Over the years , as a Buddhist practitioner and minister; as well as a Licensed Social Worker; I have been very disheartened when I hear people talk about “Buddhist Therapy.” It is because it is never Buddhist AND therapy. When I read the literature over the years, I have seen many great Buddhist scholars talk about how Buddhism can help people’s suffering, and many great psychologists take Buddhist terms and concepts and apply it to therapeutic interventions. But I never read of someone taking the Buddha’s teachings and distilling it to an actual therapeutic intervention model. I believe that this is a first in developing such a direct therapeutic model.
The Buddha’s teachings were, in essence, one of the first therapeutic interventions. Whether attempting to achieve an enlightened state of Nirvanna or just to reduce the suffering anguish of dealing with life, the Buddha was working in a framework of promoting mental wellness. His theory of the mind has been taken and adapted in therapy over and over again: from Freud to Beck. Many Buddhist practitioners attempt to heal themselves through Buddhist practice. When we strip away 2,600 years of spiritual ritual and cultural adaptations that have added to the direct teachings, we are left with a dharma practice and teaching that the Buddha described as “I teach only the understanding and cessation of suffering.”
It has been a labor of love pulling the therapeutic theory out of the Buddhist theological context and make it applicable to everyone as a mental health only practice. There is 45 years of teachings, and nearly three millennia of commentary to work with. It is evidenced-based by its longevity, but not in its particular components. There are differing traditions, and cultures. But at the core of it all is the simple truth (dharma) that the Buddha practiced methods that both transform the cognitive and behavioral lives towards mental well being. He did this through radical reframing of world view, intense self-inquiry, and physical acts that remove concepts of isolation. His premise is that all suffering comes from our instinctual fears that develop maladaptive coping mechanisms in absence of more conducive living strategies. These include delusions of the self, avoidance behaviors from danger, and clinging behaviors for survival.
In Buddhism, there are four noble truths: there is unsatisfactoriness (dukkha), that the cause is through dukkha (the thirst for unworthy things), that there is a cure, and that cure is the Buddhist practice.
Therapy should never be prescriptive and impose world views on the client. So instead Buddhist therapy borrows from the Buddhist practice. It acknowledges that clients have a sense of unsatisfactoriness, that it is caused by fear-based maladaptions, there is a solution and that is to work collaboratively developing skills and thinking reframes that create confident decision making in the clients life. Confidence in this case is defined as a sense of self-assurance that is needed to function competently through life without unnecessary stress that is created encouraging the client to choose maladaptive compensation strategies out of fear.
For example, a client who suffers from a fear of dogs may chose extreme avoidance behaviors in order to ensure that they do not have to deal with all dogs. This strategy is not based on current environments and may have created a lot of distress. By working with the client to reduce fear-based reactions that have been established in routine reaction protocols of the brain and use client strengths to focus on new routines that will allow the client to work more confidently and with assurance with more conducive skills when encountering dog, we remove suffering and distress. Unlike therapy interventions like CBT, that believes in negative core values creating automatic thoughts at the moment– Buddhist Therapy seeks out the fear-based motivation that the client thought would benefit and then work to replace those motivated actions that are not working for the client, identify what it is the client does want to accomplish and work to replace those routines.
In Buddhism, there is a concept of anatta (no self). This is the belief that individuals are not fixed but constantly evolving. This is a belief that both client and therapist must collaborate for therapy to move forward. The concept of anatta for some Buddhist traditions asserts that the ego also does not exist. In Buddhist therapy, we assert that the ego (or sense of self) is forever changing and evolving, and when the concept of self-becomes static, this is the time that the client develops dysfunctions of delusion and hypothetical storytelling. In this theory, when a client sees the concept of “I” as a rigid permanent concept, then they often will start creating stories of their perceptions of reality as truths without the need of evidence and impose the rigid thinking of “should” into their vocabulary. This is why the therapist, even if never mentioned to the client, but always be developing a sense of flex and acceptance of change into the client’s world view. This is called “anicca” (impermanence).
It is the acceptance of dukkha, anatta and anicca that are the cornerstones of Buddhist world view. But in Buddhist Therapy, they are tools in developing insight and change in the client: always meeting the client where they are and not imposing personal or theosophical concepts into the client’s world as a requisite.
