You have been sitting on the cushion for what seems like an eternity, though a glance at your clock assures you that it has only been 23 minutes. Your legs are going to sleep in the cross-legged position and your back – free from supports as you were instructed to have it be – is starting to ache in the unaccustomed upright posture.

A fly has been buzzing around, alternately interesting and irritating you, and you wonder why you never noticed how much traffic goes by your street outside. You must have eaten something that you are allergic to at breakfast, because your guts are steadily expanding to their fully bloated state, making you feel like you swallowed a beach ball. You notice the usual stiffness in your neck and upper spine (the pain from which motivated you to take up this unusual practice of doing nothing), and you have the most intense desire to scratch an itch in the middle of your back. All of this is in addition to your humdinger of a toothache.

Welcome to the world of mindfulness, you grimly tell yourself, where every pain, irritation, and sensation, from barely there to unbearable, is brought to your earnest attention. Then you realise: oh, that’s a thought. I’m not supposed to get carried away with thoughts. Back to noticing the itch, the toothache, the fly…

And yet, amidst the flux of sound, pain, and thought intrusion, you are also immersed in a novel experience: the curiously comforting sensation of stillness. It’s an odd, expanding peacefulness. Could this be what all those Eastern religious dudes are rabbiting on about?

Mindfulness is…

Although only recently embraced by Western psychology, mindfulness practices and techniques have been part of many Eastern philosophies, such as Buddhism, Taoism, Tai Chi, Hinduism, and most martial arts, for thousands of years. The various definitions of it revolve around bringing non-judgmental consciousness to the present experience, so it can be considered the art of conscious living. Mindfulness is said to be:

1. “Bringing one’s complete attention to the present experience on a moment-to-moment basis” (Marlatt & Kristeller, 1999, p 68).
2. “Paying attention in a particular way; on purpose, in the present moment, and nonjudgmentally” (Kabat-Zinn, 1994, p4).
3. “Consciously bringing awareness to your here-and-now experience, with openness, interest, and receptiveness” (Harris, 2007).

Let’s note some of the important elements of these definitions. First, we can observe that mindfulness is a process of awareness, not thinking. Awareness involves noticing experience, as opposed to getting caught up in thoughts. Second, the three definitions above hint at a corollary aspect: the attitude that goes with being mindfully aware. It is not one of closed-minded pre-judging. Instead the stance is one of openness and curiosity, which induce acceptance rather than conflict or avoidance of whatever is happening. Thus, a person can be having the unpleasant experience of intense pain and yet – through mindfulness – regard that pain with curiosity and openness, as merely a sensation to be explored, rather than something to fight with or escape, say through drugs.

Third, paying attention in a particular way – “on purpose” – suggests that we are able to choose what we pay attention to. When we can direct our awareness, focusing on different aspects of our experience, we are free to deeply connect with ourselves, appreciating the fullness of each moment of life. We can use the awareness to enhance our self-knowledge, and to connect more deeply with those we care about. We can use mindfulness to expand our repertory of responses to our world, thus greatly increasing our psychological resilience and life satisfaction. Dr Harris, a strong advocate of Acceptance and Commitment Therapy (which uses mindfulness-based techniques), suggests that this may be why ACT has been shown to increase therapist effectiveness and reduce therapist burnout (Harris, 2009).

Mindfulness is not…

Mindfulness can be contrasted with several other philosophies or practices. CBT (Cognitive Behaviour Therapy) also involves becoming aware of one’s thoughts, but those practicing CBT are encouraged to evaluate and then dispute unhelpful thoughts, changing them to something kinder and more accurate. In mindfulness, practitioners are not generally interested in whether thoughts are true or false, but in whether it is helpful in the moment to hang on to or get caught up with them.

If the practitioner observes that a thought is likely to put his/her life into the “stuck and struggling” zone rather than making it fuller, richer, and more meaningful, then the practitioner agrees to let the thought come and go rather than engage with it, but there is no attempt to fight it (Harris, 2009). In recent years, mindfulness advocates have merged mindfulness with cognitive therapies, adapting Mindfulness-Based Stress Reduction (MBSR) techniques to Cognitive Therapy for purposes of relapse prevention in addiction cases.

While mindfulness practices require a certain degree of calm and equanimity and although they tend to engender greater relaxation, they should not be confused with relaxation practices in some other schools of thought, which differ significantly. Mindfulness is a form of mental training intended to enhance awareness and the ability to disengage from maladaptive patterns of mind that make one vulnerable to stress responses and psychopathology. Training in mindfulness attempts to increase awareness of thoughts, emotions, and maladaptive ways of responding to stress, thereby helping practitioners learn to cope with stress in healthier, more effective ways (Bishop et al, 2004, in Shapiro et al, 2005).

Clinical applications of mindfulness

Let’s review what some of the main clinical applications of mindfulness are.

Mindfulness-Based Stress Reduction (MBSR)

Probably the most commonly-cited method of mindfulness training in the literature is MBSR. Developed in a behavioural setting for populations with chronic pain and stress-related disorders, it has typically been conducted as an 8 to 10 week course for groups of up to 30 participants who meet weekly for two to two-and-a-half hours for instruction and practice in mindfulness meditation skills, along with discussion of stress, coping, and homework assignments.

