Mindfulness‐integrated CBT has made a unique contribution to evidence‐based approaches in health care – centrally relevant for those interested in teaching or learning mindfulness and those who practice Cognitive Therapy. The evidence shows that it helps people with some of the most serious physical and emotional difficulties, as well as working well to enhance flourishing and well‐being. This manual for therapists and teachers is a very welcome step forward to make MiCBT even more available across the world.
Professor Mark Williams, PhD
Emeritus Professor of Clinical Psychology, University of Oxford
Co‐author of Mindfulness‐based Cognitive Therapy for Depression
It is an investment when you buy a book (both time and money). I recommend that you invest in the best authors. There is none better for MiCBT than Cayoun, Francis and Shires.
Professor Bruce A. Stevens, PhD
Clinical psychologist, Wicking Chair of Ageing and Practical Theology, Charles Sturt University Canberra
Author of Happy ever after? A Practical guide to relationship counselling for clinical psychologists
Dr. Bruno Cayoun and his colleagues Drs. Francis and Shires have written the most comprehensive book to date integrating mindfulness and CBT in a framework successfully designed to give therapists practical guidance to foster well‐being in clients with an array of difficulties. Highly recommended.
Arthur P. Ciaramicoli, Ed.D., Ph.D., Clinical psychologist
Author of The Stress Solution: Using Empathy and Cognitive Behavioral Therapy to Reduce Anxiety and Develop Resilience
Bruno Cayoun developed a concise and effective mindfulness program in Mindfulness‐integrated Cognitive Behaviour Therapy. Now, Dr. Cayoun and his colleagues have offered a valuable companion book for clinicians and clients that brings compassionate care into the lives of therapists and their clients as co‐participants in mindfulness. It is a privilege for me to have known Dr. Cayoun as friend and colleague and to appreciate deeply the precision of his thinking and practice. This clinical handbook reflects not only his talent and insights, it highlights his dedication to colleagues who can join him in providing an important level of ethical and effective therapeutic care to others.
Lynette M. Monteiro PhD, Psychologist, Director of Ottawa Mindfulness Clinic Co‐author of Mindfulness Starts Here and co‐editor of Practitioner’s Guide to Ethics and Mindfulness‐based Interventions
MiCBT integrates the principal evidence‐based methods of traditional CBT with mindfulness meditation with seamless grace and an ability to preserve the important elements of both. I highly recommend this comprehensive and helpful clinical handbook to mental health professionals.
Shauna Shapiro, PhD
Professor of counseling psychology, Santa Clara University
Author of The art and science of mindfulness and Mindful Discipline
This important work is a masterful integration of mindfulness meditation training and clinical science for individual and group therapy. It fills a gap in the literature by linking the essence of mindfulness practice—equanimity—with carefully articulated behavioral change strategies. The authors explain the theoretical foundation of MiCBT, followed by generous, session‐by‐session instructions for every aspect of treatment. Almost 2 decades in the making, MiCBT is an innovative, transdiagnostic approach to clinical care that will surely inspire and inform clinicians for years to come.
Christopher Germer, PhD
Lecturer (part‐time), Harvard Medical School
Author, The Mindful Path to Self‐Compassion
Co‐editor, Mindfulness and Psychotherapy
This edition first published 2019
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Library of Congress Cataloging‐in‐Publication Data
Names: Cayoun, Bruno A., 1961– author. | Francis, Sarah E., 1951– author. | Shires, Alice G., 1963– author.
Title: The clinical handbook of mindfulness‐integrated cognitive behavior therapy : a step‐by‐step guide for therapists / Bruno A. Cayoun, Sarah E. Francis, Alice G. Shires.
Description: Hoboken, NJ : Wiley‐Blackwell, 2018. | Includes bibliographical references and index. |
Identifiers: LCCN 2018018086 (print) | LCCN 2018021975 (ebook) | ISBN 9781119389620 (ePub) | ISBN 9781119389644 (Adobe PDF) | ISBN 9781119389637 (paperback) | ISBN 9781119389644 (ePDF)
Subjects: | MESH: Mindfulness–methods
Classification: LCC RC489.C63 (ebook) | LCC RC489.C63 (print) | NLM WM 425.5.C6 | DDC 616.89/1425–dc23
LC record available at https://lccn.loc.gov/2018018086
Cover image: ©MiCBT Institute
Cover design by Wiley
I slept and dreamt that life was joy.
