How does mindfulness work?
By focusing our attention in the here and now, mindfulness is thought to prevent rumination and worrying, both about the past and the future. By spending too much time in the past or future, there is a risk that we taint the present either by bringing negative past experiences into it, or by it not measuring up to positive ones. Furthermore, worrying about possible threats is generally a future-focused activity and so it would seem logical that mindfulness could be a useful tool in anxiety and other mental disorders.
It is also hypothesized that mindfulness enables people to react to stress with awareness in the present moment and become aware of emotions or motives underlying their reactions, rather than allowing instinctive (and possibly dysfunctional) behaviors to drive the situation. Mindfulness encourages people to open up and accept their emotions, which helps people more easily identify and process them.
In contrast, other approaches such as cognitive behavioral therapy focus on changing thoughts, where mindfulness-based approaches aim to change the relationship a person has with their thoughts. When anxious, instead of avoiding uncomfortable sensations, a person would be encouraged to focus on them, leading them to fully experience their thoughts as see them for what they really are. In this sense, there are strong parallels with exposure approaches such as flooding, which encourage people to sit with their discomfort until it passes.
Less emphasis on the removal of symptoms, and more on cultivating a different relationship to distressing thoughts, feelings, and behavioral impulses, enables people to respond differently and overcome the dysfunctional fight-or-flight reactions that arise. Mindfulness techniques for anxiety and stress reduction aim to enable the person to remain grounded in the present so that the stress and anxiety feel less overwhelming. The goal is to replace fear with curiosity.
Mindfulness can be applied to anxiety in two main ways. It is a component of other psychotherapies (such as dialectical behavior therapy, for example) but is applied more specifically to stress and anxiety in the forms of mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive behavioral therapy (MBCT).
Mindfulness-based stress reduction (MBSR) is an integrative approach with the aim of reducing the physical, emotional and psychological consequences of chronic stress. It brings together various elements of Eastern meditation practices and merges them with western psychological theory. Kabat-Zinn, who developed the approach, used scientific terminology to reframe some Buddhist terminology, and built a program basically blending yoga with mindfulness meditation. It has a range of techniques including breathing and body-scanning and one which is especially applicable to anxiety known as “worry surfing”. Here, someone is encouraged to turn their attention to an approaching negative feeling and imagine it as a wave that they ride until it passes.
Mindfulness-based cognitive behavioral therapy (MBCT) combines mindfulness components such as breathing, meditation and yoga stretches with cognitive therapy elements. The cognitive therapy techniques are used to counteract distorted or dysfunctional thoughts; and the mindfulness techniques for calm and peace, even in the context of overwhelming and unwanted thoughts. In combination they are believed to prevent emotions from spiraling into distorted thought processes that tend to automatically proceed and trigger distress.
Reflections on mindfulness
This is, to a certain extent, true of many emerging therapies (and not just mindfulness) but there is a risk that practitioners are not aware of dangers and risks and how to manage potential mental health crises in the mindfulness context, or of the power of the therapeutic relationship. For example, while mindfulness is likely to be okay for most, there is a risk that it can lead to dissociative experiences and may bring to the fore formerly suppressed trauma.
Technique and types of meditation as well as individual factors determine its impact. People may have been taught poorly or not be aware that the mode of meditation they are using may be counterproductive. For example, for some, increasing awareness can enable them to identify unhelpful patterns of thinking or behavior, whereas this amplification can, for others, lead to an intensification of their symptoms. Meditation also alters our state of consciousness which, for the most part, is a relaxing experience; however for others it can lead to a feeling of depersonalization which can exacerbate mental distress.
Research does seem to support the idea that mindfulness acts as a buffer against stress, so it may be a useful thing for people to be doing to maintain good mental health, manage stress and prevent anxiety developing. In addition, neuro-imagining studies seem to indicate it may have a positive impact on emotional regulation, which may be a useful outcome for people with anxiety. However, the extent to which mindfulness can be used as a stand-alone treatment for pathological anxiety is still subject to debate.