Mindfulness-Based Cognitive Therapy

Question 1

What is mindfulness?

Answer 1

Mindfulness is the practice 
of bringing your awareness deliberately 
to the present moment in time 
and experiencing it 
without judgement or expectation.

Question 2

How do you practice mindfulness?

Answer 2

Experience awareness 
of the present moment 
as an unbroken progression, 
coming and going, 
without being censored or interpreted, 
or held on to 
or pushed away.

Experience thoughts
without adding emotional memories from the past
that may taint them
as positive or negative.

Question 3

Explain CBT.

Answer 3

Cognitive behavioural therapy (CBT) is one of the most highly recommended and respected talking therapies of the 21st century.

It can be defined as an
active, directive, time-limited, structured approach
used to treat a variety of mental problems

CBT mainly focuses on the here and now,
and the therapist accompanies the client towards chosen goals.

In this sense, CBT (and MBCT) is client driven
and you choose what you want to work on
throughout the whole therapy.

Question 4

What is MBCT?

Answer 4

The ‘M’ stands for mindfulness,

B stands for based, as in ‘derived from’ or ‘connected to’,

C stands for cognitive, which refers to the thinking, planning and measuring part of your brain,

T stands for therapy: the treatment of disorders and illnesses.

MBCT is a fusing of two distinct techniques:
the Eastern, Buddhist philosophy of
meditation and everyday mindfulness
and the Western psychological treatment called
cognitive behavioural therapy.

MBCT is used today as a path of healing for loads of mental and physical health issues.

MBCT was developed by three clinical psychologists:
Mark Williams, John Teasdale and Zindel Segal.

Question 5

What is the essence of MBCT?

Answer 5

The essence of MBCT is
discovering how to let go
of negative thinking and behaviour patterns.

Question 6

What is MBSR?

Answer 6

Mindfulness-Based Stress Reduction (MBSR),
a programme based on
mindfulness
meditation
and yoga
that Jon Kabat-Zinn created in the US
to help people with chronic pain and illness.

Question 6

Ex.

Choose to live in the now,
bringing your awareness to this moment.

Answer 6

Bring your awareness to this moment:
are you aware of any immediate danger or threats?
If not, you can safely adopt an attitude of
‘right now, in this very moment, everything is okay’.

Continue to check in with yourself every hour or so.
Think to yourself:
‘I’m fine, all is okay right now’.

Feel into your body;
what are you aware of when you just soothe yourself this way?

As an experiment,
write down in your diary all the things
that are okay, good or wholesome in this very moment.

Question 7

Ex.:

Name a few ways you can live in the moment in everyday practice:

Answer 7

Drink and talk more slowly.

Eat nuts, raisins, chocolate buttons and the like one at a time, instead of scoffing a whole handful!

Don’t read or watch TV while eating.

Don’t look at your mobile phone when meeting with friends and family, or just before you go to bed.

When feeling stressed, ground yourself, feel your feet rooted to the floor and connect deeply to your breathing.

Question 8

Explain autopilot.

Answer 8

Autopilot refers to functioning without awareness
(being ‘mindless’).

The concept of not living on autopilot is central to mindfulness.

Autopilot, however, does have a place in your life. If you had to learn everything daily over and over again, you wouldn’t learn very much and wouldn’t fulfil your potential. Life would become very repetitive.

So what you’re aiming towards is the middle ground: using autopilot and also bringing awareness to special moments throughout the day.

Question 9

Ex.:

What are some ways to open up to ?

Answer 9

• Go for a long walk and observe what attracts your attention – you may be fascinated by things you never thought would interest you.
• Read an unusual book, watch a new film or listen to unfamiliar music.
• Draw a self-portrait from memory (that is, without looking in the mirror first) so that you can see how you see yourself. Your self-portrait doesn’t have to be a masterpiece, but may well reveal the things that stand out most strongly about yourself in your mind.

Question 10

In a balanced life what do you have time for?

