A Mindfulness Response: Group Discussions

            Kim discussed receiving special messages, which explained how some people cannot distinguish between what is real and what is not. Kim explained that the special messages come from electronic devices, such as TVs, Radios, or computers, and they rarely watch movies. After conversations with the group, Cary and Kim realized the delusional thought was a symptom and not actual. This took time to challenge the feelings and thoughts associated with the delusional thought. Kim was able to identify thoughts and feelings related to the delusion after practicing ways to recognize emotions and negative thoughts. The group pointed them out during discussions and talked about them in detail.

Cultural Awareness

Cognitive behavior therapy (CBT) was developed in the United States and has its Western roots, which involve examining facts about thoughts and situations. The CBT approach is used as a base for therapy in the USA as an effective, evidence-based treatment.

CBT does not address deep levels of shame and guilt. With different cultures, ethnicities, LGBTQ+, and different diagnostic issues, shame and stigma became essential discussions. Shame can cause people to hide symptoms and interrupt their healing process. The addition of self-compassion concepts and Person-Based Cognitive Therapy for Psychosis (PBCT) helped reduce shame. It opened conversations in ways that surprised some group members, who were grateful for finally experiencing a group where they could openly discuss their symptoms and feelings.

Therapy techniques have evolved to incorporate cultural narratives to support healing. Literature on racialized trauma speaks about making adjustments with culturally informed techniques and including multigenerational issues in therapy. Indigenous techniques in therapy utilize a healing circle, storytelling, and a positive body image approach. Spiritual practices connect with faith and elders, challenging racism and implicit bias rooted in older traditions.

Therapists include community resources and community groups to help build a bridge to that culture. The Black churches are essential to many participants, and accepting faith as part of the healing process is vital to some. To help heal from hate crimes against Asians, Jews, or other BIPOC members, therapists have used community resources for specific groups. Therapy includes information from families, Imams, pastors, or ministers, which is crucial to BIPOC groups.

Native American culture encompasses healing beliefs as a vital component of the recovery process.  The use of powwows, the sweat lodge, singing, drums, and the way the beat uplifted spirits and gave people new energy. The sound of the beat explained that it was the heart of the earth and energy with a deep connection to Mother Earth, representing the pulse of life itself. The drum is a central and spiritual element of the ceremony. The group understood the power of the rituals. Integrating indigenous cultural healing processes with group therapy allowed individuals to combine traditional healing practices with modern treatment, ultimately feeling whole.

Others who were first-generation Asian or African immigrants described intergenerational trauma to the group and how they felt it had touched their lives. They discussed traditional healing methods from their culture and how they have influenced their attitudes and behaviors. They learned therapy skills through group therapy and shared with group members how they applied them to their daily lives.

Being a light-skinned person in their culture impacted social status and class in their previous country. American Black participants listened and then responded. The treatment of skin color was different in the USA, and the class structure was not the same in the USA as in other countries. Other participants from diverse racial backgrounds emphasized the legal rights of all citizens ,regardless of theirracial or ethnic backgrounde.

The group summarized this conversation by employing self-compassion skills, including noticing, observing, and refraining from judgment. They concluded that combining the original Eastern cultural beliefs with contemporary Western American beliefs was a challenging task. The participant now lived in a different culture with new beliefs and had to understand this difference to adapt to Western culture.

One participant with Autism Spectrum Disorder talked to the group about losing time and daydreaming too much. The participant discussed how this could become a problem, and it wasn't easy to separate reality from the daydream. The group discussed how valuable it was to understand that such an event could happen. The discussion included strong feelings and thoughts that can be delusional.

Albert Ellis: Thoughts Can Be False and Irrational

            Albert Ellis (1957) developed Rational Emotive Therapy (RET), also known as Rational Emotive Behavior Therapy (REBT) (Ellis & Joffe-Ellis, 2019). Irrational thoughts can darken our mood and obscure our thinking. This was a surprise to group therapy participants, who read the irrational thoughts and noticed their negative thoughts matched those that Ellis wrote.

RET & Irrational Thought Examples

 I must be loved and admired by a partner or significant other.

Some actions are inherently evil, and those who commit them should be condemned.

It's frustrating when things don't go the way I want.

Misery is forced upon us by outside forces.

If something is dangerous or stressful, I must avoid dwelling on and obsessing about it.

