Imagine you are sitting to meditate, and you find yourself distracted. For some reason, you cannot focus on your breath. After a few moments, you hear your inner voice saying, “Why can’t you sit still? What’s wrong with you?“
Mindfulness allows us to hear that voice, acknowledge it, and even examine where it might be originating. Then, like a cloud in the sky, we can let it float by and return our attention to our breath.
Various therapeutic approaches combined with mindfulness create the therapy. Here we offer a look at what those are, the research behind them, and more.
This article contains:
- What is Mindfulness Therapy? (Definition)
- Research and Studies on its Effectiveness
- 6 Mindfulness Therapy Techniques
- Other Types Of Therapy That Incorporate Mindfulness
- A Look at Using it in a Group Context
- Mindfulness Therapy for Couples
- Mindfulness Therapy and Depression
- Using Mindfulness Therapy to Treat Anxiety
- Can Mindfulness-Based Therapy Help Treat Insomnia?
- 3 Mindfulness Therapy Exercises and Games
- Mindfulness Therapy Training and Certification
- A Take-Home Message
What is Mindfulness Therapy? (Definition)
Mindfulness, from a therapeutic, secular perspective is a conscious awareness of our present moment. This includes openness and non-judgment about the experience. It is often coupled with other types of therapy, such as Cognitive-based Therapy (CBT), Dialectical Behavior Therapy (DBT), or Acceptance and Commitment Therapy (ACT).
Mindfulness therapy is not concerned with relaxation, though that might be a result of certain practices. The focus is on increasing our awareness of the thoughts, feelings, and actions that hinder our progress. When we are better able to do that, we can engage with those aspects of ourselves, learn to tweak our language, and choose how to respond.
Research and Studies on its Effectiveness
Most research centers around two specific types of mindfulness training. The first is mindfulness-based stress reduction (MBSR) pioneered by Jon Kabat-Zinn. The second is mindfulness-based cognitive therapy (MBCT). John Teasdale, Zindek Segal, and Mark Williams — all therapists — created MBCT.
MBCT originated from cognitive therapy, and it includes techniques such as mindfulness meditation, yoga, and other inward-focused activities. You can read more about these therapeutic techniques later in this article.
Collectively, therapies employing mindfulness have the name mindfulness-based interventions or MBIs. The research outlined below sought to determine the effectiveness of various types; however, MBSR and MBCT still receive the most attention. What follows in this section, and later in this article, are several outcomes you can, or cannot, expect from utilizing some form of MBIs.
Kuyken and colleagues (2015) asserted that MBCT is an effective and cost-effective method for treating and preventing relapse in depressive patients. In their randomly controlled study, they compared two groups: the first received maintenance antidepressants, and the second MBCT-TS (tapered support). The trial continued for 24 months.
Sometimes research findings do not support the hypothesis. That was the case for Kuyken and his fellow researchers. They found that “cost-effectiveness analysis does not support the hypothesis that MBCT-TS is more cost-effective than maintenance antidepressants, in terms of either relapse or recurrence.” They did, however, state that the two treatments provide positive outcomes that last. Since this is the case, they recommended continued study, and that MBCT could be useful for high-risk patients.
Good mindfulness-awareness practices (MAP) programs can reduce perceived stress in urban communities. Researchers Galla et al. (2015) implemented the Mindful Awareness Practices for Daily Living 1 for 127 residents (mostly Caucasian and female). Their findings support that MAPs offer “a promising approach for general public health promotion.” The UCLA MAPs program, which was their model, includes the following:
- Overview of Mindfulness
- Mindfulness of the Body
- Obstacles to Mindfulness
- Mindfulness to help with Physical Pain
- Working with Difficult Emotions
- Cultivating Positive Emotions
- Working with Difficult Thoughts
- Mindful Interactions
Students also learn a variety of practices. Some are:
- sitting meditation
- standing meditation
- practices to develop positive emotions; and,
- relational mindfulness
In 2017, Hofmann and Gomez also studied MBIs for anxiety and depression. They asserted that MBIs have “consistently outperform [ed] non-evidenced-based treatments and active control conditions.” Their examples of these are health education, relaxation training, and psychotherapy.
Researching the effectiveness of MBIs is not without its challenges. Some common problems are that some studies do not include a control group or have too few participants. They also sometimes lack diversity, as was the case in the Galla et al. (2015) study. Even so, the most reliable research supporting MBIs comes from studies involving MBSR or MBCT (Hofmann & Gomez, 2017).
