- Mindfulness-Based Therapy
- What Is Mindfulness?
- How Mindfulness Is Used in Therapy
- Types of Mindfulness-Based Interventions
- Mindfulness-Based Stress Reduction
- Mindfulness-Based Cognitive Behavioral Therapy
- Dialectical Behavioral Therapy
- Acceptance and Commitment Therapy
- Mindfulness Therapy in Addiction and Mental Health Treatment
- Can Mindfulness Help Stop Substance Abuse?
- Tools for telling a new story
- Mindful for the long run
- Not everyone benefits
Interest in the concept of mindfulness has skyrocketed in the last 15 years. The ability to be aware of and at peace with one’s current state is a skill that is useful in virtually any context. In mindfulness therapy (also called mindfulness-based therapy), clients can learn how to use these skills to address thought and behavior patterns that have caused dysfunction.
Mindfulness therapy can take place with an individual therapist or in a mindful therapy group. Both approaches can lead a client to a deeply satisfying and sustainable way of handling everyday situations.
What Is Mindfulness?
The concept of mindfulness has become popular in our culture for many reasons, but what is mindfulness, exactly? Does it require living a simple life on a mountaintop, meditation in a lotus position by a peaceful stream or maintaining a yoga pose on a mat? While those situations can certainly promote it, mindfulness can be utilized in everyday thought and behavior. One mindfulness definition states:
“Mindfulness allows you to establish life in the present in order to touch the wonders of life that are available in that moment.”
The quote comes from Thich Nhat Hanh, the Vietnamese Buddhist monk who introduced mindfulness concepts to many Western audiences in the 1970s. One of his students, clinical psychologist Jon Kabat-Zinn, integrated these teachings with research findings to help pioneer mindfulness therapy. According to Dr. Kabat-Zinn, one mindfulness definition is:
“… the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally, to things as they are.”
How Mindfulness Is Used in Therapy
In mindfulness, participants are asked to practice being aware of their current environments — their surroundings, their thoughts, their feelings — in an accepting and non-judgmental way. Mindfulness therapy uses the concept of mindfulness to increase overall psychological and physical well-being.
Teaching mindfulness in therapy can be both challenging and rewarding. It may be difficult for clients to shift their thoughts away from past mistakes or future worries. However, the freedom clients can feel by accepting their thoughts without judgment is invaluable.
Types of Mindfulness-Based Interventions
Because of their ability to treat many health conditions, mindfulness-based interventions have become widely utilized. In the field of psychotherapy, mindfulness is the central concept in a variety of treatment options.
Mindfulness-Based Stress Reduction
In the early 1980s, Dr. Kabat-Zinn adapted the mindfulness teachings he had learned and created the Mindfulness-Based Stress Reduction (MBSR) program. Originally designed to help hospitalized patients reduce blood pressure and anxiety, MBSR was found to help in many other ways. Now, MBSR programs can be found in corporate offices, sports clubhouses and high school classrooms.
Most MBSR programs are group workshops which focus on “acquisition of mindful awareness.” Workshops usually last for eight weeks, with groups meeting weekly for 2.5-hour sessions. In MBSR programs, trained therapists teach clients how to
- Practice mindfulness meditation
- Be in touch with body sensations
- Accept and be at peace with body sensations
- Execute basic yoga postures
The primary goal of an MBSR program is to teach mindfulness practices well enough to integrate them into everyday thoughts and activities. As participants experience the substantial benefits of MBSR programs, an increasing number of people are now willing to practice mindful meditation.
Mindfulness-Based Cognitive Behavioral Therapy
Students of Dr. Kabat-Zinn’s MBSR programs developed a therapy that combined cognitive behavioral therapy with mindfulness techniques. Cognitive behavioral therapy has been shown to help those with depressive disorders.
Mindfulness-based cognitive behavioral therapy (also called mindfulness-based cognitive therapy or MBCT) helps people develop an awareness of the state of their bodies and minds as they experience their moods.
By practicing mindfulness in everyday activities eating or cleaning, clients learn how to manage natural shifts in mood, including feelings of sadness or depression.
Over time, participants develop strategies for understanding and managing their current feelings.
Dialectical Behavioral Therapy
Another therapeutic approach which pairs mindfulness with cognitive behavioral therapy is dialectical behavioral therapy, or DBT.
This therapy was developed by psychologist Marsha Linehan at the University of Washington in the 1980s to treat borderline personality and other patients prone to chronically suicidal thoughts.
Dialectical behavioral therapy asks the therapist to develop non-judgmental acceptance of the patient and asks the patient to develop non-judgmental acceptance of feelings.
The term “dialectical” refers to the search for resolution between two contradictions or conflicting opinions. Dialectical behavioral therapy is performed in groups and limited individual sessions, which help therapists and clients identify unhealthy behaviors and set appropriate limits around them.
Dialectical behavioral therapy aims to help patients accomplish several goals:
- Establish the therapist as an ally
- Experience emotions without critique or attachment
- Tolerate emotional extremes with more balance
- Teach patients how to live in the present
- Improve communication with others
Acceptance and Commitment Therapy
The primary feature of acceptance and commitment therapy (ACT) is the goal of accepting one’s emotions and behaviors rather than avoiding or being in conflict with them. By using their personal value system, a person can commit to changing behaviors that don’t align with their values.