I awoke and saw that life was service.
I acted and behold, service was joy.
—Rabindranath Tagore
Bruno Cayoun is a clinical psychologist and the principal developer of Mindfulness‐integrated Cognitive Behavior Therapy (MiCBT), which he and his colleagues have been teaching to mental health professionals since 2003. He is also the founder and Director of the MiCBT Institute, a leading provider of training and professional development services in MiCBT to mental health services and professional associations internationally. Dr. Cayoun keeps a private clinical practice in Hobart, Australia, and undertakes mindfulness research at the MiCBT Institute and in cooperation with universities in various countries. He has practiced mindfulness meditation in the Burmese Vipassana tradition of Ledi Sayadaw, U Bah Kin and S. N. Goenka, and undergone intensive training in France, Nepal, India and Australia since 1989. He is the author of research articles and books, including Mindfulness‐integrated CBT: Principles and Practice (Wiley, 2011), and Mindfulness‐integrated CBT for Well‐Being and Personal Growth: Four Steps to Enhance Inner Calm, Self‐Confidence and Relationships (Wiley, 2015).
Sarah Francis is a registered psychologist trained in a number of mindfulness‐based therapies. She specializes in Mindfulness‐integrated Cognitive Behavior Therapy (MiCBT) and has been implementing it since 2006. In addition to her work in clinical psychology, Sarah has worked in a number of professional contexts including education, human resources, and business consulting. She is the author of Workplace Communication: A Teacher's Guide (Pitman, 1993). She is the convenor of the Melbourne MiCBT Interest and Research Group and a senior trainer for health professionals who train through the MiCBT Institute. Sarah’s research interests include the measurement of mindfulness and the differential efficacy of MiCBT and treatment‐as‐usual in clients with a range of mental health disorders at Monash University.
Alice G. Shires is a clinical psychologist and Director of the Psychology Clinic and senior lecturer at the Graduate School of Health, University of Technology, Sydney (UTS) and was a founding Board Member of the Australian Clinical Psychology Association. Alice is a teacher, trainer and supervisor of clinical psychologists and has worked in acute and specialist mental health services in the United Kingdom. She has developed an interest in mindfulness and its integration with cognitive and behavioral therapies and has established a mindfulness‐integrated research clinic at UTS. Her research includes the efficacy of MiCBT in chronic pain, the process of supervision and assessment of competencies in clinical psychology, and the inclusion of mindfulness training in the clinical psychology training process. Alice is a senior teacher of MiCBT for mental health professionals and supervises clinicians during the course of their MiCBT training.
Discover real peace and harmony within yourself, and naturally this will overflow to benefit others.
—S. N. Goenka
As clinicians, we are continually looking for best practices that assist our clients to decrease their suffering. We begin by holding awareness of the certainty that a reduction in suffering is possible. Mindfulness‐integrated Cognitive Behavior Therapy (MiCBT) supports us in the ensuing process of making meaningful change manifest for clients. It does this through the skillful integration of equanimity cultivated in meditation practice and cognitive behavior therapy‐based exposure techniques. The authors of this manual accompany us step‐by‐step through the four stages of MiCBT, anticipating challenges and providing demonstrable advice and strategies for optimizing skill development.
I first met Bruno through our common commitment to precision and proficiency in meditation practice, and clarity of underlying theoretical frameworks, in an effort to optimize the rigor and effectiveness of mindfulness‐based interventions. Alice, Bruno and Sarah bring decades of combined clinical wisdom across the full range of mental health conditions to this practical guide. They integrate their personal meditation experience within the Burmese Theravada Vipassana tradition of U Ba Khin with a structured therapeutic approach that can be adapted to a wide variety of clinical issues. The authors’ integrity and embodiment of insights gained through meditation imbue both the explanations of the theoretical framework of MiCBT and the associated clinical examples with lucidity; this assists the clinician in merging the personal and experiential with the interpersonal and clinical.
