What is mindfulness and how is it used in therapy?
Mindfulness-based therapy is therapy that integrates components of mindfulness into the therapeutic work. There are many ways to practice mindfulness, including meditation, exercise, walking, eating, music, and any intentional use of the five senses.
You can practice mindfulness by being fully present in the moment, right here, right now. The way in which you attend to this moment makes all the difference.
For this reason, mindfulness practice is often separated into the “what” and the “how.” The “what” is whatever you are doing in the moment you choose to be mindful. The “how” is how you are as a person when you do that thing.
When practicing mindfulness and teaching it to clients, I often describe the qualities of awareness, acceptance, kindness, compassion, curiosity, and non-judgment. Essentially, mindfulness is the way you pay attention to one thing at a time as you are doing it in this moment.
For example, when doing the dishes (“what”), you can practice being aware of your senses. You can notice what the dish soap smells like, what the sponge feels like, and what temperature the water is. You can do this task with curiosity (“how”) of not knowing what the experience will be like and with non-judgement (”how”) of the experience you go through. You can also be compassionate and kind (“how”) towards yourself while engaging in this or any other task (“what”).
If you’ve tried guided meditation before, you were probably prompted to pay attention to your breathing (“what”), what the breath feels like on the inhale and exhale, and what your body felt like breathing. If you practice yoga, the way in which you attend to your body is with curiosity (“how”) towards any tension or discomfort, kindness (“how”) so as to not hurt yourself, and non-judgement (“how”) towards your body’s natural ability and physical limitations.
Mindfulness-based therapy allows the therapist to cultivate these mindfulness skills with you in session while teaching you to practice them for yourself. This can be done informally, through whatever goals or issues you came to therapy to work on, or formally, if you have an explicit interest in learning about mindfulness and/or meditation.
How does mindfulness-based therapy work?
In mindfulness-based therapy, a parallel process occurs. I pay attention to my clients mindfully, meaning that I attend to them and their needs as they are in the moment, and I do it with awareness, acceptance, kindness, compassion, curiosity, and non-judgment.
By way of me attending to them in this manner, my clients also learn to be more mindful of themselves and others. Oftentimes, as I talk about mindfulness and these qualities more, my clients become interested in learning about mindfulness more directly. At this point, I can teach them specific ways to practice mindfulness both formally through meditation, and informally in their day-to-day lives.
Mindfulness-based therapy can help you become more aware, improve your relationship with others and with yourself, and help you be more accepting and curious about any challenges or stressors you have to face. Research shows that when you approach difficult situations in this way, you improve your creativity, ability to solve problems and think flexibly, and even enjoyment of tasks you previously disliked (e.g., Ackerman, 2021; Davis & Hayes, 2012).
While you can cultivate these skills through your own mindfulness practice (for example, by using guided meditations), when you work with a mindfulness-based therapist you can learn to deepen your practice, apply it to different areas of your life, and ask/answer questions that you otherwise might not have thought of.
Mindfulness-based therapy may not look any different than other forms of therapy from the outside and many therapists who practice mindfulness may not even consider themselves to be mindfulness-based therapists. Many, if not all, forms of therapy help clients become more aware of themselves and learn to examine their relationships to people, situations, and concepts. For this reason, mindfulness-based therapy is often integrated into other forms of therapy, such as cognitive behavioral therapy (CBT), Acceptance and Commitment Therapy (ACT), and psychodynamic therapy.
However, a therapist who specializes in mindfulness-based therapy will be better able to help you integrate mindfulness into your life directly and cultivate some of the specific attributes discussed above (e.g., acceptance, compassion, non-judgment). They can also help you establish a mindfulness meditation practice, if that’s something you’d like to try or have struggled with in the past.
In general, a mindfulness-based therapist can help bring mindfulness to any therapeutic goal. However, not every therapist can infuse mindfulness effectively into their therapy practice if they’re not properly trained, and also, if they do not have a mindfulness practice of their own.
While anyone can learn to do a guided meditation or practice a task mindfully, not everyone embodies “the spirit” of a full mindfulness practice, that is truly ever-evolving and incorporates specific evidence-based techniques and concepts.
How can I use mindfulness in therapy?
The easiest way to use mindfulness in therapy is through direct practice. You can ask your [properly trained] therapist to guide you in a meditation or teach you ways to practice mindfulness in your daily life.
In addition to some of the practices mentioned above (doing the dishes mindfully, yoga, meditating on the breath), I have included a few additional practices below. You can use them with your therapist in session and practice on your own between sessions, reflecting back on your practice at your next appointment.
The reason it’s important for your therapist to be properly trained and ideally to have their own mindfulness practice is because they will know what questions to ask you to reflect on from your practice. They will also be able to highlight changes they observe in you that appear to be a direct result of the practices you’re doing. It’s kind of like having a personal trainer tell you that your exercise posture is exactly as it should be or a medical doctor telling you that your cholesterol is down after changing your diet. They know what to look for and how different aspects of the practice are connected to observable changes in your life.