6 Mindfulness Therapy Techniques
During mindfulness meditation, an expert practitioner guides a person or persons to focus on the present moment. This is not always an easy task. Often, our mind wanders. To combat this, the practitioner instructs participants to accept the wandering mind without judgment. She also might tell the person to notice where their mind went before reeling it back to the present.
If practicing alone, you might consider using some timer. Meditation need not be lengthy. If you are a beginner, strive for one minute. This idea of starting small, supported by research done by BJ Fogg, helps reduce barriers to beginning a new habit.
Body scanning and walking also are options or alternatives to more traditional forms of meditation. Thich Nhat Hanh explains the goal of walking meditation is to be the “happiest person in the world.” If you can do this, you are successful. There is no destination in mind. “Walking is an end in itself.”
Guided imagery also is a popular form of mindfulness. Some call this creative visualization or visualization. Regardless, the practice involves bringing to mind, through images, the words one hears. There are a variety of ways to practice this with and without a therapist.
Shakti Gawain’s book, Creative Visualization, is a nice jumping-off point if you would like to explore this subject on your own. Feel free to leave your suggestions in the comments for tools you use or books you’ve found useful.
Breathing techniques are a wonderful way to gain control when you feel anxious or stressed. For example, you can practice belly breathing. Place one hand on your stomach and the other on your chest. Inhale, filling your belly with air, pushing your hand out.
Allow your breath to fill your lungs, pushing your other hand out. Finally, slowly exhale. You also could choose to hold the inhalation for a specified count, such as four. The University of Michigan has examples of several other breathing techniques. You can find their information in the references section.
Hundreds of thousands of people practice yoga, and for good reason. Not only does it increase your flexibility, but it also helps reduce stress and focus your mind. Researcher Catherine Woodyard (2011) found that in addition to these benefits, therapeutic yoga:
- enhances muscle strength,
- improves respiratory and cardiovascular function,
- helps people recover from addictions,
- reduces anxiety, depression, and chronic pain; and,
- improves sleep.
Are you interested in learning more? Sitting Together: Essential Skills for Mindfulness-Based Psychotherapy might be useful to you. Authors Pollak, Pedulla, and Siegel offer several insights. You will discover why mindfulness, in a therapeutic setting, is beneficial to the client and therapist. They also share how to begin implementing it.
Other Types Of Therapy That Incorporate Mindfulness
Dialectical Behavior Therapy (DBT) assists the person in identifying and changing destructive thinking patterns. It involves working with a trained therapist to learn how to apply DBT skills. Clients also can work in group settings, which allows them an opportunity to practice newly acquired skills.
Two other delivery modes are in-the-moment phone coaching and consultation teams for therapists (Behavioral Tech, n.d.). Originally developed to treat borderline personality disorder, it also is effective in treating PTSD, self-harm, and suicidal thoughts.
DBT brings together opposites. For example, clients learn to replace black or white thinking with “and” thinking. DBT is about balancing acceptance with change. It includes a focus on mindfulness, interpersonal effectiveness, distress tolerance, and emotion regulation. Most of us are familiar with the first two, so let’s take a look at the last ones on this list.
Distress tolerance teaches a client how to accept emotions as they are, in the moment. There is no need to turn away from the emotion in part because one might not be able to make an immediate change. Thus, acceptance that is non-evaluative and non-judgmental becomes important. Acceptance does not mean we approve of whatever is happening. It merely means we accept it for what it is in that moment (Psych Central, n.d.).
Emotional regulation is, in part, about identifying and labeling our emotions. This is not always easy, particularly if the client has had to suppress this in the past or was only able to express extremes. There are nuances to emotional expression that DBT allows clients to learn and practice. Clients also learn to deal with obstacles to changing emotions.
Acceptance and Commitment Therapy also incorporates mindfulness. This evidenced-based approach is about being open to what bothers us and actively choosing a course of action (Gordon, 2018). Mindfulness practices help clients do this and form the bridge between acceptance and commitment.
A foundation for ACT is the Relational Frame Theory. This takes into consideration the language and learning we engage in via relational networks. The networks we build show up everywhere and in everything. Ignoring them is virtually impossible. Relational learning comes from behavioral learning. It is the ‘why’ behind the acceptance part of ACT. In the practice of ACT, we are observers.
ACT is powerful because it places you in control of your “thoughts, feelings, sensations, and memories” (Gordon, 2018). Mindfulness (awareness) becomes the tool that helps us see those things more clearly.
A Look at Using it in a Group Context
A significant advantage of offering group therapy is the reduction in cost to the client. The concern that creeps up is whether group therapy is better than, as good as, or worse than individual treatment. In 2015, Sundquist and colleagues put together an 8-week randomized controlled study to find out.
