Mindfulness in Couples Counselling
Mindfulness as a practice is centered on present-moment awareness and a non-critical, open mindset. In recent years, researchers have worked to bridge the gap between mindfulness and empirical studies in psychology and medicine. There are three essential components of mindfulness: intention, attention, and attitude (O'Kelly and J. Collard 2003)
Intention is about having a clear understanding of why one practices mindfulness, grounded in meaningful and functional values.This means motivation and practical goals play a vital role in the practice. Attention involves the direct observation of each moment as it happens, including both internal experiences and external events. Attitude refers to the manner in which one pays attention mindfully. This requires cultivating a compassionate, open-hearted, and non-judgmental approach to whatever arises in awareness.
Mindfulness, in essence, seeks to reduce automatic, mindless responses where sensations, perceptions, emotions, and actions occur without conscious awareness (O'Kelly and J. Collard 2003). Mindfulness counters this automaticity by encouraging conscious, deliberate awareness of one's thoughts and actions. A critical aspect of mindfulness is its flexibility, both in awareness and attention. This flexibility allows individuals to shift perspectives, gaining a broader view of a situation while also focusing on important details. Additionally, mindfulness promotes an empirical stance towards reality, encouraging objective observation and an understanding of each moment's experience.
The benefits of mindfulness are becoming increasingly recognized, particularly in enhancing quality of life and improving romantic relationships. Mindfulness helps individuals approach stressful events as challenges rather than threats, which can reduce stress and its negative effects on relationships. Early research supports this, suggesting that mindfulness fosters deeper connection and closeness between partners (O'Kelly and J. Collard 2003). While this body of research is still in its early stages, the initial findings are promising and point to mindfulness as a valuable tool for both individual well-being and relationship health.
A. Vernon (ed.) Monica O’Kelly and James Collard, Cognitive and Rational-Emotive Behavior Therapy with Couples: Theory and Practice, DOI 10.1007/978-1-4614-5137-2_2
Exposure and Response Prevention (ERP) and Anxiety Disorders
Exposure as a Path to New Learning
One of the most crucial insights in creating effective exposure therapy is the understanding that extinction learning is actually a form of new learning, not just the weakening of previous associations. This means that while the original fear-based learning remains intact, new associations of safety compete with those old fear connections. Treatment is successful when the new, safety-based learning becomes the dominant response to the previously feared cues, such as an anxious anticipation of an audience in social anxiety disorder (Otto 2010).
In simpler terms, after exposure therapy, the meaning of fear inducing cues becomes mixed, holding both anxiety and safety associations. The role of the cognitive behavioural psychologist is to guide this process, ensuring that the sense of safety outweighs the old fear response so that cues that once triggered anxiety and avoidance no longer do so. Ultimately, the therapist's challenge is to structure the exposure process in a way that helps the patient fully recognize that the feared cues are actually somewhat safe (notice I'm accepting that life is uncertain by saying 'somewhat').
To help patients make lasting progress, I focus on linking their feared cues with positive, successful exposure experiences. This is done by guiding patients through exposures to a range of relevant cues and situations while using as many recall and generalization cues as possible. Essentially, the more vivid and meaningful the exposure is to the patient, where they can directly connect their fear with the fact that a negative outcome didn’t happen, the more impactful the learning will be. Additionally, the more a patient can rehearse and recall these positive learning experiences, the more accessible and useful they become.
The approach I use is grounded in animal learning research and experimental studies. However, it's worth noting that this approach aligns closely with cognitive perspectives that use "behavioural experiments" to challenge and change the core beliefs behind anxiety disorders. When extinction is seen as a form of new learning, and when techniques for reinforcing retention and recall are employed, such as using empowering cognitive cues like “I can handle this” or “these situations no longer bother me,” the difference between behavioural experiments in cognitive therapy and exposure interventions becomes less significant (Otto 2010).
When structuring exposure therapy for anxiety, I focus on three key tasks: (1) helping the patient identify the core fears driving the anxiety disorder, (2) using exposures to directly challenge those fears by demonstrating the patient’s ability to safely confront and manage the feared cues, and (3) ensuring that this ability is experienced across enough different contexts so that it becomes strongly embedded for future use (Otto 2010).
In identifying core fears, we recommend careful evaluation based on patterns observed in psychopathology research. For example, panic disorder is often characterized by fears and catastrophic interpretations of anxiety and panic symptoms, while social anxiety disorder tends to involve fears of humiliation or embarrassment. Although these core fears are common across individuals with these disorders, there can be significant variation in how these fears manifest. For instance, in panic disorder, one person may fear symptoms like dizziness and interpret them as a sign they will faint, while another may worry about falling, being scrutinized, or feeling incapacitated. By targeting exposure to the specific fears that the patient is experiencing, I provide the most relevant learning experiences, breaking the connection between the feared cue and its negative outcome. Using techniques like "downward arrow" questioning can help clarify the exact concerns that need to be addressed in exposure therapy.
Otto, M. W., & Hofmann, S. G. (2010). Avoiding treatment failures in the anxiety disorders (1st ed.). Springer.
Acceptance and Commitment Therapy (ACT) Counselling With Couples
The main goal of Acceptance and Commitment Therapy (ACT) is to address emotional avoidance, the tendency to over-interpret thoughts literally, and difficulty in making and maintaining commitments to change.
When working with couples and families, acceptance isn't just seen as an internal psychological experience, it’s also viewed as a dynamic process between individuals. Acceptance involves how a person responds to their own thoughts or feelings and how these responses are received by others, whether they’re accepted or not. This can apply to anything from emotions to personal thoughts.
One way acceptance can manifest in relationships is by learning to tolerate distress. The focus here is on transforming the initial source of discomfort into something more manageable, shifting from stress to contentment. Accepting stress means living in a way that aligns with one’s values and increases the likelihood of achieving personal goals. At a basic level, acceptance also involves recognizing that a problem exists and understanding its relevance to the relationship.
Fruzetti and Iverson (2004) define acceptance with three key components: (1) being aware of the experience, (2) not solely focusing on changing the experience or the stimulus causing it, regardless of whether the experience is pleasant or unpleasant, and (3) having some understanding of how the experience relates to the triggering stimulus (Datillio 2010). They also describe two levels of acceptance: (1) balancing acceptance with change and (2) pure acceptance. The latter can range from simple tolerance to genuine or radical acceptance, where a negative experience is transformed into a neutral or even positive one.
These principles have been found to be particularly helpful for couples in conflict. Datillio suggests that acceptance work for couples should aim to foster emotional acceptance between partners. They recommend strategies like empathic joining to create an environment where partners naturally increase their emotional acceptance of one another (Datilio 2010).
Dattilio, F. M. (2010).Cognitive-behavioral therapy with couples and families: A comprehensive guide for clinicians.The Guilford Press.
