The Purpose, Mechanisms, and Benefits of Cultivating Ethics in Mindfulness-Integrated Cognitive Behavior Therapy

  • Bruno A. Cayoun
Part of the Mindfulness in Behavioral Health book series (MIBH)


The inclusion of ethics in mindfulness-based interventions (MBIs) has become a hot topic in recent years, contributing to a differentiation between what has recently been called first- and second-generation MBIs. This chapter first discusses the origins and purpose of ethics in Theravada Buddhism and the traditional understanding that developing mindfulness also aids in monitoring and preventing harmful intentions and actions, while cultivating beneficial ones, to decrease suffering. It will then describe the role and benefits of cultivating ethics in Mindfulness-integrated Cognitive Behavior Therapy (MiCBT), a four-stage transdiagnostic approach that combines Burmese Vipassana meditation and core principles of traditional CBT. There are three principal reasons for which MiCBT dedicates a whole therapeutic stage to the development of empathy grounded in loving-kindness meditation and ethical living: (1) the cultivation of compassion, (2) the prevention of relapse into common mental health disorders, and (3) the cultivation of joy and well-being. The chapter also offers some insight into the reasons for which more advanced mindfulness states inevitably lead to the observation that ethics and compassion are interdependent, and reflects on some of the implications that this may have for MBI programs.


Mindfulness-integrated cognitive behavior therapy MiCBT Ethics MBIs Second-generation MBIs SG-MBIs 



I am grateful to Drs. Lynette Monteiro, Glenn Bilsborrow, and Andrea and Nick Grabovac for their useful suggestions.


  1. Abroms, B. D., Fillmore, M. T., & Marczinski, C. A. (2003). Alcohol-induced impairment of behavioral control: Effects on the alteration and suppression of prepotent responses. Journal on Studies of Alcohol, 64, 687–695.CrossRefGoogle Scholar
  2. Apkarian, A. V. (2008). Pain in relation to emotional learning. Current Opinion in Neurobiology, 18, 464–468.CrossRefPubMedPubMedCentralGoogle Scholar
  3. Baer, R. A. (2015). Ethics, values, virtues, and character strengths in mindfulness-based interventions: A psychological science perspective. Mindfulness.
  4. Bahrani, S., Zargar, F., Yousefipour, G., & Akbari, H. (2017). The effectiveness of mindfulness-integrated cognitive behavior therapy on depression, anxiety, and stress in females with multiple sclerosis: A single blind randomized controlled trial. Iranian Red Crescent Medical Journal, e44566.
  5. Baliki, M. N., Geha, P. Y., Apkarian, A. V., & Chialvo, D. R. (2008). Beyond feeling: Chronic pain hurts the brain, disrupting the default-mode network dynamics. The Journal of Neuroscience, 28, 1398–1403.CrossRefPubMedGoogle Scholar
  6. Baliki, M. N., Petre, B., Torbey, S., Herrmann, K. M., Huang, L., Schnitzer, T. J., … Apkarian, A. V. (2012). Corticostriatal functional connectivity predicts transition to chronic back pain. Nature Neuroscience, 15, 1117–1119.CrossRefPubMedPubMedCentralGoogle Scholar
  7. Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., … Devins, G. (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice, 11, 230–241.Google Scholar
  8. Bodhi, B. (2000). The connected discourses of the Buddha: A translation of the Samyutta Nikaya. Boston: Wisdom Publications.Google Scholar
  9. Bowen, S., Chawla, N., & Marlatt, G. A. (2010). Mindfulness-based relapse prevention for addictive behaviors: A Clinician’s Guide. New York: Guilford Press.Google Scholar
  10. Bowen, S., Witkiewitz, K., Dillworth, T. M., Chawla, N., Simpson, T. L., Ostafin, B. D., … Marlatt, G. A. (2006). Mindfulness meditation and substance use in an incarcerated population. Psychology of Addictive Behaviors, 20, 343–347. CrossRefPubMedGoogle Scholar
  11. Brewer, J. A., Worhunskya, P. D., Gray, J. R., Tang, Y., Weberd, J., & Kobera, H. (2011). Meditation experience is associated with differences in default mode network activity and connectivity. Proceedings of the National Academy of Sciences USA.