Their findings surprised even them. Differences between the group and individual settings were not significant. They concluded that group therapy was “non-inferior to treatment as usual for patients with depressive, anxiety, or stress and adjustment disorders.”
One of the best examples of MBIs used in a group setting is the MBSR program. Developed and implemented by Jon Kabat-Zinn, this deep-dive into secular mindfulness is as intense as it is invigorating. The other evidenced-based model is MBCT. But, as pointed out by Creswell (2017) and Shapero, et al. (2018), interventions in the form of retreats, web-based, and smartphone app interventions, as well as brief interventions have beneficial effects.
Mindfulness Therapy for Couples
The nuts and bolts of mindfulness at the individual level works for couples, too. Some might argue that beginning with oneself is the best place to start. That could be true. On the flip side, something is uplifting about learning mindfulness with your partner.
Instead of, or maybe in addition to, practicing with strangers, you get the benefit of working with someone you know and who knows you. You also get the gift of seeing each other heal and grow. This can increase and solidify the bond you share.
Dr. Toni Parker (2016), writing for the Gottman Institute, suggests couples learn the Four Foundations of Mindfulness. They are mindfulness of your body, feelings, mind, or consciousness, and how your mind operates.
How do you do this? Using some of the same exercises you would if you were doing it on your own – body scan, mindfulness meditation, and breathwork. These three are particularly helpful in getting you in touch with your feelings, sensations, and perceptions in the present moment.
They also help you to turn toward uncomfortable emotions and accept them. As a couple, you have an opportunity to gain empathy and understanding for each other.
Mindfulness Therapy and Depression
MBCT, DBT, and ACT all are useful in treating various levels of depression. Each combines mindfulness with observing, dissecting, accepting, and choosing alternative behaviors.
Clinicians know that emotional regulation is difficult for depressed patients. This is one of the strengths of DBT. It explicitly focuses on building this skill. But what if the patient’s responses could become more adaptive? This is what Berking and colleagues (2019) wanted to test.
They used an affect regulation training (ART) intervention and compared it against a waitlist control condition (WLC) and a condition for controlling common factors (CFC).
ART participants received instruction on,
- muscle relaxation,
- breathing relaxation,
- non-judgmental perception and description of one’s feelings,
- acceptance and tolerance of undesired feelings,
- compassionate self-support when working to cope with such feelings,
- constructive analysis of the antecedents and consequences of one’s feelings; and,
- active modification of one’s feelings toward a desired direction.
People in the treatment group learned and practiced specific skill-building exercises. They created and followed their daily training schedule, had access to CDs to guide skill-acquisition, and could receive texts with short workouts.
Training included one 180-minute session per week for six consecutive weeks. After this time, participants spent another four weeks practicing mostly on their own. A 90-minute booster happened in week eight. Training occurred in groups of four to eight people.
Their results showed that compared to the waitlist group, participation in the ART group “was associated with a greater reduction of depressive symptom severity.” The difference between ART and CFC was not statistically significant.
Based on their findings, we now have a better understanding of the role enhancing emotion regulation can play in the treatment of depression.
Using Mindfulness Therapy to Treat Anxiety
Many studies contend that mindfulness can reduce anxiety, but is this fact or fiction? Hofmann, Sawyer, Witt, & Oh (2010) reviewed thirty-nine studies and found that mindfulness-based therapy significantly improved anxiety. They are not alone in their analysis (Vollestad, Nielsen, & Nielsen, 2012).
People suffering from mild to more extreme anxiety also experience elevated stress levels. Goyal and colleagues (2015) investigated the usefulness of mindfulness meditation for reducing stress. Their review included 47 trials with more than 3000 participants. They found:
- moderate evidence of improved anxiety and depression at eight weeks; but
- low evidence of improved stress/distress
- low evidence for mental health-related quality of life
- low evidence of no effect or insufficient evidence of any effect of meditation programs on, positive mood, attention, substance use, eating habits, sleep, or weight
- no evidence that meditation programs were better than any active treatment.
That seems somewhat contradictory, but the researchers do support the potential usefulness of meditation programs. They also emphasize the need for stronger study designs in the future.
Can Mindfulness-Based Therapy Help Treat Insomnia?
Do you have trouble sleeping? Do you wake during the night and find it difficult to return to sleep? Using mindfulness meditation, Black and colleagues (2015) set out to help older adults improve their sleep. Participants had moderate sleep disturbances. Two groups were either assigned to a sleep hygiene education (SHE) or MAPs intervention. The randomized controlled trial continued for one year.
