Our Rezl app uses Mindfulness Based Cognitive Therapy (MBCT) to build resilience… and more. So, I wanted to answer some questions about Mindfulness Based Cognitive Therapy and to explain why we chose it as the basis for Rezl.
If you wish to cut to the chase, then further down this post I have set out some very interesting research papers to demonstrate the impact of mindfulness and of MBCT in particular.
But first, let’s go back a few years. At Carina Sciences we started our journey by investigating ways to support the personal development our users. Initially, we were interested in the application of “deliberate practice” and the ways to increase willpower, or grit, to sustain a long-term pursuit of improvement. We became interested in how “executive function” can help to avoid distractions and in the importance of good habits. We also looked at the development of improved interpersonal skills that would enable people to acquire opportunities; and in the development of the thinking skills – to remain objective, to make good decisions and to demonstrate strong leadership.
Yet what stood out to us was that, for most people, their biggest barrier to improvement and growth was a lack of resilience – or in many cases, their use of their precious resilience dealing with day to day challenges. And so, we chose to focus on the development of resilience.
So, what is resilience? Well, our “resilience” is what helps us to respond to “challenges and setbacks” so that we can focus on the things that we wish to achieve at work and in our private lives. It’s as if each of us has a tank of resilience inside us – and as we encounter challenges, this resilience is used up. And when we’re on empty problems can start. So, it makes sense to build-up our resilience so that we’re ready to deal with whatever life throws at us.
Now we quickly identified the volume of scientific research showing that by learning to be mindful we can increase our resilience in a way that lasts. Mindfulness it is about honing the skills to meditate – so that we can become more aware of our thoughts and our reactions …. in an objective, non-judgemental way …. so that we are better able to manage our feelings and emotions. This empowers us… so that we build confidence and self-esteem… and we reduce negative reactions. And this enables us to become more resilient.
In particular, our review of the research led us to a particular type of training called “Mindfulness Based Cognitive Therapy” – or MBCT – which was developed at the universities of Massachusetts and Oxford.
So for Rezl, we chose to work with MBCT for two big reasons: –
- It is a formalised programme – an eight-step programme – as we knew that many people using mindfulness apps find them a little open-ended and so while these apps are relaxing… they can lack a sense of progress.
- The impacts of MBCT have been extremely well researched over the last 25 years. It was clear that the benefits were very significant.
So What is MBCT?
Jon Kabat-Zinn, professor at University of Massachusetts, together with Mark Williams and Danny Penman from the University of Oxford have set out the formal mindfulness foundation methods known as “Mindfulness Based Cognitive Therapy” – MBCT.
MBCT normally comprises an eight-week foundation course and an ongoing maintenance programme. The research shows that MBCT helps people to deal with stress and pressure; it reduces absenteeism and staff turnover; it improves concentration…reducing mistakes and increasing productivity; it makes people more open and more empathetic; improves self-esteem and job satisfaction; reduces anxiety and depression; and in a change management situation, it enables people to embrace change… positively
Comment on MBCT and CBT:
When someone has some common mental wellbeing problem (e.g. anxiety, depression, phobia, attachment or obsessive/compulsive behaviours etc.) the traditional approach was psychanalysis – to go back into their past to identify what caused them to develop such a problem. Yet by the late 20th century it was clear that this approach works for some but not for others (- off the top of my head, it was about half and half). In fact, going back can, in some cases, simply “cement” the issues (e.g. “my mother didn’t love me” is a shattering realisation that might be difficult to move on from, even with the best counselling and absolution).
An alternative approach was CBT – to give people an understanding of their emotions, thoughts and reactions that can cause problems, and, giving subjects some methods (practice or tactics) to intervene and to deal with such thoughts.
Mindfulness is such a technique – so it is fair to say that “mindfulness is a CBT”. The problem is that mindfulness can just be mediation for relaxation (…to set aside ruminations of the past and anxieties about the future) – and most of the popular apps do this… but that doesn’t really give people authority over their thoughts and feelings.
