first attempts will probably not go well. And that is perfectly one hundred percent okay and normal and I'll ask as well that you give yourself permission to forgive yourself if you don't nail it on your first try. 

Okay, so now we have a thought or two to examine and we're going to start questioning the ones we've chosen. There's quite a process for this, and I'm going to have to write a separate column for how this works, but I want for now to start with this idea and process of questioning our thoughts. I want to start with the idea and process of questioning whether these thoughts really have to be there at all, I want to start with the idea and process of questioning the very truth of these thoughts and ideas that are plaguing our minds and lives. 

As an example, let's start with a very common one - that we're ugly, we're bad people and nobody wants to be around us and that everyone hates us. For this time, during our mindfulness CBT session, we're going to challenge the truth of these thoughts. 

This will be very, very hard for many of you. For these thoughts have been so much a part of our inner landscape that they have become an "undeniable truth". Furthermore - and this is a "buggy" way the human brain works - when we get a "truth" like this in our minds, our brains will actively search for "evidence" to support these "truths". But for now we're going to question that. 

And to do this, I want you to actually question them. Try it! Just ask yourself, "Hhmmm, is that really true?" And of course your mind will immediately leap to provide all kinds of "evidence" that of course it's true. But we're going to be very stubborn here. We're going to keep pushing back on these thoughts and "evidence". Let's start with something easy like "nobody likes us". Really?? Nobody?? Nobody?? Not a single solitary person on the whole planet likes us? Seven billion people on the planet and not a single one likes us? Really?? 

Now, if we start questioning this and asking if this is really true, we may well find that it's not. If we start thinking through it, we may find that it's not as true as we thought. Now it may be true that we may not exactly be popular, but we'll find that it's not exactly true that "nobody" likes us. 

So we'll just go ahead and focus for a few moments on thinking of people who like us, or who don't mind us too much or even, to start with, who don't "hate" us. It might only be one. It might be five. It could be any number. What we want is to see evidence that counters our "belief" that "nobody" likes us. 

Now, as we examine the truths of our thoughts, it's also important to learn acceptance of some of our more unpleasant thoughts and truths behind them and - AND - to take ownership for them. Very, very, very important. For when we learn to take ownership of something, we give ourselves the power to do something about it. And if we have that power, we can change it. 

So now that we have identified a thought we don't like, and furthermore the basis for that thought and what's true and not true about the basis for it, let's try to think of some simple daily courses of action for what we can do about it. If we are troubled by feeling, or perceiving, that we are not popular, what are some daily actions we can do to change that? (I'll let you think on this for yourself, as exploring this will quickly stretch the boundaries of this post too far). Just remember the formula above in that thoughts and supporting behaviours must be in alignment so we must create better behaviours that will support our better thoughts and better thoughts to create our better behaviours. 

We can also use this time as an opportunity to start working on black or white thinking and the belief that everything has to be painted in stark either/or colours such as someone either "likes" us or "hates" us. We can start to think that maybe there are all kinds of shades or that there are different aspects to how people feel about us. Maybe they like us in this way but not so much in that way. 

We can start to question the black and white thinking about our very selves. Are we really "bad" people or maybe we're just bad sometimes? Maybe we're not "bad" but just do bad things sometimes.We can start to separate "us" from our behaviour (a classic therapy technique).

And so it will go as we look through and examine our thoughts and feelings about and reactions to our mental states and experiences of the world around us. 

We're not going to turn around our thoughts, feelings about any one aspect of ourselves or our reactions to the world around us in one session but we're going to start chipping away these long held "truths" about ourselves, these thoughts and ideas about ourselves that we are just convinced are "self-evident". As well, we're going to start learning more about 
common cognitive distortions and working through those.

And more importantly, we're going to start establishing the habit of creating the time and mental space to work on mindfulness meditation CBT. Way back when I wrote out my positive difference making fundamentals, I wrote that I worked on creating better habits. This is one of those. This was perhaps the most important new habit I created. 

For as I've written before, if we don't learn to work on our thoughts, to change our thoughts, we will be their bitch; they will mess us up.

So, before I go, a brief recap of what makes up mindfulness meditation CBT:

Mindfulness: This simply means paying mindful attention to what we are doing and in the case here, paying mindful attention to our thoughts.

Meditation: This is a tool we use to channel our focus on to specific things. Practicing simple meditative techniques like those in 
an introduction to meditation. We use it in practicing mindfulness in the sense of to what we are mindfully paying attention. 

Cognitive Behaviour Therapy: These are methods and tools for changing our thoughts and behaviours. It is generally done with a therapist working with you - and this is great if you can find one who's good (not a given) - but we're going to start learning how to do it on our own. 

Method: set aside periods of time each day that are quiet and you will not be disturbed to allow yourself to mindfully examine the thoughts and beliefs that are predominant at any one time. Learn to question the truth and validity of these thoughts and beliefs. Learn to reframe them. This time of mindfulness CBT can be just a few minutes to start, up to half an hour, an hour or more. 

Lastly, I want to remind that this is not easy work. But then again, nothing worthwhile doing is going to be easy. Now pay attention to that word "worthwhile". Many of us will have issues with this idea of "worth" and being "worthwhile", for one of our dominating thoughts and ideas are probably that we're not "worth it". 

It is now been five years since I created this program for myself and started regularly practicing it. In that time it has become an ingrained natural habit, a default mechanism that kicks in after I go through a difficult life or mental (and often both at once, of course). It is this process that is always the core to bringing myself around and moving forward as positively as possible. And this is the ultimate goal with a practice like this - make it a daily habit that comes to you naturally. Further mastery comes from more consciously deliberate sessions of examining our core values, beliefs and goals and making sure our thoughts, behaviours and emotions are in alignment with those. 

So here's a little bit of homework for you today. Practice believing that you are worth the work. Yes. You are worth it. Yes. You. Are. 

(1) While I'd come to see the Core Program as an excellent resource, unfortunately the facilitator I had leading the 8 week therapy program was very poor and I gained little from it at the time. That said, many of the things I'd learned I'd later see I'd begun to subconsciously use, so I think being exposed to it despite the poor facilitator made a difference in the long run.

(2) At one point from the fall of 2012 into the spring of 2013 I was extremely fortunate to work for free with a therapist who specialized in suicidal danger through the University of British Columbia's psychology program (the sessions and the relationship with that therapist in training ended, however, with the end of that school term). Though I'd been told I was welcome to register for free therapy again the following fall, when I tried to do so I was told that because my case was so difficult they did not feel comfortable having me see any of their therapists.


  1. Some very well thought out ideas. As a meditator of 40+ years I really like what you said about questioning our thoughts of negative self-worth like I am ugly. I would just add I think questioning all thoughts is important. Thoughts are just thoughts not reality.

  2. This is one of the most valuable, important pieces you have ever written.
    I am here to testify as your 'student' that if you put in the work, the results are more than worthwile. And I thank you, for your work, for being here.

  3. Nice to read your article! I am looking forward to sharing your adventures and experiences.
    unwind your mind