Journal of Religion & Spirituality in Social Work: Social Thought
ISSN: 1542-6432 (Print) 1542-6440 (Online) Journal homepage: http://www.tandfonline.com/loi/wrsp20
Buddhist Psychology and Cognitive-Behavioral Therapy: A Clinician’s Guide Leyla Feize To cite this article: Leyla Feize (2018) Buddhist Psychology and Cognitive-Behavioral Therapy: A Clinician’s Guide, Journal of Religion & Spirituality in Social Work: Social Thought, 37:1, 98-102, DOI: 10.1080/15426432.2017.1363618 To link to this article: https://doi.org/10.1080/15426432.2017.1363618
Published online: 20 Feb 2018.
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JOURNAL OF RELIGION & SPIRITUALITY IN SOCIAL WORK: SOCIAL THOUGHT 2018, VOL. 37, NO. 1, 98–102
BOOK REVIEW
Buddhist Psychology and Cognitive-Behavioral Therapy: A Clinician’s Guide, by D. Tirch, L. R. Silberstein, and R. L. Kolts, New York, NY, Guilford Press, 2016, 266 pp., $27.22 (Hardcover), ISBN: 978-1-4625-2324-5
Overview Buddhist Psychology and Cognitive-Behavioral Therapy: A Clinician’s Guide introduces Buddhist psychology (BP) and its applications in Cognitive-Behavioral Therapy (CBT). The authors, Dennis Tirch, Laura R. Silberstein, and Russell L. Kolts, skillfully integrate BP and CBT and elaborate on the similarities and differences between them in conjunction with modern psychology and neuroscience to encourage CBT practitioners to employ mindfulness in clinical settings. The authors focus on the common goal of both BP and CBT, which is alleviating human pain and suffering. They also provide practical methods that introduce CBT practitioners to different clinical modalities such as simple breathing, meditation, and metameditation or loving kindness.
A step by step journey In this book, the authors guide the readers through a journey to fully understand mindfulness. Like storytellers, the authors narrate the history of Buddha (Siddhartha Gautama). They connect to the readers, especially CBT practitioners, by introducing BP as a scientific and practical model, similar to CBT. BP is defined in the book as a combination of psychology and the other traditional aspects of Buddhism. To facilitate the reader’s understanding of BP, they introduce its foundation and invite the readers to practice simple breathing and from there gradually take readers to a deeper level of the BP realm. They introduce the training model of Buddhist Psychology: “healthy speech, healthy action and healthy livelihood” (p. 51) and masterfully connect the training model with CBT training and neuroscience evidence. The authors begin introducing basic ideas, but as the readers advance through the steps of comprehending mindfulness, the ideas become more complicated. As more complicated ideas are presented, more complicated empirical practice is also introduced which creates a balance between comprehending and experiencing mindfulness. To ensure the accompaniment and presence of the readers throughout this journey, the authors guide them back to previously explained ideas as they are explaining new ones. However, at times, it seems as though they repeat their concepts over and over again. Regardless, the authors thoughtfully lead the readers from one step of mindfulness to the other. They are aware that going through the journey of mindfulness is difficult for the readers, especially step 6, understanding and practicing compassion. Thus, they provide neuroscientific evidences to make this part of the journey easier. After comprehending compassion, the authors accompany the readers to the last step of their journey, a journey toward enlightenment, a journey from “not knowing” to an awakening mind.
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Four noble truths The book’s foundation is on the four noble truths of BP. The first truth: incongruity, inadequacy and suffering are part of life. Suffering is inevitable and there is no way to reach perfection. Second truth: nothing is permanent. Change is unescapable and causes suffering. One cannot live in one’s comfort zone; the only way to avoid pain is to adjust to new situations. Third truth: everything in the world has a deteriorative nature. No phenomenon is permanent and omnipresent. Fourth truth: practical methods can help one liberate from pain and suffering. One cannot escape from pain; however, through practice, one can be free from suffering. In the book, the elaboration of the four noble truths is followed by some clinical examples in each chapter and facilitates the reader’s understanding of the concept and provides opportunities to practice mindfulness.