MBCT was developed as programme to teach people how their brains work and to learn the mental skills and habits so that they can become more authoritative: – to understand why particular emotions arise, and to choose appropriate responses rather than “knee jerk responses”. MBCT teaches the subject to be aware (of their thoughts and reactions) with their “thinking brain”. It also allows people to build self-compassion (…”don’t be too hard on yourself”) and it considers the ego and the correct impact of goals. It is a formal eight step programme.
So MBCT combines the skills of mindfulness with techniques from cognitive therapy so that we become aware of how the brain works – and change not only what we think about, but also how we can observe incoming information; so that we notice our emotions and thoughts that may be triggers and we become able to choose how we respond.
You see… whatever our age, our brains are pretty flexible…. and can always make new connections – and so we can “change our reactions and unconscious responses.” This is called “Neuro plasticity”. And even if you “think you can’t change” … you can.
The Research pointed to MBCT
At the bottom of this post I have included some of the research papers that we were able to gather – and that persuaded us of the power of MBCT.
In summary, from the user’s perspective, then working with Rezl will:
- increase your resilience – the signs that your resilience may be getting low include difficulty sleeping, irritability and mood swings, poor levels of concentration and restlessness
- improve ability deal with stress, pressure, challenges and uncertainty.
- make you more empathetic open to the views of others
- increase positivity and self-esteem – increase self confidence
- teams with mindful team-members are more effective and more likely to collaborate towards achieving team goals.
- increase job satisfaction and life satisfaction
- reduce absenteeism and staff turnover
- US special forces use mindfulness to help them to improve their decision making in high pressure situations
- boost your performance at work or in sport, increase your focus, your engagement and your ‘flow’.
- enable you to develop the skills to manage in challenging and disruptive business environments and to attain the objectivity, focus and emotional stability that are required.
There are a lot of benefits there – but it is important to stress that Rezl isn’t just about helping those with mental wellbeing issues – Rezl can help all of us to achieve more in our lives. It’s for everyone!
So, what’s inside Rezl?
Rezl includes:
- An Introduction – explaining the background facts and statistics and how the mindfulness programme will help you to build up your resilience, together with clear instructions on how to use Rezl.
- A Mindfulness Based Cognitive Therapy Foundation Programme – an eight-stage course to enable you build up your resilience using MBCT – which is scientifically proven to build up your resilience.
- A Maintenance Programme – with options for frequency and duration of use – to enable you to continue to reinforce your regular use of Rezl.
- The Rezl Toolbox – a set of tutorials and meditations to help you to overcome particular problems or challenges that you may face – including living with uncertainty, dealing with stress or change and avoiding sleep problems.
The Rezl Foundation Programme is an eight steps and for each step there is a tutorial and meditation.
Summary of Research
Here I have summarised some of the research papers that we collected to demonstrate the power of MBCT:
For people suffering depression or anxiety – then MBCT is shown to be as effective as prescription medications – in fact slightly more so – yet without the side-effects or the problems with withdrawal. Here are three papers looking at the effectiveness of MBCT for such conditions:
In this 2014 study by University of Sussex – the first published randomised controlled trial (RCT) of MBCT self-help. Titled “The effectiveness of self-help mindfulness based cognitive therapy in a student sample: a randomised controlled trial” and published in “Behaviour Research and Therapy” (Lever Taylor, Billie Lever, Strauss, Clara, Cavanagh, Kate and Jones, Fergal). The research investigated the effectiveness of self-help mindfulness-based cognitive therapy in a student sample: a randomised controlled trial, measuring the impact on not only mental wellbeing, but also on life satisfaction, self-esteem and self-compassion (which is key In dealing with set back and challenges).