  12. Buckner, R., Andrews-Hanna, J., & Schacter, D. (2008). The brain’s default network: Anatomy, function, and relevance to disease. New York Academy of Sciences, 1124, 1–38.CrossRefGoogle Scholar
  13. Cayoun, B. A. (2010). The dynamics of bimanual coordination in ADHD: Processing speed, inhibition and cognitive flexibility. Saarbrücken, Germany: Lambert Academic Publishing.Google Scholar
  14. Cayoun, B. A. (2011). Mindfulness-integrated CBT: Principles and practice. Chichester: Wiley.CrossRefGoogle Scholar
  15. Cayoun, B. A. (2015). Mindfulness-integrated CBT for wellbeing and personal growth: Four steps to enhance inner calm, self-confidence and relationships. Chichester: Wiley.Google Scholar
  16. Cayoun, B. A., Francis, S. E., & Shires, A. (2017). The Clinician’s Guide to Mindfulness-integrated CBT: A step-by-step workbook and resource for therapists. Manuscript in preparation.Google Scholar
  17. Cayoun, B. A., Simmons, A., & Shires, A. (2017). Immediate and lasting chronic pain reduction following a brief self-implemented mindfulness-based interoceptive exposure task: A preliminary open trial. Manuscript submitted for publication.Google Scholar
  18. Cramer, S. C., Sur, M., Dobkin, B. H., O'Brien, C., Sanger, T. D., Trojanowski, J. Q., … Vinogradov, S. (2011). Harnessing neuroplasticity for clinical applications. Brain, 134, 1591–1609. CrossRefPubMedPubMedCentralGoogle Scholar
  19. Crane, R. S. (2016). Implementing mindfulness in the mainstream: Making the path by walking it. Mindfulness.
  20. Desbordes, G., Gard, T., Hoge, E. A., Hölzel, B. K., Kerr, C., Lazar, S. W., … Vago, D. R. (2015). Moving beyond mindfulness: Defining equanimity as an outcome measure in meditation and contemplative research. Mindfulness, 6, 356–372. CrossRefGoogle Scholar
  21. Dimyan, M. A., & Cohen, L. G. (2011). Neuroplasticity in the context of motor rehabilitation after stroke. Nature Reviews Neurology, 7, 76–85. CrossRefPubMedPubMedCentralGoogle Scholar
  22. Dreyfus, G. (2011). Is mindfulness present-centered and non-judgmental? A discussion of the cognitive dimensions of mindfulness. Contemporary Buddhism, 12, 41–54. CrossRefGoogle Scholar
  23. Farb, N. A. S., Anderson, A. K., Mayberg, H., Bean, J., Mckeon, D., & Segal, Z. V. (2010). Minding one’s emotion: Mindfulness training alters the neural expression of sadness. Emotion, 10, 25–33.CrossRefPubMedPubMedCentralGoogle Scholar
  24. Farb, N., Daubenmier, J., Price, C. J., Gard, T., Kerr, C., Dunn, B. D., … Mehling, W. E. (2015). Interoception, contemplative practice, and health. Frontiers in Psychology, 6, 763. CrossRefPubMedPubMedCentralGoogle Scholar
  25. Farb, N. A. S., Segal, Z. V., & Anderson, A. K. (2013). Attentional modulation of primary interoceptive and exteroceptive cortices. Cerebral Cortex, 23, 114–126. CrossRefPubMedGoogle Scholar
  26. Farb, N. A. S., Segal, Z. V., Mayberg, H., Bean, J., McKeon, D., Fatima, Z., & Anderson, A. K. (2007). Attending to the present: Mindfulness meditation reveals distinct neural modes of self-reference. Social Cognitive and Affective Neuroscience, 2, 313–322.CrossRefPubMedPubMedCentralGoogle Scholar
  27. Farzinrad, B., & Nazari, K. M. (2013). Comparison between Effectiveness of mindfulness integrated cognitive behavioral therapy (MiCBT) and rational emotional behavior therapy (REBT) on procrastination, perfectionism and worry in students. Dissertation, Tabtiz University of Medical Sciences, Iran.Google Scholar
  28. Fox, M. D., Snyder, A., Vincent, J., Corbetta, M., Van Essen, D., & Raichle, M. E. (2005). The human brain is intrinsically organized into dynamic, anticorrelated functional networks. PNAS, 102, 9673–9678.CrossRefPubMedPubMedCentralGoogle Scholar
