Mindfulness in Psychotherapy
I believe that I first read The Miracle of Mindfulness by Thich Nhat Hanh in 1987. I was pursuing my first music therapy degree at that time and was very interested in the mind-body connection in the pursuit of wellness. My journey in wellness began in 1977 when I was taking pre-nursing courses at Southern Oregon University (then a State college). In my first introduction to nursing course, I was exposed to some (then) radical ideas in nursing practice. One of them was the idea of high level wellness (also a book by Donald B Ardell, 1977). The Wellness model was radical at the time as it viewed the individual as a whole being and healing as a whole body-mind experience. I was intrigued by the principle of quantum entanglement: the idea that the state of an individual particle in a group cannot be described independently of the state of the others (Horodecki, R., Horodecki,P. Horodecki, M., Horodecki, K. (2009). The meaning I made of that at the time was the undeniable interdependence between the body and the mind.
These days, we are profoundly influenced by brain studies and they are fascinating. I appreciate Daniel Levitan making a useful distinction between brain and mind. He likens the brain to hardware and the mind to software. What makes sense to me is that the mind influences the brain as well as the body; the brain influences the body and mind; and the condition of the body influences the workings of the mind and the brain. More recently, ecological models of wellness also explored the influences of social and environmental factors and these models imply that our environments and social inputs have at least equal influence over our experienced wellness- maybe even our potential for wellness. One has only to consider societies that live with the generational and long-range impacts of war or armed conflict to acknowledge this dynamic interrelationship. Indeed, developing the capacity to be aware of the activities of the mind and its influence on felt-emotion and behavior moment to moment grounds several models of psychotherapy: Dialectic Behavior Therapy (DBT), Trauma-Focused Cognitive Behavior Therapy (TF-CBT), Acceptance and Commitment Therapy (ACT), and Mindfulness-based Cognitive Therapy movement (MB-CBT) (Kress & Paulo, 2019).
When one studies histories of ideas, it is very clear that ideas begin as a way of making sense of direct experience. Thus it was that somewhere around 20 BCE that followers of Siddhartha (called The Buddha in his own time) recorded his words and wisdom practices (these were actually recorded on palm leaves with natural inks). These became known as the Suttas (Sutras). So, thousands of years before the advent of cognitive therapy, the Satipaṭṭhāna Sutta, Majjhima Nikāya 10 was disseminated in the Pali language. In this Sutra the writer explores four foundations of mindfulness. Mindfulness of body, mindfulness of feelings, mindfulness of mind or mental formations, and mindfulness of objects of mind. The effects of practicing mindfulness have been recorded, documented and re-experienced across these thousands of years. In recent times, the effects of mindfulness practices have been subjected to rigorous scientific method and both outcomes and effects are now acknowledged as ‘evidence’ of therapeutic (as well as spiritual) value. We can connect the dots and link the four foundations of mindfulness as they are understood from the Satipaṭṭhāna Sutta to modern practices of psychotherapy and medicine. This is not an exhaustive treatment of the topic.
Mindfulness of Body:
Mindfulness of body involves paying attention to aspects of the physical body. These can be any sensation or awareness felt in the body. These could be recognizing sensations such as warmth, coolness, tingling, pain, numbness, awareness of position or posture, of movement, of weight, of the sensation of places of contact between the body and a chair, bed, or pillow. Included in this can be ease (or not) of breathing, painful or pressured sensations, and certainly the bodily response to emotional states such as anxiety, fear, irritation, love. These should not be confused with mindfulness of feeling (to be discussed) but the physical effects of feeling states. Mindfulness of body sensations grounds mindfulness in medicine and has been associated with benefits in Cancer treatment, Cardiac Conditions, Headache management, Chronic Pain and Addiction recovery. In psychotherapy, mindfulness of body is often used in working with people living with dissociative disorders, Post traumatic stress disorder, Anxiety conditions of all types and more.