Similarities of and differences between BP and CBT and readers’ comprehensions The authors strongly emphasize the integration of BP and CBT. They familiarize the readers with the benefits of merging them as well as recognizing their unique approaches. We, as readers, learn both BP and CBT models, and become motivated to freely use our critical thinking skills to evaluate both approaches and decide how the combination of these approaches best benefits us. Both approaches introduce the readers to healthy thoughts, healthy speech, and healthy behaviors. This training model leads to building a system of values. This system in Buddhist Psychology is recognized as universal laws while in CBT is defined as building a personal system. Therefore, we are encouraged to build our own systems of values, take control of our lives and move toward a richer and more meaningful life style. Buddhist Psychology inspires us to start observing our mental status and CBT provides details to challenge and change our mental views. We learn that the combination of BP and CBT increases our knowledge and understanding of human potential and our ability to change. We realize that developing wisdom expands and deepens our perspectives whether we use it in the limited level of CBT model or in the broader level of BP model. We realize that practicing the CBT approach might assist us with loving our “self” and others; however, practicing BP increases our sympathy toward all creatures. In order to understand and practice compassion, we need to reach a higher level of awareness of our feelings, thoughts, and behaviors. Enlightenment or Awakening Mind in BP’s approach is a deep understanding of the connectedness of “self” with all other phenomena in the present moment, while CBT defines enlightenment as the maximum flexibility and awareness to endure equally pain and alleviation of pain. Reaching enlightenment could be perceived as an unapproachable dream. However, it strengthens our hope that humans have a great capacity for growth. As the authors emphasize, CBT and BP, in spite of their differences, focus equally on human well-being and easing suffering. We as readers grow hopeful that through understanding and practicing these two models we can significantly be free from suffering. Although this book is written to guide mental health practitioners, it is not necessary to be a practitioner to enjoy and exercise mindfulness through the clear instruction and guidance of this book.
Review of chapters The authors organize the book based on the Seven Factors of Awakening Mind of traditional BP. Each step of the journey is described in a single chapter. In Chapter 1,
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the authors elaborate on the similarities between BP and CBT. According to the authors, CBT has been very successful in treating mental health disorders such as depression and anxiety and by integrating CBT and BP, CBT’s effectiveness will increase. The authors write on how to integrate BP and CBT while arguing that BP is not a religion but a scientific method; it is an experiential research on observing, exploring, and discovering the self. In this world of “dis-ease” (p. 7), the authors invite us to embrace step one of the Seven Factors of Awakening Mind, Mindfulness of Awakening/Sati-sambojjhañga: taking a step back from our goals, desires, and dreams and start to just be, and practice simple breathing. In Chapter 2, as an introduction to BP and also to facilitate and connect western readers to the idea of mindfulness, the authors briefly explain Buddha’s personal life and elaborate on the history of Buddhism, Buddha, Siddartha Gotama, and his life path. In this chapter, the authors distinguish between assumptions of mindfulness and what mindfulness really is. In addition, there is an explanation of each of the four noble truths of BP followed by a practical example to facilitate the readers’ understandings of the concepts. In Chapter 3, the BP training model based on “adaptive conduct, mental discipline and wisdom” (p. 51) is introduced. The readers learn the “adaptive conducts of ‘healthy speech, healthy action and healthy livelihood’” (p. 51). Healthy speech means using clear, sensitive, kind, meaningful, and positive words in communication with the “self” (selftalk) and others as well as avoiding hostile, defensive words. Healthy action includes using kind, purposeful, and value-based behaviors which promotes pro-social behaviors, couple relationships and in general the well-being of the self and others. Thus, if we, as readers, design our lives and write our stories, we will not pursue destructive behaviors. “Adaptive conduct” is elaborated on and is then followed by some visualization examples in the book which provide the opportunity to practice mindfulness. The authors invite the readers to challenge