CBT: mindful moments – a five-minute mindfulness strategy

Summary

Mindfulness is increasingly being recommended to help patients with recurrent depression and anxiety stay well. However, current treatment recommendations ask a lot in terms of commitment, with around 100 hours of practice and learning over a 2-month period. There is therefore increased interest in approaches that deliver key mindfulness skills in a shorter time frame.

Key elements of the mindfulness approach

Central to mindfulness is the decision to bring full attention to the present moment without any sense of judgement about the self, the situation or the future. This is a skill that can be developed, nurtured and improved with practice.

When someone is experiencing low mood or stress, their experience is often dominated and overwhelmed by a confusing range of thoughts, fears, bodily sensations and the problems or challenges facing them. They feel overwhelmed and out of balance. In contrast to the predominant hypothesis-testing cognitive–behavioural therapy (CBT) approach (which suggests actively noticing and gathering thoughts, noticing vicious cycles and changing thoughts and behaviours helpfully), the mindfulness approach involves stepping back from all these experiences and instead making a choice to slow down and observe. To achieve this it uses a powerful tool – the mindful moment.

How to take a mindful moment

Patients can use the following simple instructions on taking a mindful moment.

1. 1 Slow down.

2. 2 Focus all your attention on your breathing – let all other sensations, thoughts and emotions take second place. This breaks cycles of rumination, self-criticism and distress.

3. 3 Choose to notice any sensations in the body – anything that stands out (e.g. tense shoulders). Taking a systematic scan round the body (head, face, neck, shoulders, arms, hands, chest, abdomen, legs, feet) may help. By focusing on breathing, posture and sensations (e.g. when walking, feel your feet on the ground) there is a move away from distressing and unhelpful cycles of thought.

4. 4 Then, decide to respond with helpful or more skilful actions. So, choose not to lose your temper, write an angry email, resign your job, drink that bottle of wine, have an argument, slam the door, etc. Instead, make a conscious decision to defuse the tense situation, face the fear, engage in a conversation, etc.

Building mindful moments into everyday life

Any time and place can be an opportunity to practise mindfulness. The following are examples of everyday opportunities to take a mindful moment and calm our inner lives.

Setting up a mindfulness routine

It can be useful to get into the habit of taking a mindful moment in certain situations, e.g. on waking up in the morning, passing through a door, drinking a cup of tea, standing in a queue. A practical tip is to stick a coloured dot in key places where it can be helpful to be reminded to take a moment of stillness (e.g. on the computer to avoid firing off angry emails, on the phone, by the front door, on the steering wheel of the car – anywhere a situation can push our buttons or lead to distress).

Noticing stress and slowing down

If someone starts to become upset or stressed, angry or irritated, they should slow down and take a moment rather than letting the distress build up and up.

Developing your own mindfulness skills

Psychiatrists might try out these skills for themselves: mindfulness-based stress reduction has been found to reduce stress and burn-out in health professionals (Dobie 2015). Patients and practitioners can learn more mindfulness skills from an increasing range of books (e.g. Williams 2011; Collard 2014), audio resources, apps (e.g. www.headspace.com/headspace-meditation-app) and online courses (e.g. www.themindfulnesssummit.com).