Recenter. Reprogram. Recover.
Learn more about how one of our therapists, Ray, integrates mindfulness and attachment into his trauma-informed psychotherapeutic approach.
Mindfulness-based cognitive therapy (MBCT) is a treatment for eating disorders that is born from the union of techniques in cognitive behavioral therapy (CBT) and strategies that promote mindfulness.
Interweaving these two effective approaches in the form of MBCT helps patients to better understand and manage their own thoughts and emotions, so that they can eventually free themselves from their eating disorder or disordered eating patterns.
Mindfulness-based cognitive therapy is a recently developed, yet highly effective therapy that relies on two well-established evidence-based therapeutic approaches. First is CBT, which serves to empower patients to recognize their negative thought patterns and replace them with healthier and more realistic thoughts. The second is mindfulness, which essentially refers to being fully present in every moment and accepting reality as it is.
Here at ‘Ai Pono Hawaii, our team of highly skilled and experienced therapists are well equipped to provide effective mindfulness based cognitive therapy for eating disorders. Located in Maui, our eating disorder treatment center has over three decades of experience in treating a wide variety of eating disorders and related conditions.
MBCT is a relatively new therapy. As a mindfulness-based intervention, it is regarded as a third-generation or “third-wave” of cognitive-behavioral therapy.
In recent decades, there has been a growing interest in using mindfulness-based behavioral therapy to treat a variety of eating disorders. Besides mindfulness-based cognitive therapy (MBCT), the list of such interventions also includes dialectical behavior therapy (DBT), mindfulness-based eating awareness training (MB-EAT), acceptance and commitment therapy (ACT), and mindfulness-action based cognitive–behavioral therapy (MACBT).
In general, these recent interventions are categorized as mindfulness-based because they specifically promote mindfulness—openly and fully experiencing the present experience with purpose—and not necessarily because they involve formally practicing mindfulness meditation. These interventions likewise don’t focus on cultivating mindfulness in and of itself, but harness mindfulness as a means of improving a person’s wellbeing as part of a holistic treatment and recovery approach.
As a modified form of CBT, MBCT incorporates mindfulness practices such as present moment awareness, breathing exercises, and meditation. It was originally developed in the 1990s by Zindel Segal, Mark Williams, and John Teasdale to prevent patients from relapsing into depression.
MBCT is largely rooted in the earlier work of Jon Kabat-Zinn, as well as John Teasdale's and Phillip Barnard's interactive cognitive subsystems (ICS) model. Kabat-Zinn developed the mindfulness-based stress reduction (MBSR) program, an 8-week program for helping patients manage the physical and mental effects of their various health concerns.
Meanwhile, in the ICS model, the mind is believed to have different modes for receiving and processing data; the two main ones are the “doing” and “being” mode. Mental health is regarded as dependent on a person’s ability to detach from one mode and move between the other modes, based on what’s surrounding the person. MBCT considers the “being” mode as beneficial for promoting enduring emotional change, especially among people who suffer from depressive episodes.
Researchers have seen the benefits of MBCT in a variety of clinical populations—such as patients with chronic pain, cancer, diabetes, epilepsy, and fibromyalgia. It has been shown to be effective not only in its original goal of preventing relapse of major depression, but also in improving a number of mental health conditions, including anxiety disorder, obsessive-compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD), psychosis, bipolar disorder, various addictions, and of course, eating disorders.
In particular, researchers have seen how MBCT and other mindfulness-based approaches on eating disorders led to positive results for patients who struggled with bulimia nervosa (BN), anorexia nervosa (AN), and binge-eating disorder (BED).
CBT has long been the treatment of choice for most eating disorders, particularly binge eating disorder and bulimia. CBT is a form of talk therapy that helps patients recognize unhelpful thoughts that negatively influence their emotions and behaviors.
One of the tenets of CBT is that people’s thoughts, feelings, and behaviors are all interconnected in what is called the cognitive triangle. With this in mind, CBT helps patients reframe their thoughts in order to improve their resulting feelings and behaviors. As a treatment for eating disorders, CBT primarily focuses on helping patients address irrational thoughts and feelings about their weight and body shape, which may lead to their disordered eating behaviors.
Meanwhile, mindfulness is the practice of directing one’s attention to the present moment in an accepting manner without making any judgments on that experience. Mindfulness meditation has been proven as an effective psychotherapeutic treatment for anxiety and stress. Mindfulness-based interventions (MBIs)—which include meditation—have helped patients who are struggling with various eating disorders, such as binge eating, emotional eating, and overeating.
Together, this integration of CBT and mindfulness into MBCT results in a potent therapy that takes care of the whole person, and not just their physical or mental health. Since it addresses both the mind and body, MBCT is incredibly helpful to patients who are suffering from pain and chronic health conditions, enabling them to more effectively cope with their condition, and promoting their long-term health and wellness.
There are some major differences between CBT, MBSR, and MBCT:
First, MBCT puts together the cognitive approach of CBT and the mindfulness approach of MBSR, making it a one-of-a-kind treatment option.
CBT is usually considered a short-term individual therapy that doesn’t follow a strict timeline.
CBT focuses on helping patients acknowledge their thought patterns, so they can afterwards challenge and replace their dysfunctional beliefs.
MBCT also helps patients recognize such negative patterns; however, MBSR does not include this concept of thought replacement.
MBCT includes mindfulness to help patients learn how to regulate themselves.