themselves by imagining their dream life and writing their own life stories. In this chapter, the authors elaborate on the second step of Awakening Mind: Investigation in Awakening, Dhamma-vicaya-sambojjhañga, which is the exploring of the mind and the focusing on the present moment without clinging to habitual thoughts and behavioral patterns. In Chapter 4, the authors’ focus is on developing wisdom. In BP, wisdom is a result of mental training on focused attention. This creates a thought process of healthy intention, compassion and love and at the same time reduces disturbing emotions. Wisdom is also an understanding of interconnectedness: “When a dewdrop enters the ocean, so the ocean enters the dewdrop” (p. 82). Thus, wisdom and in general mindfulness is directly related to physical and mental health. The authors explain that mindfulness is beneficial for all, especially for those with feelings of shame, guilt, and emotional disturbance such as anxiety, depression, and personality disorders; it boosts the immune system; decreases cortisol levels, breathing rate, heart rate, skin conductance response, and more. Mindfulness also motivates individuals to exercise self-care. The authors use neuroscientific evidence to substantiate the claim that mindfulness has many positive effects and to convince practitioners to value and practice mindfulness. Mindfulness activates brain areas related to positive emotions, and intensify the mass of gray matter which is responsible for memory and learning, emotion regulation, and the perception of self. In this chapter, the authors embrace the third factor of Awakening Mind: persistence in Awakening, Viriya-sambojjhañga, which allows one to choose one’s dream life. In Chapter 5, the authors’ focus is on mindfulness as a foundation of both Buddhism and CBT. Mindfulness is rooted in the word sati, which refers to focused attention and the acceptance of internal and external mental events in the present moment. In other
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words, mindfulness means experiencing the present moment completely and fully. The authors present a deeper understanding of mindfulness in this chapter and provide examples of each form of mindfulness; “mindfulness of body, Kaya-sa; mindfulness of feelings, Vedana –sati; Mindfulness of mind or consciousness, Citta-sati; and mindfulness of mental phenomena Dbamma-sati” (p. 99). The authors indicate that mindfulness promotes mental health by increasing selective attention and decreasing attachment to emotions and environmental stimuli which in turn leads to a nonjudgmental analysis of thoughts and feelings. It results in less attachment to negative thoughts and facilitates letting-go experiences. They also describe the integration of BP training with CBT more in depth. In CBT clients are encouraged to let “should” and “ought to” attitudes go and develop flexible and evolved thoughts and feelings. According to the authors, the only constant in the universe is its inconsistency, thus there is no fixed self; it constantly changes. In both BP and CBT, suffering is the source of problems and at the same time is the solution because it makes one free from conditioned situations and provides a path to enlightenment. In this chapter the fourth factor of Awakening Mind is also incorporated: Happiness in Awakening, Pitisambojjhañga: realizing that satisfaction and positive emotions broaden one’s responses to stimuli, while anxiety, depression, and other maladaptive emotions are threatening based and limit one’s attention and cognitive capacities. In Chapter 6, the authors introduce the concept of compassion as a process of developing sensitivity and motivation to recognize and alleviate mental pain. The readers learn that Compassion-Focused Therapy (CFT) practitioners train clients on compassion meditation to recognize and alleviate their mental pains. Compassion meditation facilitates emotional regulation which has a strong neuroscience base, developed to protect humans from environmental threats and provide a sense of safety. Compassion training activates a section of the brain which is responsible for prosocial and positive emotions and adaptive behaviors. In Chapter 7, the authors elaborate on the concept of compassion as the closest step to enlightenment. The word compassion is a compounding of two terms: com (together) and pati (to suffer). Compassion, Karuna, is an infinite concept and embraces components of wisdom and loving kindness, sensitive pleasure, and equability (not preferring one being to another). The authors direct the readers’ attention to CBT training and practicing letting go negative thoughts and feelings which in turn promotes compassion, sympathetic pleasure, and self-thriving. Suffering is due to an overattachment to personal feelings and thoughts and so compassion expands the