The Clinical Handbook of Mindfulness-integrated Cognitive Behavior Therapy

The essential guide to MiCBT for therapists working in clinical settings

The Clinical Handbook of Mindfulness-integrated Cognitive Behavior Therapy offers therapists working in clinical settings a practical set of evidence-based techniques derived from mindfulness (vipassana) training and the principles of Cognitive Behavior Therapy. The increasing popularity of Mindfulness-integrated Cognitive Behavior Therapy (MiCBT) is principally attributed to its transdiagnostic applications. It offers novel tools that address a broad range of psychological disorders both acute and chronic, including those with complex comorbidities, and helps prevent relapse.

The authoritative guide to this unique approach includes:

• A clear explanation of MiCBT’s origins and development, structure and content, scientific underpinnings and supporting empirical evidence
• A comprehensive guide to the 10-session MiCBT program for groups and individual clients that includes worksheets and handouts for each session and suggestions to overcome common difficulties
• A presentation of the research and practical experience of the authors, noted experts in the field of MiCBT

Written for mental health therapists working with groups and individual clients, The Clinical Handbook of Mindfulness-integrated Cognitive Behavior Therapy offers an effective guide for implementing the principles of MiCBT within their professional practice.

About the Authors xiv

Foreword xvi

Acknowledgments xviii

Introduction xix

About the Companion Website xxiii

Part 1 The MiCBT Approach, Theory and Validation 1

1 Principles of MiCBT 3

Definition and Purpose of Mindfulness 3

Origin and Development 5

Basic Principles 7

Structure and Content of MiCBT: The Four Stages 11

References 19

2 Theoretical Framework and Empirical Findings 23

The Co‐emergence Model of Reinforcement: A Rationale for MiCBT 24

Empirical Evidence 32

References 35

3 Preparing for Implementation 40

Importance of Commitment 40

Helpful Attitudes 42

Program Delivery 46

Client Suitability and Contraindications 46

Professional Training and Ethics 47

Resources 49

References 50

Part 2 Step-by-Step Application 53

Session 1: Therapy Contract and Commitment to Self‐Care 55

Writing a “Therapy Contract” 55

Readiness for Change 57

Three Ways of Learning 58

Importance of Neuroplasticity 62

This Week’s Practice 62

Application with Individual Clients 64

Application with Groups 67

Frequently Asked Questions 71

References 84

Session 2: Regulating Attention Through Mindfulness of Breath 85

Introduction 85

Checking Client Readiness 85

Purpose of Mindfulness of Breath 86

Practice Set‐up 87

Differentiating Mindfulness from Attentiveness 92

Normalizing Intrusive Thoughts 93

Application with Individual Clients 97

Application with Groups 100

Frequently Asked Questions 104

References 115

Session 3: Understanding and Regulating Emotions 117

Introduction 117

Checking Client Readiness 117

Mindfulness of Body Sensations 118

The Main Purpose of Learning Body Scanning 120

Implications of Co‐emergence Effects 122

Explaining the Co‐emergence Model of Reinforcement 123

Experiential Explanation of the Co‐Emergence Model 125

Example of Use of the Diary of Reactive Habits 126

Mindfulness of Body Sensation Through “Body Scanning” 127

Application with Individual Clients 129

Application with Groups 131

Frequently Asked Questions 133

References 145

Session 4: Applied Practice and Skill Transfer 147

Introduction 147

Checking Client Readiness 147

Increasing Practice Efficacy 148

Effects of Body Scanning on the Development of Insight 152

Applying the Practice and Recording Equanimity 153

Application with Individual Clients 156

Application with Groups 158

Frequently Asked Questions 160

References 173

Session 5: Integrating Mindfulness and Behavioral Methods 174

Introduction 174

Checking Client Readiness 175

Advanced Scanning: Symmetrical Scanning 176

Integrating Mindfulness with Exposure Skills 178

Application with Individual Clients 186

Application with Groups 188

Frequently Asked Questions 191

References 203

Session 6: Generalizing Self‐Confidence and Self‐Efficacy 204

Introduction 204

Checking Client Readiness 204

Advanced Scanning: Partial Sweeping 206

Extending the Integration of Mindfulness and Exposure: Bipolar and in‐vivo Exposure 209