This guide is an essential resource for therapists in that it provides an accessible, structured approach to applying MiCBT principles in both individual and group settings. It provides demonstrations of how to assist clients to identify clear treatment goals, including specific behavioral changes, and develop awareness of the benefits they will experience as motivation to establish and sustain a twice‐daily meditation practice. The theoretical framework underpinning MiCBT emphasizes that it is automatic reactions to the hedonic tone of co‐emerging sensations in the body, fueled by identification with experience, that in large part drive clients’ symptoms and habitual behaviors. Therapists will find a refreshingly clear rationale for each stage of the therapy process, along with suggested methods for adjusting the treatment protocol based on clinical progress and need.
One of the challenges we repeatedly face as clinicians is skillfully selecting and applying the most appropriate components of mindfulness to meet the immediate needs of the client in the room. The content of this book, as carefully crafted by Alice, Bruno and Sarah, addresses this by clearly outlining the links between the various facets of mindfulness and their clinical effects. For instance, they explain how practicing mindfulness of breath develops metacognitive awareness, which, in turn, generalizes into daily life, resulting in decreased rumination. Importantly, they also provide examples of effective ways to explain these mechanisms to clients, serving as a further source of motivation for their daily mindfulness practice.
Throughout the book, considerable attention is devoted to problem‐solving specific clinical situations, illustrated by clinical vignettes. With forethought to the challenges our clients may face in their CBT and meditation practices, such as difficulty accepting unpleasant bodily sensations or managing intrusive thoughts, the authors recommend specific practice modifications. By providing a comprehensive, yet adaptable, in‐session and at‐home therapeutic framework, while also clearly explicating the rationale for progression of practice as taught in MiCBT, this manual enables the clinician to adjust the treatment for each clinical case.
Having this handbook when I was first eagerly implementing MiCBT would have saved me much time in determining how to summarize succinctly the purpose of each practice for clients and how most effectively to bring together the mindfulness and CBT components. Most importantly, this manual empowers us to carry the insights gained in our personal mindfulness practice into the therapeutic relationship, equipping our clients with the skills not only to reduce their own suffering but also to express their full and unique potential.
We express our gratitude for the traditional teachings and teachers of Vipassana meditation, which have inspired and taught us and from which this program is developed. We thank Gabrielle Cayoun for her assistance with figures, and Karen Cayoun and Dr. Glenn Bilsborrow for their reviews of drafts. We are also grateful to our colleagues and past clients for their permission to include their experience in the book, and to the entire team at Wiley for their patience and support. We would also like to express our gratitude to all mindfulness researchers who endeavor to remain true to the original teaching of mindfulness and provide an invaluable support to the clinical field and assist in the modern understanding of this ancient approach to cultivating well‐being.
The faculty of voluntarily bringing back a wandering attention, over and over again, is the very root of judgement, character and will. An education which should improve this faculty would be an education par excellence. But it is easier to define this ideal than to give practical instructions for bringing it about.
—William James, 1890
As we become more insightful in our therapeutic work, we progressively direct our interest to methods that best suit our personality and approach to life in general because we feel more at ease with these methods. Additionally, as we grow as human beings, becoming wiser over time, we choose what we believe are genuinely wholesome therapeutic tools. A wiser mind is more attracted to tools that promote wisdom, such as mindfulness. Since mindfulness is the art of being objective about subjectivity, many therapists from various disciplines choose to use mindfulness‐based interventions as their primary toolset.
Over the past 15 years, there has been a surge of interest and requests for training in mindfulness‐based therapies all around the globe. Among the most cited approaches that include mindfulness meditation are Mindfulness‐Based Stress Reduction (MBSR; Kabat‐Zinn, 2014) and Mindfulness‐Based Cognitive Behavior Therapy (MBCT; Segal, Williams & Teasdale, 2002), but there are many more. Some of these approaches are associated with a second generation of mindfulness‐based interventions, partly because they preserve skills that have been traditionally integral to mindfulness training, such as ethics and compassion training, and require extended education and mentoring (see Van Gordon, Shonin, & Griffiths, 2015, for detailed description). Second generation mindfulness‐based interventions include Mindfulness Based Symptoms Management (Monteiro & Musten, 2013), Meditation Awareness Training (Shonin, Van Gordon, Dunn, Singh, & Griffiths, 2014), Mindfulness‐Based Positive Behavior Support (Singh et al., 2014), Mindful Self‐Compassion (Neff & Germer, 2013), Compassion Focused Therapy (Gilbert, 2009), and Compassion Cultivation Training (Jazaieri et al., 2013).