Instructed to practice the skills outside group meetings for at least 45 minutes per day, participants become skilled in focusing the attention on the target of observation (e.g., the breath), and through this they improve on their ability to be aware of it in each moment. When emotions, sensations, or thoughts arise, participants are instructed to observe them non-judgmentally, not becoming absorbed in their contents, returning their attention to the present moment, to the object of observation (Baer, 2003).

Mindfulness-Based Cognitive Therapy (MBCT)

Teasdale, Segal, and Williams (1995) saw that the skills of attentional control taught in mindfulness meditation could be helpful in preventing relapse of major depressive episodes. Their theories of depressive relapse suggest that many individuals who have formerly had major depressive episodes become vulnerable to recurrences upon experiencing mild dysphoric states because these states reactivate the depressive thinking patterns present during previous episodes, thus triggering a new episode.

MBCT is an eight-week program based on MBSR which incorporates elements of cognitive therapy that facilitate a de-centred (defused or disidentified) view of one’s thoughts, emotions, and bodily sensations. MBCT prevents depressive relapse by showing formerly depressed individuals how to observe their thoughts and feelings non-judgmentally, viewing them simply as mental events that come and go. Thus, such clients do not escalate negative thoughts into ruminative patterns.

Dialectical Behaviour Therapy (DBT)

DBT is a multi-faceted approach to treating Borderline Personality Disorder which is based on a dialectical worldview. This proposes that reality consists of opposing forces, the synthesis of which leads to a new reality, which in turn consists of opposing forces, in a continual process of change. Participants in such therapy are mostly concerned with the dialectic between acceptance and change. Clients are encouraged to accept themselves, their histories, and their situations as they are, while working to change their behaviours and environments to create a better life.

Synthesising this apparent contradiction is a central goal of DBT, and mindfulness skills are taught within this context. While the concepts taught (e.g., nonjudgmental observation of thoughts, emotions, and sensations) are similar to MBSR, they are organised differently. The course is a year-long weekly skills group. Some highly impaired participants are unable to meditate as extensively as the MBSR courses require, so the DBT version does not prescribe a specific amount of time to be set aside for the practice, leaving this to be determined by participants’ individual therapists (Baer, 2003).

Acceptance and Commitment Therapy (ACT)

Theoretically based in contemporary behaviour analysis, ACT does not describe its treatment methods in terms of mindfulness or meditation, but is included here because its strategies are consistent with the mindfulness approaches described. Participants in ACT are taught to develop an Observing Self capable of watching their bodily sensations, emotions, and thoughts.

They are encouraged to see these as separate from themselves, the person experiencing them. Thus the thought “I’m greedy” would be transformed into “I’m having the thought that I’m greedy”. ACT students are explicitly taught to abandon any attempts to control thoughts and feelings, instead merely observing them non-judgmentally, accepting them as they are, while changing their behaviour in constructive ways to improve their lives (Hayes, 1994).

Relapse prevention

This is a cognitive-behavioural treatment package designed to forestall relapses in individuals treated for substance abuse. Mindfulness skills are taught as part of it to help participants cope with urges to use. Mindfulness involves acceptance of the constantly changing experiences of the present moment, whereas addiction is an inability to accept the present moment as the next “high” associated with the addiction is sought.

Participants are taught to “urge surf”: that is, to “ride” the urge to use like a wave, knowing that the wave will build, crest, and subside. The client knows that he or she is not “home free” when that happens, as there will always be more waves; the urges cannot be eliminated. Thus they must be accepted as normal responses to appetitive cues. Mindfulness skills enable such clients to observe the urges as they appear, accept them non-judgmentally, and cope with them in adaptive ways (Baer, 2003).

This article was adapted from the upcoming Mental Health Academy CPD course “Mindfulness in Therapeutic Practice”. For more information, visit www.mentalhealthacademy.com.au.

References

• Baer, R. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. American Psychological Association: 10(2), 125-143.
• Harris, R. (2007).The happiness trap: stop struggling, start living. Wollombi, NSW, Australia: Exisle Publishing, Ltd.
• Harris, R. (2009). Mindfulness without meditation. In HCPJ (Healthcare Counselling and Psychology Journal), October, 2009, pp 21 – 24.
• Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in everyday life. New York: Hyperion.
• Marlatt, G. A., & Kristeller, J. L. (1999). Mindfulness and meditation. In W. R. Miller (Ed.), Integrating spirituality into treatment (pp. 67-84). Washington, D.C.: American Psychological Association.
• Shapiro, S.L., Astin, J.A., Bishop, S.R., & Cordova, M. (2005). Mindfulness-based stress reduction for health care professionals: results from a randomised trial. International Journal of Stress Management, 12 (2), 164-176.
• Teasdale, J.D., Segal, Z.V., & Williams, M.G. (1995). How does cognitive therapy prevent depressive relapse and why should attentional control (mindfulness training) help? Behaviour Research and Therapy, 33, 25-39.