Mindfulness: what it is, and the core techniques

Here we look at mindfulness both in theory and in practice. Techniques without the underlying theory do not help much, especially in approaches such as CBT, where the therapist needs to explain the rationale to the client. The same is true of mindfulness: we need to understand and explain the reasoning so the client can see how mindfulness can help them.

How did mindfulness enter psychotherapy?

Today, mindfulness is seen as a common thread across many therapy approaches, and at its heart it is about changing attention.

Mindfulness is an important idea in psychotherapy and psychology. It first appeared as part of Buddhism and spiritual meditation practices in Eastern philosophy, and in recent decades it entered the Western world as a broad approach to psychological and physical problems.

The turning point for mindfulness in modern psychotherapy came with the work of Jon Kabat-Zinn, a molecular biologist at the University of Massachusetts Medical School, who launched the Mindfulness-Based Stress Reduction (MBSR) program in 1979. He offered mindfulness-based meditation programs as a way of recovering from psychological problems and stress.

Mindfulness involves paying deliberate attention to the present moment, accepting without judgement, and focusing on your current experience, which can reduce stress and worry. It has helped with many problems, including depression, anxiety, eating disorders, chronic pain and relationship problems.

Since then, mindfulness has become one of the important approaches in psychotherapy and is used in combination with other approaches. Mindfulness practice can increase awareness of yourself and your surroundings, improve focus, reduce stress and increase life satisfaction.

Why mindfulness entered psychotherapy

1. Fighting, fleeing and giving in to unpleasant experiences. It is as if we are programmed to fight unpleasant things. (There are two kinds of struggle: outer struggles with unpleasant things around us, such as a toxic workplace, and inner struggles with unpleasant experiences such as sadness.) In more scientific terms, these are unpleasant emotions, thoughts, memories, images or bodily sensations.

How does discomfort turn into emotional suffering? Imagine we are upset that our brother does not call us. We tell our partner, link it to other hurts ("he didn't call last year either, and he didn't come to our child's birthday"), and it becomes emotional suffering. Here, pain has turned into suffering. Mindfulness helps us find inner and outer peace instead of fighting, fleeing or giving in.

2. Psychotherapy moving closer to cognitive science and neuroscience. Attention is a major focus in cognitive science (Michael Posner is one of its leading researchers). Attention gives us a mechanism that makes us more effective in dealing with the outer and inner world, and this awareness plays a big part in regulating behaviour. So when we say someone is "unaware", we often mean the problem is one of attention.

3. It can be researched. Mindfulness has generated a great deal of research. Therapists can be seen as "regulators of attention": our task is to direct clients' attention to the parts of their lives that increase their awareness, and that awareness leads to improvement. In 1994, Adrian Wells and Gerald Matthews wrote Attention and Emotion, showing how strongly attention affects our emotions. Daniel Goleman has argued, after decades of work on emotional intelligence, that focus, the ability to hold attention, is one of its most important parts.

4. The spirit of the times. Psychotherapy reflects its time, and one reality of today's world is speed; everything seems to be getting faster. Mindfulness aims to slow down the pace of modern life.

There are other reasons too, but these are the most important.

What is mindfulness? Meaning and definition

Definition 1: mindfulness means paying attention to the present moment, on purpose and without judgement. It sounds simple but is hard in practice. (Our attention often drifts to the past and the future, because for many of us the present is painful.)

Definition 2: an active state of mind with several features, including stepping out of routine and repetition, and being aware of different perspectives.

Definition 3: awareness of the moment.

Definition 4: awareness of present realities.

Awareness, the present moment and attention appear in every definition.

What is the goal of mindfulness?

Mindfulness is a path that can serve several goals:

1. Reaching inner and outer peace (for example, someone with washing compulsions who constantly thinks about getting up to wash something, and wants to be free of these thoughts).

2. Helping identify values: noticing what really matters to us in life.

3. A main road to acceptance.

4. Helping us face the symptoms of our difficulties more effectively.

The underlying attitudes of mindfulness

Therapists need to understand and practise mindfulness themselves before they can teach it well, so the first step is to practise it on ourselves.