Answer 10

In a balanced life, you have time for:

• Working and looking after yourself and those you love
• Learning and growing as a human being
• Simply being alive
• Following your dreams
• Relaxing and rebalancing
• Searching for your deeper purpose

Question 11

Ex.:
Which regular mindfulness practices give you a greater understanding of the concept of living in the moment. Give a few examples of things that you can experience.

Answer 11

Here are a few examples of things that you can experience if you just let yourself:

• Feeling the rain on your face
• Biting into a fresh apple
• Listening to a piece of music
• Having a relaxing shower
• Stroking your pet
• Holding the hand of a loved one
• Drinking your first cup of tea/coffee in the morning
• Breathing in fresh air
• Watching clouds in the sky
• Smelling fresh flowers, fresh coffee, warm bread, and so on

Question 12

Distinguish between meditation, mindfulness and awareness training.

Answer 12

• Meditation:
  A general term for any practice that involves
  sitting or kneeling (sometimes even standing)
  and focusing the mind on an object, sound or feeling.

- Mindfulness meditation: 
Focuses on the here and now 
and uses an anchor of awareness 
to keep your mind from flitting off 
into ruminating, thinking or planning.

• Awareness training:
  Becoming more mindful by
  intentionally becoming aware of
  the present moment over and over again.

Question 13

Explain Attachment.

Answer 13

Attachment is wanting to have something,
not letting it go
and needing reassurance that you can have it forever (or at least again and again):
examples include a person, a car, your looks, youth, money, achievements, and so on.

Question 14

Explain aversion.

Answer 14

Aversion refers to having 
an absolute disgust of something, 
a total intolerance, 
and investing a lot of effort into 
not having to do something or accept something or someone, 
such as being fat 
or looking old, 
being poor or losing your importance, 
or not getting the best results. 

Aversion can also connect to the inability
to accept low or angry moods in yourself or others.

Question 15

Ex.:

Engaging in the body scan practice.
40’ - six times per week for the first two weeks

Answer 15

1. Lie or sit down when you feel ready and gently cover yourself with a light blanket or similar to avoid feeling cold.
   If you prefer, you may close your eyes or keep them in soft focus (half open, unfocused).
2. Decide to bring your awareness slowly to your body, feeling the points of contact it makes with the floor, the rug, the mat or the chair.
3. Place one of your hands on your chest or stomach and notice how it rises on the in-breath and falls on the out-breath.
4. Observe whether each breath is different – longer or shorter, deeper or shallower.
5. Put your hand gently back into its original position after a little while and please change your focus to your body as a whole.
6. Guide your awareness to your left foot when you feel ready to continue.
7. Choose now to switch your focus to the rest of your left foot, the sole, the instep, the heel, the upper part, all the little bones, blood vessels and tendons, and then the left ankle, feeling these parts or just knowing that they’re present.
   Gently move your focus of attention upwards… having scanned your whole left leg.
8. Consider how your left leg is feeling now versus the right one.
9. Let go mentally of your left leg. When you feel ready, carry out the awareness practice of Steps 6 to 8 on your right leg.
10. Pause for a moment and allow your legs to recede into the background of your awareness after completing the passage, bringing your torso centre-stage.
11. Now concentrate on some of your vital organs, starting with the heart and then lungs, liver, stomach and digestive tract, kidneys and urinary tract.
12. Notice that you’ve scanned your whole torso, gently breathing into it and allowing any tension or discomfort to be released on the out-breath.
    Please continue repeating this process a few more times.
13. Turn your awareness to your left arm and hand, starting with the fingertips…
14. Breathe into your left arm and hand on the next in-breath, releasing any tension or discomfort on the out-breath.
    After repeating this action, breathing in and out a couple more times, move to the right arm and hand and repeat the practice.
15. Shift your awareness now to your neck and head area…
16. Imagine now, if possible, a big blowhole in the crown of your head.
    Breathe in deeply through this opening, sending clear and refreshing energy to every cell of your body, releasing any tension or discomfort on the out-breath.
17. Start stretching gently, wriggling your toes and fingers, opening your eyes and orienting yourself.

