Mindfulness and Mental Health

Over the past twenty years, awareness of the importance of mental health has increased dramatically, and at the same, an increased awareness of the relationship between mindfulness and mental health has become common among both patients and providers.

What is Mindfulness?

It’s possible to find a wide range of definitions for this single term. However, we’ll offer the simple definition favored by the Vietnamese monk, Thich Nhat Hahn, the foremost mindfulness expert in the world. Hahn is often cited as the father of the modern mindfulness movement. His book, “Present Moment, Wonderful Moment” is a short, easy read, and a perfect introduction to mindfulness for anyone new to the topic.

Here’s his basic definition:

“Mindfulness is our ability to be aware of what is going on both inside us and around us. It is the continuous awareness of our bodies, emotions, and thoughts.”

This definition gets to the heart of mindfulness: the quality of our attention and awareness. Another essential component of mindfulness is related to its Buddhist origins: non-attachment. Or, in language that connects mindfulness and mental health, nonjudgment. Thich Nhat Hahn encourages us “to be aware of what’s going on both inside us and around us.”

By “inside of us” he means two things.

1. The physical sensations in our bodies
2. Our thoughts, feelings, and emotions

The two are most certainly related, but that’s a different topic for a different article, with one quick aside: our physical sensations can often reveal our emotional states, and understanding our emotional states is often the first step in understanding the connection between mindfulness and mental health.

But we digress.

Thich Nhat Hahn advocates for people – all people, not only those with mental health disorders – to engage in a “continuous awareness of our bodies, emotions, and thoughts” with one important caveat. To benefit from mindfulness, we must maintain this awareness of our bodies, emotions, and thoughts without judging them.

When we practice any type of mindfulness, we learn to identify our thoughts and emotions without placing value judgments like good or bad on them. That lesson leads to an important insight many people new to mindfulness experience. Most of us constantly judge our thoughts and feelings, and we’re not always kind to ourselves when we do. In fact, most of those judgments – especially for people with mental health disorders – are counterproductive.

How Does Mindfulness Work?

Mindfulness can give patients with mental health disorders practical tools that help them identify and experience their emotions without judgment. When they can do that, two important things happen. First, patients learn to define their thoughts, feelings, and emotions as they choose, rather than by their default reactivity. Second, they learn they have the power to replace their automatic negative thoughts – sometimes called ANTS – with positive thoughts that contribute to, rather than detract from, their overall mental health and wellbeing.

Those are the components common to all genuine mindfulness practices: awareness, nonjudgment, and compassion. They’re part of any practice labeled as mindfulness, and if they’re not, the practice is probably not a genuine mindfulness practice. It may have value, but it’s not mindfulness. That leads us to another important point: almost any activity can be mindful, when practiced with those three things in mind.

We’ll talk about that below. First, we’ll list the various types of mindfulness practice most often found in mental health treatment programs. After that, we’ll discuss clinical adaptations of mindfulness practices. Finally, we’ll close with a discussion of mindful activity in daily life.

The Most Common Mindfulness Techniques in Mental Health Treatment

The following list includes the types of mindfulness practices included in mental health treatment plans across the country.

Mindful Meditation

Clinical trials confirm benefits of mindful meditation and show mindful meditation helps patients with the following challenges/conditions/disorders:

• Anxiety
• Depression
• Stress
• Insomnia
• Chronic pain
• Hypertension

There are myriad variations of mindful meditation. The most common include:

• Progressive relaxation/body scan/body awareness. This type of meditation involves either sitting, laying down, or standing still. Once comfortable and focused, patients bring their attention to each part of the body, from head to toe, and identify the sensations they feel. The goal is to identify the sensations without judgment, and to intentionally release any unconscious tension from the body.
• Seated meditation. Seated meditation most often focuses on breathing as a way to enter a mindful state. Seated mindful meditation may begin with relaxation or a body scan, but then most often transitions to the breath. When thoughts or sensations draw the attention away from breathing, the patient simply allows them to happen and then refocuses on breathing. That’s the essence of the practice: allowing thoughts to be there without controlling, allowing them to pass, then returning the focus and attention to the breath.
• Moving meditation. In standard mindfulness practice, the most common technique is mindful walking. Mindful walking was a favorite activity of Thich Nhat Hahn. But walking is not the only movement that can be mindful. When performed with a mindful perspective, there are many types of moving meditation, from dance to martial arts to yoga to activities as simple as gardening.

Yoga

Yoga is an effective mindfulness practice because it integrates several components of mindfulness – attention, awareness, breathing, movement, and nonjudgment – into one comprehensive, integrated system. In addition, since mindfulness is derived from Buddhism, and Buddhism is partially derived from Hinduism, which is the spiritual foundation of yoga, the two practices share a common origin. The pattern most yoga classes follow reflects the core principles of mindfulness:

• Breath work. Called pranayama, breathing is central to yoga. Think of the instructions common in a yoga class: inhale, raise your arms, exhale, relax them back to your sides. That’s very basic, but basic goes a long way.
• Yoga poses. Called asanas, these are the positions most people associate with yoga. Think of downward dog, forward dog, the crow, the plank, the headstand. It takes focused attention, breathing, and physical awareness to perform even a standing posture such as tadasana, or the mountain pose. Integrating breath, movement, and attention increases mindfulness, which in turn, leads to the same benefits of attributed to mindful meditation, which we list above.
• Called savasana, most yoga classes end with this posture. Savasana involves laying in the floor in a comfortable position, following the breath in and out, and relaxing the body one part at a time. If that sounds familiar, it should. Here’s a secret: almost every relaxation technique – even it has a fancy scientific like progressive muscular relaxation (PMR) – that involves focusing the breath and attention on a body part to relax it comes from the yoga pose known as savasana.

Tai Chi

While tai chi is less common than yoga and standard mindful meditation, many treatment centers that incorporate mindfulness into mental health treatment offer tai chi. When most people think of tai chi, they imagine older Chinese people practicing slow, relaxed, fluid movements early in the morning in a public park. That’s not a bad way to think of tai chi. Although it began as a martial art, the focus on keeping a completely relaxed body while executing complex movements very slowly has become the definition of moving meditation.

Clinical studies here, here, here, and here show the following benefits of tai chi for mental health:

• A regular tai chi practice can reduce the impact of daily stress.
• Tai chi can reduce the frequency and severity of depressive symptoms.
• Tai chi can reduce the frequency and severity of the symptoms of anxiety disorders.
• A regular tai chi practice can improve overall feelings of wellbeing.
• Positive Affect. Tai chi can improve emotional states, and increase frequency of positive affect, compared to negative affect.

In most treatment centers that include mindfulness practices, meditation, yoga, and tai chi are called complementary, adjunct, or experiential therapies. What that means is that they’re not the primary clinical treatment, but rather, support primary clinical treatments. In other words, the techniques above are used in addition to, rather than in place of, traditional approaches to treatment.

However, experts have adapted at least two standard forms of psychotherapy to include core components of mindfulness: cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT).

Psychotherapy + Mindfulness: Powerful Impact on Mental Health

The variation of CBT that incorporates mindfulness is called Mindfulness-based cognitive behavioral therapy (MBCBT). We recently published an article about MBCBT on the blog section of our website:

Clinical and Cost Effectiveness of Mindfulness-Based Cognitive Behavioral Therapy Vs. Traditional Cognitive Behavioral Therapy for Depression Treatment

That article addresses exactly what the title implies: the effectiveness of traditional CBT compared to MBCBT. To learn what the researchers found, please read the article – it’s informative. Now we’ll offer a basic description of MBCBT, which is not difficult to understand.

Mindfulness-Based Cognitive Behavioral Therapy

Standard CBT is an effective, first-line treatment for a variety of mental health disorders, including depression, anxiety, bipolar disorder, and treatment resistant depression. CBT focuses on the relationship between thought, feeling and behavior. CBT posits that the mental health problems can result from our responses to thoughts and feelings, which in turn have an impact on our behavior. When our responses are negative, our behavior may become counter-productive.

CBT helps patients alter behavior by creating techniques to alter our responses to our thoughts. MBCBT does the same thing but places an emphasis on accepting our thoughts as they are, without judgment, rather than trying to change them immediately. In short, mindfulness helps patients identify the thoughts and emotions that cause them problems, while CBT helps patients process those thoughts and emotions in a productive manner.

Evidence-based benefits of MBCBT include, but are not limited to:

• Cognitive Restructuring. MBCBT helps patients change automatic, counterproductive thoughts to productive thoughts that promote recovery.
• Improved cognition/enhanced executive function. MBCBT can help improve the cognitive distortions associated with some mental health disorders, thereby improving overall decision-making skills and improving impulse control.
• Improved stress tolerance. MBCBT can decrease automatic, negative responses to stress, and reduce the time it takes to recover from or process stressful experiences.
• Enhanced self-efficacy. MBCBT teaches patients the basics of self-acceptance, non-judgment, and self-awareness that allow them to manage challenging emotional circumstances. Mindfulness helps give balance and perspective to thoughts and feelings, and CBT helps them process those thoughts and feelings in a way that promotes positive behavior.

MBCBT is most effective for patients with disorders such as depression and anxiety, but can also help with a variety of other mental health conditions.

Dialectical Behavior Therapy (DBT)

Dialectical behavior therapy incorporates mindfulness and helps people with mental health disorders characterized by high levels of emotional reactivity and low levels of stress/distress tolerance. Developed by CBT practitioner Marsha Linehan, DBT synthesizes elements of CBT with mindfulness to help patients in crisis manage their symptoms without engaging in life-interrupting behaviors. Components of DBT include four modules, also called essential skills:

1. Mindfulness skills. Mindful awareness of emotional states is the core of DBT. Mindfulness helps patients slow down, take a step back, and create room for further therapeutic activities.
2. Interpersonal effectiveness skills. Building on a base of mindfulness skills, DBT helps patients recognize and manage the impact of their emotions and behavior on relationships with family, friends, and peers.
3. Emotional Regulation skills. This skill helps patients develop specific, practical, immediately useful techniques to manage extreme, overwhelming, and powerful emotions. The mindfulness-derived emotion regulation skills associated with DBT can help patients manage intense anxiety, mood swings, and excess irritability and/or angry outbursts.
4. Distress tolerance skills. The distress tolerance skills in DBT are also derived from mindfulness. These skills are what they sound like: they help patients manage their responses to circumstances or situations they can’t control. Mindfulness helps patients identify what they can and can’t control and accept reality as it is, rather than as they wish it could be. When that happens, patients can handle situations that would previously have triggered intense and painful emotions. With DBT distress tolerance skills, based in mindfulness, patients can manage challenging emotions without resorting to behaviors that could exacerbate, rather than improve, their current situation.

There are other forms of psychotherapy that incorporate mindfulness practices into their standard techniques, but CBT and DBT practitioners have created a powerful synthesis of mindfulness and psychotherapy that’s appropriate in a wide range of therapeutic milieu, and effective for several different mental health disorders.

Mindfulness and Mental Health in Everyday Life

In the introduction to this article, we mention that when we include attention/awareness, nonjudgment, and compassion in everyday activities, those activities can become part of a mindfulness practice. Take mindful walking, for instance. There are many ways to take a mindful walk, but one thing is common to all of them: slowing down and paying attention. If you go for regular walks around your neighborhood, try the next one mindfully: slow down and pay attention. Try to see things you’ve never seen before and notice things you’ve never noticed. In other words, slow down and not only smell the roses, but also see them, notice all the details about them, and learn to appreciate them as they are: perfect as-is.

Another popular mindful activity is mindful cooking and eating. To engage in mindful cooking and eating, simply apply mindfulness principles to the entire cooking process. When you wash the vegetables before chopping them, take the time to feel their texture and shape. When you brown garlic in a pan of olive oil, allow yourself to fully experience the pleasant aroma. And when you sit down to eat, chew each bite at a leisurely pace, and learn to appreciate the differences between all the things on your plate. This will enhance your overall eating experience, and at the end, you may realize something happened: while you were focused on the moment, the immediate sensations, and the experience of eating, you probably become more relaxed, centered, and focused.

That’s the power of mindfulness – and you can apply to just about any activity, starting in this very moment.