Dr Bruno Cayoun is a clinical and research psychologist and principal developer of an internationally recognised method for treating a range of mental health conditions –from anxiety and depression to obsessive-compulsive disorder (OCD), pain and post-traumatic stress.
The method, known as Mindfulness-integrated Cognitive Behaviour Therapy (MiCBT), is being used worldwide, with editions of Cayoun ’s books, which include self-help and clinical handbooks, translated into three languages, and now a newly published workbook.
Growing up in France, Cayoun saw his mother suffer from clinical anxiety and depression and wanted to do something to help. After discovering mindfulness as a young adult, he was motivated to study psychology. Foremost in his mind was finding a way to integrate the benefits of mindfulness into clinical psychological practice.
Now, Cayoun is founder and Director of the MiCBT Institute, writes books and training modules for mental health professionals, and runs a clinical practice in Hobart. But his initial motivation to help people like his mother remains the same.
Here he describes his journey, the therapy approach he has developed, and offers a simple meditation practice for you to try.
Where did your interest in psychology come from?
My mum was chronically depressed and anxious; when I was 10, I remember she asked us to make a wish. My wish was to become a doctor, because I thought doctors can fix people, and I wanted to be like those who could heal my mum. I wanted my family to be happy. At that time, in 1971, I didn’t know what psychologists were.
The second wave of interest was when I discovered mindfulness meditation and saw its benefits. I was living in Byron Bay and looking at alternative therapies. I had done some yoga and various meditation practices in India. But it was only after I started my first 10-day intensive Vipassana retreat in 1989 that my life changed rather abruptly for the better. As the years went by, I had an increasing urge to bring mindfulness meditation to mainstream Western psychology.
I had done other things as a career – interior decorating, marketing – but eventually, at the age of 35, I started a university degree in psychology at the University of Tasmania.
Usually, most psychologists are interested in learning mindfulness techniques to incorporate them in their toolbox, as part of their professional development. But for me, it was the other way around. Mindfulness training brought me to mainstream psychology, and my clinical and research psychology career.
What have been some of the highlights of your career?
My first piloting of the Mindfulness-integrated Cognitive Behaviour Therapy approach in 2001 was my first real career highlight. Suddenly, the method I had developed was being implemented, and it showed that even hospitalised people with severe trauma symptoms were benefiting from it. Initially, some psychiatrists were a little confronted by the observation that traumatised patients they had been treating for years with standard methods started to feel better after only a few weeks of MiCBT. This initial resistance has now been overcome, given the numerous brain studies explaining why this kind of method helps and is becoming increasingly popular.
The second highlight was the creation in 2009 of Macquarie Psychology Clinic, where I am still working as a clinician. It meant that like-minded colleagues could join me in assisting people using this method. Also, my first book was published with Wiley in 2011, which was quite a significant achievement for me; I didn't know I was going to write another four! The book meant that clinicians and researchers worldwide could also learn about MiCBT and research its benefits. The following two books were also important in my career because one was a self-help book, which was so important in order to provide a practical resource for people to use. The other development was the publication of a clinical handbook for mental health professionals. It meant clinicians could follow the program week by week, even if they could not attend training with me or my colleagues.
And, finally, the creation of the MiCBT Institute, in 2009 as well, was one of the greatest shifts in my career because my colleagues and I started training mental health professionals around the world through its teaching infrastructure.
Have you got any sense of how many clinicians you've trained?
I don't know how many, but thousands. We now have a MiCBT Institute chapter in Canada; the North American Chapter. We also have a Japanese chapter located in Kyoto, a Latin American chapter in Mexico, and soon there will be a chapter in India, and another in Iran. MiCBT trainers in these countries teach in their own language and cultural context.
Interestingly, much research has been done in Iran, because my first book was translated by the University of Tehran 10 years ago. My first presentation in French will be at the University of Montreal in Quebec in February next year, at their psychiatric hospital. After Australia, Canada is where MiCBT is most popular.
