The Integration of Mindfulness in Therapy
Micere S. Oden, M.S.
Doctoral Candidate, Walden University
This article includes an overview of mindfulness and theoretical orientations that utilize mindfulness. Clinical applications of mindfulness in therapy will also be addressed. The first empirical paper on mindfulness within the Western scientific perspective was published by Ellen Langer, Ph.D. and was conducted without an orientation to Eastern spiritual thought and practice (Langer, Blank, & Chanowitz, 1978). Dr. Langer has been described as the “mother of mindfulness”. Langer’s seminal research revealed the profound benefits of increasing mindful behavior for aging, health, creativity, and the workplace (Langer, 1978). Later in Langer’s (1989) research, she extended the discussion on mindfulness and addressed how human potential may be extended by engaging in mindful social psychological interventions.
Prior to Langer’s pioneering work, mindfulness was established 2600 years ago as a meditation technique in Buddhist practice (Shonin & Gordon, 2016; Zou, Wu, & Fan, 2016). Mindfulness-Based Interventions (MBIs) incorporates modern psychology and Jon Kabat-Zinn, Ph.D. states, mindfulness is the process of “paying attention in a particular way: on purpose, in the present moment, and non-judgmentally” (1994, p. 4). Furthermore, mindfulness has two essential components: (a) the awareness and perception of experiences is in the here and now and (b) the application of an attitude of acceptance and openness to personal experiences without judgment (Zou et al., 2016). In summary, mindfulness involves focusing on the situation occurring right now and observing thoughts and emotions without judgment.
Mindfulness has been incorporated in theoretical orientations. Several Mindfulness-Based Interventions are utilized in the field of psychology and are discussed in this article. Mindfulness-Based Stress Reduction (MBSR) founded in 1979 by Dr. Kabat-Zinn includes intensive training in mindfulness meditation and integration into challenges and adventures in everyday life to respond more effectively to stress, pain, and illness (University of Massachusetts Medical School Center for Mindfulness in Medicine, Health Care, and Society, 2017). Additional Mindfulness-Based Interventions include: Mindfulness-Based Cognitive Therapy (MBCT) and Mindfulness-Based Relapse Prevention (MBRP). Two additional theoretical orientations grounded in mindfulness are identified: ACT and DBT.
Acceptance and Commitment Therapy (ACT) created by Steven C. Hayes, Ph.D. in 1986 has six core processes: Acceptance, Cognitive Defusion, Being Present, Self as Context, Values, and Committed Action (Hayes & Smith, 2005). ACT focuses on behavioral change as clients accept their thoughts and feelings, in the present moment, choose a valued direction, and take action (Harris, 2009). Being Present (mindfulness) in ACT centers on clients becoming more mindful of the sensations, thoughts, and feelings that are happening to them moment to moment. ACT has been evaluated as an Evidence-Based Practice (EBP) and has received strong research support for chronic pain, modest research support for depression, and modest research support for mixed anxiety disorders (American Psychological Association Society of Clinical Psychology: Division 12, 2016).
Dialectical Behavior Therapy (DBT) founded by Marsha M. Linehan, Ph.D., ABPP in the 1970s, focuses on four modules in skills training: Mindfulness, Distress Tolerance, Interpersonal Effectiveness, and Emotion Regulation (Linehan, 2015). Mindfulness in DBT centers on the present of being fully aware and present in this one moment. Specifically, DBT includes Core Mindfulness Skills: the “Wise Mind” skill, three Mindfulness “What” skills: Observing, Describing, and Participating, and three Mindfulness “How” skills: Nonjudgmentally, One-Mindfully, and Effectively (Linehan, 2015). DBT has been evaluated as an Evidence-Based Practice (EBP) and has received strong research support for Borderline Personality Disorder (American Psychological Association Society of Clinical Psychology: Division 12, 2016). Clinical applications are featured in the following sections.