The MAPs intervention improved sleep quality at “immediate post-intervention, which was superior to a highly structured SHE intervention.” This is great news for anyone who needs better quality shuteye. The effects of poor sleep impair cognition, increase one’s waistline, and stress level.
3 Mindfulness Therapy Exercises and Games
Scour the internet, and you will find a plethora of mindfulness games and exercises. There are some for adults, teens, pre-teens, and children. Rather than give you a laundry list of sites to review, here are three exercises with three different objectives.
The basic idea of this exercise, borrowed from Mindfulness, Acceptance, and Positive Psychology, is disarmingly simple. Based on a statement from the US Declaration of Independence, “We hold these truths to be self-evident…,” clients explore their life assumptions.
They also evaluate things they believe and never need to question, or those ideas that they consider to be obvious, i.e., a given. In a clinical setting, this is homework and clients have a week to complete it.
Upon returning, the therapist leads a discussion about the person’s assumptions. What themes surface? What are the client’s fundamental assumptions about their life or circumstances? Does the therapist need to challenge some assumptions to help the client move forward?
2. Taking Care of Business with Gratitude
For this exercise, taken from Activities for Teaching Positive Psychology, participants will recall a difficult memory. The therapist gives clients advance notice so that they have time to think about the memory they want to share. Then clients receive instructions to write about it in a way that helps them gratefully reappraise the memory.
Grateful people tend to deal well with difficult circumstances (Froh & Parks, 2013). Once finished, clients check their sense of closure and the emotional impact of the memory. This activity includes suggested language and worksheets available in the book.
3. Using a Strengths Approach to Build Perspective-Taking Capacity
This small-group activity helps clients better understand strengths in themselves and others. The backdrop for this is the VIA Character Strength inventory or the Clifton StrengthsFinder. Divide the group into small groups to discuss a specific strength and how to use it in particular scenarios.
They do this from the perspective of someone possessing this strength, not as though it is one of their actual strengths. For example, if the situation is “preparing a dinner party for twenty guests,” the therapist asks the group to reflect on,
- What might be the priorities or goals of someone with your assigned strength/theme in this situation?
- Which questions might someone with your assigned strength/theme tend to ask in this situation?
- What might a person with this strength/theme do in this situation?
This activity emphasizes awareness of personal strengths, strengths in others, and self-awareness. It also shows the value of each different strength within various scenarios. This activity is also included in Activities for Teaching Positive Psychology. (Froh & Parks, 2013)
Mindfulness Therapy Training and Certification
The Institute for Meditation and Psychotherapy is a non-profit organization. The goal of the institute is to provide training to mental health professionals in the area of integrating mindfulness meditation and psychotherapy. Their course is for experienced clinicians, regardless of meditation experience.
Participants earn 72 CE hours through completing the Certificate in Meditation and Psychotherapy program. It is APA and NBCC approved for both psychologists and licensed mental health counselors. Nurses and social workers should check the website for more details.
UCSD Center for Mindfulness houses the Mindfulness-Based Professional Training Institute (MBPTI). Through the institute, you will find certification programs for:
- Mindfulness self-compassion (MSC),
- Mindful Eating-Conscious Living (ME-CL),
- Mindfulness-based Relapse Prevention (MBRP), Mindfulness-Based Childbirth and Parenting (MBCP), and more.
UMASS Center for Mindfulness offers MBSR and MBCT certification online and in person. You also can take part in MBSR in Mind-Body Medicine, Unwinding Anxiety, or Mindful Eating. This is where Kabat-Zinn’s program started.
All the above programs cost anywhere from several hundred dollars to several thousand. The time commitment varies based on courses taken and location.
Another resource is the International Mindfulness Teachers Association. From their site, you can find accredited programs for a variety of MBIs.
A Take-Home Message
One of the key takeaways is that research design is crucial. The various meta-analyses all include several requirements for inclusion or exclusion. This, too, is important when evaluating their conclusions. More recent studies, though stronger, focus on two main types of MBIs (MBSR and MBCT) or derivatives of them. These, as mentioned above, tend to provide more reliable evidenced-based results.
There are many activities and games that strengthen our use of mindfulness. Some are group-oriented, while others are specific to individuals. You can find these resources in many forms, including through a therapeutic relationship, retreats, and phone applications.
Becoming a trained mindfulness therapist or instructor requires additional education and can be costly. Standards for therapists are higher, and licensure is necessary in the United States and many other countries. In most cases, continuing education also is a requirement for renewing one’s license.
Mindfulness therapy is not a panacea. It does not work for every person in every circumstance, but there is research supporting its use, and current studies include more rigorous designs.
How do you use mindfulness practices? Feel free to share your experiences in the comment section.
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