An important skill taught during the training is the “mindfulness-based interoceptive exposure task”, or MIET. The technique involves learning to perceive pain objectively by breaking it into observable body sensations that are continually changing and accepting them for what they are. This lessens a patient’s reaction to pain, which in turn lessens the intensity of their pain experience. North America is getting very excited about this method for treating chronic back pain. Researchers at the University of California have asked me to provide training of the MIET, as part of their $US 40 million grant to implement this method with 5,000 participants with chronic back pain. This is to offset the opiate epidemic in North America. I'm very, very proud of being part of that. Two studies are already showing great results.
Can you tell us more about your PhD at the University?
This was interesting. After completing my honours degree in 2001, I was very fortunate to be the recipient of an APA (Australian Postgraduate Award) scholarship for three years, so I could be more present for my new family – I had young children then – and work on the PhD without worrying about money.
I wanted to do research in mindfulness, but no one in Hobart in 2001 had the expertise to supervise me, so I chose to study under Professor Jeff Summers, who specialised in attention research. Instead of studying mindfulness, I studied its dysfunction: ADHD (Attention Deficit Hyperactivity Disorder).
This actually gave me much more understanding of mindfulness than if I had studied mindfulness itself. This is because looking at the dysfunction, I could understand mechanisms that we ordinarily cannot. This suddenly spoke to many mental health professionals. Basically, it was about examining the systems involved in attention, such as “executive functions”, instead of just looking at “mindfulness”.
Do you treat ADHD with mindfulness?
Yes, lots of adults with ADHD these days. I used to see kids with ADHD and train them using a protocol I developed in 2005. This protocol consists of breath counting, first with open eyes, then closed eyes, vocalising, then sub-vocalising, and then giving them lots of trials of breath counting for a few weeks. Then they become more able to observe the breath like adults, initially for shorter periods that are progressively increased. So, we can shape attention behaviourally, which produces brain plasticity.
For adults, we go straight to mindfulness with some adjustments to the model of delivery. This might mean starting with practicing only for 10 min twice a day, Or maybe 5 min three times a day, and then we increase the amount of practice.
Can you describe the MiCBT method for our readers?
The MiCBT approach combines an ancient type of mindfulness training, the Vipassana meditation taught in the Burmese tradition for the past 25 and a half centuries, with evidence-based methods used in cognitive behaviour therapy. It is an evidence-based transdiagnostic therapy, which is interesting and advantageous for people. It consists of one method that is adjustable and applicable across a wide range of conditions.
It produces neuroplasticity in important areas of the brain for self-regulation. If you start to modify brain areas that are involved with emotional reactivity, and increase executive functioning, then you are already effective with more than half of mental health disorders.
We also adjust cognitive behavioural techniques according to what the disorder brings. So, if it's addiction, then we adjust it to that. If it is OCD, we adjust it to that, et cetera. But it's always the same theoretical framework and structure. It’s cheaper, easier, and quicker to learn than many other treatment modalities. With the right training, it becomes easier and more enjoyable over time. And it works across cultures, which is beautiful to see.
Can you please step us through a short introductory practice of mindfulness of breath, which I understand is one of the first steps you teach in your training?
Yes. Sit comfortably, cross-legged or on a chair, ensuring your knees are lower than your buttocks (use cushions if needed). Keep your neck and back straight. With your eyes closed, focus on the sensation of breath at the nostrils, observing the natural in-and-out flow.
You might feel coolness as you inhale and warmth as you exhale. If you don’t feel anything, breathe slightly harder briefly before returning to normal breathing. Notice if the breath is more prominent in one nostril or the other, its depth, and speed, but avoid trying to control it – simply observe.
Your mind will wander in the past or future. When this happens, acknowledge the thought without engaging, reacting or identifying with it, and gently return your attention to the breath. Do your best to stay in the present moment, moment by moment.
Each time your mind drifts, patiently and confidently bring it back to the breath without making judgements. You may feel sensations around your nose or body – acknowledge them but prevent reacting.
Over time, this practice strengthens three mental skills known as executive functions: (1) sustaining attention and working memory, (2) inhibiting engagement with distracting thoughts, and (3) refocusing attention whenever it drifts. Commitment to practice is key.
For more on MiCBT including Dr Cayoun’s new book, The Mindfulness and Meditation Workbook for Anxiety and Depression, and upcoming events, visit the MiCBT website. For more on studying psychology at the University of Tasmania, see the course description.
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