Mindfulness and

other 3rd wave CBT

approaches
20th October, 2015
Dr. Pamela Jacobsen, Clinical Psychologist
NIHR Clinical Research Fellow

Session Plan
1)Mini mindfulness session
2) Theoretical background
3) Clinical applications

1) Mini mindfulness session

Ground rules
Confidentiality (safe space, keeping things within the group)
Respect (for yourself and each other, everyones experience will be
different)
Talking (please talk if you wish to but not if you dont, only one person
speak at a time)
Taking care of yourself (move around if needed, keeping warm,
comfort break)
Leaving
Mobile phones (off during session if urgent please leave room to
answer call)
Stay within your own experience and allow others to do the same

2) Theoretical background

3rd wave CBT approaches

Mindfulness (Jon Kabat-Zinn)
Acceptance and commitment therapy (ACT; Steve Hayes)
Compassion focused therapy (CFT; Paul Gilbert)
Dialectical behaviour therapy (DBT; Marsha Linehan)
Metacognitive Therapy (MCT; Adrian Wells)
.to name but a few!

3rd wave CBT approaches commonalities

Trying to change how we think, not what we think
Relationship to experience, not content of experience
Recognising that attempts to control the form or frequency
of experiences (e.g. thoughts, emotions) might be part of
the problem not the solution
Re-focusing on goals and values

You have an interview for a job you

really want

3) Clinical applications

Applications of Mindfulness
Mindfulness-based Stress Reduction (MBSR)
- chronic pain, physical health problems

Mindfulness-based Cognitive Therapy (MBCT)

- recurrent depression

Mindfulness for psychosis

- distressing psychotic symptoms

MBSR for physical health difficulties

Pioneered by Jon Kabat Zinn - founded Stress Reduction Clinic at
the University of Massachusetts Medical School
http://www.umassmed.edu/cfm/about-us/
Structured 8 week program
Key components: psychoeducation, formal meditation practice
(body, breath, movement), teacher-led enquiry and discussion,
daily homework practice and exercises
Participants learn to recognize habitual, unhelpful reactions to
difficulty
Learn instead to bring an interested, accepting and nonjudgmental attitude to all experience, including difficult
sensations, emotions, thoughts and behaviour

MBCT for recurrent depression

MBCT for recurrent depression

(Segal, Williams &

Teasdale, 2002)

Adapted from original 8-week MBSR programme with added components from
cognitive therapy
Designed for people with a history of depression to undertake when in remission,
in order to prevent relapse
Based on findings that depressive relapse is associated with reinstatement of
automatic models of thinking, feeling and behaving
Intended to teach people to become more aware of the bodily sensations,
thoughts and feelings associated with depressive relapse
Recognise automatic pilot mode and learn skills into stepping out of this mode
Decentred awareness (e.g. thoughts are not facts), acceptance of difficulties with
self-compassion, grounding in the current moment to open up more choices of
how to respond skilfully
Developing an action plan that sets out strategies for responding when they
become aware of early warning signs of relapse/recurrence

MBCT for recurrent depression

Strong evidence base recommended in NICE guidelines
for depression, for people with >3 previous episodes
Reduces risk of relapse/recurrence of depression compared
to treatment as usual (Piet & Hougaard, 2011)
As good as maintenance anti-depressants in reducing risk
of relapse - but no evidence of superiority (Kuyken et al, 2015)
MBCT provided significant protection against relapse for
participants with increased vulnerability due to history of
childhood trauma, compared to an active therapy control
group (Williams et al, 2014)

Distressing experiences in
psychosis

Applying Mindfulness in Psychosis

Relatively recent application of mindfulness pioneered by Paul
Chadwick & colleagues (2005, 2009)
compatible with the theoretical basis of CBT for psychosis
patients distress does not arise directly from the psychotic symptoms
themselves, but rather from the patients threatening interpretations and
maladaptive reactions to their symptoms

Patients who are distressed by their psychotic symptoms often

either:
engage in experiential avoidance strategies
get lost in the struggle of rumination and confrontation of symptoms.

Mindfulness offers a third way: an alternative way of relating to

symptoms

Rationale for applying mindfulness in

psychosis

Chadwick et al., 2005

AVOIDANCE
Trying to run away/block out
experiences

STRUGGLE
Getting caught up in fighting
against experiences

VS.

ALTERNATIVE

MINDFULNESS
Non-judgemental acceptance of
moment by moment experience

Mindfulness

(Newman-Taylor & Abba in Gaudiano, (Ed). 2015)

Taught as a skill
Stepping out of automatic pilot
Noticing habitual patterns of relating to
internal experiences
Responding with acceptance &
compassion as alternatives to
rumination & avoidance

Adaptations to Mindfulness when working

with psychosis (Chadwick, 2006)

Meditation practices limited to 10

minutes
Prolonged silences are avoided,
frequent anchors provided
Use concrete, everyday language in
guidance
Give prior permission for the person
to stop the practice at any time if
needed

Mindfulness groups for psychosis

Morris, Johns & Hodkinson, 2011

Jacobsen,

Compassion for voices A tale of courage and hope

Produced by: Dr. Charlie Heriot-Maitland

Animation by: Kate Anderson

Thats all folks thanks for your

participation!
Contact:
Pamela.Jacobsen@kcl.ac.uk

@pamelacjacobsen