Mindfulness-Based Treatment Approaches

Clinician's Guide to Evidence Base and Applications

Ruth A. Baer

• Publisher: Academic Press
• Year: 2014
• ISBN:
  9780123914521
• Edition: 2
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

The second edition of Mindfulness-Based Treatment Approaches discusses the conceptual foundation, implementation, and evidence base for the four best-researched mindfulness treatments: mindfulness-based stress reduction (MBSR), mindfulness-based cognitive therapy (MBCT), dialectical behavior therapy (DBT) and acceptance and commitment therapy (ACT). Eastern spiritual traditions have long maintained that mindfulness meditation can improve well-being. More recently, mindfulness-based treatment approaches have been successfully utilized to treat anxiety, depressive relapse, eating disorders, psychosis, and borderline personality disorder.

All chapters in this new edition are written by researchers with extensive clinical experience. Each chapter includes the conceptual rationale for using a mindfulness-based treatment and a review of the relevant evidence base. A detailed case study illustrates how the intervention is implemented in "real life, " exploring the clinical and practical issues that may arise and how they can be managed. This book will be of use to clinicians and researchers interested in understanding and implementing mindfulness based treatments.

• Covers anxiety, depression, eating, psychosis, personality disorders, stress, pain, relationships, and more
• Discusses a wide range of populations (children, adolescents, older adults, couples) and settings (outpatient, inpatient, medical, mental health, workplace)
• Clinically rich, illustrative case study in every chapter
• International perspectives represented by authors from the US, Canada, UK, and Sweden

Part I

Introduction

Outline

Chapter 1. Introduction to the Core Practices and Exercises

Chapter 1

Introduction to the Core Practices and Exercises

Ruth A. Baer Department of Psychology, University of Kentucky, Lexington, KY, USA

Abstract

Interventions based on the practice of mindfulness meditation and related skills are increasingly popular and empirical support for their efficacy continues to grow. The present volume focuses on mindfulness-based stress reduction (MBSR; Kabat-Zinn, 1982, 1990, 2013), mindfulness-based cognitive therapy (MBCT; Segal, Williams, & Teasdale, 2002, 2013), and closely related interventions. This introductory chapter provides a general overview of MBSR and MBCT in their standard forms, with emphasis on their mindfulness and acceptance-based skills, practices, and exercises. Mechanisms through which mindfulness training leads to beneficial outcomes are briefly discussed and important questions remaining for future research are considered. Building on the foundation provided by this introductory chapter, the remaining chapters describe adaptations and new interventions for specific populations. Each chapter includes theoretical foundations, a summary of empirical support, and a case study illustrating a typical course of treatment and practical issues that arise in implementing it.

Keywords

Mechanisms of change; Meditation; Mindfulness-based cognitive therapy; Mindfulness-based stress reduction; Mindfulness-based treatment

From a Western psychological perspective, mindfulness is typically defined as a form of nonjudgmental and nonreactive attention to experiences occurring in the present moment, including bodily sensations, cognitions, emotions, and urges, as well as environmental stimuli such as sights, sounds, and scents (Kabat-Zinn, 1990; Linehan, 1993a). Most Western discussions of mindfulness acknowledge its roots in Buddhist meditation traditions, which for many centuries have maintained that the practice of mindfulness facilitates insight into the nature of human suffering and develops adaptive characteristics such as wisdom, equanimity, compassion, and well-being. Instruction in mindfulness has become widely available in Western society. Meditation centers in North America and Europe offer retreats in the Buddhist traditions with guidance and instructions in mindfulness practices. Numerous books about mindfulness and meditation are available for the general audience (e.g., Goldstein, 2003, 2013; Gunaratana, 2011; Salzberg, 2011). Of most importance to the present volume is the rapidly growing array of mental health treatment and stress-reduction programs based on secular adaptations of mindfulness training, several of which now have extensive empirical support for their efficacy in a wide range of populations.

Mindfulness has been conceptualized as a state, as a trait-like or dispositional quality, and as a set of skills. Bishop et al. (2004) provided a two-component definition of mindfulness as a state. The first component is the intentional self-regulation of attention so that it remains focused on present-moment experiences (i.e., thoughts and feelings) as they arise. The second component is an attitude of openness, acceptance, and curiosity toward whatever arises. In general, a person in a mindful state is intentionally and flexibly aware of and attentive to the ongoing stream of internal and external stimuli occurring in each moment, and is observing them with a stance of openheartedness, interest, friendliness, and compassion, regardless of whether they are pleasant, unpleasant, or neutral. Dispositional mindfulness is the general tendency to adopt a mindful state consistently over time and in many situations: noticing internal and external experiences; attending to them with acceptance and openness; and staying aware of ongoing behavior, rather than acting mechanically or automatically while preoccupied with other matters (Brown & Ryan, 2003). The skills training approach to mindfulness, which characterizes the treatments described in this volume, suggests that with the regular practice of a variety of exercises, people can learn to be more observant, accepting, and nonjudgmental of their daily experiences and to participate with awareness in their ongoing activities. That is, they learn to adopt a mindful state more often and more consistently across situations and over time. The evidence suggests that practicing mindfulness leads to increases in general tendency to be mindful in daily life and to improvements in mental health.

