The essence of cognitive therapy is that you don’t have to believe your thoughts. Cognitive therapy works by helping people identify counterproductive, illogical thoughts, to untwist cognitive distortions and to work with life events or their own thoughts to develop strategies that lead to a more balanced, realistic perspective.
As I went through training in cognitive therapy, I was struck by its strong similarities to mindfulness meditation practice and Buddhist psychology. I have also been working with clients using a combination of cognitive therapy and mindfulness, and it has become clearer and clearer to me that the two methods dovetail.
Cognitive therapy works primarily with the destructive underlying beliefs—sometimes called “maladaptive schemas”—that people hold about themselves. Maladaptive schemas can be expressed in phrases such as, “I have to be perfect in everything I do,” or “I’m incompetent,” or “If I express my own needs, people will reject me.” According to Dr. Jeffery Young, with whom I have trained, the most common themes in maladaptive schemas are: failure, separation, unlovability, dependency subjugation, loss of control and mistrust.
Changing maladaptive schemas feels awkward and unfamiliar—it doesn’t feel like you, just as new sneakers aren’t as comfortable as old worn-in ones. Cognitive therapy helps people see how self-defeating situations in their lives reflect their dysfunctional schemas. Clients learn to investigate how the schemas developed through their lives, and how these schemas now work to maintain their negative beliefs about themselves. Gradually, they disidentify with the schemas. Even new sneakers eventually become comfortable.
In Buddhist psychology there is no fixed self, but instead an impersonal process of physical and mental phenomena (nama-rupa) that arise and pass in each psychological moment. The main elements that arise in the mind are called mental factors.
Taken together, the mental factors represent the emotional/cognitive spectrum. Maladaptive schemas are like unwholesome mental factors in the Abhidhamma system, determining how we interpret reality. They are filters on awareness, coloring our beliefs.
Just as Abhidhamma says one must eradicate the unhealthy mental factors from the mind to become mentally healthy, cognitive therapy seeks to neutralize the maladaptive schemas.
Theory: Breaking the Chain
The cause and effect chain of dependent origination in the Abhidhamma is remarkably parallel to information processing theory, which is at the heart of cognitive psychology. The first three links of the chain are “sense base,” which leads to “contact,” which leads to “feeling.”
The same sequence in information processing is put in terms of “sensation” leading to “cognition” which leads to “emotion.”
The full cycle, in each system, runs more or less as follows:
Chain of Dependent Origination: Sense Base > Contact > Feeling > Craving > Clinging > Action.
Information Processing: Sensation > Cognition > Emotion > Intent > Plan > Action.
Both Abhidhamma and cognitive therapy recognize that change can occur through awareness at the feeling/emotion phase, so that the feelings do not result in action.
In cognitive therapy, a neutral awareness is used to intervene between cognition and emotion, breaking the hold of maladaptive schemas. The cognitive therapist can appreciate Joseph Goldstein’s comment, “If we can be mindful in each moment—aware of the object, aware of the feeling, whether it be pleasant or unpleasant—the awareness prevents the arising of desire.”
The tracking of schemas can be helped by “noting,” exactly as is done in some vipassana techniques, by labeling schemas over and over until the mind can flip into an observing mode. This helps a person recognize the transparency of these conditioned patterns of mind. A client can gain some emotional leverage by observing these negative mind states with equanimity rather than a compelling urge to keep acting them out.
The unwholesome mental factors can arise in meditation as hindrances. The Abhidhamma system proposes specific antidotes for these hindrances—for example, concentration for agitation, effort for sloth and torpor. The same principle is used in countering the tendencies of mind of the Abhidhamma personality types. The greedy type, for example, is to be given a sparse, dilapidated hut full of cobwebs and bugs. The angry type would be given the best accommodations with nothing to complain about, to neutralize the dominant tendency of mind.
A similar strategy is used in schema-focused cognitive therapy: habitual self-defeating mind sets are neutralized by specific antidotes. The antidotes involve intentionally bringing to mind the opposite point of view to counter the schema. For example, the person who is prone to the subjugation schema would be given instructions to practice being more assertive or to practice being more in touch with their own needs and desires. The aim is to replace distorted with more balanced, realistic states of mind.
Therapy works with the mind’s content, while meditation works with the context. The two are separate paths, but they can also complement and facilitate each other.
Apart from regular vipassana retreats, it might be helpful for some meditators to have psychologically oriented retreats for the explicit purpose of combining mindfulness practice with psychological investigation. Added to a regular retreat schedule would be therapy sessions where people could investigate and process distracting schemas. These retreats should not be confused with intensive meditation practice.
It is important not to get caught in the tranquility of meditation without attending to unfinished psychological business. Meanwhile, the insights of deep meditation are also psychologically healing. Seeing the impermanent, selfless nature of the mental phenomena allows us to understand the mind itself.