Emotion is only a label to talk about aspects of the mind. Emotions are psycho-physical process evolved to solve different problems: defend against danger, create social connection, etc. Brain systems evolved emotional behaviors to survive in the world to survive so that the species can create offspring. The Human systems are incredibly complex, but understanding the core purpose of our evolutionary process allows us a reminder that all actions (including emotions) are done for a purpose. Humans have the capacity of conscious self-awareness. For centuries we only undertsood this consciousness in a circular argument “cogito ergo sum” (I think therefore I am). What may be more true is the definition by American satirist Ambrose Bierce, “cogito cogito ergo cogito sum” (I think that I think, there for I think that I am).
In science, the study of consciousness is broken down into the study of the proximate (the how) and the ultimate (the why). In the philosophy of Buddhism, neither is truly answered. Of course no science and philosophy has truly been able to successfully explain either yet. But what is known is that our self-aware consciousness makes certain evolutionary processes happen for our survival.
- Object Permanence – The ability for humans to continually conceptualize objects as being there beyond our ability to still see them. We can see a lion walk into the tall grass and then see the tall grass move and extrapolate the lion’s movements. Small children under the age of two have not developed permanence and this is why the game ‘peekaboo’ is so entertaining.
- Simulation– The ability for humans to imagine experiences BEFORE they happen. Think of chocolate cake covered in mustard and three day old fish might taste like. Most of us would either NOT entertain that thought or move through each flavor and simulate what that may taste like together. This is a very important tool in human evolution. It allowed for us to build our civilization.
- Emotions– Emotions are psycho-physical protocols created to survive. Our body reacts differently to each emotion: adrenaline is released in anger, ocytocin is released when in love; even how our eyes process information changes. Emotions are protocol reactions to our environment. More importantly, emotions are what allow us to make decisions. How we evaluate experiences as good, bad or ambivalently make a major portion of our decision making process. How often have you found yourself looking at the logic of a choice between “choice A” and “choice B” only to see that the logic usually loses to emotional desire.
Looking at the emotions mechanically, fear is the first of all emotions. It is the survival emotion. In Buddhism, many traditions talk about “Buddha nature” and the ultimate true nature of people being Buddha-like. This in contrast to other Buddhist traditions who believe that achieving arahant (or Buddha-hood) is a process that comes from liberating from the natural ignorance and ‘poisons’ of the world. Regardless of philosophical differences all Buddhists are working to deal with the issues of unhealthy hatred (avoiding), greed (clinging) and delusion. From a psychological view, these three coping mechanisms are dysfunctional defenses that are all rooted in fear.
Why is fear our primal emotion and how do we know it to be true? Fear is the emotion that works to keep us alive. It is the serious of routines that exist in the brain to get the mind-body to work together and survive. When we are afraid the brain kicks the thalamus and the amygdala into overdrive (areas of the limbic system). In the theory of the triune brain, the limbic system is the evolutionary process of the mammals aspects of us. But parts of the brain that make us the human beings we are today comes from later evolution of the neocortex that allows for permanence and simulation.
So we have these emotional processes that exist for us to survive, but why is important to Buddhism or modern therapy? Because scientists like Joseph LeDoux and Antonio Damasio have discovered that this limbic system (and possibly all emotions) create those emotion routines and the neocortex is asked to come in and help out. But the neocortex is an imagination machine as much as anything else. It creates simulations, and theories and stories. It is able to do what other animals can’t, which is create reality from nothing.
The stories told in the brain, without any contradicting evidence, become realities. We can rationalize that our imaginations become truth. As a kid, I would see shadows in my room and my imagination would create creepers and monsters, but when the lights were on, they were ordinary things like chairs with a coat on them. As an adult, when I waited an hour for a friend to arrive, I create hypotheses and stories about how my friend forgot me and evoke emotional worry that feeds into my stories validating them from within. In truth, my friend had a flat tire and needed to take time to change it.
THE THREE INFLUENCES OF FEAR ON DECISION MAKING
POWER OF IGNORANCE: Often, even when the evidence of external reality is presented, the emotional/imagination bond is so powerful that evidenced-based reality is occasionally rejected. There can be many reasons for this but there is always a motivating reason. Often the energy of fear and anger is exciting and can become addictive or a safe routine to live within.
POWER OF CLINGING: I have spoken to many women in abusive relationships. Even though the evidence is overwhelming that leaving their husband would lead to a safer, healthier and more rewarding life, they often choose to stay with their husband. Their fear of reprisal, failure, and change is too overwhelming. We are often more willing to stick with the comfort of an unhappy life than risk the fear that comes from change.