Avoid life difficulties and your responsibilities.

Depend on someone else and do not take risks.

I am entirely competent and intelligent to do anything and have no weaknesses

or limitations.

I shall always be affected by the trauma that occurred in childhood and cannot overcome it ever in my life.

I have perfect control over everything.

Happiness is achieved by not acting and not doing things.

Emotions rule all human beings, and we cannot control them.

Ellis developed the ABC and the ABCDE Models to explain the developmental process of irrational thoughts. When thoughts were discussed, many sighs were heard in the room. Participants were surprised at how many they had. They studied these models.

A  The Antecedent is the problem.

B  Belief is the interpretation or reaction to the situation.

C  Consequence includes feelings and behaviors involved.

D         Dispute or challenge your negative beliefs to create a new consequence or result.

E         Effective New Beliefs:  Adopt new beliefs to change the old negative beliefs.

   ABCDE      

            I became aware of my irrational thoughts, understood them, identified them, and practiced thought journals to change old behavior patterns, bad habits, and responses. To develop new opinions, I employed mindfulness to observe and understand my thoughts, slow down my responses, and reconsider my reactions. Mindfulness has taught me to pause before reacting, slow down, and choose a more thoughtful alternative.

An Example: 

My friend wins the lottery, and I experience a jealous thought, which makes me want to reconsider being her friend.  I bought the next ticket and did not win. I should have won, not her. I feel jealous, angry, and frustrated…

Negative Thought                               Cognitive Distortion               Emotions                    

“I should have won the lottery.”         “SHOULDs”                           frustration, anger       

            Group discussions revealed the presence of false and irrational thoughts, accompanied by strong emotions. One participant talked about depression and feeling worthless and lazy. The group used common humanity to challenge this, saying that others with depression feel that way, but that is not the real you; it is the depression talking.

Understanding the Influence of Thoughts

            As a group, we learned to slow down the negative thoughts and reconsider what is happening. Participants learned to become aware of them, understand them, and question their effect on actions and feelings. The group applied self-compassion to the process.

Cognitive Behavior Therapy

            When Aaron Beck (1967) developed Cognitive Behavior Therapy (CBT), he drew upon ideas from Ellis and emphasized the importance of early childhood experiences.  As children, we hear adult messages that influence our behaviors and thoughts. Childhood Abuse and neglect, or hearing irrational reasons for chaos in the family, can lead to cognitive distortions and behaviors that can continue into adulthood.

            Staff instructed us to add self-compassion to all levels of therapy. Participants said, “Oh, I am just crazy,” or “I am such an idiot.”  The group responded by telling the person that they are just humans and that humans can make mistakes. Applying self-kindness and being non-judgmental helped them accept their symptoms and refrain from judging themselves.

            A participant talked about racing thoughts and going into a downward spiral, and that psychosis was worse. The group reminded the participant to refocus on the present, take deep breaths, stay grounded, and be in the moment. 

            The group discussed how regrets keep participants stuck in the past. They notice how focusing on the present reduces anxiety and depression, and that we can make plans for the future today, but we cannot control the future.

Identify Childhood Messages That Influence Current Negative Thoughts.

            The group learned to recognize how childhood messages can continue into adulthood. One participant was surprised by this and talked about creating an updated message. The new understanding decreased the intensity of the message. Participants with PTSD triggers and psychosis talked about being relieved to understand why and how the negative thoughts caused chaos.

Participants wrote down difficult symptoms. With mindfulness, they became aware of and observed their negative thoughts.

Early Experiences     (My parents criticized me, yelled at me, blamed me. I was bullied at school.) _____________________________________________________________

_____________________________________________________________

Core beliefs formed from childhood experiences…  (I am defective, ugly, bad. Everything is my fault.) _____________________________________________________________

_____________________________________________________________

Rules linked from this belief and behaviors…. (I do not speak up. I go along, even if it is wrong. I want to belong to a group, so I do risky behaviors.)

_____________________________________________________________

Triggers….      (Loud people, dominating people, judging, critical people, violent movies, crowds, open spaces) ____________________________________________________________

_____________________________________________________________

            We studied cognitive distortions and discussed how they manifest in arguments, isolation, and poor communication. They identified many cognitive distortions and shared experiences with the group. One participant noted that magnifying made psychosis symptoms worse.