Application with Individual Clients 212

Application with Groups 214

Frequently Asked Questions 216

References 228

Session 7: Developing Interpersonal Insight 229

Introduction 229

Checking Client Readiness 229

Advanced Scanning: Sweeping en masse 230

Integrating Mindfulness with Interpersonal Skills 234

Experiential Ownership 235

Application with Individual Clients 240

Application with Groups 241

Frequently Asked Questions 243

References 254

Session 8: Mindful Communication Skills 255

Introduction 255

Checking Client Readiness 255

Advanced Scanning: Transversal Scanning 256

Assertive Communication 258

Mindful Assertiveness 261

Mindful Assertiveness and the Co‐emergence Model 264

Application with Individual Clients 265

Applications with Groups 266

Frequently Asked Questions 267

References 276

Session 9: Cultivating Compassion and Connectedness 277

Introduction 277

Checking Client Readiness 278

Advanced Scanning: Sweeping in Depth 279

Cultivating Interpersonal Connectedness and Compassion 280

Loving‐Kindness Meditation 283

Grounding Compassion in Ethical Conduct 286

Practicing the Five Ethical Challenges 288

Application with Individual Clients 290

Application with Groups 292

Frequently Asked Questions 294

References 303

Session 10: Promoting Well‐Being and Outgrowing Suffering 305

Introduction 305

Checking Client Progress 305

Assessing Results 307

Supporting Personal Growth: Ten Maturing Factors 309

Maintenance of Mindfulness Practice 310

Application with Individual Clients 312

Application with Groups 313

References 318

Part 3 Summary Checklists and MiCBT Scripts 319

Appendix 1: Summaries of Weekly Content 321

Session 1: Summary of weekly content—individuals 321

Session 1: Summary of weekly content—groups 322

Session 2: Summary of weekly content—individuals 323

Session 2: Summary of weekly content—groups 324

Session 3: Summary of weekly content—individuals 324

Session 3: Summary of weekly content—groups 325

Session 4: Summary of weekly content—individuals 326

Session 4: Summary of weekly content—groups 327

Session 5: Summary of weekly content—individuals 327

Session 5: Summary of weekly content—groups 328

Session 6: Summary of weekly content—individuals 329

Session 6: Summary of weekly content—groups 329

Session 7: Summary of weekly content—individuals 330

Session 7: Summary of weekly content—groups 330

Session 8: Summary of weekly content—individuals 331

Session 8: Summary of weekly content—groups 332

Session 9: Summary of weekly content—individuals 333

Session 9: Summary of weekly content—groups 334

Session 10: Summary of weekly content—individuals 334

Session 10: Summary of weekly content—groups 335

Appendix 2: Audio Instruction Scripts for Therapists 337

Guidelines for Therapists 337

General Introduction 337

Rationale for Mindfulness Training 338

Introduction to Progressive Muscle Relaxation Script (Session 1) 340

Progressive Muscle Relaxation Script (Session 1) 340

Introduction to Mindfulness of Breath Script (Session 2) 342

Mindfulness of Breath Script (Session 2) 342

Introduction to Part‐by‐Part Body Scanning Script (Session 3) 344

Part‐by‐Part Body Scanning Script (Session 3) 344

Withdrawing Audio Instructions Script (Session 4) 347

Introduction to Advanced Scanning Script (Session 5) 348

Symmetrical Scanning Script (Session 5) 348

Introduction to Partial Sweeping Script (Session 6) 349

Partial Sweeping Script (Session 6) 349

Introduction to Sweeping en masse Script (Session 7) 350

Sweeping en masse Script (Session 7) 351

Introduction to Transversal Scanning Script (Session 8) 352

Transversal Scanning Script (Session 8) 352

Note on Session 9 353

Introduction to Loving‐Kindness Meditation Script (Session 9) 353

Loving‐Kindness Meditation Script (Session 9) 354

Index 356

BRUNO A. CAYOUN is a clinical psychologist, researcher and the developer of Mindfulness-integrated Cognitive Behavior Therapy. He is the founder and Director of the MiCBT Institute.

SARAH E. FRANCIS is a registered psychologist trained in a number of mindfulness-based therapies. She specializes in the research and clinical applications of Mindfulness-integrated Cognitive Behavior Therapy.

ALICE G. SHIRES is a clinical psychologist and Director of the Psychology Clinic at the Graduate School of Health, University of Technology, Sydney (UTS) and heads the UTS Mindfulness Integrated Therapies Research Clinic.

THE ESSENTIAL GUIDE TO MiCBT FOR THERAPISTS WORKING IN CLINICAL SETTINGS

The Clinical Handbook of Mindfulness-integrated Cognitive Behavior Therapy offers therapists working in clinical settings a practical set of evidence-based techniques derived from mindfulness (vipassana) training and the principles of Cognitive Behavior Therapy. The increasing popularity of Mindfulness-integrated Cognitive Behavior Therapy (MiCBT) is principally attributed to its transdiagnostic applications. It offers novel tools that address a broad range of psychological disorders both acute and chronic, including those with complex comorbidities, and helps prevent relapse.

The authoritative guide to this unique approach includes:

• A clear explanation of MiCBT's origins and development, structure and content, scientific underpinnings and supporting empirical evidence
• A comprehensive guide to the 10-session MiCBT program for groups and individual clients that includes worksheets and handouts for each session and suggestions to overcome common difficulties
• A presentation of the research and practical experience of the authors, noted experts in the field of MiCBT

Written for mental health therapists working with groups and individual clients, The Clinical Handbook of Mindfulness-integrated Cognitive Behavior Therapy offers an effective guide for implementing the principles of MiCBT within their professional practice. The text is accompanied by online resources, including free downloads of full-size client handouts and audio instructions for the practice of mindfulness meditations.

"Mindfulness-integrated CBT has made a unique contribution to evidence-based approaches in health care. 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." —Professor Mark Williams, PhD, Emeritus Professor of Clinical Psychology, University of Oxford, Co-author of Mindfulness-based Cognitive Therapy for Depression

"This important work is a masterful integration of mindfulness meditation training and clinical science for individual and group therapy. The authors explain the theoretical foundation of MiCBT, followed by generous, session-by- session instructions for every aspect of treatment. MiCBT is an innovative, transdiagnostic approach to clinical care that will surely inspire and inform clinicians for years to come." —Christopher Germer, PhD, Lecturer, Harvard Medical School, Author of The Mindful Path to Self-Compassion, Co-editor of Mindfulness and Psychotherapy

"MiCBT integrates the principal evidence-based methods of traditional CBT with mindfulness meditation with seamless grace. I highly recommend this comprehensive and helpful clinical handbook to mental health professionals." —Shauna Shapiro, PhD, Professor of counseling psychology, Santa Clara University, Co-author of The art and science of mindfulness and Mindful Discipline

“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 Dr.'s 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 Behavioural 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 a 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