Question 16

Ex.:

Which everyday activities could you perform mindfully?

Answer 16

Experiment with performing the following activities in a mindful way:

• Treating yourself to a shower: Feel the water on your skin, its temperature and sensation. Smell the soap or body wash and really notice it. Bring your awareness to the wonderful gift of having running hot water available at the turn of a tap.
• Brushing your teeth: Notice how your hand holds your toothbrush and applies the toothpaste. Observe the action of brushing itself. What does it feel like having clean, smooth teeth at the end?
• Getting dressed: Notice how many actions and moves are necessary just to put on one sock.
• Travelling to work (or anywhere): Be mindful of how you get into your car or onto your bike; mindfully follow all the actions necessary to get from A to B.
• Going shopping: How do you know whether you need a basket or a trolley? Take a breath and choose mindfully what you need or what you want.
• Waiting in a queue: At the checkout, train station or bus stop, observe your environment or attend mindfully to your breathing.
• Speaking to others: Deeply listen and mindfully reply; notice that certain words can hurt and impatience can make others feel less happy to talk to you or accept your opinion.
• Choosing what to read or watch on TV: In this area of your life you may be able to reduce the amount of time you spend on these activities in order to create space for mindfulness practices; however, you can watch or listen to programmes that nourish rather than deplete you.

Question 17

Ex.

Eating with awareness: Raisin exercise.

Answer 17

1. Look at these raisins as if you’ve never seen raisins before.
2. Decide to focus deeply on these little objects.
3. Select and pick up a raisin, feeling its weight and texture.
4. Feel its surface structure between your thumb and forefinger.
5. Move on when you feel ready to explore the raisin’s smell.
6. Bring the raisin close to your ear and squeeze and rub it.
7. Pick up this raisin or another one with the intention of putting it in your mouth.
8. Take the first bite.
9. Chew this one raisin slowly until its original shape completely changes and you feel ready to swallow.
10. Assess your feelings now.

Question 18

Ex.

Listening mindfully:
A ten-minute sound meditation.

Answer 18

1. Bring your awareness to the surface that your feet are resting on and what it feels like.
   In the same way, scan through your whole body and notice the areas that are in contact.
2. Close your eyes or maintain a relaxed focus on an object such as a candle, gradually bringing your awareness to any sounds you can hear.
   Just allow them to arise in your awareness and pass through it.
3. Try to focus on the distance or closeness of a sound, its pitch, strength, length, its coming and going, and whether or not it repeats itself.
4. Notice the sound of the timer or alarm after ten minutes, returning your focus gently to the sensations in your body and the points of contact with the surface you’re sitting on.
5. Write down any interesting or unusual aspects of the experience in your diary.

Question 19

What are two points of a mindfulness practice?

Answer 19

1) The reality of impermanence – that everything changes all the time.
You will have different reactions to the same exercise each time you engage in it – you might say that change is the only constant truth.

2) The fact that every time you do an exercise
you’re developing the muscle of mindful awareness;
noticing the wandering mind in itself enriches awareness.
Thus no right or wrong way exists for doing an exercise
and you’re always getting something out of it.

Question 20

Name some Barriers to Practising Mindful Exercises.

Answer 20

• Lack of time
• Lack of trust
• Lack of belief in the message of mindfulness
• Lack of motivation

Question 21

Ex.:

Regulating the breath: Mindful breathing exercise.
15’ - 20’

Answer 21

1. Place yourself in a comfortable yet dignified posture, with your spine erect and self-supporting, chin slightly down. Allow your shoulders to rest in a comfortable, neutral position (neither falling forward, nor thrust backwards) so as not to inhibit your breathing in any way.
2. Close your eyes gently. By all means, keep them in soft focus (half-closed) if you prefer.
3. Bring your awareness to certain body sensations by focusing your attention on the touch or contact your body makes with the floor and whatever you’re sitting on.
4. Turn your attention to your abdomen.
5. Focus on your breathing, being with each in-breath for its full duration and with each out-breath for its full duration, as if you’re riding on the waves of your own breathing.
6. Let go of the anchor of awareness (your breath) after about 15 minutes or so, and slowly focus on those parts of the body that are in touch with the surface you’re sitting on.

