Research-based Recovery Information*
for Adult Survivors of Childhood Abuse and Adversity


Mindfulness, a concept and practice known to Eastern cultural philosocphies such as Buddhism for hundreds of years, has become a topic of major importance in both Western clinical psychology and the popular press over the past 10-15 years. While many people think mindfulness means meditation, this is not the case -- see Hayes & Shenk (2004) -- [LINK].

Mindfulness is a mental state of "openness", awareness and focus, and meditation is just one way amongst hundreds of learning to cultivate this state. A crucial aspect of this quality of mindfulness, linked to "openness", is the capacity to nonjudgmentally accept the experience of at times troubling internal states, such as memories, feelings, emotions, and "behavioral dispositions" (including the tendency to do such things as drink alcohol when stressed, or smoke cigarettes, or eat chocolate!). As a result the different aspects of mindfulness have sometimes been assessed by different measures, separately looking at observing, describing, acting with awareness, nonjudging of inner experience, and nonreactivity to inner experience (having the experience without being compelled to react to it). Research has shown -- [LINK] -- that several of the facets contribute independently to well-being.


Introducing Mindfulness to Patients with Diverse Beliefs and Backgrounds
      -- Ron Siegel, Ph.D. [LINK]

When Mindfulness Will (and Won’t) Work for Treating Trauma,
      and One Technique That Can Be Effective
     -- Bessel van der Kolk [LINK]


Research has looked at the effects of mindfulness practice on both clinical and non-clinical outcomes. Of course, continuing research has provided guidelines as to how to construct research to more effectively understand these relationships. However, recent reviews of research studies includes that of Chiesa and Serretti (2011) -- [LINK]. These researchers looked specifically at the effect of mindfulness training on psychiatric disorders. Main findings included the following: 1) Mindfulness-Based Cognitive Therapy (MBCT, the integration of mindfulness training into usual forms of cognitive therapy) in adjunct to usual care was significantly better than usual care alone for reducing major depression (MD) relapses in patients with three or more prior depressive episodes (4 studies), 2) MBCT plus gradual discontinuation of maintenance Anti-Depressantss was associated to similar relapse rates at 1 year as compared with continuation of maintenance antidepressants, 3) the augmentation of MBCT could be useful for reducing residual depressive symptoms in patients with MD and for reducing anxiety symptoms in patients with bipolar disorder in remission and in patients with some anxiety disorders.

Another review, this time by Eberth and Sedlmeier (2012) -- [LINK], looked at the effects of mindfulness meditation on various psychological variables, for meditators in nonclinical settings. The effects differed widely across which dependent variables were examined. Moreover, large differences were found between the effect sizes reported for complete Mindfulness-based Stress Reduction (MBSR) programs vs. “pure” meditation. MBSR seems to have its most powerful effect on attaining higher psychological well-being, whereas pure mindfulness meditation studies reported the largest effects on variables associated with the concept of mindfulness. In a related review by Sedlmeier et al (2012) -- [LINK] -- the pattern of results found, they argue, could not be accounted for by relaxation or cognitive restructing (the usual mechanisms by which Cognitive Therapy is presumed to work). In general, results found were strongest (medium to large effects of training) for changes in emotionality and relationship issues, less strong (about medium) for measures of attention, and weakest (small to medium) for more cognitive measures.

With specific reference to the sorts of changes in symptoms suffered by survivors of childhood abuse and trauma, studies by Bondolfi and colleagues (2010) -- [LINK] -- and Segal and colleagues (2010) -- [LINK] -- found that for depressed patients achieving stable or unstable clinical remission, MBCT offers protection against relapse/recurrence on a par with that of maintenance antidepressant pharmacotherapy. The data also highlighted the importance of maintaining at least 1 long-term active treatment in unstable remitters, which those recovering from childhood trauma tend to be.

The combination of lack of acceptance and low mindfulness has been linked to both posttaumatic stress symptoms substance abuse problems -- Garland & Roberts-Lewis (2012) -- [LINK]. Results indicated that thought suppression, rather than extent of trauma history, significantly predicted post-traumatic stress symptom severity while dispositional mindfulness significantly predicted both post-traumatic stress symptoms and craving. In multiple regression models, mindfulness and thought suppression combined explained nearly half of the variance in post-traumatic stress symptoms and one-quarter of the variance in substance craving. Moreover, multivariate path analysis indicated that prior traumatic experience was associated with greater thought suppression, which in turn was correlated with increased post-traumatic stress symptoms and drug craving, whereas dispositional mindfulness was associated with decreased suppression, post-traumatic stress, and craving. The maladaptive strategy of thought suppression appears to be linked with adverse psychological consequences of traumatic life events. In contrast, dispositional mindfulness appears to be a protective factor that buffers individuals from experiencing more severe post-traumatic stress symptoms and craving. Research conducted by Brian Thompson and Jennifer (2010), of the University of Montana found that Mindfulness, specifically nonjudgment of experiences, accounted for a unique portion of the variance in PTSD avoidance symptoms -- [LINK].

An important and common symptom in posttraumatic stress disorder is depersonalization (DP) -- A dissociative symptom in which the patient feels that his or her body is unreal, is changing, is dissolving, or does not to belong to oneself, or in which one loses all sense of identity. It also can be considered as a form of mental escape from the full experience of reality. The relationship between depersonaliation and mindfulness has been studied by Michal and colleagues (2007) -- [LINK]. These researcheers found a strong inverse correlation between DP severity and mindfulness, which persisted after partialing out general psychological distress. In a community, nonpatient, sample additional significant correlations were found between childhood emotional maltreatment on the one hand and DP severity (positive) and mindfulness (negative) on the other.