  29. Gard, T., Hölzel, B., Sack, A. T., Hempel, H., Lazar, S. W., Vaitl, D., & Ott, U. (2011). Pain attenuation through mindfulness is associated with decreased cognitive control and increased sensory processing in the brain. Cerebral Cortex, 191, 36–43. Google Scholar
  30. Gethin, R. (1998). The foundations of Buddhism. Oxford: Oxford University Press.Google Scholar
  31. Goenka, S. N. (1998). Satipatthana Sutta Discourses: Talks from a course in Maha-satipatthana Sutta. Seattle, WA: Vipassana Research Publications.Google Scholar
  32. Grant, J. A., Courtemanche, J., & Rainville, P. (2011). A non-evaluative mental stance and decoupling of executive and pain-related cortices predicts low pain sensitivity in Zen meditators. Pain, 152, 150–156.CrossRefPubMedGoogle Scholar
  33. Grossman, P. (2015). Mindfulness: Awareness informed by an embodied ethic. Mindfulness, 6, 17–22. CrossRefGoogle Scholar
  34. Hakamata, Y., Lissek, S., Bar-Haim, Y., Britton, J. C., Fox, N. A., Leibenluft, E., … Pine, D. S. (2010). Attention bias modification treatment: A meta-analysis toward the establishment of novel treatment for anxiety. Biological Psychiatry, 68, 982–990. CrossRefPubMedPubMedCentralGoogle Scholar
  35. Hart, W. (1987). The art of living: Vipassana meditation as taught by S. N. Goenka. New York: Harper Collins.Google Scholar
  36. Hawley, L. L., Schwartz, D., Bieling, P. J., Irving, J., Corcoran, K., Farb, N. A. S., … Segal, Z. V. (2014). Mindfulness practice, rumination and clinical outcome in mindfulness-based treatment. Cognitive Therapy and Research, 38, 1–9.CrossRefGoogle Scholar
  37. Hölzel, B. K., Brunsch, V., Gard, T., Greve, D. N., Koch, K., Sorg, C., … Milad, M. R. (2016). Mindfulness-Based Stress Reduction, fear conditioning, and the uncinate fasciculus: A pilot study. Frontiers in Behavioral Neuroscience, 10, 124. CrossRefPubMedPubMedCentralGoogle Scholar
  38. Hölzel, B. K., Carmody, J., Evans, K. C., Hoge, E. A., Dusek, J. A., Morgan, L., … Lazar, S. W. (2010). Stress reduction correlates with structural changes in the amygdala. Social Cognitive and Affective Neuroscience, 5, 11–17.CrossRefPubMedGoogle Scholar
  39. Hutcherson, C. A., Seppala, E. M., & Gross, J. J. (2008). Loving kindness meditation increases social connectedness. Emotion, 8, 720–724.CrossRefPubMedGoogle Scholar
  40. Ingram, R. E., Atchley, R. A., & Segal, Z. V. (2011). Vulnerability to depression: From cognitive neuroscience to prevention and treatment. New York: Guilford Press.Google Scholar
  41. Jääskeläinen, I. P., Schröger, E., & Näätänen, R. (1999). Electrophysiological indices of acute effects of ethanol on involuntary attention shifting. Psychopharmacology, 141, 16–21.CrossRefPubMedGoogle Scholar
  42. Jayasaro, A. (2011). Mindfulness, precepts and crashing in the same car. Bangkok, Thailand: Panyaprateep Foundation.Google Scholar
  43. Jayasaro, A. (2013). Without and Within: Questions and answers on the teachings of Theravāda Buddhism. Buddhadasa Indapanno Archives, Bangkok: Panyaprateep Foundation. Retrieved from content/uploads/2014/10/11/Without-and-Within-by-Ajahn-Jayasaro.pdf.
  44. Jazaieri, H., Jinpa, G. T., McGonigal, K., Rosenberg, E. L., Finkelstein, J., Simon-Thomas, E., … Goldin, P. R. (2012). Enhancing compassion: A randomized controlled trial of a compassion cultivation training program. Journal of Happiness Studies, 14, 1113. CrossRefGoogle Scholar
  45. Kabat-Zinn, J. (1994). Wherever you go, there you are. New York: Hyperion.Google Scholar
  46. Kabat-Zinn, J. (2005). Coming to our senses: Healing ourselves and the world through mindfulness. London: Piatkus.Google Scholar
  47. Kirk, U., Downar, J., & Montague, P. R. (2011). Interoception drives increased rational decision-making in meditators playing the ultimatum game. Frontiers in Neuroscience, 5.