Question 22

Explain NAT.

Answer 22

Negative automatic thoughts (NATs)
are thoughts that lurk just beneath the level of your awareness
and can significantly affect your mood.

By definition, these thoughts occur automatically
and you aren’t consciously aware of them.
You need to become more aware of NATs, however, so that you can respond to them wisely.

Question 23

Explain PAT.

Answer 23

PAT: a positive automatic thought

Question 28

Why do you aim to adopt an erect and dignified posture, with your head, neck and back aligned vertically in the sitting exercises?

Answer 28

This position is the physical equivalent of the inner attitudes of
self-reliance, 
self-acceptance, 
patience 
and alertness.

Question 29

What do you do when intense or even uncomfortable sensations in your body appear?

Answer 29

Naturally this causes your attention to switch to this discomfort.
Explore the discomfort – is its intensity continuous, does it come and go like waves?
Breathe into it to see what unfolds.
But if you start thinking too much about it and creating a story around the discomfort, I advise changing position and returning to the breath as your anchor of awareness.

Question 30

Ex.:

Walking meditation

Answer 30

Walk slowly across a room and back or from one end of your garden to the other:

1. Find a stretch for walking forwards and back that’s safe. All you need is about ten steps in each direction.
2. Start standing naturally and begin by shifting all your weight into your left leg while lifting the heel of the right foot. Try your best to now shift the right, lifted foot forwards and gently place it down so that you complete a single step.
3. Feel your body and notice where the weight has shifted to. Feel the sensations in both feet; the right one that’s mainly carrying you now and the left’s emptier feel.
4. Repeat the same motion with the left foot. Notice that while you place the right foot down, the heel of the left foot starts peeling itself off from the floor.
5. Shift your left foot forwards and place it down as well. Again, the right foot has been waiting for this action and starts peeling its heel off as the left foot prints its stamp on the ground.

Question 31

Explain the two nervous systems.

Answer 31

Humans have two nervous systems:

1) The parasympathetic nervous system (PNS) is what people ideally want to operate in as often as possible;
it is the one in which they feel relaxed, at peace and in equilibrium.

2) The sympathetic nervous system (SNS) is the one used when people feel under threat.
The SNS is switched on for survival and enables you to be swift, effective and purposeful.
Breathing becomes rapid, and your lungs take in more oxygen. Blood flow increases, strengthening the muscles, lungs and brain to deal with short-term added demands.
This system focuses on areas that may get wounded in a fight, sending the immune-boosting troops to the body’s front lines where injury or infection is most likely to occur, such as the skin and the lymph nodes.

Often, however, the SNS gets switched on many times each day, even though no danger is present, and remains switched on if you feel stressed a lot of the time, adversely affecting your heart, lungs and blood circulation.
When the body prepares to defend injury, other areas are left unprotected and so long-term stress can be responsible for respiratory and other infections.

Question 32

Which are the physical problems of stress?

Answer 32

These are physical problems that long-term SNS activation can cause, perpetuate or exacerbate:

Gastrointestinal problems, frequent urination and diarrhoea

Lupus, multiple sclerosis, thyroid dysfunction, chronic fatigue syndrome and frequent infections of the respiratory tract, the skin and the digestive system

Depression, suicidal thoughts and burn-out.

Lack of energy and motivation, sleep disorders, appetite disruption, obesity/diabetes, psoriasis, fibromyalgia, chronic pain, high blood pressure and infertility

Increased fear/negativity, becoming stuck in old, fearful ways of thinking, impaired memory and an inability to concentrate and make decisions

In short, long-term stress causes damage to almost all regions of your body and mind.

Question 33

Which are two serious potential results of stress if you leave it untreated?

Answer 33

1) Burn-out is caused by a real or perceived overload of responsibilities and is considered the most debilitating consequence of long-term stress.
It’s a complete breakdown of psychological responses and abilities and can often be accompanied by physiological diseases.

