Mindfulness is a useful addition or alternative to Cognitive Behavioural Therapy (CBT) when treating depression and is largely based on Buddhist and other religious practices. It was introduced by Jon Kabat-Zinn in 1990, and there is currently a lot of evidence to support the efficacy of the use of mindfulness, among other third-wave approaches to therapy (Hunot et al., 2012). These approaches target the emotional response to a situation, focusing primarily on the function of cognitions, and contrast with traditional CBT which links thoughts, feelings, and behavior. Rather than target the response to a situation, CBT targets the situation that triggers the response, thereby focusing on changing the content of cognitions (Hunot et al., 2012).
CBT has been used successfully for both children and elderly adults. Although it can be used to treat a wide range of psychiatric disorders, the strongest support exists for anxiety disorders, somatoform disorders, bulimia, anger control problems and general stress (Hofmann et al., 2012). CBT is seen as being a cost-effective therapy, mainly because it is a short to medium-term intervention and due to the structure of cognitive therapy, much can be achieved in the 45-minute sessions (Wedding & Corsini, 2019).
The degree to which CBT is effective depends largely on the experience and expertise of the therapist (Wedding & Corsini, 2019). The efficacy of CBT can be enhanced when significant others are included in a therapy session (Wedding & Corsini, 2019). Family and friends can help sustain behavioural improvements by assisting the person with reality testing and encouraging homework. This is particularly applicable in a country like South Africa, where the African culture subscribes to a philosophy of Ubuntu and community belonging. The traditional black person exists not as an individual but as a part of a larger group, and functions in codependent relationships within this group.
Mindfulness can be helpful in treating depression, and treatment would include attending a group-skills training programme and performing regular mindfulness exercises. This approach is recommended specifically for preventing depression in people who have had three or more episodes to address vulnerability between episodes of recurrent major depression (Williams et al., 2008).
A trained counsellor can use CBT to help a person who is vulnerable to depression by targeting their automatic thoughts and examining the cognitive schemas and vulnerabilities that influence the way they process information. Treatment would entail replacing the automatic responses with deliberate thinking, conscious goal-setting, problem-solving and future planning. The client can be encouraged to look at experiences they have had in the past that can be linked to their current misperceptions and beliefs and test the reality of their perceptions by evaluating the conclusions reached. This would hopefully reduce the cognitive distortion of information and allow a shift in the information so that they can evaluate the events in a more balanced and neutral way.
It is important for the client to differentiate between thinking that is based on reality, versus distorted cognitions. It is not simply about replacing negative thoughts with positive ones (Wedding & Corsini, 2019). Usually, the client will need to acknowledge that although there are real problems that are not imaginary, the biased perspective is preventing them from finding solutions to their problems and limiting their range of response (Wedding & Corsini, 2019). Deactivation can occur through distraction or reassurance, but lasting change only occurs with the modification of the core beliefs that promote faulty conclusions (Wedding & Corsini, 2019).
Core beliefs should be tested for validity and adaptiveness and when dysfunctional, can be replaced with a new set of beliefs. In this way the counsellor can help the client to use a new set of skills that will hopefully become more natural, involuntary and automatic over time and with practice. Other CBT techniques that can be used are more focused on behaviour, which is where mindfulness-based therapy would be useful.
There are numerous mindfulness-based training programs available in South Africa. Jan van Zyl is a church pastor in Stellenbosch, who presents an 8-week course on Mindful-Based Stress Reduction (MBSR) based on work by Jon Kabat-Zinn, MBSR program founder and creator of the MBSR curriculum. Alternatively, The Mindful Way Workbook (Teasdale, J. et al., 2014) is a book and CD containing an 8-week program designed to help you free yourself from depression and emotional distress. There are also free mindfulness courses available online (https://caring-mindfulness.thinkific.com).
Mindfulness is a way of life, and it is important to continue the practice with regular meditation. MBCT emphasizes living in the present moment without judging the situation (Wedding & Corsini, 2019). A mindfulness course can help a client not to engage in an intricate mental debate with their thoughts, but to rather see them as fleeting and impermanent. Clients can realize that their thoughts are part of the depression and that they are neither adaptive nor a reflection of the true situation or a part of who they are. The client-directed counsellor can be a guide and perhaps a catalyst for change, but lasting change is achieved when the client can independently apply skills they have acquired in therapy. CBT teaches cognitive skills that, when linked with continued mindfulness practice, provides hope for a possible complete cure for depression and other disorders.
Author: Lisa Kirsch
Corsini, D. & Corsini, R.J. (2019). Current Psychotherapies. Brooks/Cole Cengage Learning
Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. In Cognitive Therapy and Research (Vol. 36, Issue 5, pp. 427–440). Springer New York LLC. https://doi.org/10.1007/s10608-012-9476-1
Hunot, V., Moore, T. H., Caldwell, D., Davies, P., Jones, H., Lewis, G., & Churchill, R. (2012). Mindfulness-based “third wave” cognitive and behavioural therapies versus other psychological therapies for depression Europe PMC Funders Group.
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