From , , Mindfulness-Based Therapy 5887

Issue Links: Mindfulness-Based Therapy 5887

Topics: Psychotherapy

Mindfulness training (MT) helps to counter individuals’ tendency toward rumination about the past and future.

Mindfulness is both the process and state of being present with whatever is happening in the moment with purposeful management of attention. This is often cultivated by sitting meditation, in which one sits in a comfortable position, whether on a chair or a cushion, in a quiet environment with an upright, yet comfortable, posture. Practitioners of sitting meditation continuously focus attention on a single neutral stimulus, such as the breath. This focus on the breath anchors one’s attention to the present. From this foundation, the constant arising and passing of thoughts, emotions, and sensations may be observed in a curious and nonjudgmental manner that may gradually generalize to daily experiences.

For example, when Jane is walking to school, she may be anxious about her work and be preoccupied with a conflict she had that morning with a family member. If she were to practice mindfulness, she may notice her thoughts and the tightness in her neck that reflect her worries, as well as noticing the pressure of her backpack on her body, the sensation of her legs moving through the air, and her feet hitting the ground as she walks. By being mindful, she is curious of her current experience, and more present, rather than being focused on the future and past which can be related to feelings of depression and anxiety (Kabat-Zinn J, Clin Psychol-Sci Pr 2003;10(2):144–156).

MT can also have an important impact on automatic thoughts and behaviors. Often when presented with a challenge, we make quick, conditioned judgments based on past experiences, rather than discern what judgment is most appropriate for the present situation. This results in automatic behaviors with minimally conscious awareness of what we are doing (Bargh JA and Chartrand TL, Am Psychol 1999;54(7):462–479). Through MT, individuals can learn to become more aware of the immediate experience, and of automatic cognitive and behavioral reactions, and thus can exercise a more active choice in how they respond (Duncan LG et al, Clin Child Fam Psychol Rev 2009;12(3):255–270).

MT can be particularly important for individuals under stress. Some individuals respond to difficult experiences by over-identifying with negative thoughts, such as worthlessness and hopelessness, which MT counters by recognizing thoughts simply as thoughts rather than as reflections of the self or reality.

Being Present with Reality

Unpleasant states can also cause rumination whereby individuals brood over regrets or strategize to avoid potentially unpleasant events or to obtain pleasant situations in the future. This can lead to heightened anxiety and depression. MT focuses on the reality of sitting with the present, regardless of how pleasant or unpleasant this may be, rather than clinging to the past or planning for hypothetical future scenarios. MT can thus help individuals learn to disengage from rumination. Avoidant strategies can include active denial of the stressor and distraction by indulging in unhealthy behaviors (eg, substance use, emotional eating). Such avoidant behaviors may temporarily decrease the unpleasant experience, but this creates a reinforcement loop for more avoidance, which may contribute to the maintenance of many psychiatric disorders (Brewer JA at al, Psychol Addict Behav 2012:online ahead of print).

MT cultivates the ability to sit with discomfort and change while meditating, so when uncomfortable states and disruptive changes occur in life, the individual is able to remain present and reflective rather than avoidant and reflexive. For example, Jane may feel increasingly anxious about her work and conflict with a family member. She may perseverate on these negative thoughts, or she may try to avoid these thoughts and feelings by distracting herself with unhealthy behaviors. By being mindful of her overall experience, she can allow all of her thoughts, feelings, and sensations to be present, without attaching to them or avoiding them, and realize that each will occur, then pass, and be replaced by another. Also, by simply observing her thoughts and feelings, her attention is not taken up by elaborations of them, so she may be able to attend to information that may otherwise have remained out of awareness. A wider perspective on the current experience may become available.