POWER OF AVOIDANCE: Everyone has a story of having bad news they do not want to tell someone: a bad report card, a broken vase, an ugly truth, etc. Not facing reality seems like an easy solution, but soon the energy that must be maintained to avoid an unpleasant co-worker, maintain a lie, etc. becomes stressful. There are many defense mechanisms that can become very complex in avoiding dealing with the realities of the world around them.
Fear emotions can work in two ways: there are short-fused and slow-devouring. Short fast fear are survival triggers of “fight or flight” instincts. A lion shows up in your office, the neocortex doesn’t need to spend a lot of time imagining horrible things happening, we just need to survive. The “fight or flight” instinct actually has three levels to it: freeze to attempt to not be noticed, flight to avoid danger, fight to re-establish control when all else fails. Short-fused emotions make us pay attention and take action without thinking. They are the routines of emergency protocol.
The amygdala takes charge and evokes strong emotional response that can (after the fact) seem to be inappropriate. Think of a scary movie, where you know everything is just a story on the screen, and yet we still jump at the moment of surprise or cower when the monster creeps up on the protagonist. Most of us will attempt to freeze or run away from problems first, since they have the highest chance of survival. Nevertheless, there are those who have been conditioned to jump directly to fighting as their main (and often only) recourse of survival.
In many ways, the flight or fight process deals in parallel with the three core coping mechanisms: ignorance (remain still and hope that you are invisible to the danger), avoidance (run away from the danger), and fight (use energy to keep control).
Expressed Emotions and Adaptive psycho-physical function
|Fear||Increased visual field, speed eye movement. Blood rushes to legs and core||Protection from physical threats|
|Disgust||Constriction of openings to reduce potential consumption or inhalation||Protection from dangerous substances|
|Anger||Narrowing visual field, increased focus, Blood rushes to arms and core.||Protection from physical threats|
CBT vs BUDDHIST THERAPY
Looking at the Buddhist Therapy model, it might seem to be very similar or easily overlayed with Cognitive Behavioral Theory. There are a lot of similarities and I would say that Buddhist Therapy is a type of C-B therapy. But there are some significant differences.
In the traditional Cognitive-Behavioral Model (figure 1), the client is considered to have certain negative core beliefs that impact his decision making. These core beliefs are often themes of being unloveable, hapless, unworthy. In Buddhist philosophy, these negative core beliefs to not differ from the narcissistic views of “I am the most loved,” “I am the most hopeful,” “I am the most worthy.” Narcissism is a delusion compensation developed by fear. The conditioning of fear responses are created in the past and codified in the client’s world view. This creates coping strategies when dealing with life that do not work for the client’s sense of well-being. Core beliefs are just one more level of compensation strategy.
Instead of dealing with “core beliefs,” Buddhist therapy (figure 2) looks at what fears the client has and how they motivate the client’s actions. Interventions work at breaking or changing fear-based routines and mental processes, ultimately changing how the client perceives contact with the world around them, and change the processes of rationalization about the experience. This leads to more mindful and “confident” responses.
Mental wellness in this Buddhist Therapy theory is shifting mental thoughts and routines that are on a spectrum from fear-based behaviors and feelings towards actions of confidence. This is done by identifying established unmindful routines, hypothetical storytelling and fear-based thinking and providing cognitive- behavioral tools to use for compensatory strategies that lead to more confident living.
The measure of evidenced based success is in the collaborative evaluation of behaviors that the client wants to change on a spectrum of importance for change to occur and a spectrum of fear-or-confidence.
Importance Ruler: “On a scale of 0-10, how important do you think it is to …?”
Confidence Ruler: “On a scale of -10 being most fearful and 10 being most confidence, where would you rank your response to …?”
The Buddhist therapy most is to focus on exploiting the strengths of the client to build new more conducive confidence building skills. The therapist works on the following premises:
- The homeostasis of being is not on a scale of happy or sad but on confidence and fear
- That fear-based thinking and behaviors are manifested in either avoidant, clinging or delusional defenses.
- That all actions, volitional or habitual; conducive or counter-productive, are purposeful. The therapist works with the clients to identify what the value of that thought and/or action is to the client and determine if change needs to occur before developing strategies new change. Strategies.