Pick something that you can eat. Try to hold it between your lips. Do you taste anything?
Now, put it on your tongue, trying not to move it around. What does it feel like? Is it heavy? Is it difficult keeping it still?
Start moving it around your mouth. At what point do you notice what it tastes like? Does it taste or feel differently depending on what part of your mouth it’s in?
When you start chewing, notice the texture. When you finally swallow it, how does it feel? How long can you taste it for? Do you notice feeling full, hungry, or satisfied? Do any memories come to mind? What emotions arise as you eat?
This exercise can be done for an entire meal or for parts of a meal. It can also be done as a stand-alone mindfulness practice.
Mindful eating can change people’s relationship to both specific foods they eat, as well as the process of eating in general. For example, people who don’t like raisins, might end up enjoying the experience of eating a raisin mindfully. Similarly, people who don’t typically like the process of eating each meal and just want to “get it over with,” can end up enjoying the food they taste and how they feel eating different things.
Mindful eating can also help increase compassion towards your own body that works really hard to make sure your food is properly digested and brings nutrients to where they need to go.
Start with a standing posture. Notice what it’s like to stand still for a moment.
Turn your attention to your breathing. What does the breath feel like while you stand?
Start taking slow deliberate steps forward, not moving very far. Notice what each movement feels like. Picking your foot gently off the floor and choosing a place to put it down. Gently lifting your other heel up, transferring the balance from one foot to the other.
As you keep walking, you can increase your pace after a few minutes. Notice what the increase in speed does to your ability to walk smoothly. Notice where your attention goes as you walk, and kindly bring it back to each step.
You may want to hold on to something in the beginning so you don’t lose your balance. Since most of us are not used to walking at a very slow pace, it can be really interesting to pay attention to what each step is like. Observe this process with curiosity and non-judgment. Be compassionate towards yourself if it feels hard or not as you expected.
You can walk mindfully in your home, pacing back and forth across a few feet, or you can take it outside on any walk. This can be done both formally, as a meditative walking practice, or informally, when you’re just out and about by gently noticing what your stride feels like.
Mindfulness of Emotions
Important note: You might first want to do this with a therapist before trying on your own.
As you sit to meditate, gently take a few deep breaths and settle into a healthy posture (alert, grounded, not slouching, but not uncomfortable).
Bring to mind a specific situation from today or the last week. For the first time you do this, you can pick something mild that was perhaps slightly uncomfortable, but not terribly overwhelming.
Notice what emotions arise as you think of this situation. Is there a primary emotion? Are there many different emotions? Where in your body can you feel the strongest sensations?
Do you feel it in your stomach? Your chest? Your throat? Your legs? Your back? Your shoulders? Your face? Your head? Your eyes?
Try to describe the sensations (in your head or to your therapist).
If a cartoonist were drawing a caricature of you, how might they draw the sensations you’re experiencing? Steam blowing out of your ears? A heavy brick on top of your chest? A balloon that’s inflating bigger and bigger in your stomach? Needles poking at your face? What color would the object in your body be? What shape would it take on? Is it stationed in one place or moving all around?
Notice what the experience is like for several minutes. Pay attention to how it starts and how it changes. What do you notice the longer you pay attention to it? Has the experience shifted at all since you first remembered the situation? Does the brick on your chest feel just as heavy? Has the balloon in your stomach shrunk down?
It’s okay if you notice that nothing has changed. We’re not looking for any specific results. We’re simply being curious and non-judgmental towards any and all experiences that we encounter.
The more frequently you practice this type of exercise, the more aware you can become of emotions in your body and how different situations affect you. This can allow you to change your relationship towards yourself and your experiences and help you respond in a healthy compassionate way, even when you’re angry, sad, guilty, embarrassed, tired, etc.
How Often Should I Practice Mindfulness and Meditation?
For overall wellbeing and to see the most changes (decreased stress, increased flexibility, increased compassion, less judgement, changes in mood, awareness of thoughts, feelings, and sensations, acceptance of discomfort, improved focus, better sleep, etc.), it’s best to practice mindfulness daily.
Like exercise or dieting, you’re not going to see immediate results. Unlike exercise and dieting, the results you do see may not be visible to others. The more frequently and consistently you practice, the easier it will be to return to the practice and to remember to be mindful in daily life.
The hardest part of practicing mindfulness is remembering to do it. This is why working with a mindfulness-based therapist can help you start, enhance, and deepen your practice. I’ve worked with many clients who tried meditation apps on their own but felt like they were doing it wrong or just forgetting to do it regularly. When we started working on it in therapy together, they were able to maintain and grow their personal practice to a level that suited their life.
