Mindfulness and its Possibilities for those Living with Depression and Anxiety
Published in Anxiety Recovery Centre Newsletter Victoria Vol. 11, No. 4, August 2006.
Mindfulness is typically defined as “paying attention in a particular way: on purpose, in the present moment and non-judgementally„ (Kabat-Zinn 1990). It is extremely difficult to define because it is an experience. While the above quote is useful and the details that I will describe in this article may assist you to explore mindfulness, there is only one way that you can truly understand mindfulness. You must experience it. And not just once. You may understand it after one practice session, but each month, each year that I practice my experience of Mindfulness Therapy .....s (Improves is not the right word as I hope you will appreciate by the end of this article).
Mindfulness is the capacity to maintain awareness of your current experience without the limitations of your past experiences and your expectations of how things should or shouldn’t be. It is a term that describes a relationship of your inner and outer world that is accepting of whatever is occuring at a point in time. The acceptance is so complete that there is no thought of accepting or not accepting. What is happening is happening. There is merely an experience of what is happening without desire, judgement or rejection. There is only the experience, nothing more and nothing less. Mindfulness is in effect an alteration in the way we typically relate to our internal and external world. As such it has the potential to influence every aspect of your world. Interviews of psychologists who used Buddhist principles in their therapeutic work revealed disagreement regarding using Buddhist principles such as mindfulness directly with clients (Anderson, 1999). But all agreed that the Buddhist principles where fundamentally important to their work as therapists (Anderson, 1999). Freud refers to “evenly suspended attention„, which is his way of describing mindfulness, as being fundamental to the therapists work (Epstein, 1984). This fundamental part of Freud’s contribution to psychology has been lost in professional training, as Freud did not outline a clear process for therapists to develop this skill and trainers and trainees found it to difficult to achieve without such a process (Epstein, 1984). Interviews with therapists in the US clearly support the value of “evenly suspended attention„ in the work of therapists (Anderson, 1999). It appears that Buddhist principles and Mindfulness Therapy .....rticular were important for there work with clients and for their survival as therapists (Anderson, 1999).
In addition to the value of mindfulness for the therapist, research published over the last 20 years is suggestive that mindfulness can be useful in a therapeutic context when directly taught to clients (Baer, 2003). Mindfulness has been successful used to treat chronic pain (Kabat-Zinn, 1982), generalised anxiety disorder (Kabat –Zinn et al, 1992) and depression (Teasdale et al, 2003). Mindfulness is a core component in DBT (treatment of borderline personality disorder) and ACT which has been shown to effectively treat depression, anxiety disorders, psychosis, substance abuse, chronic illness, eating disorders, work related stress and problems (Hayes, Matsuda & De Mey, in press). Hayes et al (in press) also reported findings that concluded therapists trained in ACT achieved better therapeutic outcomes compared to therapists not trained in ACT.
Mindfulness presumes that whatever is happening in the moment is perfect as it is, and that our problems arise out of our reactions to what is happening. In relation to depression, anxiety or any strong emotion it is our attempts to avoid the emotion or physical symptoms that create a pattern of behaviour that merely achieves an exacerbation of those very symptoms or emotions to which we are attempting to avoid. This is exemplified in the experience of fear of the fear that a panic attack might occur. Another example is a depressed person’s ruminating over a particular negative experience. While this ruminating on the surface may have some problem solving legitimacy, when it is put under the microscope the ruminating reveals a pattern of perpetuating the depressive symptoms. A mindfulness approach encourages observation of the experience and even an observation of our desire to avoid the experience. It encourages us to maintain this observational stance with curiosity, patience and openness to the experience that acknowledges that the experience is temporary and that if we do nothing but observe the experience, the experience will pass. I am in no way inferring that is always easy to achieve (although for some it can be). For most people to achieve this mindfulness stance, it requires extensive practice and the guidance of an experienced practitioner.
In practicing mindfulness the practitioner begins to recognise the unhelpful role (if not destructive role) our reactions play in our experience of emotions. They begin to witness the role of thoughts in feeding the emotion. It is through the practice of mindfulness that an individual can learn to alter the relationship they have with their emotions and thoughts. It is this shift in the relationship with thinking that is the distinct difference mindfulness offers from cognitive therapy.
A mindfulness approach does not attempt to alter thinking; it merely encourages a non reactive or non – judgemental awareness of thinking. It is through this shift in the way an individual relates to their thinking that things change. Paradoxically the change occurs by not aiming for a particular outcome but rather by staying process focussed. Process focussed means staying with the mindfulness practice, being present to what is occurring.