2) Rust-out is caused by a lack of direction or purpose in your work and/or life.
The psychological and physiological reactions are similar to the effects of burn-out.
The trigger, however, is often connected to feeling strongly unvalued, or staying in a job only out of fear rather than finding another opportunity.

Question 34

In general, you react to experiences in one of three ways:

Answer 34

1) Indifference:
Switching off from the present moment and going somewhere else in your head (daydreaming, remembering a holiday, planning exciting trips for the future, and so on). Nothing is wrong intrinsically with switching off, but it doesn’t help the problem go away.

2) Attachment:
Wanting to hold on to the current experience or desiring experiences that you aren’t having right now. Enjoying yourself is absolutely fine, but feeling that every similar future experience must be just as fantastic or even better isn’t so great.

3) Aversion:
Wanting to get rid of experiences that you’re having right now or avoid experiences that may be coming along that you don’t want.

Question 42

Ex.:

Taking note of thoughts throughout the day

Answer 42

One way of bringing automatic thoughts into your conscious awareness is to write them down and note what effects they have on your body sensations, moods and other thoughts and actions.

Complete a pleasant event diary for a week.
Begin by writing down a pleasant event as soon as possible after the experience.
Seeing how they unfold is one way of becoming more familiar with the nature of your mind.
Pleasant entry diary layout:
Day
Experience
Where you aware of the pleasant event?
How did your body feel?
What thoughts, moods, feelings came up?
What thoughts do you have now while writing?

Question 43

Ex.:

Seeing mindfully: Making a short mind-movie

Answer 43

In this exercise I ask you to look at a microcosm of life.

Please choose an outlook that you want to explore closely,
such as through a window frame or door.
Look at only that one view with awareness and curiosity.
Let the moment dictate what you see and what forms your personal slice-of-life film.
You can choose to sit or stand.
If standing, please opt for a relaxed posture, letting your shoulders hang loosely and bending your knees gently.
For the next ten minutes or so, see the world go by and really look with attention.
Even if nothing much happens, you may start to notice minuscule details that otherwise you’d never have spotted.

Question 44

Ex.:

Finding the breathing space: An emergency meditation
3x daily - maximum of three minutes

Answer 44

You can carry out this brief meditation anywhere, standing, sitting, kneeling, jogging, lying down . . .

1. Imagine the shape of an hourglass: See how it starts wide, becomes narrow and eventually widens out again. In the same way, you begin this exercise with a broad awareness, focus into a narrow awareness, and then broaden out again, as you’ll see in the next three steps.
2. Growing awareness of what is: Bring yourself into the present moment. Gently close your eyes and ask yourself:
   • What thoughts are going through my mind right now?
   • What feelings are present right now?
   • What sensations am I aware of in my body right now?
   Acknowledge everything, even unwanted thoughts and feelings.
3. Focusing in: Redirect your full awareness to the sensation of breathing; focus on each in- and out-breath as they come and go. Your breath is your anchor, helping you to stay in touch with the now. Breathe about ten mindful breaths.
4. Expanding awareness: Expand your sense of awareness to your entire self and integrate awareness of your body as a whole: consider the circumference of your body and sense the inhalation and exhalation from every pore of your body. Feel your feet firmly grounded on the floor.

Question 45

Ex.:

Allowing awareness of sight, sound, breath and body.
This 25-minute sitting meditation is a fusion of individual practices.

Answer 45

You start with the awareness of sight and sound, move to anchoring your awareness in the breath and finally focus on your body as a whole, even bringing awareness to discomfort or intense sensations in certain areas.

