AN INTRODUCTION TO MINDFULNESS
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.
MAKING MINDFULNESS WORK FOR YOU [LINK]
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]
THEORY AND RESEARCH
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.MECHANISMS OF MINDFULNESS
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:
- Mindfulness per se
- Psychological Flexibility
- Emotion Regulation -- see here for a further discussion -- [LINK]
- Changes in the Brain
- Changes in attention and working memory
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]
ONLINE MINDFULNESS RESOURCES
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:
- What to do in a crisis -- [LINK]
MINDFULNESS BASED COGNITIVE THERAPY website [LINK]
THE COMPASSIONATE BRAIN
-- audiovisuals page [LINK]
-- RICK HANSON'S series [LINK]
UCLA Mindful Awareness Research Center[LINK]
- variety of resources, including the excellent Mindfulness Research Monthly newsletter
- includes various podcasts available onsite and on YouTube -- [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]
buddhistgeeks -- [LINK]
In a recent podcast -- [LINK] -- David Vago, an instructor of psychology at Harvard Medical School, who has held the position of Senior Research Coordinator for the Mind & Life Institute, a not-for-profit organization dedicated to fostering dialogue and research at the highest possible level between modern science and the great living contemplative traditions, relates how his personal mindfulness practice has integrated with his professional scientific research. He talks about the thriving community of scientists interested in mindfulness that has taken root in contemporary academia and research, and he highlights some current projects and lines of inquiry that have benefited from this uniquely supportive atmosphere."
MINDFULNESS Digest -- archives -- [LINK]
- Scholarly discussion and dissemination of mindfulness and acceptance
Ottawa Mindfulness Centre -- [LINK]
Both a website and a blog, this can be considered one of the "key" links, due to the number of prominent researchers subscribed to their discussion list.
MindfulnessMuse -- [LINK]
Blog-based website run by Laura Schenck, a PhD student in Counseling Psychology,looking ar various aspects of Acceptance and Commitment Therapy, Dialectical Behaviour Therapy, Choice Theory, and Mindfulness. I particularly like this post about
- Five Ways to Let Go of Judgement -- [LINK]
The Dharma Overground -- [LINK]
The Dharma Overground is a resource for the support of hardcore meditation practice. It is a place where everything related to the support of practice may flourish, including where to go on retreats, what techniques may lead to what, an in depth look at the maps of possible states and stages, discussions about how to determine what experience was what, and in general anything that has to do with actually practicing rather than what typically occurs in standard meditation circles. Here you will find a robust and variable community of people with a wide range of experience levels, perspectives and interests, though all loosely bound by the same basic principles of empowering, helpful, engaged dharma and exploration of the possibilities of the mind.
One discussion topic has been "acceptance and learned helplessness". The concept of "learned helplessness" was developed by Seligman to describe the "why bother" attitude to tryinng to avoid adversity when past exposures (e.g., abuse) have been unexpected and uncontrollable -- a situation confronting many children who are exposed to abuse. See this discussion here [LINK]
- STUCK IN MEDITATION -- [link]
This blog is for people who are meditators, meditators-to-be, skeptical meditators, or simply people who might like the lighthearted approach to dealing with challenge and difficulty in our daily lives. The author is Steven Hickman, Psychologist). The author's goal is to support people who have gotten started in mindfulness (perhaps through MBSR, MBCT, MBRP or any other MB (fill in the blank) and are dutifully practicing (or "trying" to practice) and finding some rocks and potholes on that path. Over time it is expected it will accumulate resources, links and other aspects, all intended for the benefit of those engaged in mindfulness practice.
The author states he hopes "to create an online community of people who are actually already a community by virtue of their shared experience of learning and practicing mindfulness meditation. They just may or may not know it. I am open to lively and engaging debate, discussion, questioning and flights of fancy, and curious to see what will happen there. In fact I guess you could say that I am taking a mindful approach to the blog, setting an intention and pursuing it, but being open to what unfolds with a great sense of playful curiosity. Most of all I want it to be fun and light. Meditation, as you know, doesn't have to be serious business. No need to "practice like a Samurai" as Jack Kornfield says. Let's sit lightly on the cushion together and see what arises and maybe we can find our way to some moments of peace and joy in our lives in the mutual endeavor."
Transform Your Mind, Change Your Brain -- [LINK]
Presented by Richard J. Davidson
In this YouTube video, Richard J. Davidson explores recent scientific research on the neuroscience of positive human qualities and how they can be cultivated through contemplative practice. Distinctions among different forms of contemplative practices are introduced and shown to have different neural and behavioral consequences, as well as important consequences for physical health in both long-term and novice practitioners. New research also shows that meditation-based interventions delivered online can produce behavioral and neural changes. Collectively, this body of research indicates that we can cultivate adaptive neural changes and strengthen positive human qualities through systematic mental practice.
RECENT MINDFULNESS / MINDFULNESS RESEARCH
Psychologist Ken Pope's page on Meditation Research -- provides complete citations for over 150 research articles. All were published from 2010 to the present. The research explores the relationship of meditation to executive functioning and decision-making; depression; anxiety; memory; brain structure, function, & plasticity; pain control; dispositional mindfulness; therapists' therapeutic presence; health; well-being; quality of life; and so on. [LINK]
This page of meditation research is a companion to another page of resources on the same web site: "Mindfulness Resources for Clinical Training & Practice." [LINK]