focus from the self to others. The authors cleverly indicate that promoting compassion in a society whose core values are individualism, competition, and pragmatism is difficult. This chapter incorporates the fifth and sixth Factors of Awakening Mind which are Serenity in Awakening, passaddhisambojjhañga; and Concentration in Awakening, Samãdhi-sambojjhañga. They refer to practicing calmness and selective attention. Calmness decreases the attachment to mental status and the sixth factor states that focusing leads to enlightenment. In Chapter 8, the authors explore the barriers to self-compassion in western society. They explore the barriers through cultural and religious perspectives. From the cultural perspective, in western society, competition is a cultural value. Thus, we develop more competition, more self-criticism and more self-hate than those nations who embrace collective cultural values. In addition, we rely more on self-esteem than self-compassion. From the religious perspective, the authors explain that we are carrying our ancestors’ sin and this attitude affects our feelings about the self as well. In addition, we mostly learned to be compassionate toward others but not ourselves. The authors write on the development of
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compassion by introducing Paul Gilbert’s (2009) model of emotional regulation. Gilbert’s model includes three systems of the “old brain,” the “new brain” and the “affiliation and connection system” (p. 109). The “old brain” is related to the fight or flight response. “It is built for us not by us” (p. 156). The “new brain” is associated with evaluation, reflection, and problem solving. The “affiliation and connection system” is responsible for attachment, caring, and satisfaction responses. Compassion is a result of combining the second and third systems. CBT and CFT, under the umbrella of CBT, train clients to recognize and utilize these three systems to alleviate mental pain. In Chapter 9, the authors revisit the four foundations of BP and review the integration between CBT and BP. They restate and re-emphasize the positive impact of mindfulness on overwhelming situations and the importance of pursuing healthy thoughts, healthy speech, and healthy actions. In this chapter, the authors continue providing concrete neuroscience evidence as well. In this book, the authors assist the readers in understanding BP and its integration with CBT step-by-step. Therefore, in order to prepare the readers for the concept of enlightenment, the authors introduce Madhyamika, a second century Buddhist philosopher and his Two-Truth Theory. According to Madhyamika, one perceives reality based on one’s conditioned and experiential mind (relative truth), instead of the true reality (absolute truth). Absolute truth or emptiness, Sunyata, is the highest level of the traditional Buddhist journey. The readers learn that mindfulness means accepting these truths and balancing between relative and absolute truths. This perspective helps readers in understanding that human beings have the ability to perceive reality the way it actually is. In Chapter 10, the focus is on enlightenment. As the authors mention in the book, the word light has been used in religious texts as well. Light is the end of darkness and represents the awakening. Awakening means reaching the point of emptiness. The authors differentiate between the concept of emptiness and nihilism and define emptiness as a deep understanding of the connectedness of the self with all other phenomena in the present moment. A summary of the Seven Factors of Awakening Mind concludes this book. It is clear that mindfulness is beneficial to all and reduces mental disorder symptoms. However, it cannot be viewed as a panacea. In this book, only the positive aspects of mindfulness are explored. The authors have not addressed the possible negative consequences of mindfulness. For example, when a situation is disturbing and unbearable, defense mechanisms could be more beneficial than mindfulness. In this case, defense mechanisms, at least in the short term, can promote overall well-being (Brown, Ryan, & Creswell, 2007). In general, this book is a useful source for those who are not familiar with Buddhism and mindfulness. It is also a detailed practical guide for mental health practitioners, especially CBT practitioners. Leyla Feize, PhD, LCSW Assistant Professor University of Texas Rio Grande Valley (UTRGV), Edinburg, Texas
[email protected] © 2017 Taylor & Francis
https://doi.org/10.1080/15426432.2017.1363618
References Brown, K. W., Ryan, R. M., & Creswell, J. D. (2007). Mindfulness: Theoretical foundations and evidence for its salutary effects. Psychological Inquiry, 18(4), 211–237. doi:10.1080/ 10478400701598298 Gilbert, P. (2009). The compassionate mind. London, UK: Constable & Robinson.