To achieve these goals, ACT-trained therapists help clients look for ways to come to terms with feelings and work on building the skills which can create lasting changes. Acceptance and commitment therapy is succinctly embodied by a staple of 12-step programs called the Serenity Prayer:
“God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”
Mindfulness Therapy in Addiction and Mental Health Treatment
Mindfulness therapies have particularly effective applications in the treatment of addictive disorders and mental health conditions. In addition to the mindfulness mental health treatments DBT and MBCT, addictive disorders are remarkably responsive to mindfulness-based therapy.
In addiction, behaviors often lack mindfulness. Hallmarks of addiction include cravings that create an urgency to act without thinking, excessive consumption and patterns of unconscious behavior.
Since not being conscious of one’s behavior is the very opposite of mindfulness, treatment and relapse prevention strategies often ask clients to develop greater consciousness around their emotional lives and behavior.
In 12-step programs, steps 10 and 11 calls for participants to be mindful of potentially destructive behavior and improve conscious contact with the divine through prayer and meditation. Because of this, there is a natural synergy between mindfulness and addiction treatment.
If you struggle with addiction or a co-occurring mental health disorder, mindfulness-based therapy can be a powerful tool on the path toward recovery. Our extensive network of experienced and caring therapists utilize mindfulness techniques in many treatment programs. Contact The Recovery Village today to begin treatment for addiction and mental health conditions.
- Sources Greater Good Magazine. “Mindfulness Definition.” 2019. Accessed May 16. 2019.Grossman, P., Niemann, L., Schmidt, S. and Walach, H. “Mindfulness-based stress reduction and health benefits: a meta-analysis.” Focus on Alternative and Complementary Therapies, June 14, 2010. Accessed May 16, 2019.Sibe, Walter and Eisendrath, Stuart. “Mindfulness-based cognitive therapy: theory and practice.” Canadian Journal of Psychiatry, February 1, 2012. Accessed May 16. 2019.Psychology Today. “Acceptance and Commitment Therapy.” (n.d.). Accessed May 16, 2019.Behavioral Tech. “What is DBT?” (n.d.). Accessed May 16. 2019.Plum Village. “Dharma Talks by Thich Nhat Hanh.” (n.d.). Accessed May 16, 2019.
Can Mindfulness Help Stop Substance Abuse?
“It’s a human tendency to want to have pleasure and want to avoid pain or discomfort,” says Sarah Bowen.
But the University of Washington researcher adds that we’re often unaware of this tendency. We might reach for our cell phone to escape boredom or for food to escape stress, without knowing that these are coping strategies.
Our Mindful Mondays series provides ongoing coverage of the exploding field of mindfulness research. © Dan Archer
According to Bowen, substance abuse is another example of that too-human automatic drive to move toward pleasure and away from pain—one that affects an estimated 24 million Americans, according to the National Survey on Drug Use and Health.
Traditional treatment for substance abuse often focuses on avoiding or controlling triggers that result in negative emotion or craving. While research has shown that this approach can help, substance abuse relapse remains a problem: about half of those who seek treatment are using again within a year.
Bowen has spent much of her career studying another approach: mindfulness, which involves cultivating moment-to-moment, nonjudgmental awareness of thoughts, feelings, and surroundings.
She and her colleagues have developed a program called Mindfulness-Based Relapse Prevention (MBRP), which combines practices sitting meditation with standard relapse prevention skills, such as identifying events that trigger relapse.
Rather than fighting or avoiding the difficult states of mind that arise when withdrawing from a substance, this combination tries to help participants to name and tolerate craving and negative emotion.
But how do mindfulness-based approaches compare to traditional substance abuse treatments? And do mindfulness-based treatments work for everyone? Researchers Bowen are beginning to answer these questions.
Tools for telling a new story
Bowen tells the story of a woman she calls Sophia, a MBRP participant who had a chronic issue with alcohol.
When Sophia got an invitation to help her co-workers set up for a party at work, she knew there would be alcohol everywhere—which, in Sophia’s mind, could only mean one thing: she’d start drinking and she wouldn’t stop.
She’d drink during the party’s setup, and then she’d drink all night long, and then she wouldn’t go to work the next day, or attend her MBRP meeting the next week.
But thanks to MBRP, when Sophia’s mind started telling this story, she recognized that that’s what it was: a story.
When Sophia recognized her thought patterns for what they were, she decided to try an exercise from her MBRP group (even though she thought it wouldn’t work).
She stopped to observe her present experience. In this pause, Sophia realized that she had a choice: She didn’t have to believe her mind’s story about what was going to happen; she had the choice to not drink.
From then on, when cravings or urges arose, Sophia could recognize them—and be aware of her freedom to act differently, and observe thoughts and feelings until they passed.
This, says Bowen, is the key to the success of the program: MBRP helps people to relate differently to their thoughts, and use tools to disengage from automatic, addictive behaviors.
