What Happens in Mindfulness-Based Cognitive-Behavioral treatment for Post-Traumatic Stress Disorder (PTSD)?

November 25, 2013

A Mindfulness-Based Cognitive-Behavioral approach to Post-Traumatic Stress Disorder (PTSD) integrates components from two forms of treatment, Cognitive-Behavioral Therapy (CBT) and Mindfulness-Meditation techniques.

Briefly, CBT helps people to learn how they can control the thoughts (e.g., intrusive images, distressing beliefs), emotions (e.g., tension, fear), and actions (e.g., avoidance behaviors) that characterize PTSD. Specific procedures used in CBT include relaxation training, graduated exposure, and cognitive restructuring.

Relaxation training in CBT primarily involves controlled breathing, progressive muscle relaxation, and visualization. Clients learn the relaxation technique that works best for them, or some combination of techniques, and then practice the skill of relaxation until they are able to easily induce a state of complete relaxation.

Once the ability to relax has been learned, clients will very gradually be exposed to some of the thoughts, feelings, and situations that they have been trying to avoid. Initial exposure may be imaginal; for example, clients will imagine themselves in situations that are causing distress. Later actual (in-vivo) exposure may occur, although again in a gradual way. Graduated exposure is very effective for reducing unpleasant reactions to thoughts and events because exposure itself can lead to reduced distress and because clients can use their relaxation skills to manage their response to events.

A third important element in CBT is cognitive restructuring. Much distress is often caused by what we repeatedly say to ourselves that exacerbate rather than reduce our distress.  Through cognitive restructuring exercises, clients learn to accept unhelpful thoughts about themselves and the world as temporary mental events that may not be accurate.

Mindfulness-Based CBT enhances these methods with mindfulness practice designed to help clients become more aware of and more accepting of the unwanted thoughts and feelings associated with PTSD. Rather than responding strongly to these events and feeling compelled to take action, clients learn that these are natural consequences of traumatic experiences that often gain unwarranted control over people’s lives.

A major skill in achieving acceptance of unhelpful thoughts and feelings is to distance the self somewhat from these intense emotions and thoughts. Clients learn to recognize that they exist separate and largely independent of intrusive images and thoughts.  Such acceptance ultimately reduces the amount of distress produced by unhelpful thoughts and is more effective than fighting them.

Specific mindfulness techniques that help to produce this acceptance include Mindfulness of the External World, Body Scan, and Mindfulness of Difficult Thoughts. These exercises help clients to practice being fully in the present and to accept and notice with gentle curiosity their body and their mind in its comfort and discomfort.

I hope this brief introduction to Mindfulness-Based Cognitive Behavioral Treatment gives you some idea of the methods used to help clients with coping and ultimately reducing the distressing symptoms associated with PTSD.

Dr. Anastasia Barbopoulos, R. Psych.

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