- That concepts of “right” or “wrong” thoughts or behaviors do not exist (avoiding rigid ‘should’ thinking), only thoughts and behaviors that are conducive and productive.
- All dysfunctional thinking and behaviors are compensatory strategies that do not produce functional results for short and long term benefit to the client leading to stress and dissatisfaction.
- That actions can predicate changes in mental processes as well as insight. Socialization is a cornerstone for change homework assignments should be experiments in interaction. In Buddhist philosophy the practice of dana (acts of giving) are considered to be of utmost importance. Dana is broken down into three parts: giving for obligation, giving for reward, giving for self-satisfaction. It is believed that the practice of giving will take a practitioner into an operant mindset, theoretically finding the benefits of actions for immediate gain replaced with a practice of mindful practices that find greater benefit in operant rewards.
- The best opportunity for change is experiential. Therapist and client should collaborate on practices to develop change and then discuss them during sessions. Focuses should be heavily centered around self-inquiry, socialization, mindfulness insight, and (when possible) group dialogue.
- Memories are not concrete recordings of the past. What is important is to work with the meaning of memories to the client and how they inform his cognitive world view and decision making processes. This works toward developing a mindful present-centered thinking when evaluating actions in the face of fear-based thinking.
Buddhist Therapy has six phases (Expectations of therapy to last 6-8 weeks).
- Assessment. Therapist and client work together to identify areas of distress, prioritize them, and develop a collaborative treatment goal.
(Step 2,3 and 4 work in tandom rather than sequentially)
- Dialectic inquiry for motivation. Therapist and client collaborate insight into what compensatory strategies the client uses in situations and then work together to develop understanding what motivates the use of those strategies.
- Skills acquisition. Therapist and client collaborate experiments of mental and behavioral change making changes and adjustments as evidenced by measures of success.
- Mindful insight. This section is the least individualized and least collaborative portion of therapy. Every client should take on a practice of socialization skills, self-reflection and (if appropriate) group dialogue). Buddhist practice is about developing practices of interconnection with others, practices of patience, while also developing a practice of potential insight. One mandatory practice is to sit at least 20 minutes a day in silence, and engage in a weekly activity with the community.
- Confidence building. Therapist and client work various practices and experiments from steps 2-4 and evaluate how the client moves up in his confidence skills for his defined areas of progress.
- Post-treatment assessment follow-up. At the end of treatment skills, insights and change should be discussed and how the client can use those new compensation strategies to live a more confident life. There should also be discussions on relapse prevention.
In CB models, clients deal with cognitive distortions to deal with the world and make it fit their maladaptive thinking. In the Buddhist model, cognitive distortions are just fear-based strategies to justify thoughts, perceptions or actions. Insight into the validity of this distorted thinking is approached not by challenging these thoughts but identifying how these thoughts were used in an attempt to benefit the client, and then evaluated in how well these cognitive distortions performed their function. It is only by offering a better tool, that a client can have the confidence in letting go of the dysfunctional cognition or behavior.
BUDDHIST THERAPY vs SCHEMA THERAPY
While CBT works in the model of “Core Values”, Schema Therapy believes that dysfunction is developed in Early Maladaptive Schemes (EMS), which fixes a dysfunctional world view for the client. Buddhist therapy would acknowledge EMS only to the point that they create dysfunctional world views; however, they are not fixed. They are constantly evolving, only that the more entrenched the routines and compensatory strategies are, the more difficult they are to change.
The security a client has in a world view (even a dysfunctional one) is almost always more comforting and preferable than the insecurity of change. Emotional memory works a lot like muscle memory and once a habit is created it is difficult to change (but not impossible).
Often unconditional schemas sabotage therapy because the client does not want their world view challenged. The concept of self (“I”) becomes an anchor and that identity (even if negative) is comforting. The client knows where they are in the world.
There are myriad other therapeutic interventions. I have not worked with them all. Some are different enough that they aren’t worth mentioning. Others like Brief Treatment are so open-ended that they would encompass any treatment plan that is strengths-based and measurable.
As far as I have gotten in this model, I am convinced that Buddhist Therapy is as valid as any other. If the Buddha had lived today, his practice would have been renowned. It is a strengths-based practice that works directly on engaging the client into being the progenitor of their own success, combining modern understanding with knowledge and techniques developed 2,600 years ago.