The success of MBRP is not just anecdotal. Bowen and her colleagues recently published a study in JAMA Psychiatry investigating how effective the Mindfulness-Based Relapse Prevention program is in comparison to a standard relapse-prevention program as well as a conventional 12-step program.
Six months following the intervention, the mindfulness-based program and the standard relapse-prevention program were both more successful at reducing relapse than the 12-step program. One year later, the mindfulness-based program proved better than the other two in reducing drinking and drug use.
Bowen says that when people cultivate mindfulness, they’re developing a tool to become aware of that inclination to want only pleasurable things and escape uncomfortable things.
Mindfulness also helps people learn to relate to discomfort differently. When an uncomfortable feeling a craving or anxiety arises, people Sophia are able to recognize their discomfort, and observe it with presence and compassion, instead of automatically reaching for a drug to make it go away.
Bowen says that awareness of our experience and the ability to relate to our experience with compassion gives us more freedom to choose how we respond to discomfort, rather than defaulting to automatic behaviors.
Mindful for the long run
More research is needed to determine why MBRP might be more successful than other programs in reducing substance abuse relapse, but Bowen speculates that MBRP holds an advantage because mindfulness is a tool that can be applied to all aspects of one’s life.
Standard relapse-prevention programs teach tools specific to struggles with substance abuse—for instance, how to deal with cravings or how to say no when someone offers you drugs. A year after completing the program, a person may have a very different set of challenges that the relapse-prevention program did not equip them to deal with.
But because mindfulness is a tool that can be used in every part of a person’s life, practicing moment-to-moment awareness could continue to be an effective coping tool.
Bowen and her colleagues are not the only researchers who are studying mindfulness as a tool to cope with addiction. James Davis and his colleagues at Duke University are investigating mindfulness training as a way to help people quit smoking.
Similar to Bowen, Davis speculates that mindfulness is ly an effective tool in helping people with addiction because it’s a single, simple skill that a person can practice multiple times throughout their day, every day, regardless of the life challenges that arise. With so much opportunity for practice—rather than, say, only practicing when someone offers them a cigarette—people can learn that skill deeply.
Their intervention targeted low-income smokers, because, says Davis, the the lower your socioeconomic status, the more ly you are to smoke. The results, recently published in Substance Use and Misuse showed a significant difference in smoking cessation for people who completed the intervention, as compared to people who were given nicotine patches and counseling from the Tobacco Quit Line.
“Some people might have a bias to say that mindfulness is kind of a ‘new age-y’ thing, or something that falls primarily in the upper-middle class, intellectual population in the US,” Davis says. “The reality is, mindfulness as a practice itself is very simple. You don’t need to be an intellectual to do it, and you don’t need much of an education.”
Not everyone benefits
Both Bowen and Davis emphasize that mindfulness is not a panacea; it doesn’t always work for everyone.
How can we tell if mindfulness will be an effective tool for a given person?
Researcher Zev Schuman-Olivier and his colleagues at the Massachusetts General Hospital Center for Addiction Medicine recently published a paper in Substance Use and Misuse suggesting that the type of therapy a person responds to may have something to do with their disposition—specifically, people who had the tendency to treat thoughts and behaviors with non-judgment and acceptance before the intervention began were more ly to be successful in reducing smoking following the mindfulness training. They write that if a person already has the skill to treat the self with non-judgment and acceptance, learning mindfulness practices ly comes easier to them than someone who has not previously practiced this skill.
Ultimately, the type of therapy that works best for a given person will ly capitalize on their pre-disposed strengths.
Of course, as Bowen and Davis both note, the skills of mindfulness can be taught to everyone. But Schuman-Olivier’s finding suggests that people who are not pre-disposed for mindfulness may need a more vigorous or lengthy intervention, in order to more thoroughly learn mindfulness skills. Or perhaps, people with less disposition toward mindfulness would fare better with a different therapy.
Another predictor of success in mindfulness-based treatment could be a person’s motivation to engage in the therapy.
In Davis’ study, the people that started the intervention with the highest level of nicotine addiction were the most successful in reducing smoking by the end of the treatment.
Davis said that this seemingly counterintuitive result ly reflects their motivation to quit; the people that were the most addicted had, at that point, tried everything, and were willing to try their hardest to make this therapy work. Meanwhile, people that were less addicted saw their addiction as less of a problem.
They reasoned, “If this doesn’t work, I’ll be ok—something else will work, eventually.” As a result, they were ly less motivated to quit, and less engaged in the therapy.
So where do the researchers go from here?
Bowen says she’d to investigate how well MBRP does in different kinds of settings, as well as zero in on the mechanisms of mindfulness practices—for instance, what’s going on psychologically, and what’s going on in terms of neurochemistry when someone relates mindfully to a craving.
Davis says that he also has plans to expand on his research, and that many are already applying mindfulness training for smoking cessation in new settings.
Duke University wants to provide the training to cancer patients, and one company is even developing a mindfulness app to help people quit smoking.
Bowen says that it’s tempting to conclude that mindfulness is the “best new thing” for addiction treatment, but that in reality, further study is needed. “It absolutely has promise, we have a lot more to learn,” she says. “This is the beginning.”