Mindfulness of Feelings:
In the practice of being mindful of feeling, one pays attention to the ‘tone’ of their feelings, or emotions. The feelings can be named or not, but what is noticed is whether the experience is being interpreted by mind as pleasant or positive, unpleasant or negative, or neutral. Becoming skillful at noticing how we interpret our feelings is a core element of cognitive therapy- where any subsequent mental process (such a proliferation) or behavior (such as agitation, acting out or self-harm) is identified and linked back to the origin, trigger, or antecedent of the behavior. The goal of mindfulness practice in cognitive behavior therapy is to stop or challenge thoughts from dictating behavior in an unconscious manner. In the Dialectic Behavior Therapy tradition, mindfulness of feeling tone is intended to bring a person to a state of ‘radical acceptance’ of self and one’s experience. Similarly Acceptance and Commitment therapy (ACT) seeks to help people accept their feelings for what they are, and to separate those from the identity. An example of this might be a progressive insight from “I am an anxious person who will always be anxious” through “Right now, I am having anxious thoughts” to perhaps observing anxious thoughts rise up and pass away as they are being observed. These processes are accepted as a feature of the individuals experience of being. In Trauma therapy, I use mindfulness of feeling to help a person recognize when they are feeling overwhelmed, ungrounded or anxious. I also teach self-soothing or emotional regulation strategies to help increase a person’s window of tolerance for overstimulating experiences or memories. Sometimes I use music as a sensory override system to help shift the body-mind to a different input source that the client finds grounding.
Mindfulness of Mind or Mental Formations
Mindfulness of mind is the one foundation of mindfulness that I find challenging to talk about. I understand this practice to be one of observing the movement or actions of the mind. Tempel Smith describes this practice as viewing the activity of mind as if in the third person. For example: “ Mind is focused right now”, “Mind is scattered right now”, “I notice Terra’s mind flashing like lightning”, “Mind is very slow and dull this morning”. This awareness or noticing is embraced without judgment. We aim to avoid proliferating the awareness by thinking “Terra’s mind is flashing like lightening and this is a bad thing- I need to get focused”. Eventually, one notices that mindfulness of mind naturally moves to mindfulness of feeling or mindfulness of mental objects- such as thoughts. Mindfulness of mind is a core skill in cognitive therapy. See the diagram of the CBT Triangle below. Cultivating the objectivity of mindfulness of mind can help one see the relationship between thoughts, states of minds, and feelings and behavior. At first, mindfulness of mind and mental objects can feel contrived and artificial, as if one is stating the obvious. But, it is part of the exercise- remember that this awareness is training mind to cultivate a neutral or objective subjectivity…one that notices but does not judge. Krishnamurti describes this as the state when the observer and the observed are one and the same.
Mindfulness of Objects of Mind.
I mentioned mindfulness of mental objects in the above paragraph. This form of mindfulness involves noticing actual formations of the mind. Examples of this is thoughts, or thought formations. Mental objects are particularly important for people in addiction recovery. Thoughts may proliferate around a craving or a rationalization until the mind is unable to focus on anything other than the object of the craving. As one proliferates more on the tension between the craving and the desire to abstain, thoughts can expand to feelings and anxiety arises. A way to practice mindfulness of mental objects could be to notice a thought and watch it rise up, intensify and then pass away. Our biological brains are really only able to process one thing at a time so while it may seem that many thoughts and feelings are present and intensifying simultaneously, with practice you will notice that they occur in succession and that anywhere along that chain of thought and effect you have the power to make a different choice. In Dialectical Behavior Therapy, this practice is called ‘chain analysis’.
Mindfulness is a core element of many models of therapy. Your therapist may introduce you to these ideas and practices with a view toward helping you develop skills that can serve you on your healing journey. If this is something that you are interested in, please contact me to set up an appointment or ask me about the possibility of integrating more mindfulness based interventions into your counseling sessions.
References:
Ardell, D.B. (1977). High level wellness: An alternative to doctors, drugs and disease. Bantam.
Horodecki, Ryszard; Horodecki, Pawel; Horodecki, Michal; Horodecki, Karol (2009). "Quantum entanglement". Reviews of Modern Physics. 81 (2): 865–942.
Kress, V.E. & Paylo, M.J. (2019). Treating those with mental disorders- A comprehensive approach to case conceptualization and treatment. Merrill Counseling Series. Pearson.
Nhat Hanh, T. (1987). The miracle of mindfulness. Beacon Press.