“Results showed significant reductions in depressive, anxiety and stress symptom severity… There were also significant improvements in life satisfaction, mindfulness and self-compassion, with medium to large effects. Moreover, improvements for participants were maintained at a ten-week follow-up.” http://sro.sussex.ac.uk/id/eprint/57138/1/Self-help%20MBCT%20(accepted%20pre-proofs).pdf
From the Journal Consulting and Clinical Psychology (April 2010) “The Effect of Mindfulness-Based Therapy on Anxiety and Depression: A Meta-Analytic Review” (by Stefan G. Hofmann, Alice T. Sawyer, Ashley A. Witt, and Diana Oh).
This review of many MBCT trials showed that improvements on depression scores and anxiety scores were robust (repeatable and consistent) and significant; both for those with the conditions and for those without these conditions. – i.e. Even for those who were not suffering from depression or anxiety their mood was raised and worry was lowered – it’s not about a return to the normal – it is an elevation in mood and ability to avoid worry. The researchers said that “[MBCT] improves symptoms of anxiety and depression across a relatively wide range of severity.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2848393/
Journal of Evidence-Based Practice: April 2020 “Is mindfulness-based cognitive therapy effective in the treatment of anxiety?” (Cass, Alvah R. MD, SM; Abara, Ndidi O.I. MD; Bueso, Francisco J. MD; De La Cruz, Nathaniel R. MD; Linebarger, Carol A. MBBS.) This research involved a systematic review of studies to investigate the effectiveness of MBCT for patients with anxiety. The researchers concluded that “Mindfulness therapy protocols including MBCT generally lead to moderately large reductions in anxiety systems.”
https://journals.lww.com/ebp/Citation/2020/04000/Is_mindfulness_based_cognitive_therapy_effective.14.aspx
Looking at the impact of dealing with pressure and stress, then this paper demonstrates how MBCT helps US Special Forces to perform in pressured situations:
Professor Amishi Jha from the University of Miami published a paper in 2018 on the effectiveness of mindfulness among members of the US Special Operation units. The research shows that the soldiers are “better able to discern key information under chaotic circumstances and to demonstrate increased working memory function”; plus the soldiers reported making fewer cognitive errors than those who are not trained in mindfulness. Prof Jha pointed out that members of the special forces are chosen for their ability to focus and so the fact that they experience an improvement speaks to the power of the mindfulness training. https://news.miami.edu/stories/2018/11/ensuring-success-in-demanding-roles.html
Professor Jha added: “They ‘re the best and what they are trying to do is the hardest. When the US Special Forces do something not only does the rest of the US military pay attention, the rest of the world’s militaries pay attention”.
The following paper looks at how the US Marines are using mindfulness training to reduce the possibly of PTSD:
The US Marines, known for turning out some of the military’s toughest warriors, have studied how to make troops even tougher through meditative practices based on mindfulness. Facing a record suicide rate and thousands of veterans seeking treatment for post-traumatic stress, the US military sought for ways to reduce strains on service members burdened with more than a decade of fighting in Iraq and Afghanistan. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4458258/pdf/nihms690084.pdf
The Marine Corps experimented with a series of mental exercises called “Mindfulness-Based Mind Fitness Training” to see if they could enhance the performance of troops, and their preparation to better handle stress. The study involved 160 Marines who were taught to focus their attention by concentrating on their body’s sensations, including breathing, in a period of silence. The Marines practiced the calming methods prior to being immersed in a mock Afghan village with screaming actors and controlled blasts to expose them to combat stress. Another 160 other Marines went through the mock village with no mindfulness-based training, acting as the control group.
The paper was published in American Journal of Psychiatry (2014 August). The research was led by Naval Health Research Center scientist Douglas C. Johnson. The research showed that inn comparison with the control the group the marines prepared with the mindfulness programme:
- Demonstrated less apprehension prior to the exercise
- Demonstrated a more rapid recovery (breathing and heart rate) at the end of the exercise
- Exhibited bio markers representing lower levels of stress and associated physical responses
- MRI scans showed reduced emotional responses to stimuli after the exercise.
