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Anthony Quintiliani, Ph.D, LADC

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July 1, 2018 By Admin

Liberation of the True Self

Liberation of the True Self

Socrates is reported to have noted that “the secret of change is to focus all of your energy, not on fighting the old but on building the new.” In Buddhism there are clear relationships between “no-self” and the force of impermanence, that reality that ensures constant change and thus personal dissatisfaction as a norm.  In the lived experiences of our psychological turmoil we humans do the utmost to direct our energy to obtaining what we want (attachment, desire, craving) and avoiding as much pain and suffering as possible. Our endless effort to obtain material and status goals for some form of inner security against the world repeatedly leads us to struggle, fear, and loss – suffering. Our cognition, emotion, behavior and sensory contact with all phenomena are fully engaged in evaluation of everything: did I get what I wanted and avoid suffering for now or not? This is the hedonic treadmill of lived attachment and avoidance. Cognitive-Behavioral analytics ends up in the same place over and over again: short-term pleasure (getting what I want for now)  and longer-term suffering  (fear of losing it or being involved in more emotional pain).  This state of constant seeking (how many “likes” do I have?) tricks us into thinking that this time, it will work. We seek safety, security, and various forms of wealth; we expect to achieve these goals and to avoid as much suffering as possible. This is impossible, since the seeking and attaching itself eventually causes more personal suffering. We humans have very short memories when it comes to the realities of pleasure and pain, happiness and suffering. Our emotional striving to be perfect and get ahead often leave us with just more desire.  The sad fact is that no matter how successful we are in accumulating all the goodies, we tend to continue our suffering sometimes in different forms.

A possible solution to consider for liberating yourself from the merry-go-round of life’s seeking and avoiding is to practice intensive, regular deep meditation and yoga. Through these regular/daily practices you will, indeed, confront yourself and perhaps open a pathway to spiritual freedom. You may liberate your true self in the process. Narrowly focus on your consciousness – the mirror of your true self.  It does not change even when the content of experience does change. Become your observing self in a state of pure awareness without judging or evaluating. In the evolutionary process, clinging is one of the most primal actions. The “vapor of thoughts” along with strong attachment clinging causes our norms to be related to our false self – with its entitlement, feeling special as a defense, greed, anger, even hatred.  Just STOP all of this process as much as you can; focus on who/what you are at the deepest most spiritual levels. Who am I is the eternal and most important question. As you meditate and do yoga, concentrate on radically accepting everything that has happened to you and may still be happening to you.  This does not mean stand by and allow yourself to be abused by cruel people; however, it does mean to pay very acute attention to what experiences trigger your ego-defenses and negative reactions in thoughts, emotions, and behaviors. How much control over your emotions are you willing to give up to other people?  Radically accept as a norm, do your asanas, meditate often, allow your true self to “let go” of the false self”s ego and superego demands. Pursue spiritual practices, be compassionate and generous, and live the life your true self desires for you. This is a life of more inner peace, even tranquility, more happiness, less competition, more love, and DOING good for others. This path is difficult in our materialistic world. The fruits of your efforts will be gratifying! If you practice, you will discover the truth about being a happier, more lovable person.

If you are not satisfied with the outcomes from your efforts here are three more things to practice. When you become entangled in the ego defenses of your mind, use the Buddha’s “best friends.” Calming breath, the half smile, standing, sitting, walking or laying down all may change your neurophysiology and thus your mood and level of self-control. This will allow you better capacity to apply radical acceptance and let go of harmful  emotional reactivity.  Another approach championed by the Buddha is to gently control your second arrows.  The first arrow is when something unpleasant happens to you and there is nothing you can do about it; this is pure suffering, and it is painful.  However what you decide to have your mind, body and emotions do with the first arrow of suffering is called the second arrow.  This very sharply pointed arrow can lead to long-term, even life-long suffering about something you failed to radically accept and let go. Become an expert in perceiving the initial activity of your second arrows, and STOP as soon as possible. At this point you may apply RAIN – recognize what if happening; accept it; investigate causation; and, apply no-self or if less skilled “its not about me attitudes.” These follow-up practices should be very helpful to you in your effort to become a more calm and more happy person.

For more details see Singer, M. A. (2007). The Untethered Soul: The Journey Beyond Yourself. Oakland, CA: New Harbinger Publications, pp. 127-137.

Anthony R. Quintiliani, PhD., LADC

From the Eleanor R. Liebman Center for Secular Meditation in Monkton, Vermont and the Home of The Monkton SanghaChiYinYang_EleanorRLiebmanCenter

Author of Mindful Happiness  

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New Edition of Mindful Happiness in Production…Coming soon!