Mindfulness practice provides an environment that allows us to observe our emotions long enough to increase our understanding of the process in which they arrive and pass away. Mindfulness is an opportunity to practice the necessary skills for psychological and emotional well-being in a simplified and controlled environment. That way we do not have to wait for the heat of the battle or when we are in the midst of an emotion, such as when we are anxious or depressed in order to begin our practice. If we assume that we are unskillful, then it would be a tough ask to put ourselves into a difficult situation and then expect to show mastery. For example, if we are learning to play the guitar, we practice in an environment where we feel safe, comfortable or unthreatened. The bedroom would be a good example. We do not start practicing in an auditorium full of people who have paid large sums of money to hear us play the guitar. Mindfulness practice provides us with the forum to strengthen our existing skills to the point where we are working at our optimum. Not just getting along but rather excelling, full of energy and with a deep seated contentment that is difficult to shift.
Mindfulness practice provides a productive and simplified environment in order to practice developing our psychological and emotional skillfulness. Mindfulness practice allows you to work with your physical sensations, emotions and thoughts. As you practice your mind follows its habitual patterns. Therefore as you practice mindfulness you can gain insight into these habitual patterns. You also have the opportunity to practice working with these habitual patterns. This is a unique opportunity. We rarely get to observe how these experiences occur for us. We are generally too caught up in them or the consequences of these experiences to actually observe the process which generates the experience.
The objective of mindfulness practice is not to achieve relaxation. The objective is to develop your emotional and psychological skills. It is in some ways a form of mental gymnastics. Mindfulness practice is the arena for developing mental skills that can be applied in day to day living, specifically in the area of emotional and psychological skilfulness. It is not about achieving some particular state, as numerous mental states will occur in mindfulness practice. You may achieve some exeptional skillfulness from regular and committed practice. These are the outcomes of the practice but not the practice itself. Mindfulness practice is not the only way to achieve the outcomes of mental and emotional skilfulness but it is a very effective way.There are four key skills developed through mindfulness practice:
- Stability of mind – being able to manage the variuos mental states ranging from agitated to dull so that your mind is predominantly stable.
- Flexibility of Awareness – the skill to shift your awareness away from or onto what ever object you chose.
- Self Awareness – to be present to your mental activity and to understand how you mind works.
- Non-reactivity – the skill of being less reactive to your internal and external world.
Most of us have had the experience of a very unstable mind. This is where thoughts are intense and often overwhelming. For some people this experience can be very strong and a regular occurrence. For most of us it is less frequent and less intense, however, there are situations that occur that can trigger an unstable mind in anyone. Similarly most of us have experienced a very dull mind. That is the type of experience where we are not sure where our mind has been. An example of this is when we drive home and cannot remember which way we travelled. Our days consist of regular experiences of this mindlessness. These are two examples of points on a continuum. An overactive mind and a dull/absent mind. This continuum represents the degree of stability of our mind. A stable mind is well balanced between these points. A mind in this balanced state is pliable, alert and yet relaxed (free of tension).
There are many misconceptions or misinterpretations of mindfulness. Mindfulness emphasises awareness. This allows its particular benefits to be relevant to our day to day experience. Our emphasis in the mindfulness approach is not about concentration. That is, it is not important that your mind is focused on its object for you to gain benefits from this technique. The objective of mindfulness is to observe whatever is happening in your mind in a particular way.
Consistently I hear people who begin their practice of mindfulness, claiming that they cannot do it. Generally what they mean by this is that they cannot concentrate for prolonged periods. What is required is that we achieve a more stable mind with clarity and alertness and less swinging from dullness to agitation, not concentration.2. Flexibility of Awareness
Focus your awareness on to the left hand button. Then shift it to the right hand button. Repeat this shifting from one button to the other approxiametely ten times.
This shifting of your awareness from one button to the other is an attempt yo illustrate flexibility of awareness. How easy or difficult did you find that task? Some people find this difficult as their mind questions the reason for it or some other mental activity interferes with the task. Others find they can shift their awareness effortlessly. The objective is to learn to be able to shift your awareness effortlessly. Not merely in the above exercise but more importantly in day to day experiences. For example, noticing your awareness is focused on your anger which has arisen from the injustice of a recent event. Your capacity to recognise the anger, to then identify its value and if appropriate to then shift your awareness, refocusing on something constructive, will in part determine your mental and emotional skilfulness.