Empirically supported mindfulness-based interventions include many methods for teaching mindful awareness. Some of these are formal meditation practices, in which participants sit quietly for periods of up to 45 minutes while directing their attention in specific ways. Others are shorter or less formal exercises emphasizing mindfulness in daily life, in which participants bring mindful awareness to routine activities such as walking, bathing, eating, or driving. Several general instructions are common to many formal and informal mindfulness practices. Often, participants are encouraged to focus their attention directly on an activity, such as breathing, walking, or eating, and to observe it carefully. They are invited to notice that their attention may wander into thoughts, memories, or fantasies. When this happens, they are asked to note briefly that the mind has wandered, and then gently return their attention to the present moment. If bodily sensations or emotional states arise, participants are encouraged to observe them carefully, noticing how they feel, where in the body they are felt, and whether they are changing over time. Urges or desires to engage in behaviors, such as shifting the body’s position or scratching an itch, also are observed carefully, but are not necessarily acted on. Brief covert labeling of observed experience, using words or short phrases, such as “aching,” “sadness,” “thinking,” or “wanting to move” is often encouraged. Some mindfulness exercises encourage observation of environmental stimuli, such as sounds, sights, or smells. Participants are encouraged to bring an attitude of friendly curiosity, interest, and acceptance to all observed phenomena, while refraining from evaluation and self-criticism (and noticing these nonjudgmentally when they occur), or attempts to eliminate or change what they observe. For example, no attempt is made to evaluate thoughts as rational or distorted, to change thoughts judged to be irrational, to get rid of unwanted thoughts, or to reduce unpleasant emotions or sensations. Rather, cognitions, sensations, and emotions are simply noted and observed as they come and go.

The mindfulness-based interventions with the best empirical support are mindfulness-based stress reduction (MBSR; Kabat-Zinn, 1982, 1990), mindfulness-based cognitive therapy (MBCT; Segal, Williams, & Teasdale, 2002, 2013), dialectical behavior therapy (DBT; Linehan, 1993a, 1993b), and acceptance and commitment therapy (ACT; Hayes, Strosahl, & Wilson, 1999, 2012). The previous edition of the current book included chapters on all four of these treatments. Currently, the literature is so large that it is no longer practical to cover all four of these interventions in one volume. Recent books describe numerous applications of DBT and ACT (Dimeff & Koerner, 2007; Hayes & Strosahl, 2004; Hayes et al., 2012; Koerner, 2011). The present volume focuses on MBSR, MBCT, and closely related interventions developed for specific populations. These include acceptance-based behavior therapy (ABBT) for anxiety (Roemer & Orsillo, 2009), mindfulness-based childbirth and parenting (MBCP; Bardacke, 2012), mindfulness-based eating awareness training (MB-EAT; Kristeller, Wolever, & Sheets, 2013), mindfulness-based elder care (MBEC; McBee, 2008), and mindfulness-based relapse prevention (MBRP) for addictive behavior (Bowen, Chawla, & Marlatt, 2011). Applications for nonclinical populations seeking stress reduction and enhanced well-being are also covered.

The remainder of this introductory chapter provides a general overview of MBSR and MBCT in their standard forms, with emphasis on their core skills, practices, and exercises. This will prevent redundancy across chapters in basic descriptions of the primary practices, freeing the subsequent authors to focus on adaptations or new exercises developed for their specific population, detailed accounts of how their participants respond to the treatment, empirical support for the efficacy of their treatment, and practical issues in implementing it.

Mindfulness-Based Stress Reduction

MBSR (Kabat-Zinn, 1982, 1990, 2013) is based on intensive training in mindfulness meditation and was developed in a behavioral medicine setting for patients with chronic pain and stress-related conditions. In its standard form, it is conducted as an 8-week class with weekly sessions lasting 2.5–3 hours. An all-day intensive mindfulness session is often held during the sixth week. Extensive homework practice of mindfulness exercises is encouraged. Classes may include up to 30 participants with a wide range of disorders and conditions. Rather than grouping participants by diagnosis or disorder, MBSR has traditionally included people with a wide range of problems in each group, emphasizing that all participants, regardless of disorder, experience an ongoing stream of constantly changing internal states, and have the ability to cultivate moment-to-moment awareness by practicing mindfulness skills. However, in some settings, MBSR is applied with more specific populations, such as cancer patients (Campbell, Labelle, Bacon, Faris, & Carlson, 2012), health care professionals (Irving, Dobkin, & Park, 2009), or caregivers for family members with dementia (Whitebird et al., 2013).

Many MBSR programs begin with an individual or small-group orientation and assessment session, in which the group leader explains the rationale and methods of the course and encourages potential participants to ask questions and to discuss their reasons for participating. The challenge presented by the program’s extensive requirements for home practice of meditation exercises is discussed, and participants are encouraged to make a verbal commitment to attending all group sessions and completing daily home practice assi...