The research concluded that the results show that mechanisms related to stress recovery can be modified in healthy individuals prior to stress exposure, with important implications for evidence-based mental health research and treatment.
The paper states: Our investigation yielded three main results. First, mindfulness altered heart rate and breathing rate recovery following stressful training. Second, mindfulness modulated a strongly correlated set of peripheral biomarkers before, during, and after exposure to a stressful training session. Third, the neuroimaging results support the hypothesis that mindfulness affects brain structures that are important in integrating information about the internal physiological state and the body’s response to stress. Thus, the mindfulness programme demonstrated beneficial effects across multiple domains indicating enhanced recovery from stress. ….Taken together, these findings constitute evidence for the prevention and treatment of stress-related pathology.
This research looks at how Mindfulness training can help prepare subjects to deal with stressful events:
Dealing with stress: Less burnout… rapid brain recovery from highly stressful events (…ref: elite performers) … less stress… less PTSD – http://ucsdnews.ucsd.edu/pressrelease/war_and_peace_of_mind
Both these studies, one in UK and one in Canada show how absenteeism was reduced by 30% though the implementation of a mindfulness programme:
Transport for London case study: https://www.personneltoday.com/hr/how-practising-mindfulness-in-the-workplace-can-boost-productivity/
Toronto Healthcare (Quan) case study: http://www.changemanagementreview.com/pages/mindfulness-innovative-change-management-wendy-quan/
This paper looks at how mindfulness training can reduce staff turnover:
This 2016 trial reduced staff turnover by 13% within Dutch hospital nurses . Dierynck et al (2016). “The Role of Individual and Collective Mindfulness in Promoting Occupational Safety in Health Care”. Medical Care Research and Review. http://www.themindfulnessinitiative.org.uk/images/reports/MI_Building-the-Case_v1.1_Oct16.pdf
This paper looks at how mindfulness increases job satisfaction:
The trail increased Job satisfaction: a lasting mean improvement in Job Satisfaction (MBI) scores of 18%. “Abbreviated Mindfulness Intervention for Job Satisfaction, Quality of Life, and Compassion in Primary Care Clinicians: A Pilot Study” Fortney et al http://www.annfammed.org/content/11/5/412.full.pdf+html
Finally, I like this Dutch research that show how MBCT can significantly reduce anxiety ion cancer patients:
This 2018 Dutch study “Mindfulness-Based Cognitive Therapy for Psychological Distress in Patients With Cancer” publish in the Journal of Clinical Oncology., studied 245 patients using Mindfulness Based Cognitive Therapy (MBCT) to reduce anxiety. See here: https://www.ascopost.com/News/59063?utm_source=TrendMD&utm_medium=cpc&utm_campaign=The_ASCO_Post_TrendMD_0
The study compared patients treated with the usual psychological support with those receiving an eight-week course in either “therapist lead” MBCT or self-help (internet based) eMBCT. Each of the cancer patients taking part in the study was categorised as experiencing “psychological distress” — I.e. demonstrating a score ≥ 11 on the Hospital Anxiety and Depression Scale (HADS). The results demonstrated that both face-to-face and internet-based self-help mindfulness based cognitive therapy significantly reduced psychological distress in patients with cancer – reducing fear of cancer recurrence and improving mental health–related quality of life.
The results showed:
- “Usual treatment” produced a change in mean HADS score from 17.04 at baseline to 16.37 at post-intervention
- “Face to face MBCT” achieved a change from 18.81 to 13.25
- and the “eMBCT group” achieved a change from 17.24 to 11.87 – almost eliminating “psychotically distress” as defined
So, both MBCT and eMBCT significantly reduced fear of cancer recurrence and rumination and increased mental health–related quality of life, mindfulness skills, and more positive mental health compared with usual treatment. The investigators concluded, “Compared with treatment as usual, MBCT and eMBCT were similarly effective in reducing psychological distress in a sample of distressed heterogeneous patients with cancer.”
I hope that these papers are of interest and demonstrate the broad benefits of MBCT.
