The TAO: Mindfulness-Based Cognitive Behavior Therapy

THE TAO
Mindfulness-Based Cognitive-Behavior Therapy

When everyone recognizes beauty as beautiful, there is already ugliness;
When everyone recognizes goodness as good, there is already evil;
"To be" and "not to be" arise mutually;
Difficult and easy are mutually realized;
Long and short are mutually contrasted;
High and low are mutually posited;
Before and after are in mutual sequence.
-Lao Tzu

The origins of "mindfulness" have its roots in Eastern thought. The Chinese term it
"Taoism". The Japanese term it "Zen". Some have associated it with the practice of
yoga, and others have associated it with the religion of Buddhism. However, Tao in its
purest sense is not religion or philosophy; nor is it psychology or a type of science.
Simply put, Tao is a way and view of life. Then what is mindfulness? Mindfulness is part
of that way of life to reduce suffering.

All things in the world come from being. And being comes from non-being. -Lao Tzu

This is the essence of what we have come to know today as mindfulness. Learning to
let go and be without thought, without judgment, without mind. So, the word
"mindfulness" actually contradicts, in its literal sense, the essence of The Way.
Moreover, the English word "mindlessness" isn't any better. This of course is a topic for
a completely different article.

How do you let go? By being in the present moment. For many of us, that is easier said
than done. Instead, we waste our time either ruminating over past mistakes or worrying
about future catastrophes. We can't change the past. So why live in it? There are no
guarantees for the future. So why jump to conclusions? Of course it is intelligent to plan
for the future. It is also smart to learn from our past mistakes. However, it is irrational to
worry about that which we have no control - e.g., the past and the future. Living in the
"now" allows us to be present, mindful, and experience the passing of time. Whatever
emotion or thought you are experiencing, whether positive or negative, over time, has to
pass. The moment you read these words has just passed. Try to hold onto it... You
can't. The moment you read THESE words has passed again. And so on and so forth.

This is what is meant by "This too shall pass." Every moment is moving toward the next
moment. Being present in THIS moment as it occurs leads to mindfulness.

In Cognitive-Behavior Therapy (CBT), this is coined the "process of habituation". The
passage of time allows our triggered fight-or-flight response to exhaust itself.
Remember that classic saber tooth example? How long do you think your motors can
keep you running or fighting? Until exhaustion or, as we call it in CBT, habituation
occurs. Or until you become the saber tooth's lunch. Whichever comes first. So, if you
are feeling anxious with fearful thoughts, this will pass. Similarly, if you are feeling joy
with happy thoughts, this too will pass. Whatever it is, it has to pass. No one thing can
ever be static. Everything evolves and passes. And time cannot be recycled.

How do you attain mindfulness? There is no definitive "achievement" of mindfulness,
especially when the essence of it is to empty your mind. Mindfulness is just a state of
being. Many of us are often consumed with "doing" rather than "being". Our society
today is so busy doing, doing, doing that we rarely take the time to sit and simply be and
absorb our environment. After all we are called "human beings" and not "human
doings". How often have you met someone new and were asked, "What do you do?"
When someone asks, "How are you?" how often have you responded with, "I just am."?
When you respond with "I am fine." or "I am upset." you are basically adding judgment
to your statement. Judgments of good and bad always leave an aftertaste of
unnecessary emotions. However, since our society cannot do without such judgments, it
is important to recognize and be mindful that one cannot exist without the other. With
good, comes bad. Without bad, one will not comprehend what is good. In CBT, it is
fundamental to identify these black-and-white irrational judgments, and reappraise the
situation accurately so that it is representative of reality. These all-or-nothing cognitive
distortions keep us from perceiving our experiences for what they actually are. All-or-
nothing thinking is only one of many cognitive distortions that keep us from being
mindfully aware of reality. The reader is referred to Greenberger & Padesky's "Mind
over Mood" to learn about other various types of cognitive distortions.