  48. Koelega, H. S. (1995). Alcohol and vigilance performance: A review. Psychopharmacology, 118, 233–249.CrossRefPubMedGoogle Scholar
  49. Kramer, G. (2007). Insight Dialogue: The interpersonal path to freedom. Boston, MA: Shambhala Publications.Google Scholar
  50. Kumar, A., Sharma, M. P., Narayanaswamy, J. C., Kandavel, T., & Reddy, Y. C. J. (2016). Efficacy of mindfulness-integrated cognitive behavior therapy in patients with predominant obsessions. Indian Journal of Psychiatry, 58, 366–371. CrossRefPubMedPubMedCentralGoogle Scholar
  51. Lackner, R. J., & Fresco, D. M. (2016). Interaction effect of brooding rumination and interoceptive awareness on depression and anxiety symptoms. Behaviour Research and Therapy.
  52. Leary, M. R., Tate, E. B., Adams, C. E., Batts Allen, A., & Hancock, J. (2007). Self-compassion and reactions to unpleasant self-relevant events: The implications of treating oneself kindly. Journal of Personality and Social Psychology, 92, 887–904.CrossRefPubMedGoogle Scholar
  53. Lokopalo, B. (2010). Importance of vedana and sampajanna in the Vipassana (Insight) system of meditation. Igatpuri, India: Vipassana Research Institute. Retrieved from
  54. Lutz, A., Brefczynski-Lewis, J., Johnstone, T., & Davidson, R. J. (2008). Regulation of the neural circuitry of emotion by compassion meditation: Effects of meditative practice. PloS One, 3, e1897.CrossRefPubMedPubMedCentralGoogle Scholar
  55. Mansour, A. R., Farmer, M. A., Baliki, M. N., & Apkarian, A. V. (2014). Chronic pain: The role of learning and brain plasticity. Restorative Neurology and Neuroscience, 32, 129–139. PubMedPubMedCentralGoogle Scholar
  56. Marczinski, C. A., & Fillmore, M. T. (2003). Preresponse cues reduce the impairing effects of alcohol on the execution and suppression of responses. Experimental and Clinical Psychopharmacology, 11, 110–117.CrossRefPubMedGoogle Scholar
  57. Marinkovic, K., Rickenbacher, E., & Azma, S. (2012). Effects of alcohol intoxication on response conflict in a flanker task. Journal of Addiction Research and Therapy, S3, 002. Google Scholar
  58. McDonald, J., Schleifer, L., Richards, J. B., & de Wit, H. (2003). Effects of THC on behavioral measures of impulsivity in humans. Neuropsychopharmacology, 28, 1356–1365.CrossRefPubMedGoogle Scholar
  59. Monteiro, L. (2016). Implicit ethics and mindfulness: Subtle assumptions that MBIs are values-neutral. International Journal of Psychotherapy, 20, 210–224.Google Scholar
  60. Monteiro, L., & Musten, F. (2013). Mindfulness starts here: An eight-week guide to skillful living. BC, Canada: Friesen Press.Google Scholar
  61. Monteiro, L., Musten, R. F., & Compson, J. (2014). Traditional and contemporary mindfulness: Finding the middle path in the tangle of concerns. Mindfulness, 6, 1–13. CrossRefGoogle Scholar
  62. Monteiro, L., Nuttall, S., & Musten, R. F. (2010). Five skilful habits: An ethics-based mindfulness intervention. Counseling et Spiritualité, 29, 91–104.Google Scholar
  63. Narada, M. (1968). A manual of Abhidhamma. Kandy, Sri Lanka: Buddhist Publication Society.Google Scholar
  64. Neff, K. (2004). Self-compassion and psychological wellbeing. Constructivism in the Human Sciences, 9, 27–37.Google Scholar
  65. Neff, K. D., Kirkpatrick, K. L., & Rude, S. S. (2007). Self-compassion and adaptive psychological functioning. Journal of Research in Personality, 41, 139–154.CrossRefGoogle Scholar
  66. Oscar-Berman, M., & Marinkovic, K. (2007). Alcohol: Effects on neurobehavioral functions and the brain. Neuropsychology Review, 17, 239–257. CrossRefPubMedPubMedCentralGoogle Scholar
  67. Peters, J. R., Geiver, P. J., Smart, L. M., & Baer, R. A. (2014). Shame and borderline personality features: The potential mediating role of anger and anger rumination. Personality Disorders: Theory, Research, and Treatment, 5, 1–9.CrossRefGoogle Scholar