Filed Under: Breathing, Buddhism, Calming, Cognitive Behavioral Therapy, Featured, Inner Peace, M.A.Singer, Meditation, MIndfulness, Self Care, True Self Tagged With: BUDDHISM, CALMING, LIBERATION OF TRUE SELF, M.A.SINGER, MEDIATION, THE UNTETHERED SOUL

May 25, 2017 By Admin

Using Cognitive Defusion in Mindfulness Psychotherapy

Cognitive Defusion in Mindfulness Psychotherapy

A well-meaning therapist might ask: What is cognitive defusion. Well this practice, as used in Acceptance and Commitment Therapy, is beyond cognitive restructuring of cognitive distortions and automatic negative thoughts ( I call “Red Ants”). The practice concretely de-literalizes the personal truth and meaning of unhelpful, repetitive thoughts and words. As The Buddha warned: We probably should NOT believe the distinctions of thoughts in our heads. Our strong thoughts may be our best friends or our worst enemies. In neuroscience the fact that more negative than positive thoughts occur in humans implies we are more attached to limbic reactivity and fear than to positive thoughts and emotions. When we get stuck in negative cycles of thinking, feeling and doing our right brain and limbic area dominate. A very old mindfulness belief is that you are not your thoughts, your emotions, or your behaviors; these parts of you are simply associated with your life experiences. When a client learns to defuse a though it means they have changed its linguistic structure and removed it from being cemented into their CABs, or cognition-affect-behavior cycles. In all good therapies, especially Cognitive-Behavioral Therapy and various mindfulness therapies (MBCR, DBT, MBCT, MBRP, ACT), helpers often work on truth-analysis of unhelpful, repetitive, negative thoughts patterns – especially those embedded into CABs cycles of ineffective experiences. Self-medication, isolation, and avoidance are commonly associated with these realities. Sometimes this work includes meta-cognitive analysis regarding your thoughts about your thoughts or the patterns of your thoughts. The clear logic is that the words we often tell ourselves in times of stress or fear are NOT often true. Of course, if indeed you are seriously endangered best to allow your limbic brain area to save your life. The list below will note various approaches used to defuse thoughts from our experience of being, our CABs cycles.

  1. Stay the thoughts out loud and mindfully notice the sensations, images, emotions, and associated CABs cycles that arise. Now say the words over and over again for at least half a minute. Note any changes that follow.
  2. Use scrambling of the phrase to change it grammatical brain-connections. Your brain should react a different way to the “scrambled” message. It is like changing the code of the phrase. For example: try saying “am person a bad” or “person I a bad am” instead of “I am a bad person.”  Notice what your brain-mind does now.
  3. Speed up and then slow down the rate of inner and outer speech. Try all four options; notice any relief you have obtained.
  4. Reduce then intensify your energy level when saying the phrase. Notice, again.
  5. Elongate the sounds of the key words in your phrase.  Keep elongating and notice what happens. Elongate and slow as far as you can.
  6. I like this approach. Change the most important one or two words in your phrase.  Now say the phrase out loud with one or two slightly less harsh words.  You will need to repeat this technique for effects. For example: “I am so worthless” helps solidify your brain plasticity about personal meanings and images. Try this: “Sometimes I feel worthless” or “When really bad things happen, I can feel worthless”  or “My unpleasant feeling can relate to feeling less worthwhile.”
  7. Change the language code of your key word/s. For example: change “I am a terrible person” to “I am a spanty person.” Spanty being Czech for terrible or bad.  Notice how the brain/mind/body responds to this simple change.
  8. You could also sing your statement, or say it in a foolish voice tone.
  9. I have used defusion and added body movements to the process. Here are four examples.

A) Find a spot on the floor where you try to project all your bad feelings about your repetitive phrase. You are consciously projecting the bad feeling into the spot on the floor. Now stand in it and notice how your mind body reacts. Slowly, but with some bodily energetic force, step out of the spot on the floor.  Notice the effects.

B) Stand in the same spot, and pretend you are taking off a pair of pants – BUT when you are out of the imaginary pants, immediately step aside. Notice.

C) Find a pleasant place to go for a brief walk. Enjoy the environment, but say your statement to yourself. Split your attention in two: attention to the beauty of the walk (and watch your step), and attention to repeating your phrase. Notice any changes and shifts that occur.

D) This one is out-there but fun. Energize yourself (if healthy enough) into a rapid skipping movement. At the same time say your phrase, and pay attention to where you are skipping. Your body will respond by contrasting the negative statement against the body-memory of good-old skipping. For most adults, skipping was a fun thing to do. Notice the effects.