Flexibility of awareness underlies some significant shifts in your relationship with your thoughts, emotions and actions. Typically, we strongly identify with our thoughts and emotions. Often we fail to realise that they are merely thoughts and that emotions are merely information or data. This results in much of our emotional and mental distress. The strong identification with thoughts and emotions leaves us captive. Freedom comes from flexibility. Rigidity or identification leaves us with disturbance.
Mindfulness provides a very practical and effective forum in which to practice flexibility of awareness. In our day to day life it is a difficult and complex task to ascertain where our minds should be focused. The role of mindfulness is to provide a simple and controlled environment for practice. It does this in regards to developing flexibility of awareness by removing any need to identify whether your mind should be more skilfully applied to this task or that task. In mindfulness practice everything other than your breath (or whatever object you choose as your reference point) is a distraction. For the period of time you have set as your practice time, anything that occurs in your mind other than the breath sensation is a distraction. Hence in this time for your mind to be skilful it needs to return to the awareness of the breath.
When practicing mindfulness your task is to constantly return your awareness on to an object when you notice it has left the object. This object is often but not essentially the breath. For example the movement of air as it moves through your nostrils. When ever your awareness moves from the sensation of air at your nostrils you shift it back to your breath. In the same way you moved it from the left button to the right button in the above exercise.
Flexibility of awareness is about letting go. It is about letting go of judgements, thoughts, beliefs, emotions, physical sensations and all things that arise in your mind. It is about being skilful to the point that you shift your relationship to these internal and external elements to one of non-identification. This results in an acceptance of the experiences as they arise. There is no desire to escape them or to hold onto them.3. Self Awareness
Aware is defined in the Pocket Oxford Dictionary as Conscious, not ignorant. In practicing mindfulness you are aiming to be conscious of what your mind is doing at any particular time. The objective is to not be ignorant of:
- What your inner world is doing.
- The way in which your inner world is reacting to the outer world.
There are two components to this skill. One is quantitative and the other qualitative. Quantitative refers to content. What is the content of activity in your mind? What are the specific thoughts? How do you experience anxiety from start to finish? The qualitative refers to the process. That is, it is referring to the way in which you relate to your mind. Specifically this is referring to the process of being an observer rather than the actor. In relation to your mind you are observing or witnessing the activity of your mind rather than actually being so engrossed in the activity that you are lost in the activity.
Self awareness allows us to experience our emotional world immediately it commences. Many people express to me that their emotional world happens too quickly for them to alter their behaviour. This is true to a point. Because the emotion and subsequent reactive behaviour are automated: it happens with apparent speed. When we bring our awareness to the situation what occurs is an awareness of the steps that make up our reaction to the situation. In effect awareness is like turning the light on in the backroom of our unconscious. The backroom or unconscious has all the automated reactions filed away in it. To us it appears that things happen quickly and without any apparent sequential process. In the backroom, the step by step process is happening. If you can bring that process into the front room (the conscious mind) then you can see the steps and you can then become aware of numerous intervention points.
People who have experienced depression or anxiety often say that it happens too quickly to stop. It happens in a flash. On investigation this will not hold to be true. These emotions at their extreme are almost impossible to turn around. At the point of high anxiety or extreme levels of depression, it is difficult to turn it around. There is clearly a point of no return in our emotional experience, where once you have passed that point you may not be able to influence the emotional process. It may mean that you have to learn to accept and tolerate certain inner experiences such as physical and mental agitation without acting them out on yourself or others. The behavioural course can be influenced. The simplest solution is to have the self awareness to recognise the emotion at its earliest point. At this point it can be dealt with skilfully.
How does mindfulness assist us to develop self awareness. When you bring your awareness to the sensation of the breath, it will leave at some point. Your capacity to recognise this shift from the sensation of breath to something else is an indication of your skilfulness to be self aware. To notice this shift immediately is highly skilful. Being unaware has been the antedote to much of our dissatisfaction. Being unaware enables us to avoid the feelings of frustration, of feeling unloved or feeling inadequate. It would appear on the surface that this would be appropriate, but alas it is our lack of awareness and our habitual reactivity that actually magnifies the dis-satisfaction and gives it energy to sustain itself beyond the naturally existence of the emotion or discomfort.
There is a qualitative shift in self awareness that occurs through mindfulness practice. The shift is in the quality of experience. Mindfulness practice moves your awareness from being narrow and over-involved in both the inner and outer world to an awareness that is open, expansive and overseeing the activity of your internal and external world, an observer, a witness to experience.4. Non-Reactivity
A critical skill developed through the process of mindfulness practice is non-reactivity. This is the ability to observe our experience and not habitually respond. For example, when you are practicing mindfulness, and you feel an itchy sensation on your nose, do not scratch it. This itchy sensation is observed in your experience. By not scratching, you are practicing being non-reactive. To scratch is a habitual response. To not scratch is to break the hold of this automated process. Clearly whether you scratch or not is not an issue, but the development of this skill is useful as a method to practice non-reactivity for later use in other more difficult and complex situations. For this reason it is preferable that you do not move when you are practicing mindfulness. To move is to react habitually to some thought or experience of discomfort. It is by practicing breaking this cycle that we become more skilful.