  68. Roubos, L. (2011). A comparison of group-enhanced and individual implementations of Mindfulness-integrated Cognitive Behaviour Therapy (MiCBT): An effectiveness study. Unpublished master dissertation, James Cook University, Cairns, Australia.Google Scholar
  69. Salzberg, S. (1995). Loving-kindness: The revolutionary art of happiness. Boston, MA: Shambala.Google Scholar
  70. Schwartz, J., & Gladding, R. (2011). You are not your brain: The 4-step solution for changing bad habits, ending unhealthy thinking and taking control of your life. New York: Penguin.Google Scholar
  71. Scott-Hamilton, J., & Schutte, N. S. (2016). The role of adherence in the effects of a mindfulness intervention for competitive athletes: Changes in mindfulness, flow, pessimism and anxiety. Journal of Clinical Sport Psychology, 10, 99–117. CrossRefGoogle Scholar
  72. Scott-Hamilton, J., Schutte, N. S., & Brown, R. F. (2016). Effects of a mindfulness intervention on sports-anxiety, pessimism, and flow in competitive cyclists. Applied Psychology: Health and Well-Being, 8, 85–103. Google Scholar
  73. Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. New York: Guilford.Google Scholar
  74. Senderey, E. (2017). Mindfulness and group cognitive behavioural therapy to address problematic perfectionism. Athens Journal of Social Sciences, 4, 49–66.Google Scholar
  75. Sharf, R. (2014). Mindfulness and mindlessness in early Chan. Philosophy Est & West, 64, 933–964. CrossRefGoogle Scholar
  76. Shonin, E., van Gordon, W., & Griffiths, M. D. (2015). Teaching ethics in mindfulness-based interventions. Mindfulness.
  77. Siegle, G. J., Thompson, W., Carter, C. S., Steinhauer, S. R., & Thase, M. E. (2007). Increased amygdala and decreased dorsolateral prefrontal BOLD responses in unipolar depression: Related and independent features. Biological Psychiatry, 61, 198–209.CrossRefPubMedGoogle Scholar
  78. Starr, C. J., Sawaki, L., Wittenberg, G. F., Burdette, J. H., Oshiro, Y., Quevedo, A. S., & Coghill, R. C. (2009). Roles of the insular cortex in the modulation of pain: Insights from brain lesions. The Journal of Neuroscience, 29, 2684–2694. CrossRefPubMedPubMedCentralGoogle Scholar
  79. Taylor, V. A., Grant, J., Daneault, V., Scavone, G., Breton, E., Roffe-Vidal, S., … Beauregard, M. (2011). Impact of mindfulness on the neural responses to emotional pictures in experienced and beginner meditators. NeuroImage, 57, 1524–1533.CrossRefPubMedGoogle Scholar
  80. Walshe, M. (2012). The long discourses of the Buddha: A translation of the Digha Nikaya. Boston: Wisdom Publications.Google Scholar
  81. Yazdanimehr, R., Omidi, A., Sadat, Z., & Akbari, H. (2016). The effect of mindfulness-integrated cognitive behavior therapy on depression and anxiety among pregnant women: A randomized clinical trial. Journal of Caring Sciences, 5, 195–204.  10.15171/jcs.2016.021 CrossRefPubMedPubMedCentralGoogle Scholar
  82. Zeidan, F., & Vago, D. R. (2016). Mindfulness meditation-based pain relief: A mechanistic account. Annals of the New York Academy of Sciences, 1373, 114–127. CrossRefPubMedPubMedCentralGoogle Scholar
  83. Zhang, S., Wu, W., Huang, G., Liu, Z., Guo, S., Yang, J., & Wang, K. (2014). Resting-state connectivity in the default mode network and insula during experimental low back pain. Neural Regeneration Research, 9, 135–142. CrossRefPubMedPubMedCentralGoogle Scholar

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© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Mindfulness-integrated Cognitive Behavior Therapy InstituteHobartAustralia

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