Towards case-specific applications of mindfulness-based cognitive-behavioural therapies: A mindfulness-based rational emotive behaviour therapy

Abstract

Teasdale, Segal and Williams (2003) present the combination of mindfulness and cognitive-behavioural therapy as “one of the most exciting and potentially productive avenues for future exploration.” (p. 160). In the same paper they also recommend moving beyond the current general-purpose, non-case-specific applications of mindfulness (p. 157). By integrating mindfulness interventions more closely with cognitive behavioural theories, clinicians should be in a better position to administer tailor-made mindfulness-based interventions in response to specific case formulations. This paper examines important similarities and differences between mindfulness and Rational-Emotive Behaviour Therapy (REBT), in view of integrating the two practices closely within a one-on-one counselling environment. The latter half of the paper then presents recommendations of how such integration might be achieved in practice. This is illustrated with examples of three new interventions that combine mindfulness with three specific types of cognitive dysfunction as per REBT.

Keywords:

• Mindfulness
• cognitive-behavioural therapy
• Rational-emotive behaviour therapy

Notes

Notes

[1] These are: Mindfulness-Based Stress Reduction (MBSR; Kabat-Zinn, 1990), Mindfulness-Based Cognitive Therapy (MBCT; Teasdale et al., 1995), Dialectal behavioural therapy (DBT; Linehan, 1993), Acceptance Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999), and Relapse Prevention (RP; Martlatt & Gordon, 1985).

[2] Defined as ‘Strong and frequent conviction that an irrational belief is false and a rational belief is true” (Neenan & Dryden, 2004). At this level of belief a client not only understands the value of rational beliefs intellectually. The client may report he feels the truth of rational and irrational thinking in his “heart” as well as his head.

[3] In this model Cayoun (2005) also argues that the shift of focus from evaluative processing to perception, enables the client to observe potentially overwhelming private events while they are still manageable. Cayoun suggests this is an important part of the process, and that self-efficacy arises from this alone.

[4] Gerbode is the founder of a mindfulness-based therapeutic approach known as applied metapsychology. Among other things this approach consists of concept-focused, meta-cognitive and meta-emotive techniques that are tailored to specific case-formulations and client resources.

[5] “Might” is used because it makes the exercise easier to do. It removes the pressure to have a sure answer to this question. Mere possibilities of feeling are acceptable as answers. These “mere possibilities” can often relate to the finer sensations that are barely perceivable to the client.

[6] Frustrations the client chooses can be actual frustrations the client has experienced or hypothetical experiences the client has never experienced in reality. It may be necessary to explain that hypothetical frustrations are ok to some clients, particularly if they struggle to come up with many frustrations. This point is as relevant to parts 2 and 4 of this technique too.

[7] Alternative wordings for the word “bear” are “tolerate”, “face”, “comfortably face” and “put up with”. Different clients may engage better with different wordings (c.f. dimensional congruence with the client's experience (Cayoun, 2003; p. 45).

[8] “How did you want things to be in this situation?” might be an easier wording for some clients.