For more information refer to: Blackledge, J. T. (2015). Cognitive Defusion in Practice: A Clinician’s Guide… Oakland, CA: Context Press/New Harbinger, pp. 3-42, 87-109, 159-162.

Anthony R. Quintiliani, PhD., LADC

From the Eleanor R. Liebman Center for Secular Meditation in Monkton, VermontChiYinYang_EleanorRLiebmanCenter

Author of Mindful Happiness  

Mindful Happiness cover designs.indd

New Edition of Mindful Happiness in Production…Coming soon!

Filed Under: Clinical Practice, Clinicians, Cognitive Behavioral Therapy, Featured, Ideas & Practices, Meditation, Meditation Activities, Mindful Awareness, MIndfulness, MIndfulness Activities, Mindfulness Training, Psychotherapy, Therapy, Therapy Tagged With: ANTHONY QUINTILIANI, COGNITIVE DEFUSION, MINDFUL HAPPINESS, MINDFULNESS

February 16, 2017 By Admin

Details About Cognitive-Behavioral Therapy

Understanding Cognitive-Behavioral Therapy?

Cognitive-Behavioral Therapy (or Cognitive-Behavior Therapy, hereafter CBT) has been noted as the most common evidence-based therapy approach used in the United States.  That said, the most common “therapy” approach used here remains generic talk therapy with more or less psychodynamic characteristics. Given the absolute limited level of outcome-based evidence for effectiveness of generic “talk therapy,” it amazes me how many licensed therapists still use it. Perhaps there is a reciprocal – perhaps unconscious – emotional/attachment need satisfaction process between client and therapist. Most clients like this “talk therapy,” and they will continue to show up mainly because of the positive, accepting nature of the therapeutic relationship.  In some cases, the clinical alliance and therapeutic relationship may be qualitatively superior than in other therapies. However, in cases of severe co-occurring disorders (those that tend to make mental health-behavioral health treatment the most costly of all), the alliance is essential for progress but the relationship alone does NOT cure. It is interesting that systems paying for professional therapy services still fund this generic form of therapy.  Back to CBT.

A general way to understand CBT is to note it is present minded (a mindfulness characteristic), with ample skills learning AND PRACTICE in sessions, as well as in homework.  To get clients to pay attention to homework practices, best to begin them in the session. CBT is time-limited, solutions-oriented, and aimed at problem improvement/resolution and recovery processes. The behavioral components, those that are required to distinguish CBT from cognitive therapy, include behaviorally-oriented action learning.  Learning to do better, to live better, by DOING. CBT is collaborative, requires a good clinical alliance, includes ample psychoeducation, and importantly is skilled-based. It is by way of both insight and new cognitive-behavioral skills to cope better with life’s challenges/stressors that makes CBT so effective.  It must be done correctly, however, to be effective. Although effective CBT requires effective assessment of past causes and conditions, it remains present-to-future oriented in its intention and direction. Some uninformed therapists may think they are doing CBT, but without the behavioral components they are simply doing cognitive therapy.  Whereas CBT includes processes and skills from both cognitive and behavioral therapies, the earliest version was A. Ellis’ Rational-Emotive Behavior Therapy.  More on the cognitive components to follow below.

The process of CBT includes interactive, systemic cycles of repeated thoughts and behaviors.  The A-B-C model (quite behavioral) is often used. In this process model, events lead to thoughts/beliefs, which have emotional consequences.  The emotional consequences (good vs bad), lead to behavioral activations (some impulsive).  The thoughts and their related behaviors produce consequences.  CBT is a highly structured therapy, and one that includes verbal reviews of progress (from treatment), check-ins, clarification of the session plan, etc. Cognitive components of CBT include identification of idiosyncratic automatic negative thoughts (I call them “Red Ants’) and their correction via disputation techniques. Do not use the term irrational; it is outdated and insulting to clients. How would you feel if a person told you “your thoughts are irrational?” Clients are helped to recognize advantages and disadvantages of their self-defeating thought patterns (more meta-cognition than single thoughts) by examination of consequences for having such thoughts – often depression, anxiety, helplessness, hopelessness, and loss of motivation. Reattribution of responsibility for outcomes is also important, as is the reframing process often used to establish reattributions. A more balanced locus of control may be a goal. Thought records are used.  However, to do a better job using both cognitive and behavioral aspects, I suggest using an Experience Record that includes events, thoughts, emotions, sensations, behaviors (especially self-medication), consequences of behaviors and an evaluation of the helpfulness of the consequences.  Using the cost-benefits analysis grid may also be helpful. This approach includes a quadrant regarding actual good consequences about keeping the thoughts/behaviors; actual negative consequences about maintaining the thoughts and behaviors; expected good consequences about changing the thoughts and behaviors; and, expected barriers/roadblocks about making such changes.  CBT can include a harm reduction process in slowly improving thoughts and behaviors, especially in related substance misuse or self-harm aspects of problem solving. I suggest the most important parts of CBT are a solid therapeutic relationship, use of both cognitive and behavioral skills for modifying unhelpful thoughts and behaviors, and built-in behavioral reinforcement for any changes made by the client.  Now we go into the behavioral components of CBT.