You don’t have to sit and meditate for an hour a day. You don’t have to be a Buddhist monk to meditate. You don’t have to meditate at all in order to be mindful. Mindfulness-based therapy can teach you to integrate as much or as little mindfulness into your day as suits your lifestyle.
How can I start a mindfulness practice?
The best advice I can give you for practicing mindfulness is just to start doing it. If you only have a minute a day, do it for a minute a day. If you have 3 minutes, do 3 minutes. Pick whatever amount of time you know you can maintain daily. As time goes on and you get used to the practice you can always increase it. I’ve found that 8-15 minutes a day in the morning works best for me. Some days I just do 5 and other days I do 20. The beauty of mindfulness is that as long as you’re practicing it, you can’t do it wrong. Whatever happens during the practice, you end up being mindful of that (even if it’s something you reflect on after the fact).
A mindfulness-based therapist can help set you up for consistent practice that is in line with the “spirit” of mindfulness (the “how”) as well as your personal goals and values.
A favorite concept of mine in mindfulness is “begin again.” This means that any time you’ve stepped away from the practice, no matter for how long, you can always begin again.
How is mindfulness-based therapy different from mindfulness-based cognitive therapy, mindfulness-based stress reduction, and traditional CBT?
Traditional CBT is based on the model that thoughts, emotions, and behaviors are interrelated. A CBT therapist will help you identify patterns in your thoughts, emotions, and behaviors and help you navigate situations in which those patterns are working against you. They will also (ideally) help you work those patterns to your advantage.
For example, if you feel anxious and depressed, a CBT therapist will highlight different thinking patterns that may be exacerbating feelings of nervousness and sadness. Such thoughts might be, “I never do anything right!” “People always blame me for everything,” “I’ll never get married,” “My coworkers hate me,” etc. They will then use specific techniques to assess whether those thoughts are entirely accurate, point out different ways to look at the situation, and help you start reframing some of those beliefs. As your thoughts shift, you may notice that your anxiety and depression are less intense, and how you act also changes as a result.
Mindfulness-based cognitive therapy (MBCT) is an 8-week group program created by Dr. Zindel Segal, Dr. Mark Williams, and Dr. John Teasdale. It was based on Dr. Jon Kabat-Zinn’s 8-week Mindfulness-Based Stress Reduction (MBSR) program. MBSR teaches participants different components of mindfulness to alleviate stress and improve wellbeing (in addition to being shown in research to have many far reaching positive outcomes beyond the scope of this article).
MBCT applies mindfulness and CBT concepts to people who are primarily struggling with recurring depression (though it has also been shown to help individuals with other concerns). MBCT and MBSR have a similar group structure and many similar practices, but they target somewhat different populations and may have different results depending on initial concerns.
Mindfulness-based therapy, in my understanding, is any psychotherapy that largely incorporates components of mindfulness and meditation as part of regular treatment. In my practice, I discuss mindfulness as part of most sessions with clients, and this is done in line with their own goals and wishes for therapy.
In the way I think about clients and the problems that bring them to therapy, they can almost always benefit from increased mindfulness, at least in some way. Whether it’s general increased awareness, ability to accept and deal with difficult situations, compassion towards themselves and others, non-judgment towards the unknown, curiosity about mundane things, and kindness in their actions, I have yet to meet a client who did not want to cultivate these aspects within themselves.
Sometimes the mindfulness work is more subtle and informal, other times it’s about meditating together in session. I find that mindfulness-based therapy works very well with CBT. The way I explain it to clients is that in almost any situation we have two choices. Change how things are or accept how things are. CBT can help us change what isn’t working for us, and mindfulness can help us accept the things we cannot change.
Mindfulness-based therapy helps clients increase their awareness, acceptance, kindness, compassion, curiosity, and non-judgment. Regular mindfulness and meditation practices have been shown to decrease stress, alleviate symptoms of anxiety and depression, improve your ability to identify and communicate your needs, and think more flexibly to create a life worthwhile for yourself, based on what’s truly important to you.
One of the biggest benefits of mindfulness-based therapy is learning to be less reactive and more responsive. It can teach you to see that there is a choice in how you (and others) act in any situation and give you the skills to make choices that are in line with the kind of person you want to be.
There are many more nuances to all the treatments discussed above, but hopefully this overview can help you decide if mindfulness-based therapy is something that aligns with your goals and values and whether it’s something you’d like to try.
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Find Dr. Rizzi on Instagram @dralicerizzi, where she shares daily tips and resources on mindfulness.
Ackerman, 2021 – https://positivepsychology.com/benefits-of-mindfulness/ — Great overview, complete with peer-reviewed journal articles
Davis & Hayes, 2012 – https://www.apa.org/monitor/2012/07-08/ce-corner
Although many individuals find benefits in practicing mindfulness, there have been mixed results for individuals with past trauma and psychosis. If you have any hesitation about your ability to tolerate uncomfortable thoughts, emotions, and sensations, talk to a therapist or medical doctor first.