Cognitive behavioral therapy and mindfulness

I recently finished writing in a ruled 8 1/2 X 11 pad of paper that I’ve used for various purposes, turning over a page to start writing on a fresh page without discarding what I’d written before. I was about to throw the pad away, or rather, recycle it, when I decided to look at the first pages and see what was there.

Which was… 3 2/3 pages of scribbled notes that I’d taken titled “CBT & Mindfulness — Waking Up.” That made me recall listening to a series on the Waking Up app that featured a subject that interested me. I frequently fall prey to negative thinking, one of the problems Cognitive Behavioral Therapy deals with, and I’m also a fan of mindfulness.

The 23-session series by Seth Gillihan is still on Sam Harris’s Waking Up app. It’s called Mindful CBT. It looks like I listened to about half of the 23 sessions, which last around 6-10 minutes each. The summary of the series says:

In Mindful CBT, author and clinical psychologist Seth Gillihan explains how cognitive behavioral therapy and mindfulness — which “could be seen as opposing philosophies”– together form a “whole-person way” of promoting “major improvements in our well-being.”

Through real-world examples, along with hypothetical cases, Seth details the specific ways this “third wave” of CBT integrates research-validated therapies with centuries-old traditions. This hybrid model, he says, enables us not only to “trigger positive changes” but also, ultimately, to “relieve suffering and find peace.”

Not wanting to waste the notes I’d taken, here’s my attempt to decipher my handwriting — which is difficult to read at best, and more difficult to read when I’m writing quickly, as I had to do while listening to the Mindful CBT series. Hopefully this will make sense to whoever reads it. That includes me, as it could have been several years since I jotted down what follows.

CBT — change thinking and actions. Mindfulness — not thoughts and behaviors but our relationship to them. What we think, do, mindful presence.

Fundamentals of CBT: Thoughts, feelings, actions – traditionally. These interact with each other. Can change any one and affect others. Integrate mindfulness: depth introduced to each. Three dimensional. Quality changes based on quality of attention. How do we relate to our thoughts, feelings, and actions? Instead of pushing away anxious thoughts, give them less weight. Shift from “should” to mindful acceptance.

Finding leverage: Use right tools. Advice alone not very helpful. Match intention with right tools. Willpower alone is recipe for failure. Fear of spiders — start small and work up. Like a ladder — series of small steps. Not why did I fail, but what can I do to succeed.

Working with thoughts: Thoughts can cause anxiety and affect actions. But thoughts often misguided in some way. (1) What’s the story my mind is telling me? Not objective facts often, but subjective. Write down thoughts. (2) Examine evidence, like a scientist. Evidence for and against a thought. What’s true in the situation? (3) Is there a more realistic way of thinking that fits the data better? Cognitive distractions: (A) Fortune telling — prediction about future; (B) Catastrophizing — seeing things in worst possible light; (C) Mind reading — of another person. We think we know what someone else is thinking.

Addressing core beliefs: You become more aware of negative thoughts. Core beliefs drive thoughts. Regular pattern/lens that guide how we see the world. Example: seeing disapproval everywhere. But “That was great, Ryan.” Can’t stop thinking how bad it went. His thoughts warped the facts. He expected to fail. Better — review evidence from Ryan’s life.

Thoughts can feed back into a core belief and strengthen it. Circular, but completely convincing. What is actually happening right now? Minds invent stories. Be in situation as it is. Brush off unhelpful thoughts. Not “oh no.” But “oh well.” Just a mental event. Ryan’s core belief: wellbeing depends on things working out for him. Don’t assume how life has to go. Life doesn’t have to meet our expectations.

Thoughts support mindful presence: Mindfulness supports thinking, and thinking supports mindfulness. Thinking is just what the mind does. Don’t have to take thoughts too seriously. They can play a positive role in our lives. Meditation: being present with what is. Noticing what’s already there.

Working with behavior: Pavlov’s dogs. Animals learn certain things go together. Ring bell, food. Dogs salivate just with bell. Conditioned to expect food while watching TV. Classical conditioning. Baby crying when at doctor’s office. Also learn by consequences of actions. Operant conditioning. Learn patterns in world, and outcomes of our behavior.

Classical and operant go together. Cat going to kitchen after hearing can opener. Short-term vs. long-term effects. Make it easier to do what you intend to do. Make exercise rewarding, right-sized, start easy. Binding yourself to the mast. Put things in place to guide actions when motivation deserts/leaves.

Mindful action: Mindfulness determines quality of actions. With more awareness, you experience a walk. But can take on moral quality — bad if not mindful. Sometimes helpful to be on auto-pilot. Like while driving. But costs when in divided attention mode much of the time. Richer memories if more present. Act in ways that align with reality. Mindful action doesn’t try to force an outcome. Stop struggling against what is. Notice when your actions are at odds with reality.

Working with distress: Mindful CBT. Three ways to feel better. Shift thinking. Act differently. Practice mindfulness. Sometimes tools don’t work. How to make peace with discomfort. If cold: respond with openness and curiosity. It felt interesting, not bad. Mindful acceptance: could tolerate ice water bucket longer. Stop fighting against reality. Change life to match your limitations. I cursed my insomnia. Now just experience of being awake rather than asleep.

“I can’t stand all the future pain that I’m anticipating.” Focus on what’s happening right now. Be present with uncomfortable feelings. Stand for issue you care about even if it upsets some people. Well-being doesn’t depend on eliminating stress. Can I open to this?

Making peace with anxiety: Feelings — anxious, agitated. Thoughts — I’m going to fail. Action — avoid anxious task. Where is your attention focused? Mostly on future — bad things that might happen later. So how address? Come into present. Real you is right here, right now. Body, breath, surroundings. Get curious about your experience.

Now anxiety doesn’t seem like fixed entity. Pattern of mental events. Then, identify anxious thoughts and predictions. Am I certain about this? Trying to be more in touch with reality. Open to not-knowing. Would I be OK if this doesn’t go well? What is the thing you need to do in the present moment? Get started. Starting makes it easier to get going.

I enjoyed reviewing my notes. There’s a lot of good ideas in what Seth Gillihan said. Maybe I’ll finish listening to the sessions and then share notes from the second half of Mindful CBT.