1. Sit in a comfortable posture with your spine erect and let your shoulders drop. Close your eyes if doing so feels comfortable.
2. Bring your awareness to the sensations in your body. Focus your attention on the sensations of touch and contact your body makes with the floor and whatever you’re sitting on and spend a little while exploring these sensations.
3. Focus your attention on your stomach, feeling it rise gently on the in-breath and fall on the out-breath. Keep the focus on your breathing, being with each in-breath for its full duration and with each out-breath for its full duration.
4. Notice when your mind wanders off into thinking, pondering and worrying. Softly note what took your attention away and then gently escort your focus back to your stomach and the feeling of the breath coming in and out.
5. Focus on your breath and the sensation of your body touching the surface you’re sitting on. Expand your body awareness even further, noticing all the areas that are involved when breathing and even picturing all the cells of your body breathing in and out. L

Question 46

Ex.:

Going for a stroll: Walking exercises
Mindful walking from A to B

Answer 46

In a mindful walk, you intend getting from A to B as with any walk but you decide to do every part of it mindfully and not use the time for planning or ruminating on anything that’s occupying your mind.

Your intention is to be fully present as soon as you make the first step and focus on everything you sense when your feet move onto a variety of surfaces.

Furthermore, visually you take in any object that presents itself, however fleetingly, while also listening deeply to the sounds around you and perhaps the air that touches your face: is it moist, dry, warm or cold?

You complete this practice when you arrive at point B.

Question 47

Ex.:

Observing Mindfulness in Daily Movement

Answer 47

Try to observe deeply every experience you have – bearing in mind that every experience has two sides to it. For example, think about the possible benefits of observing boredom, anger or a bad body position. All these observations tell you something about your mind, your present state of emotion or what you perhaps need to change.

• Getting up in the morning
  When you first wake up, before you move, bring awareness to your breathing. You may even notice how your body connects to the bed you’re sleeping in. Thereafter, sit up mindfully and stand up with awareness.
  Proceed to walk with awareness to the bathroom, kitchen or wherever and really feel your feet lifting, shifting and placing.
• Preparing a mindful breakfast
  When you prepare your cereal, really notice how you bend down or stretch up to fetch the bowl, how you perhaps choose which type you’re having today, how you fetch it and transfer the right amount (not too little or too much: mindful eating starts here) into the bowl. Notice how you fill the kettle with water and when it has boiled, prepare your favourite beverage.
  Really take time over your breakfast, enjoying each spoonful of food and sip of drink.
• Exercising mindfully throughout the day
  Ideally you need to do any mindful exercise you engage in (formal or informal) with complete attention.
  Be mindful when vacuuming, walking down the stairs and picking up heavy objects.
  Ask yourself which movements you do every day – such as taking out the rubbish, bending, lifting, shopping and so on – and how you can be really in the moment while performing these activities.

Retiring for the night
Have a mindful bathroom routine: Be truly present when brushing your teeth, having a relaxing bath, taking off make-up, putting on face cream (or whatever applies to you).
Put on your night clothes mindfully: Close each button with awareness.
Lie down, appreciate your bed, maybe listen to calming music or read mindful poetry: In your mind, let go of all your duties that can wait until tomorrow.

Question 48

Ex.:

Meditation: Being with (negative) thoughts.

Answer 48

1. Kindly sit down in your preferred meditation place and give yourself 15 to 20 minutes.
2. Wrap a shawl around you and sit in a dignified, upright posture.
3. Bring your awareness to your breathing.
4. Feel your body’s connection points to the chair and floor and see whether this helps you to settle more and more.
5. Keep observing your natural breathing. Breath in each in-breath for its whole duration and each out-breath for its whole duration.
6. After a while, when you feel ready, allow your thoughts to freely arise: maybe see them as clouds in the sky or leaves in a river.
   One moment your thoughts are here and then they are gone. The invitation here is to look at and relate to your thoughts as an external observer, without judging them or believing their content, as best as you can. Should some of your thoughts be difficult or fear-provoking, kindly remember that thoughts are not facts. Thoughts occur, but they are not permanent or necessarily true.
7. Eventually close the thought-window and return for a few more minutes to observing the in- and out-breath.

Note:
If giving your NATs up completely appears too difficult, perhaps try to modify and soften them, in order to open spaces in your mind where new ways of thinking can grow. For example, instead of saying, ‘I can’t sort out my life’, tentatively state, ‘It’s difficult, but I’m attempting to sort out my life step by step.