The Four Steps
Mindfulness-integrated Cognitive behavior therapy, or MiCBT, teaches us two sets of skills. The first (Stage 1) involves paying attention to our inner experiences so that we can develop important personal skills. The second (Stages 2, 3 and 4) involves externalizing attention toward the outside world and applying our new skills with other people.
STEP 1: PERSONAL STAGE
In Stage 1, the personal stage, we learn mindfulness skills to manage attention and emotions through four modes of experience:
- bodily activities
- body sensations
- mental and emotional states, and
- mental content (such as thoughts and images).
We first learn to pay attention to our body’s posture, movements, and actions in the present moment and to relax potential muscle tension. This generally takes about a week. The following week, we learn skills to prevent ruminative, obsessive, catastrophic, and otherwise unhelpful ways of thinking. In the week after that, we learn to feel body sensations that continually interact with our thoughts to reduce our emotional reactivity. We learn skills that make it easy to let go of unhelpful thoughts and destructive emotional reactions.
Once these valuable skills have been developed, which takes approximately 4 weeks for most people, we are less distracted, our mind is more focused in the present, we are less likely to nurture unhelpful thoughts, sleep is generally improved, and we are markedly less emotionally reactive. We can then invest these personal skills into the second part of the program, which involves three more stages. During these three stages, we address challenges important to you.
STEP 2: EXPOSURE STAGE
In Stage 2, we learn to overcome the anxiety and fear that prevent us from taking action, particularly in situations we need to address. For example, we may have learned over time to avoid anxiety-provoking situations such as socializing, driving in the city centre, meeting colleagues for coffee at work, speaking to family members, or looking for a job. Of course, we may also be experiencing pronounced avoidant behaviour if we have a psychological condition, such as a specific phobia or post-traumatic stress disorder. The act of overcoming such avoidant habits instils a huge amount of self-confidence, allowing us to enjoy situations we may previously have avoided.
STEP 3: INTERPERSONAL STAGE
By the end of Stage 2, we have acquired sufficient skills to begin Stage 3, where we apply mindful exposure skills to address difficult situations with people. In Stage 1, we learned not to react to our own thoughts and emotions; in Stage 3, we learn not to react to others’ reactivity. We learn proficient interpersonal skills, such as assertive communication and interpersonal insight, which increase our patience and tolerance in difficult interactions with people. We begin to understand the reasons why people react emotionally and in the ways that they do on a deeper level, paving the way for compassion. Learning these interpersonal skills enhances the genuineness and friendliness in our relationships.
STEP 4: EMPATHIC STAGE
Finally, in Stage 4, we externalize attention further outward toward others and learn to remain objective about the true nature of their reactivity and suffering. We develop compassion instead of reacting to their reactivity. At this stage, the problems we targeted before starting the program seem very small, and we see what is truly important in our life. Warmth and kindness are developed sufficiently to make us feel connected to others and ourselves. Our choice of action is increasingly mindful. We think twice about performing an action that may be harmful to ourselves or someone else. Being kind to ourselves and others is central to this stage. We can now effortlessly make important decisions, decisions that can change existing relationships or initiate new ones, or even start a new kind of life, a life you never thought possible.