1. Non-striving: when we are upset or stressed, we do not struggle to reduce or change it.

2. Allowing inner experiences: not constantly trying to change our thoughts.

3. Beginner's mind: behaving as if each experience is happening for the first time.

4. Openness to experience: one of the personality dimensions measured by the NEO personality test, which shows how open people are to new experiences.

5. Patience.

6. Compassion for ourselves and others.

Myths about mindfulness

Every therapy approach attracts myths; we covered some in the CBT article. What are the common myths about mindfulness? When we study its foundations, we find these are not true:

• Mindfulness is for relaxation.
• Mindfulness is just a technique with no theory behind it.
• Mindfulness is a kind of positive thinking.
• Mindfulness means avoiding important, underlying problems.

The difference between giving in and mindfulness

Remember: giving in moves us towards blame, while mindfulness moves us towards acceptance.

The assumptions of mindfulness

Every psychotherapy approach rests on certain assumptions. For example, Freud assumed that psychic energy is not lost but changes form; behaviour therapists assume that the consequences of a behaviour strongly influence whether it continues; and Adler assumed that people are born with feelings of inferiority. Mindfulness assumes that:

1. Attention plays a part in psychological problems.

2. Attention plays a part in how we function.

3. Attention can be trained.

4. Attention can be therapeutic.

Where mindfulness is used

• Mindfulness has been shown to help with conditions ranging from social anxiety to OCD and depression.

• It is used in clinical settings, such as hospitals and clinics.

A book on mindfulness and cancer: Mindfulness-Based Cancer Recovery by Linda Carlson and Michael Speca.

• It is used in sport.

• It is used in education.

• It is used in workplaces and organisations.

Note: mindfulness is also a way of life. A therapist who is not mindful will find it hard to be present and empathic.

Mindfulness techniques

Mindfulness entered psychology through behavioural medicine and mind-body (psychosomatic) medicine.

Mindful eating: the raisin exercise

We use a raisin because it is easy, but you can use an apple or anything else. Look at the raisin as if you are seeing it for the first time. Slowly bring it to your nose and smell it. Place it gently on your tongue without chewing, let it touch different parts of your mouth, and swallow the saliva that mixes with it. Notice its taste. Slowly place it between your teeth and chew as slowly as you can, paying attention to the sound of chewing. If thoughts come, leave them be and let them pass through your mind; do the same with your feelings. Remember that you have a very important task: eating a raisin. When it has softened after chewing several times, swallow it and notice its taste.

Were you able to do it? How many times did your attention wander? What thoughts and feelings came up? How hard was it to focus? Do you see why this exercise matters? (For example, a client might say: "I came to you for depression, but this exercise seems unrelated.") If the reason is still unclear, a therapist might explain that one of the things people lose when they are depressed is their attention; depression takes over their attention, and the aim is to gradually take attention back, so that depression casts less of a shadow over their life.

*Whenever we give a client a technique, we also discuss how it went.

Mindfulness is used in treating many conditions; for example, there are books on mindfulness-based couples therapy.

Mindfulness of daily activities

First, make a list of daily activities, such as getting dressed, brushing your teeth, eating, driving or walking.

Choose one or two activities from the list.

When you do them, pay close attention to each step, fully engaging your senses of smell, taste, touch and so on.

*Note: some daily activities take up a lot of time, such as driving for an hour or two a day, and nobody can be mindful for that whole time. Choose activities that take a few minutes and practise them gradually.

If you are a therapist, ask the client about their thoughts and feelings after this exercise.

Mindfulness of the breath

There are two positions for this exercise:

• Attending to breathing in and out while sitting
• Attending to breathing in and out while lying down

*This is not belly breathing; we simply pay attention to the breath.

1. Place your right hand on your belly and begin breathing (close your eyes).

2. Do not change the flow of your breath.

3. At the same time, become aware of how you feel.

4. Do not give up the exercise (you may get bored, and so on).

5. Let go of images and other thoughts that come to mind.

6. Keep your attention only on the breath.

7. Open your eyes.

The aim of this exercise is not to fall asleep; we want to stay awake and look at what happened during the exercise. For example, if a client says they felt sleepy, it is worth asking whether they have been sleeping poorly, or slept badly the night before.

Mindfulness can stir up any feeling in us.

Clients should practise mindfulness techniques as often as they can each day; each practice takes about 5 to 10 minutes.