Transcript OC_Lecturenotes_Pschology_Compassion_Mindfulness

Psychology and Religion in the
Search for Personal Wholeness
Johann Maree
SummerSchool, UCT, Jan. 2012
What is Cognitive Behaviour
Therapy (CBT)?
 Formal definition: CBT is a form of psychotherapy
based on cognitive therapy and behaviour
modification, in which the client or patient learns to
replace dysfunctional self-speech (such as “I knew I’d
never be able to cope with this job”) with adaptive
alternatives(“The job’s not going well, but I am capable
of working out a plan to overcome the problems”).
Cognitive Therapy (CT) and
Behaviour Modification (BM)
 CT is ‘a form of psychotherapy aimed at modifying
people’s beliefs, expectancies, assumptions, and styles of
thinking, based on the assumption that psychological
problems often stem from erroneous patterns of
thinking and distorted perceptions of reality…’
 BM is a collection of psychotherapeutic techniques aimed
at altering maladaptive behaviour patterns, the basic
assumptions being that most forms of mental disorder can
be interpreted as maladaptive patterns of behaviour,
and that treatment involves the unlearning of these
behaviour patterns and the learning of new ones.
The Origins of CBT
 The emergence of CBT is ascribed to the American
psychiatrist Aaron T Beck (b.1921). He developed it while
treating people for depression.
 Beck used to adopt a psychoanalytic approach towards the
treatment of depression. He assumed the validity of its
theoretical proposition that depression was due to a
retroflected hostility, expressed as “a need to suffer”.
However, during the second half of the 1950s he came to
realise through empirical observation and study of his
depressed patients that the theory was wrong. The
treatment based on its assumptions did not work and the
patients themselves expressed their problems differently.
Aaron Beck’s agonizing reappraisal
 This ‘marked discrepancy between laboratory findings and
clinical theory’ led Beck to an “agonizing reappraisal” of his
‘own belief system’. He came to the conclusion that
depressed people had ‘a global negative view’ of
themselves.
 Consequently, Beck and his colleagues devised an
interactive treatment with their patients in which the
patients were set ‘homework’ which consisted of observing
their automatic negative mental reactions and
replacing them with positive responses structured as
incremental steps that could be taken to deal with the
observed challenges. This approach worked well and
directly ameliorated the depression symptoms.
Increasing use of CBT
 Since its development in the 1960s CBT has grown
almost exponentially in its clinical applications.
 It has proved its effectiveness with a range of
personality disorders:
 Anxiety including panic disorder
 Obsessive compulsive disorder
 Eating disorder
 Bipolar disorder, and
 Couples and family problems.
Compassion and Mindfulness
 Two exciting developments in CBT over the past twelve
years have been the introduction of compassion and
mindfulness as two key practices.
 They have the added advantage that they are available
through self-help techniques.
 There is evidence that training ourselves in
compassion and kindness, with regular practice, can
actually change our brains.
 We shall explore how this is done.
Compassion
 Paul Gilbert, Professor of Clinical Psychology at the
University of Derby, describes compassion as follows:
 ‘Compassion (which is an element of loving-kindness)
involves being open to the suffering of self and others,
in a non-defensive and non-judgemental way.’
 The focus of Western psychology on compassion is
due to the influence of Eastern psychology and
Buddhism which sees life as ‘full of threats and
suffering (or dukkha)’ and that ‘all sentient beings seek
to be free of suffering’.
Inner Compassion
 For people suffering from depression Gilbert stresses
the importance of developing inner compassion. He
explains how this is achieved.
 Firstly, a core belief is something that one thinks is
basic to oneself, such as: “At heart I feel that I am
useless” .
 When core beliefs are activated they come with
powerful feelings and emotions.
 Depressed people have very negative core ideas about
themselves, their ability to gain support, affection and
approval of others.
Self-Bullying
 Depressed people, but also others, can bully
themselves in many different ways. For instance
 Self-blame: “It is all my fault” when it wasn’t
necessarily even due to any of the depressed person’s
actions, or only partly due.
 Placing too high an expectation or demand upon
oneself: “I ought to be able to come top of the class, to
have achieved this, etc, etc. ”
 Calling ourselves names / Negative labels: “I am a fake,
inferior, inadequate, worthless, etc, etc.”
The Compassionate Mind
 Depressed people have to learn to develop a
compassionate mind.
 A compassionate mind
– has empathy and sympathy for those who are in
pain and hurting;
- is concerned with supporting, healing and listening
to what we and others need;
-recognizes that life can be painful and that we are all
imperfect beings.
How to develop a compassionate
mind
Core idea: negative
Alternative thought
 I can’t cope with the needs of
 I am feeling exhausted right
my family.
 I just want to run away from
it all.
 I am useless and a failure.
now which is understandable
given the demands on me.
 I need to create more space
for myself, take some time
out for myself if I can, and
ask my family to help out
more.
 It is understandable that I am
disappointed in myself.
Mindfulness
 Mindfulness normally means taking thought or care, being
heedful, keeping others’ circumstances in mind.
 But in CBT the emphasis is laid on awareness, on paying
attention. It involves ‘learning to pay and hold attention in
the present moment with a specific focus.’ Gilbert explains:
 ‘Many of the great teachers of meditation point out that we
only exist in this moment – we are a “point of
consciousness” passing through time. Our consciousness
does not exist in the moment just gone nor in the moment
yet to arrive – we only exist now. Mindfulness is learning
how to bring us to be fully alive to the now of our conscious
existence, the only place we actually exist.’
Becoming familiar with how our
minds work
 Gilbert links mindfulness with meditation which
actually means becoming familiar. For us becoming
more mindful is to become familiar with the contents
of our minds and how our minds work.
 The end result is to be able to direct and retain our
attention on something here and now. Then ‘our
conscious attention can be thought of as a spotlight
that moves around. It is learning how to direct that
spotlight, via our attention, which is key to
mindfulness.’
Value of mindfulness
 Our minds give us a range of thoughts, feelings and
moods. Mindfulness can help us become aware of
them without forcing them away, or being frightened
of them. We learn to stand back and observe.
 In mindfulness we are not trying to change thoughts,
but change our relationship to our thoughts and
feelings.
 We can deliberately use mindfulness to practice
stimulating emotion system that will give rise to brain
patterns that create good feelings. Appreciation is one
way of practising to do this, says Gilbert.
Evaluation of CBT
 Appreciative:
 CBT provides us with self-help techniques on how to
love ourselves and, by extension, others, especially
those who are suffering.
 It also provides us with a way of being more aware of,
and in touch with ourselves, our feelings and our
bodies.
 Critical:
 CBT does not stress enough how difficult it is to
achieve mindfulness by focusing our minds.