Merging Mindfulness Based Cognitive Therapy and ExistentialTherapy To Treat Anxiety and Depression

Tree of Half Life Mindfulness Based Cognitive Therapy  (MBCT) functions on the theory that when individuals  become distressed, they often rely on automatic cognitive processes that can trigger and/or maintain maladaptive thinking cycles. The goal of MBCT is to interrupt these automatic processe and teach people to focus less on reacting or latching onto incoming stimuli and thoughts they have, and instead accepting and observing them without judgment. This in effect buys time to select those cognitions that are more positive, or in line with the goals of therapy for prioritization.

There are several MBCTs to choose from, but the mindfulness therapy I prefer is commonly referred to as ACT, or  Acceptance and Commitment Therapy/Training. ACT is a short-term intervention approach to  help people tolerate uncontrollable, stressful situations (acceptance) and focus on what can change (commitment), instead of what cannot. What I like most about it is that the model maps onto existential therapy core values quite nicely. But unlike existential therapies, the ACT model can be more easily implemented and researched for efficacy.

Research supports the effects of MBCT in people who struggle with recurrent depression (three or more time)s and demonstrates reduced relapse rates by 50%. ACT has been successfully used not only for depression, but also with substance abusers, people suffering from chronic pain and illness, patients with obsessive thoughts,or anxiety.  ACT also works well with clients or employees who are tired of letting uncontrollable symptoms rule and want to take a more active role in defining and directing their own lives. Below are some core principles of ACT and how I see them mapping onto existential therapy principles:

ACCEPTANCE:

a) Experiencing the Present Moment Directly

It is important to remain focused on the present moment, a very Zen-like concept. In terms of
cognition,  this means focusing in on your present thoughts and feelings, rather than trying to avoid or control them. Existentially speaking, this maps onto the core value of personal awareness. I often
use introspection exercises, like a personal iceberg (Virginia Satir) or listening for feelings, which are meant to help clients know better who they are in given moment. This can be surprisingly difficult because of previous learning experiences from which we often develop judgments about ourselves. For example, when one has struggled with depression in the past and notices signs of depression coming again, they might grasp onto a thought or feeling that signals the return with veracity, saying to the self,  “You’re depressed again – You’re such a loser!”   ACT asks instead for one to focus on and describe the direct physical sensations of pain or anxiety  (e.g., my chest feels tight), rather than feeling helpless or trying to distract yourself. Watching feelings rise and fall in your body, gives you a sense of them as transient experiences, rather than as who you are in essence. Thus being present instead of past or future oriented (mindfulness) is critical in terms of knowing the self as it is now (existential), and short-circuiting maladaptive thought patterns cognitive).

b) Being Willing to Be Where You Are

In ACT terms, acceptance means “being willing to experience the present moment, even if it’s not
what we would have chosen.” Existentially speaking, this maps onto suffering/anxiety. Commonly referred to as ‘death anxiety,’ humans will often go to great lengths to pretend mortality does not
exists and this only heightens our need to control self, other, and world. But we are bound to fail since we can only truly control our own behavior. Lifting the veil of self-deception  can go a long way towards getting you focused on the right track by reducing the need to control what is not yours to control. In fact, cognitive research has long shown us that controlling or suppressing thoughts is something the brain is really quite bad at.  Exercises that help people manage the true anxiety of life, which is death, include empowerment journaling, exploring spiritual beliefs, and making a bucket list.

c)Understanding Your Core Values

Core values are the things in life that are most meaningful to us and that enrich our lives. They include such things as “Being healthy,” “Taking care of our families,”  “Being honest and accountable,” or “Contributing to society.”  We us core values to make meaning in our lives, which is something the brain must do and will do, with or without our conscious input.  It is almost funny how
hard it is to name one’s core values yet we use them so pervasively to judge ourselves and others. Core values are hard to change, they are sort of compelled, so just knowing what they are is enough. Taking action based on them falls under the commitment part of ACT. Exercises I might use to increase understanding of core values are family of origin explorations,  opinions on politics and religion, and listening for ‘shoulds’.  

COMMITMENT

a) Separating Your Self From Your Thoughts

Your thoughts, feelings, and sensations are not all of who you are. Although your thoughts feel true, they are not necessarily the whole truth, because they are biased by your expectations from past experiences and self-definition. You do not need to let your many random and unexamined thoughts and feelings determine your behavior. You can choose how to behave, based on your direct experience (what you see, hear, feel – independent of your judgments about these events) and your core values.  Existentially speaking, this maps onto taking personal responsibility for your actions
and putting them more in line with the thoughts, feelings, and other internal experiences that most reflect who your are both over time and in the given moment.  For instance, thinking you are stupid or fat does not make you stupid or fat – it is just a passing thought in your head, and you do not have to link that thought to a behavior if you choose not to do so.

b) Making Meaning Intentionally

When people are under duress,meaning-making cognitive processes can get hijacked by the subconscious. Even if one knows “I want to be a good parent,”  day-to-day behavior may not reflect this because they are preoccupied with seeking escape from daily stressthoughts about past, painful events, or trying to prevent an anticipated future threat.  And because core values are being violated, the subconscious may make meaning in harmful ways. It is important to recognize that there is no inherent meaning  in experiences, we define our own experiences, thus we must take care in how that occurs. ACT and existential therapies encourage selecting meanings for events that promote positive cognitive activity. For example, you can interpret losing your car keys as evidence that you are an idiot or that everything happens for a reason and you could have just avoided a car accident. Now the interesting thing is that you don’t have to believe a positive cognition for it to ease your cognitive load, but if you want maximum effect, insert meaning  making that reflects your core values. I often use mantras or metaphors to activate intentional meaning making in session work.

c) Committing to Motivated Action

To live a meaningful, authentic life, you need to take risks, get out into the world, and tolerate uncertainty and anxiety, which are fundamentally existential ideas. ACT exercises focus on setting manageable, attainable, meaningful goals – committing to taking specific, small steps that get you closer to your larger goals. The focus is on taking action, not expecting a particular result, since outcomes may be at least partially out of our control.  To be successful is not necessarily to always feel happy or pain-free, but to live a full life despite the anxiety or pain. By facing what you fearthe fear will eventually lessen, and, even if it doesn’t, you will know you have done your best with what you have. This takes you out of the cycle of self-doubt, regret, and second-guessing yourself.

Getting Help

If you are interested in ACT as a treatment option for anxiety or depression, contact me at:

Lavelda Naylor, MA, LMFTA

4230 Gardendale Suite 502 San Antonio, Tx
78229
(210) 460-0442
laveldanaylor@ymail.com

References

http://mindfulselfexpress.sharedby.co/share/1MaOE5
For more information about ACT, go to this link: http://contextualscience.org Or watch
this YouTube video by Dr Russ Harris: http://www.youtube.com/watch?v=PENd6ndMzAg

 

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