When we're on autopilot, we're not thinking about what we're doing or why we're doing it. We're not paying attention. Research shows that when it comes to drug and alcohol addiction, living in autopilot mode can be a recipe for disaster. If you're not tuned into why you're doing what you're doing, how can you turn around your negative thought patterns in order to change your behaviors? Being aware of what's happening in your mind and using mindfulness meditation, are at the core of mindfulness-based cognitive therapy (MBCT), a psychotherapy intervention that can be effective in addiction treatment. Originally developed to treat those struggling with recurring bouts of depression, mindfulness-based cognitive therapy incorporates mindfulness techniques and practices, such as meditation, with cognitive behavioral therapy (CBT). It's a way of changing the way you think (cognitive therapy) in order to change the way you act. According to Psychology Today, "Sometimes normal sadness is a powerful trigger for someone who has recovered from a depressive state to relapse into another bout of depression. Rather than try to avoid or eliminate sadness or other negative emotions, one learns to change their relationship with these emotions by practicing meditation and other mindfulness exercises." The use of MBCT in addiction treatment involves helping participants experience a greater level of awareness in the present moment and become more mindful of how their body feels before, during and after addictive thoughts or behaviors. Mindfulness practices help treatment participants identify emotions, thoughts or sensations that can trigger their drug or alcohol cravings. We asked clinicians at the Hazelden Betty Ford Foundation to discuss the use of MBCT in relation to substance use disorders, mental health issues, addiction treatment and relapse prevention. How would you define mindfulness-based cognitive therapy? In clinical psychology, mindfulness-based cognitive therapy combines the approach of being aware of your thoughts and reactions with being mindful, or having present moment awareness. It was modeled after mindfulness-based stress reduction (MBSR), an approach created by Jon Kabat-Zinn. He combined mindfulness psychotherapy and meditation practices into a tool to help people cope psychologically with stress, anxiety and chronic pain. Originally created as a psychological approach in the treatment of depression, MBCT helps people with drug or alcohol addiction process negative emotions related to their substance abuse, respond in productive ways and manage their anxiety. MBCT can also help in trauma recovery. For example, an individual who is struggling with depression will feel sad at times and that's perfectly okay. Feel sad, experience it on a physical and psychological level. Does it define everything about you? No. It's a feeling, an emotion, and it will pass. This is the shift in perspective that helps MBCT participants change gears. How do mindfulness practices help participants, especially in addiction treatment? Our thoughts precede our behaviors and how we feel. So when you pay attention to your thoughts in this moment—without judgment—it relieves the dilemma of having to solve a problem. If you allow yourself to get wrapped up in not being able to solve the problem at hand, the negative self-talk can start up, leading to the familiar cycle of thoughts and feelings that put you in danger of relapse. The goal with mindfulness-based cognitive therapy isn't to eliminate all negative thoughts and feelings; it's to change your response to them. Don't sidestep those thoughts, don't over-react to them, don't give them meaning and power, just accept them as a normal part of life and let them pass. By becoming more aware of your internal dialogue, you can avoid the knee-jerk reaction or habitual response. And in letting go of the negative mental chatter, we move forward and improve our mental health. Instead of letting negative thoughts ruminate, fueling the fire and leading to chaos (anxiety, envy, self-indulgence, neuroticism, hesitancy, repetition), those chaotic thoughts and feelings are acknowledged for what they are—thoughts and feelings. Nothing more, nothing less. Research supports the effectiveness of this type of cognitive therapy for individuals who are prone to relapse, including chronic drug and alcohol abusers. Why does this form of mental health treatment work? Instead of reacting with: "I'll drink because I'm feeling depressed, sad, lonely or bored," individuals who practice MBCT techniques are able to recognize the triggers or cues that lead to use. Once MBCT participants are aware of what's happening in their minds, they're more likely to recognize and prevent the progression of negative thought patterns becoming negative behaviors. It might be uncomfortable to feel sad, lonely, bored or depressed, but we can tolerate those difficult feelings without turning to drugs or alcohol. When you're aware that you're experiencing emotional discomfort and you come back into the present moment, you're training your brain to notice just one thing. It's impossible to be in the present moment and ruminate on negative thoughts at the same time. How does this therapy affect brain function? On a neurological level, mindfulness training works to deactivate areas of the brain associated with craving, negative reactions and impulsivity. Some people live in the past, and some people are so worried about the future they don't even notice what's right in front of them. Thoughts about feelings cause anxiety and depression. It's a cycle. And some people are so used to this way of thinking, they don't know how to be any other way. Their habits have created patterns of neural pathways in their brains. When negative patterns are interrupted and positive coping skills replace those reactive, compulsive, deeply ingrained habits and cravings, new neural pathways are formed, essentially short-circuiting the old addictive behaviors. Can this therapy change the essence of who a person is? Changing your thoughts doesn't change who you are as a person; it changes how you react, respond or behave, enabling you to reframe negative thoughts. You can't change the past; you can't change what you've done. People get wrapped up in this mind frame. You can change your thoughts, though, in order to function. When you do that, you can come to different conclusions. Are you going to allow negative thinking patterns to keep driving your behavior? There's an expression that "Pain is inevitable, suffering is optional." When you play the same scenario over and over, and personalize the problem, or continuously magnify the negative aspects, that's suffering. When you live in the present moment, you have the choice and the ability to create a new path. What does it mean to be mindful? Being mindful is about hitting the "pause" button and becoming present in the moment. Mindfulness practices include yoga, meditation, breathing space and body scans. These practices include focus, observation, description, participation and acceptance of what's happening. First and foremost, it's a compassionate, nonjudgmental observation of self in the present moment. What are some different mindfulness-based therapy techniques utilized in addiction treatment? Mindfulness meditation, which is often misinterpreted as relaxation, involves becoming acutely attuned to your thoughts, without getting attached to them. Thoughts are like clouds—they come and go. The idea of grabbing onto a cloud and letting it take you into a storm is the equivalent of hanging onto "what if" thinking that can lead to relapse. In mindfulness meditation, you acknowledge your experiences in a compassionate, nonjudgmental way. Body scan is a guided meditation that helps participants pay attention to one body part at a time, moment-to-moment, either while lying down or seated. Much like a professional dancer practices singular moves and exercises to build muscle memory for leaps or pirouettes, the body scan is paramount to learning and practicing mindfulness. The SOBER technique stands for Stop, Observe, Breathe, Expand, Respond. If you're in a high-risk situation, stop. Observe what's going on physically. What are you feeling? What are you craving? Breathe. Escape the "fight or flight" response. Expand—what are your options? Now you can respond. Gentle stretches in yoga, tai chi or qigong cultivate healing energy. Mindful walking and eating are practices that help you become more aware of what you're doing and how you're doing it, so that there's less space in your mind for intrusive, negative thinking. Urge surfing helps patients practice how not to respond to a craving or impulse, most frequently used in mindfulness-based relapse prevention. By envisioning the urge as a wave, the individual is able to "ride" that urge and stay on top of it until it subsides. Do people who practice mindfulness-based cognitive therapy need to have formal training? Yes. Do your research. Check the credentials of those who are "teaching" and make sure you find an MBCT-certified trainer. Ineffective use of these techniques can be ineffective—even dangerous. At Hazelden Betty Ford treatment centers, our expert clinicians and counselors understand the challenges of substance use disorders and are specially trained in mindfulness-based treatments (among many other therapies) to combat addiction.