Mindfulness‐integrated Cognitive Behavior Therapy or MiCBT (pronounced M‐I‐C‐B‐T) has become an important contributor to this growing field. Despite some inevitable overlap with other mindfulness programs, MiCBT differs in several key areas, which are discussed in Chapters 1 and 2. It offers a practical set of evidence‐based techniques derived from mindfulness training in the Burmese Vipassana tradition of Ledi Sayadaw (1965/1999), U Ba Khin (1995/2011) and Goenka (2000), and the principles of Cognitive Behavior Therapy (CBT) to address a broad range of psychological disorders. Its increasing popularity may be best attributed to its novel ability to address both crisis and chronic conditions as well as help prevent relapse.
This book reflects 17 years of effort to develop, implement, research and teach MiCBT as an efficacious transdiagnostic approach to address a wide range of conditions, including those with complex comorbidity. We have written this volume to offer therapists a trusted guide that informs and assists them in their group and individual applications of this unique approach, across a wide range of disorders. Two volumes have already been written on the topic. One was written for professionals with a focus on the scientific basis and mechanisms of action of MiCBT (Cayoun, 2011). The other (Cayoun, 2015) was written as a step‐by‐step self‐implementation to assist clients in therapy and provide an opportunity for the general public to use MiCBT for well‐being and personal growth. These books have since been translated in several languages and continue to be widely used. However, there was no comprehensive guide to assist therapists in clinical settings until now. This book was written to fill this gap and provide a detailed week‐by‐week implementation of MiCBT.
When our publisher suggested that we write a workbook for therapists, it was important to us that the book serve therapists in the best possible way, so we conducted a survey of 233 clinicians known to use or to be interested in using MiCBT as their primary approach to therapy, to probe their format preference. About 15 % preferred a book written for clinicians only, the large majority (74 %) responded in favor of a workbook for clinicians that includes information for clients as well, and 11 % didn’t mind. We went with the majority, which resulted in this book that guides both the therapist and their clients. This is because not all clients are able or willing to read, or can afford the self‐implementation guide (Cayoun, 2015)—although we highly recommend it if they can, as it has proven to be an excellent resource for clients undergoing MiCBT.
Part 1 of the book contains three chapters that will provide you with important information about MiCBT, including a clear explanation of its origins and development, its structure and content, the scientific underpinnings and empirical evidence. Part 2 of the book contains ten chapters, called “sessions” to fit with the delivery of the ten‐session program. It will guide you through the entire program, using an easy, conversational and engaging style which will encourage you to engage clients in the program. Your clients will learn about themselves in three complementary ways: through psychoeducation, through questioning their own views, and through their own experience. This clinical handbook contains precise guidance for each session, including suggestions on ways to overcome common difficulties, and worksheets and handouts that can be photocopied or downloaded and given to clients to assist them as they progress through the program. With this book, you and your clients are also given free access to the entire set of audio instructions for mindfulness training, which can be streamed online or downloaded in MP3 format. Appendix 2 also contains the scripts for these instructions, which include basic and more advanced methods given by the first author, an experienced Vipassana meditator and mindfulness teacher.
As you will notice, occasional references are made to Buddhist psychology and sometimes to the historical Buddha. The reason for this inclusion is simply good writing practice and ethics. One would expect responsible authors to include sources of their information, especially when the phenomena and methods they discuss are well established and documented. While some authors of mindfulness‐related books may not acknowledge the source of the teachings they discuss, we feel grateful for having received this rich source of knowledge and are bound by good and ethical academic practice. However, this does not make this book a “Buddhist” book, nor does it make MiCBT a “Buddhist” therapy. Irrespective of the place, culture, or period from which psychological frameworks originate, “Psychology is the science of mental life, both of its phenomena and of their conditions” (James, 1890, p. 1). In our perception, 2 + 2 = 4 for Buddhists, Christians or atheists. As long as the information is validated, we do not discriminate between cultures, and we are transparent about its source and original meaning. We hope that these occasional references to Buddhist psychology will be perceived in the light of our intention and will be a useful and enriching source of additional information.
This book is accompanied by a companion website:
www.wiley.com/go/Cayoun/Mindfulness‐integrated
The website includes: