From CBT to Mindfulness or MBCT

There are a multitude of therapeutic approaches that help decrease human distress and suffering. In this article I will talk about two that have been influential and successful in understanding and treating many mental health and quality of life issues. Both are based in a present moment orientation and represent a welcome joining of eastern and western thinking that continues to bring sorely needed understanding to the issue of human suffering.

In the late 1970’s, Dr. Aaron T. Beck popularized a cognitive psychological model based on his clinical observations. Beck’s simple but powerful idea was thoughts influence emotions and behavior.  This idea, while new to western psychological practice, was not new to humanity as a whole, Buddha observed it over 2500 years ago. This idea in Beck’s and other competent hands has shaped western conceptual and practical work with many mental health issues.

In his cognitive model, Beck states that thoughts can be, in whole or in part, wrong or distorted. Such distortions cause needless distress. He continues by saying that it is not a situation in and of itself that causes us to react in ways that cause us distress, but instead it is our thinking or attached meaning (thinking that includes a comprehensive structure of personal rules and beliefs) and our overall perception of the situation that causes the reaction. And finally, that our distress can be mediated by correcting distorted thinking, letting go of, or replacing non-useful thinking, or by switching to problem-solving if something tangible requires change.

As we continue to learn what works to helps people cope better with distress and suffering through experience, other methods continue to creatively evolve. The most recent in the evolution of psychological strategies that is influencing treatment is called mindfulness or mindfulness based cognitive therapy. Mindfulness-based treatments are borrowed from and are more in line with an enduring eastern spiritual notion that it is wiser to step outside of the flow of thinking, feeling, sensations, and urges and observe their very nature while being present to the experience from a less reactive perspective.

Being able to be less reactive to our constant flow of thinking and sensing provides us with much greater psychological flexibility.  We can learn to see rather than be our “thinking” and past learning when needed. While our brains work by designed to hold onto previous learning as fact we all experience the need to adjust old outdated so called “facts” that are wrong or have lost usefulness. We update information often in a wide range of areas from a belief in the tooth fairy to political views, religious views and if we are wise unhelpful and hurtful beliefs or views about ourselves and others.

Mindfulness, with practice, gives us the means to be able view our internal and external world objectively, to see and experience life more consistently as it is, to see beyond the error of previous learning.  It provides us the means to welcome the whole of our life experience with kindness, without judgment and outside of learned constructs as well.

This does not mean that thinking or conceptual understanding is unimportant. However, it does mean that thoughts are not facts and that while we cannot control having our thoughts, beliefs or just ignore conditioning, we can choose which thoughts and patterns are useful in our valued path in living in each new moment. In essence, we can learn to change our relationship with previous learning and the sense world that accompanies it.

Like mindfulness, Beck’s model is also based in a present moment orientation and is mindful, but focuses less on the overall nature of the way in which we relate to the mind and body as they function separately and in relationship to one another.

Beck focuses on the idea that a thought and belief can be wrong or distorted and when corrected rationally decreases distress.  While that is of course true and very useful mindfulness helps us experience thoughts and beliefs connected with a sophisticated interplay between sense experience and thinking and thinking and sense experience.

Further, mindfulness demonstrates through experience that our beliefs and conditioning, including sense experiences, act like a complete and fixed self. This idea of a fixed self can keep us stuck in harmful patterns.

In other words mindfulness can help us understand that our world of past experience does not reflect the whole of who we are.  Instead, a mindfulness practice can provide an increasing ability to be preset to this moment. It helps us become aware that past learning that appears as “fact” and can represent a smaller invention of self, the self that we believe we are, our ego if you will is not a true representation. This conceptual self or understanding that has been learned and/or conditioned developmentally does not reflect our true and complete nature, but instead reflects the thinking or doing minds summary evaluation of experience as self.

It has been my clinical experience over twenty years that applying socratic reasoning (rational questioning, the basic rational testing tool of cognitive therapy) to a person’s basic negative belief of self or core beliefs does not yield a satisfactory change in the relationship to underlying feelings, sensing and emotion.

When reality testing a core belief in treatment the person will say they “get it” but they don’t feel it. They understand that their thinking is wrong but they report that somehow they just feel “not as good as others” for instance. “No matter what I do I just can’t get past this feeling that I’m less than others.”It is not sufficient to limit our focus to repairing distorted thinking and relieving emotional distress in the short-term if a long-term durable change is ultimately what we are looking for.

Memories of experience are are not held in cognition only. Implicit memory (memory out of immediate awareness) is informed originally by sensation and the gestalt of the experience, if you will.  In other words, you feel all the senses dominant in the original experience coupled with thinking as a state of mind.  So, If feelings effect thinking and thinking effects feelings we must address the whole of the felt sense. Secondly we take thinking literally and use it as a direct and accurate reflection of “self” and accept thoughts, beliefs and conditioning in general as facts. As mentioned above, our mind takes our experiences in life and turns them into “who we believe we are.” The brain likes summarizing information into fixed conclusions.