Common behavioral components of CBT include the use of learning theory, reinforcement, and conditioning. These clinical skills are not easy to use. As clients learn to use new behavioral coping skills they actively monitor and track their situations, their thoughts, and especially their behaviors. It is common to use an activity schedule to help clients engage more fully with helpful behaviors that may slowly come to replace older unhelpful (rewarding) behaviors. Clients learn how to recognize and monitor both external conditions and internal states of being in response to the external conditions. Of course, there are also internal conditions that may be monitored as well: depression, anxiety, fear, dread, sensation-emotion links, etc.  Relaxation and mindfulness training (MBSR or ACT may be best) are used to help client cope better with
real and imagined (in session) challenging causes and conditions.  Such stress reduction and equanimity skills are taught and practiced in sessions. Sometimes a behavioral hierarchy may be used (task analysis, exposure hierarchy, etc.). In this highly organized setting, clients practice related relaxation/mindfulness coping skills as they slowly make progress up the hierarchy; the process is matching effective coping skills with imagined or real life challenges along the way. It is common to use SUDs measures: from zero to 100 how much discomfort exists right now? Since SUDs scores tend to be used with negative situations, I have developed a SUPs scale. In SUPs: from zero to 100 how pleasant is this situation right now?In such learning, clients come to recognize how conscious and unconscious cues and stimuli may trigger internal negative states; such states have in the past caused maladaptive responses, thus making bad situations worse. A very powerful intervention is to enhance self-efficacy. As clients become more skilled and competent to deal effectively with life problems and challenges, they develop an inner sense of “can-do-it-ness.” This change has dramatic impact on both self-esteem and courage to carry on. In more advanced practice of CBT, many mindfulness-based interventions may be added. I refer to this as CBT-M. For effectiveness all mindfulness skills must be practiced, personally, by the therapist. Both cognitive an behavioral aspects of CBT are used in relapse prevention practices, where new insights (cognitive) may lead to new skill applications (behavioral).  CBT, when effectively delivered and experienced, can produce highly positive changes in long-term problematic cycles of thinking and behaving.

For more information refer to Meichenbaum, D. (1977). Cognitive-Behavioral Modification: An Integrative Approach. New York: Plenum Press. Beck, A.T., Rush, A. J., Shaw, B. F. and Emery, G. (1979). Cognitive Therapy of Depression. New York: Guilford Press. Wilson, G. T. and Franks, C. M. (Eds.) (1982). Contemporary Behavior Therapy: Conceptual and Empirical Foundations.  New York: Guilford Press. Persons, J. B., Davidson, J, and Tomkins, M. A. (2001). Essential Components of Cognitive-Behavior Therapy for Depression. Washington, DC: American Psychological Association. Padesky, C. A. and Greenberger, D. (1995). Clinician’s Guide to Mind Over Mood. New York: Guilford Press. Bandura, A. (1997). Self-Efficacy: The Exercise of Control. New York: W. H. Freeman. Germer, C. K., Siegel, R. D. and Fulton, P. R. (2005). Mindfulness and Psychotherapy. New York: Guilford Press. Freeman, C. and Power, M. (2007). Handbook of Evidence-Based Psychotherapies: A Guide for Research and Practice. Hoboken, NJ: J. Wiley. I have noted some classics because their details are far more specific and explicit than some more current publications.

Anthony R. Quintiliani, PhD., LADC

From the Eleanor R. Liebman Center for Secular Meditation in Monkton, VermontChiYinYang_EleanorRLiebmanCenter

Author of Mindful Happiness  

Mindful Happiness cover designs.indd

New Edition of Mindful Happiness in Production…Coming soon!

Filed Under: ANTHONY QUINTILIANI, Clinical Practice, Clinicians, Cognitive Behavioral Therapy, Featured, Practices, Therapy Tagged With: CBT, CLINCAL, COGNITIVE BASED THERAPY

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