Therapist understanding of the relationships between acceptance, mindfulness, and client response to trauma activation is also important in guiding clients in therapy, so that therapy outcomes can be optimized. This is evident from the research conducted by Rachel Thompson in her doctoral research at the Catholic University of America -- [LINK]. See also Thompson, Arnkoff and Glass (2011) -- [LINK]. Thompson's research looked at Script-driven imagery (SDI) -- a research methodology involving repeated recitation of trauma-related "scripts", recalling specific-trauma material (indiidualized to each person's experience of trauma) that has been used to examine trauma survivors’ responses to activation of trauma memories.

In Thompson's research, lower trait mindfulness and distress tolerance, and greater experiential avoidance, were associated with greater PTSD symptom severity at baseline. Additionally, after controlling for baseline ratings on psychological symptom measures, greater trait mindfulness was associated with higher ratings of emotional arousal and lower ratings of trauma-related avoidance following elicitation of trauma memories, while greater distress tolerance was associated with higher ratings of emotional arousal, less negative affect, and less depressive symptomatology. No significant associations were found between experiential avoidance and psychological symptoms at post-SDI. These findings indicate that assessing trait mindfulness and distress tolerance may help to identify those at risk of experiencing greater psychological distress during SDI. Furthermore, greater trait mindfulness predicted lower dissociation and lower PTSD symptom severity at post-SDI within the enhanced consent condition alone, suggesting that enhanced consent may have promoted a more open and nonjudgmental orientation to experience among those who were high in trait mindfulness.

Research such as that of Thompson not only indicates the benefits of mindfulness training in recovering from trauma, and insulating clients from further trauma symptoms, but should act as an adisory for therapists of the importance of engaging clients in fully informed and collaborative therapeutic relationships if therapy outcome is to be optimized.


Various theories have been proposed by which mindfulness training achieves its undoubted (in most cases) therapeutic effects. See here for a brief introduction: -- [LINK] (.doc file). Among these are those focusing on:

As Baer notes:

Close examination of the processes of change discussed in this volume suggests that many of them are highly overlapping. Mindfulness and decentering have very similar definitions. In the context of mindfulness-based treatments, both include nonjudgmental observation and acceptance of thoughts and feelings. Psychological flexibility includes six processes, four of which are identified as mindfulness and acceptance processes. These include contact with the present moment, acceptance, defusion (which is similar to decentering), and recognition of the self as the context in which thoughts and feelings occur (rather than equating the self with the thoughts and feelings that come and go). Psychological flexibility also includes clarity about personal values and engaging in values-consistent behavior even when unpleasant internal experiences are present. Similarly, emotion regulation, as defined in this volume and discussed in chapter 4, includes awareness and acceptance of emotions, along with willingness to engage in goal-directed behavior while experiencing negative emotions. A prominent definition of self-compassion, the focus of chapter 5, includes mindfulness as a central component. Spirituality is defined in a variety of ways but can include compassion and a sense of higher meaning. The latter might be consistent with values as conceptualized in ACT. Spirituality defined as the transcendence of self might also be consistent with the self-as-context element of psychological flexibility. Additional research is required to clarify the commonalities and distinctions among these processes.

But other processes might also be involved, such as selective attention, overgeneral memory, thought suppression, and rumination. These processes are not the focus of chapters in Baer's book "because they are conceptualized as intermediate outcomes between the processes described and improved psychological functioning". That is, the development of mindfulness, decentering, psychological flexibility, acceptance-based emotion regulation, and so on, should cultivate flexibility of attention, observational noting of thoughts as thoughts rather than rumination, and willingness to experience unpleasant thoughts, memories, and emotions as they arise rather than attempting to avoid or suppress them. Clearly, the processes involved are complex and much research remains to be but this promises to be an exciting, and therapeutically fruitful, area of research for several years to come.

ASSESS YOUR MINDFULNESS -- Complete this survey, including your contact details, let me know, and I'll get back to you with your results, and recommendations -- [LINK]


American Mindfulness Research Association    [LINK]
broad range of resources, including monthly newsletter

Russ Harris, the Australian medical doctor, and psychotherapist, has a number of free resources -- links to articles, MP3 recordings, and other materials
-- for Acceptance and Commitment Therapy -- -- [LINK]
-- for Mindfulness -- [LINK]

Personally, I find the free resources provided with his first book "The Happiness Trap" amongst the most useful, in particular his suggestions for:


-- audiovisuals page    [LINK]     
-- RICK HANSON'S series  [LINK]

UCLA Mindful Awareness Research Center[LINK]
- variety of resources, including the excellent Mindfulness Research Monthly newsletter
           --                [LINK]

Psychologist Dr Rick Hanson's website --

Human beings generally, but especially victims of childhood trauma, have a "negativity bias" -- we tend to autmatically assume, and even perceive, the negative in the things we see (such as people's expressions, even neutral expressions) and experience. Psychologist Dr Rick Hanson's approach also has Mindfulness as a core basis. Dr Hanson has, as part of Psychotherapy Networker, produced a video looking at some aspects of this "negativity bias", and provides guidelines for therapists to explain why positive emotions are often an underutilized resource in psychotherapy today and describe why people are vulnerable to negative biases. Therapists will also be able to review the benefits of helping clients internalize positive emotions. He also has a weekly newsletter you sign up for -- helpful for maintaining regular practive!

               -- See Dr Hanson's Psychotherapy Networker video here -- [LINK]

                         -- Explore the free resources on Dr Hanson's site -- [LINK] -- a favourite!

Deepening the Moment with Diana Fosha

In this video you'll learn how to use mindfulness and meta-processing to help clients witness and accept, rather than avoid, their emotional processes, with a special emphasis on how to focus on “glimmers of growth”, even in those who have experienced devastating trauma.

               -- video -- [LINK]


MINDFULNESS Digest -- archives -- [LINK]