If you continue to react in the same way as you have in the past then you will experience the same outcomes. This simple statement can be difficult to practice in the hectic pace of our daily life, where we are caught up in these habitual patterns. In fact this hectic pace is in itself a habitual pattern that we struggle to be free of. As you practice you will begin to notice thoughts follow each other. One thought leads to another. When you notice your awareness has shifted from your reference point and you break the habitual patterns of thought by coming back to your reference point, you are learning to be non-reactive to your thoughts. Thoughts like “this is boring„ or “this isn’t working„ are just thoughts. They are mere distractions which take your awareness from more constructive uses of your mind. The thought is merely a thought and not a fact. Clearly life without thoughts is unimaginable. I am not suggesting that we stop thinking. I doubt we could achieve this end and I cannot see why we would need to. In fact aversion to thoughts is a common struggle in mindfulness practice. Our objective is not to remove thoughts but to change our relationship with them. The relationship shifts to one of an awareness but not a solid commitment to the thoughts or to the direction they may be taking us.
To practice mindfulness in the treatment of depression and anxiety I would recommend seeking the direction of a trained mental health professional with extensive experience in practicing practicing mindfulness and also some experience and training in introducing it to their clients. While the practice is simple enough there are many intricacies that require a trained professional to identify and fine tune your practice to optimize your outcomes. It is also likely that success requires an integrated approach using other appropriate psychological and pharmacological interventions.
The practice itself requires that you set aside some time which might start with 15 minutes building up to 45 minutes. This might seem a long time but it is necessary to give yourself the opportunity to practice working with your mind. It is the length of time that provides this opportunity but also the longer time provides an increased intensity to the practice. When practicing for 45 minutes the thoughts will arise like “I’ve had enough of this„, “this is boring„ or “I have better things to do„. It is through the practice that you learn to relate to these thoughts as thoughts not facts. They are nothing more than neurons firing in your head and it is only through your early learning that you have learned to give them importance. Through the mindfulness practice and the sustained repetitive nature of noticing thoughts and not treating them as important that you learn to alter your relationship to thoughts. This changing relationship also applies to physical sensations or external elements such as sounds.
Find a place where you can sit comfortably (lying down can encourage the dull mind and sleep). This can be in your lounge room or it can be on the train. There is no ideal environment because you are merely noticing what is happening without reaction. You might find it easier to concentrate in the lounge room but that is not the objective of mindfulness practice. You then either with your eyes open or closed, bring your awareness to your breathing. I typically observe the sensation of air moving through my nostrils, but you can observe some other aspect of the breath cycle. Then when you notice your mind has wandered off the breath you congratulate yourself for being mindful by noticing that your mind has shifted and you then return your awareness back to the breath. You then repeat this and repeat this and repeat this over and over until the time is up. That is it. Its simplicity belies the skills developed as outlined above; it belies the outcomes that people experience in managing their emotional and psychological world. Again it is recommended that you seek assistance in developing you practice. It is also useful to acknowledge that this practice may require a life long commitment so that the benefits you achieve are continued.References
Anderson, M. (1999) Buddhist principles in the work of Therapists. Unpublished and incomplete Masters Thesis.
Baer, R.A. (2003) Clinical Psychology: Science and Practice. 10, 2 125-143.
Epstein, M, (1984) On the neglect of evenly suspended attention. Journal of Transpersonal Psychology. 16, 2 193-205.
Hayes, S.C., Matsuda, A. & De May, H. (in press). Acceptance and Commitment Therapy and the Third Wave of Behavior Therapy. Dutch Journal of Behavior Therapy.
Kabat-Zinn, J. (1990) Full Catastrophe Living: Using the wisdom of your body and mind to face stress, pain and illness. New York: Delacorte.
This article has drawn some of its content from the book book Mindfulness Meditation by Michael Anderson. Copies of this book can be obtained from the author for $20 including postage and handling. This article remains the property of the author and any reproduction for more than personal use requires the expressed permission of the author.Michael Anderson, Torquay Living Centre, 86 Surfcoast Hwy, Torquay, Vic, 3228.
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