Licensed Clinical Psychologists utilize ACT and DBT in treatment plans with clients from diverse cultural backgrounds in varied clinical settings. The practicum and pre-doctoral internship offers opportunities for Clinical Psychology doctoral students to gain training in ACT and DBT. Access to therapy resources can enhance clinical practice. Numerous handouts and worksheets are available that align with the six core processes of Acceptance and Commitment Therapy (ACT) for use by clinicians in therapy. Publications and trainings for ACT provide useful resources to incorporate in sessions. The DBT Skills Training Manual, Second Edition (Linehan, 2015) contains handouts and worksheets that align with the four modules in skills training for therapy session use. Collaboration with supervisors and colleagues can promote the sharing of mindfulness practices that are useful with a range of populations and settings.
A particular resource that can be used to integrate mindfulness in therapy is Growing mindful: Mindfulness practices for all ages developed by Mitch Abblett, Ph.D. and Chris Willard, Psy.D. (2015). It is a 52 card deck which contains mindfulness practices that promotes awareness, the present moment experience, the cultivation of kindness, and curiosity (Abblett & Willard, 2015). Clinicians can use the activities to encourage clients to practice mindfulness by teaching awareness and being in the present moment. The activities range from mindfulness practice of observing surroundings and noticing: breathing, sensations, thoughts, and feelings. Additional mindfulness activities focus on listening to music, listening to sounds in the environment, engaging in mindful: eating, walking, and gratitude. This 52 card deck, Growing mindful: Mindfulness practices for all ages contains several blank cards for participants to use their creativity and write down their own ideas.
Practicing mindfulness can be completed any time of the day and in any setting which may increase clients’ receptiveness to beginning and maintaining the practice in their daily life. Additional equipment is optional including incorporating food to practice mindful eating. Mindfulness practices can be modified for short, medium, and longer durations. In closing, the practice of mindfulness is an opportunity for clients to get in touch with their own experiences in a defused and accepting way (Hayes & Smith, 2005).
Abblett, M., & Willard, C. (2015). Growing Mindful: Mindfulness practices for all ages. Eauclaire, WI: PESI Publishing & Media.
American Psychological Association Society of Clinical Psychology: Division 12. (2016).Treatments. Retrieved from https://www.div12.org/psychological-treatments/treatments/
Harris, R. (2009). ACT made simple: An easy-to-read primer on Acceptance and Commitment Therapy. Oakland, CA: New Harbinger.
Hayes, S. C., & Smith, S. (2005). Get out of your mind and into your life: The new Acceptance and Commitment therapy. Oakland, CA: New Harbinger Publications.
Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in everyday life. New York: Hyperion.
Langer, E. J., Blank, A., & Chanowitz, B. (1978). The mindlessness of ostensibly thoughtful action: The role of “placebic” information in interpersonal interaction. Journal of Personality and Social Psychology, 36(6), 635–642. doi:10.1037/0022-3518.104.22.1685
Langer, E. J. (1989). Minding matters: The consequences of mindlessness–mindfulness. Advances in experimental social psychology (Vol. 22, pp. 137-173). doi:10.1016/s0065-2601(08)60307-x
Linehan, M. M. (2015). DBT skills training manual (2nd ed.). New York, NY: Guilford Press.
Shonin, E., & Gordon, W. (2016). The mechanisms of mindfulness in the treatment of mental illness and addiction. International Journal of Mental Health and Addiction, 14(5), 844-849. doi:10.1007/s11469-016-9653-7
University of Massachusetts Medical School Center for Mindfulness in Medicine, Health Care, and Society. (2017). History of MBSR. Retrieved from https://www.umassmed.edu/cfm/mindfulness-based-programs/mbsr-courses/about-mbsr/history-of-mbsr/
Zou, T., Wu, C., & Fan, X. (2016). The clinical value, principle, and basic practical technique of mindfulness intervention. Shanghai Archives of Psychiatry, 28(3), 121-130. doi: 10.11919/j.issn.1002-0829.216060