A mindfulness perspective would support that we are not our thoughts, feelings and beliefs in a permanent way, but that it is the nature of the mind to come to summary evaluations. For instance, consider the thought:  I have been sad and depressed so often that I am just a depressed person. Does being depressed really make us unable to ever achieve an un-depressed moment?

If we experience something enough, our minds will consider the information “fact.” The brain efficiently makes summary evaluations to save energy among other reasons. It is helpful for our brain to link or chunk information when learning to drive a car so we can learn to be a “driver” but not at all helpful to take multiple failed behavior to describe the whole person as a “failure”.

Basically relearning concepts each time we are faced with an issue is vast use of energy and the brain likes to mold experience into repeatable useable “Fact”. Therefore, a concept (about self) can be held in the form of a  belief that acts like a fact or truth that influences choices in this moment. Beck would call this global reasoning and have us challenge this, rationally.

This rational challenge or socratic reasoning used in cognitive therapy would help us understand that people don’t completely fall in one or another category.  That if you have not been depressed even for a moment, that you have that ability to be “not depressed,” and therefore are not a totally depressed person. And, if you are sometimes are not depressed, then you have the ability to increase your non-depressed state with practice.

The rational, intellectual explanation does not seem to manage the intricate historical felt sense piece of the problem, however. People do feel better when they believe that they are not a totally depressed person at the moment of rational challenge. But the next time they feel sad if they have been feeling sad for a long time they will go down the old road of habit or conceptual self very quickly.

A mindfulness approach would see the idea of one’s whole self being depressed as a person’s belief or construct, as well, that is presenting as fact. But in actuality is not reflecting reality in this moment because this belief is a mental construct, simply the result of the way in which the mind learns.  It would note that self is infinitely larger than the elements of this construct, and that the construct also includes a sophisticated interaction between mind and body.

Helpful research in the 80’s shows us that in additions to our thoughts the body, our sensations and feelings play a significant part in influencing our thinking.  In fact there is an inescapable cyclic link between thinking, sensing and feeling.  If we try to understand and better manage our lives using only one element of this complex system we may be confounded by limited or short lived results as we see with conditions that tend to relapse or for individuals who do not respond at all to treatment.

Mindfulness provides a comprehensive means for personal objective introspection. It gives us a method for stepping outside of the constant flow of a full array of thinking, feeling and sensing and learn to become less reactive to our immediate perceptions of “reality” ( colored by conceptual understanding and conditioning) that may or may not be accurate to this new moment. We all possess the ability to experience awareness of our thinking and sensing.

In this regard a mindfulness practice produces more psychological flexibility. We are able to be aware of our internal and external world in a way that leads to a decrease in our immediate reaction to non-healthy patterns.  It is natural and normal in our culture to believe that you are what and who you think you are. Remember our mind does summary evaluation for convenance. If not managed, any previous learning can become our guide for this moment and lead us with information that is less than useful for this new moment and is active just out of our immediate awareness.

A committed mindfulness practice helps us become less reactive to the initial internal thought or feeling that presents itself as “fact”.  With practice we can learn that thoughts are not as solid and factual as they first appeared therefore allowing more space and time for thoughtful present oriented choice. A choice that is more in line with your personal value in this moment instead of a belief or pattern that we are reacting to automatically.

Remember this moment like the breathe is new-always but your learning, habits and patterns are not. With practice you can better see your internal process rather than automatically reacting to less than useful past learning, patterns and conditioning. Coming to know the very nature in which our brain and body operate in tandem that produces suffering can help release us from normal but distress producing mistakes of a misperception of reality. Mindfulness practice can help us recognize:

  • That emotions are a fusion of thoughts, feelings, impulses, and bodily sensations that together form a general “state of mind”. Emotions have a virtual reality felt sense that can be congruent to reality or not.
  • Feelings and emotions are not dangerous, in and of themselves, they are the result of a thought or image forming a perception of danger or reaction to real and present danger.
  • Thoughts can drive our mood and feelings and moods and feelings can drive our thoughts.
  • The mind does not exist in isolation and is exquisitely responsive to many body systems.
  • Affect, what shows on your face and your body in terms of posture, effects mood and mood effects thinking and body reactions-the relationship is cyclical and complex.
  • Trying to fix or get rid of an emotion with thinking traps us in the emotion.
  • Experiencing the emotion generally allows it to pass.
  • Examining the thought alone for error misses the complexity of the interaction between the mind and body.
  • We tend to depend on rational thinking to solve most problems in living leaving little acceptance for emotion, all of our sense perceptions and behavior as influences.
  • We can over time learn to be present with things as they are not as we want them to be.  We all have the ability to be with the whole of our experience of being just as we are.  This does not mean being complacent it means being fully alive in each moment.

I will talk a bit about the practical problems with trying to think a feeling away in the next article. Practice mindfulness!

With Kindness,


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