In working with anxiety, worry and fear along with all its uncertainties keep you either in
the past or the future, and has a domino effect. One negative thought typically triggers
another and another and yet another. And more often than not, these negative thoughts
consist of cognitive distortions in various forms. Before you realize it, your mind is
spiraling into a tornado of irrational thoughts. Because mindfulness requires you to be in
the present, it allows you the opportunity to quickly identify these negative thoughts.
Imagine having the ability to stop a distorted thought in its track before it spirals out of
control. Being aware of these mental connections allow you to interrupt negative
thought cycles. The goal is to identify the cognitive distortions and revalue them to
represent reality accurately. So when you are feeling anxious, instead of getting caught
up in those negative thoughts of the past or future, just stay with the present moment.
Rather than giving more meaning to the distorted thought than what it's worth or
appraising the unnecessary emotion with more value than what it's worth, focus on the
now to let time pass and habituation occur.

In my practice, there are a number of mindfulness methods I've integrated with
traditional CBT. In the essence of time, I will review a few of the most concrete ones
here. First and foremost, in beginning mindfulness meditations, I instruct patients to
imagine viewing themselves from a bird's eye perspective. The emphasis is to be
mindful of each of the 5 senses (visual, auditory, olfactory, taste, tactile) individually,
until the patient is able to incorporate all 5 senses together. Many patients beginning
mindfulness practice falsely believe that mindfulness meditation is a relaxing technique
where your mind is free to wander off to Never Never Land. Unlike this popular belief, it
actually takes concerted effort to empty your mind, and allow your 5 senses to absorb
your surroundings to keep you in the present. Try to take 60 seconds for a super quick
mindfulness meditation, and you'll realize just how easily your mind enjoys wandering
off to another world. To assist in this training, patients are also instructed to practice
mindfulness eating and mindfulness walking. The goal is to engage slowly in only one
activity at a time, while being mindful of all 5 senses in the process.

One of the more tangible elements of mindfulness training is what I call the "Shoulds
and Buts". Both of these words have a negative connotation and, as such, don't deserve
a rightful place in our vocabulary. "Should" is a conditional word used to express
expectations, criticisms, and judgments. Whether you are "should'ing" yourself, others,
a situation, or even an inanimate object, you are pointing a finger, criticizing in some
manner, and triggering a negative feeling. Just try it and experience what you feel
afterwards. The word "but" negates everything said before its placement, and is often
used as a defense or an excuse. For example, "Johnny, you did a great job on this
project, BUT you left out this detail." If you are going to negate what you say, then why
say it to begin with? In fact, as you become more mindful of the word "but," you'll be
amazed at how often the word is used illogically in all sorts of placement within a
sentence. Since these words are virtually unnecessary, why not increase our
mindfulness of their occurrences by scratching them from our vocabulary altogether?
LITERALLY. I have my patients carry around a pocket-sized notepad scratching an ‘X'
for each "should" and "but" they say aloud or even think quietly. Like any true CBT
practitioner who measures just about everything, my patients are instructed to tally all
the ‘Xs' each day with the goal of seeing a gradual decline in the ‘Xs' and usage of
these words.

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Narrative writing is a very powerful mindfulness training that incorporates the process of
exposures. This exercise requires patients to write about their feared situations.
Exposures via writing require the highest level of cognitive functioning. Unlike visual or
auditory processing that comes and goes, when we write we make a concerted effort to
mindfully process our thoughts before externalizing them onto paper. This is infinitely
more effective. Even if a patient exposes to a feared situation in vivo, s/he can avoid or
escape the anxiety-provoking situation mentally. However, it takes much more effort to
avoid when you have to be cognitive and mindful of your writing. To increase
mindfulness, the rules of narrative writing include: 1) staying in the present moment by
using present tense; 2) using active versus passive verbs; 3) being as descriptive and
detailed as possible. The patient is instructed to continue the narrative writing exposure and stay in the moment with whatever emotions or thoughts that arise until habituation
occur.

Finally, the "oh well" method encourages us to let go of those situations that are outside
of our control, which I must say occur more often than not. Certainty and control give us
a false sense of security. Not only do we not have control over people, objects, and
situations outside of ourselves, the truth of the matter is that we do not even have direct
control over our own emotions or what thoughts enter and exit our minds. We only have
control over our behaviors, which include our actions and reactions to those thoughts
and emotions. If we are mindful of this fact and accept it, then we will not have a need to
control those areas outside of our behaviors, and be able to let go of situations outside
of our control. So, the next time you are stuck in traffic, "oh well" it since there is really
nothing you can do in that very moment. Rather than working up a frenzy of one
negative thought after another, just breathe and empty your mind. Let's face it, those
negative thoughts aren't doing your mind or body any good anyways.