Although CBT can include principles of mindfulness, it is not an essential element of this therapy.
MBCT is normally conducted as a group therapy, although it can also be done with a therapist in one-on-one sessions. It may be part of an intensive treatment protocol, or concepts of MBCT may be integrated into weekly group sessions in either a residential or outpatient treatment setting.
Homework assignments are standard, and these may require patients to listen to audio recordings, do breathing exercises, and practice mindful meditation in a comfortable place (usually their home). In addition, are encouraged to apply present-moment awareness in their daily routines, such as while preparing meals, eating, showering, or even just walking.
Just like in MBSR, patients are taught how to perform formal meditation techniques, how to do a body scan, and basic principles of cognition, such as how their thoughts affect their feelings. There is also a whole-day session that’s typically scheduled around the eighth week.
Unlike conventional CBT, mindfulness-based cognitive therapy for eating disorders has a unique focus on reducing maladaptive emotion regulation as well as optimizing mindfulness skills—both of which are effective and crucial means of treating disordered eating behaviors. Patients undergoing MBCT receive a treatment that focuses more on mindfulness and acceptance rather than change.
‘Ai Pono Hawaii’s treatment program includes a variety of mindfulness practices that promote nonjudgmental observation and acceptance of physical sensations, cognitions, perceptions, and emotions. We help our patients practice how to observe those with curiosity and interest, while accepting them as they are, without feeling the need to modify them or run away from them.
We teach our patients how to have a de-centered view of their thoughts: for example, thoughts are simply made up in their mind and not actual facts, and they are not their thoughts. We help them see that their thoughts are simply temporary mental ideas, and not parts of themselves nor accurate mirrors of reality. True to MBCT, our program includes just a few behavioral change strategies, like promoting engagement in activities that lead to feelings of pleasure or mastery and lessening activities that are linked with low mood.
Here in ‘Ai Pono Hawaii, our highly experienced therapists expertly guide patients in developing awareness of their internal physical state (such as when they’re already feeling full or hungry) as well as enhancing their self-compassion, self-acceptance, and flexibility.
The strong CBT component of MBCT helps our patients challenge and change their negative thoughts, which include worthlessness, shame, guilt, and others.
We teach them strategies in managing their emotions, rather than letting such emotions rule their life.
Through mindfulness techniques, we help patients become more aware of their body—including their physical sensations and emotions—without passing on judgment.
We teach patients cognitive concepts to help them get over their past traumas and envision a better future while living more fully in the present.
Our patients learn to catch themselves whenever they get distressing thoughts that threaten to spiral out of control. They learn to recognize when they’re having catastrophic thoughts and emotions, which previously led them to manifest their eating disorder. Using MBCT, we teach our patients how to break off those thought spirals through proper grounding in the precious present moment.
Through mindfulness, our patients develop better self-observation skills, allowing them to more accurately recognize their internal states and enhance their ability to use the right coping skills. For instance, they learn to recognize when they are feeling satiety and hunger. They also become more willing to feel negative emotions, which often triggered their disordered eating behaviors in the past.
MBCT is very helpful in enabling our patients to deal with the need to eat while simultaneously feeling as though they can emotionally manage this experience. We consider all meals and snacks to be therapeutic groups, and provide support before, during, and after all food-related groups and activities. . This includes removing distractions such as phones and computers, so that patients can realign with their bodies and minds and regia trust in their genuine hunger and fullness cues.
As a result, our patients gradually learn how to tolerate and even enjoy the process of nourishment and put an end to their dysfunctional reliance on food as a numbing agent or distraction from their negative thoughts or unmet needs.
Meditation: In this classic mindfulness practice, ‘Ai Pono Hawaii therapists teach patients how to use their breath as a guide to becoming fully present and attentive in the here and now.
Body scanning: In this technique, we guide patients to pay close attention to different parts of their body and observe the sensations in each body part without making any judgment.
Decentering/Non-attachment: Here, we teach patients how to separate themselves from the meaning of their thoughts and to simply note when that thought occurs. For example, rather than thinking, “I’m a lazy person,” they would instead think, “I’m getting the thought that I’m a lazy person.”
Daily mindfulness: We ask our patients to practice mindfulness in their daily routines, such as daily walks to the nearby beach, spending time in our garden, honing in on the sounds of nature or of a soundscape during Sound Therapy, and more.
Mindful movement: Gentle yoga can be an opportunity to practice mindfulness, but all kinds of movement (even simply walking or stretching) are opportunities also to reground and recenter in the body. We teach our patients to stay in the present and observe the different sensations they have while performing these movements.
‘Ai Pono Hawaii takes pride in having over 35 years of success in providing effective, long-term treatment to patients who struggle from eating disorders like Bulimia Nervosa, Anorexia Nervosa, Binge Eating Disorder, Avoidant/Restrictive Food Intake Disorder (ARFID), and others. We’ve also treated patients who suffered from Laxative Abuse, Night Eating Syndrome, Body Dysmorphia, Body Image Distortion, and similar conditions.
Our holistic treatment program—including MBCT—is individualized and developed with each patient’s optimal physical, emotional, psychological, social, and spiritual wellbeing in mind. Our kind, compassionate, and non-judgmental therapists guide patients in learning the principles of self-compassion for themselves.
We offer two distinct levels of care: intensive outpatient and residential. As part of these programs, facilitate individual, family, as well as group sessions, depending on the patient’s personalized treatment plan.
